More on the generic form of buprenorphine

Hey Doc,
I went to Walgreens early this morning and they had the drug on hand. So, if there is anyone who still has doubts as to the drug being available at local pharmacies- this shows the 2nd largest drugstore chain has it available in its pharmacies.
Note: the writer is referring to a Walgreens in Wisconsin.
The tablets themselves are round and white with the imprint of 54 411 on one side and a blank opposite side. Really the best way to describe them, is that they are identical in every feature (minus the imprint code) as the “512 Generic Percocet” tablets. As for taste and texture I found them to be much easier to tolerate than the fake orange Pez flavor laced with formaldehyde that Suboxone leaves in your mouth for hours. To me it was as if chewing a large aspirin and holding it in my mouth. Yes, it was slightly bitter, but the flavor itself was mainly inert and inoffensive.
Now as for price… Walgreens lists the retail cash price for 60 tablets to be $152.99 which translates to $2.55 x tablet. Less than half of what the name brand cost!!!ee
Note: in Wisconsin, Walgreens has always been the costliest place to purchase Suboxone, with prices up to 50% higher than other pharmacies such as Wal-Mart, Pick N Save, ShopKo, and even the smaller mom and pop pharmacies.  I would expect for that reason that the generic could be found for even less money with a bit of calling around.
Hopefully some good news!
-jp
Thanks JP!

SuboxDoc Goes Negative!

I received a couple responses to my youtube videos tonight that are worth responding to.  For people who haven’t stumbled across the videos, you will find them if you go to youtube and search under ‘suboxone’ or ‘suboxdoc’.  They are pretty much the same thing as what you read here—a combination of my experiences in treating opiate dependence using Suboxone, education on the actions of buprenorphine, some of my personal ‘theories’ (maybe ‘opinions’ is a better word) on the relationship between sober recovery and buprenorphine maintenance (what I like to call ‘remission treatment’, to distinguish it from methadone maintenance, which works through a different mechanism), and my thoughts on the different treatment options for opiate dependence.

Blogging in general has been an educational experience.  I was initially surprised by the number of people who send out very angry messages to a person who simply tries to share knowledge and advice!  Just today I received a message accusing me of ‘getting my degree from a crackerjacks box’ for my opinion that ‘Suboxone withdrawal is NOT the worst withdrawal ever.’ I didn’t get it there, by the way.    I don’t know how to take the responses posted a few minutes ago that are tonight’s topic;  I am not sure if they are simple questions, respectful disagreements, or sarcastic comments.  You would think a psychiatrist would know one from the other!  Maybe the person will add more angry comments after my post, and then I’ll know for sure.  Or maybe there will be nice comments.  Whatever…

The comments, from someone going by ‘cbarrett34’ on youtube:

Dr. I’m curious, why do you say that there is no cure for opiate addiction? That doesn’t give people a lot of hope, if a Dr. is telling them there is no cure or hope for you. Basically leads to apathy and more using.

(That one was clearly very nice).

And the whole saying, once an addict, always an addict. That’s not a very positive viewpoint either.

(That one is harder to tell, don’t you think?  I might just be paranoid from that crackerjacks comment)

My answer, which as always is just one opiate addict/pain doc/psychiatrist’s opinion:

My first thought is that staying clean from opiates has nothing to do with ‘apathy’.  Maybe smoking pot has something to do with apathy, but people actively using opiates are some of the most non-apathetic people you will ever see!  There is no time for ‘apathy’ for an actively-using opiate addict;  there is that hit that is required every 4-8 hours to avoid being sick, there is that need to scam someone out of money to score the dope that is needed every 4-8 hours to avoid being sick, there is that need to come  up with a good lie to tell the parents/spouse/cops/PO/boss/kids to explain the lousy behavior over the past few months or years…  being an actively using opiate addict is a lot of work!  There is definitely a negative attitude that develops after months or years of using, but it is nothing like ‘apathy’.

Too Negative?
Too Negative?

My next thought is that I wonder what the writer would prefer—‘positive’ lies or ‘negative’ truth?  The idea that heroin or oxycontin addiction is ‘treatable’ is one of the big lies of society;  it makes for good movies and helps keep money rolling in to detox facilities and treatment centers, but if you think I’m wrong, seek out the numbers yourself!  Pick your own criteria for success– one year sobriety, five year sobriety, whatever.  If you look at people in their 20’s who go through residential treatment, the one year rate is way, way, way below 50%, even if you just use the numbers for people who go voluntarily and complete treatment!  Go out to 5 years and the numbers for opiate dependence are ridiculous- sobriety rates of less than 10%!  The writer sees danger in telling the truth about treatment I suppose because the truth will somehow take away ‘motivation’ and cause apathy.  But I see things exactly the opposite.  In my opinion based on how I thought as an actively using opiate addict, a sense of confidence is the ENEMY of sobriety.  As an addict goes from day to day using, and getting deeper into addiction, he/she comforts himself by saying ‘I’m going to get straightened out eventually’.  If the person knew that most people do NOT recover; that he is getting mired deeper in an incurable disease, maybe he will think about seeking help a bit sooner!  And if everyone knew that opiate dependence is a largely untreatable and surely incurable illness, maybe fewer high school kids would pick up in the first place.  I hear addicts say one thing over and over again:  ‘if I only knew that oc would have done this to me I never would have taken it.’  I don’t know if that is true for all of them, but I think that had the truth been known, at least some of them wouldn’t have started.

As far as the comment about ‘once an addict, always an addict,’ that is something that is not even controversial.  Yes–  at least with opiates, once an addict, always an addict.  About 7 years after getting clean ‘the first time’, I assumed that I was cured—after all I had only used opiates for 8 months or so, and it had been 7 years… I had been to hundreds of AA and NA meetings, I had worked the steps all the way through several times, and I never even thought about using!  I would get so annoyed when my old NA and AA buddies would come up to me if they saw me someplace and say ‘we miss you at the meetings, Jeff!’  I would want to tell them to bug off and leave me alone— I’m cured, after all!  I don’t need that crap.  Once an addict, always an addict…. NO WAY!

Had I listened to them I might have saved myself a great deal of trouble.  But probably not, since addicts pretty much need to find things out for themselves.    That is one of the personality traits of ‘us addicts’—we are independent thinkers who don’t think the rules of others should apply to us.  Those words on the Vicodin bottle about dosing and about the danger of dependence?  Those are just ‘suggestions’!

I wasn’t always a fan of the idea of taking a medication to treat opiate dependence.  Even after looking around me and realizing that all of the people who got clean with me had relapsed, I thought that it was better to have one out of ten people in ‘real’ recovery than have people taking medication!  Then I ended up in a position where I actually knew some of the people who were dying.  At NA or AA meetings people talk about the deaths with a ‘tsk tsk’ attitude, as if the person who died should have known better, or almost had it coming, since she stopped going to meetings.  But once I was a person who stopped going to meetings in spite of knowing better, it became harder to blame the dead person.

I have in my mind the images of four smiling people who desperately wanted to be free from opiates.  I knew all four of them pretty well at some point;  none took Suboxone, and all assumed they were going to be fine without it.  After all, they had all gone through at least part and in two cases entire treatment programs.  Three men and one woman, all less than 25 years old, two with children of their own.  Two died from suicides, presumably in part from the shame of failing to get better.  I wonder if they thought, before they died, that they were losers because treatment didn’t work for them?  The other two died from opiate overdoses, one the first time he used after being clean for several months.  I suspect he figured that he ‘beat the disease’;  that is what most of us think as we relapse.  One time won’t hurt, we tell ourselves;  we are different now.  We have been TREATED, after all!  The final person was a woman who had been resuscitated several times in her life, once after an overdose in a drug-treatment halfway house!   Maybe she had a death wish—some addicts seem to use as if they truly want to destroy themselves—or maybe she thought she was blessed by a guardian angel who eventually slept in one day and wasn’t there when she needed him.

To simply answer the writer’s questions without all the stories, I tell people that there is no cure for opiate addiction because my opinion is the same as that of everyone else who treats or studies opiate addiction—   there is no cure for opiate addiction.  As for ‘hopelessness’, sometimes ‘hope’ is just a campaign slogan.  Sometimes ‘hoping’ keeps a person from recognizing the cold hard facts of a situation and taking responsible action.  In medicine and in life, diseases do not always have cures.  Some diseases are simply not curable, and people die.  Want to have ‘hope’ about opiate dependence?  Then DON’T USE OPIATES.

The good news is that while there is no cure, there is a relatively new approach to addiction that is keeping many people alive who would have otherwise died from their addiction.  There are many diseases without ‘cures’—in fact there are probably many more ‘incurable’ diseases than ‘curable’ ones!  But every opiate addict should know the facts:  that he or she will always be vulnerable to relapse, no matter the amount of ‘treatment’.

A year or so ago I wrote an article about the relationship between Suboxone maintenance and traditional recovery.  The article has been reprinted in several forms with minor changes from one  copy to the next, but the general points are repeated here.  I have received occasional comments from people who agree with me and from people who disagree, and from people who hate Suboxone and people who say that Suboxone saved their lives.
I received a thoughtful e-mail the other day that deserves re-posting to a broader audience.  For those who are interested in the relationships between addiction and character defects, and the impact of buprenorphine or the twelve steps on these character defects, I suggest that you first read the original article, and then read the e-mail response printed below.  As always, your contributions to the discussion are appreciated, either at the bottom of this post or at Suboxone Forum.
The response:
Dear Dr. Junig,

I found your article ” Is Suboxone At Odds With Traditional Recovery?” to be an excellent piece, very informative and very helpful as we (my wife and I, both recovering alcoholics for 22 and 21 years, respectively) are working with a friend dealing with a pain pill addiction.

Just by way of background, though not a physician myself, I worked 18 years at ###### Medical School  and as a result have had considerable exposure to medical curricula, practitioners and research in medical education. That and my own personal experience, I am sure, are reasons I find the article compelling.

I would add just one note to your discussion: while addicts (of all types) do acquire “character defects” as a direct result of their addictions — a point you make and it is well taken — you do not allow very much for things that may have been wrong in their make-up PRIOR to addiction.

In other words, if I grew up in a “goodfellas” or any type of heavily dysfunctional family, I might have picked up some bad habits on the way to becoming an alkie or a junkie and just added more bad attitudes and behavior on top of the mound I had already built. Of course, all this is gradual and intertwined, but I believe you get my point.

So the person I brought into my addiction needed reparative attention long before the onset of the addiction, that so-called line we cross over.

I completely agree that a large set of people who might become pill pain addicted might likely be more “normal” than alkies-in-development, still they may have issues and we have found the step programs to be useful to anyone.

Certainly that set might be less aware or less motivated to do the work on themselves (might easily have greater denial, especially if they get into comparing) but they still likely have the need. Can’t hurt, as they say.

I hate to say this (only because 12-step programs are parsed into such small groups and subpieces) but I think a Pain Pills Anonymous that acknowledges the differentiation would be a great resource to the population you focus on.
Thanks for your attention to this.
-B

Tired and Sick on Suboxone: What Would Junig Do?

I recently receive e-mails or read posts at Suboxone Forum that go something like this:
I used all kinds of pain pills over the past ten years—Vicodin, then oxycodone, methadone, and even fentanyl patches. Then I got into heroin for a year and finally hit my rock bottom. I went to a Suboxone doctor and he put me on 16 mg per day. At first everything was great, but I don’t like the side effects. I get so tired every day. I’m not happy like I used to be. I wake up in the morning and don’t have any energy or excitement for life. I really don’t like what the Suboxone is doing to me and want to stop.
Sometimes it is a little different—the first part is the same, but then the person writes:
I really wanted to stop taking it so that my body is free of chemicals so I stopped. I was real sick for a month and now I don’t feel like myself—I am tired, I feel depressed and angry, and I’m wondering what the Suboxone did to my opiates—am I ruined forever?
I am a psychiatrist, and only about a third of my practice consists of addiction work. I get e-mails at times after people read the blog for my psychiatric practice at www.patienttimes.fdlpsychiatry.com. A typical message will be similar to this:
Dear Dr. Junig (they tend to be more polite to me there),
I used to be a very happy, energetic person. In high school I was outgoing and everybody liked me, and I had tons of friends. The problem? Now I am in my 30’s and I’m never happy anymore. I have worked at the same place for ten years (or maybe, I change jobs every 18 months) and every day I wake up and dread getting out of bed and going to work. I keep telling myself I should exercise, but I never get started actually doing it. I’m single and don’t have any interest in dating (or maybe, I’ve been married to the same person for ten years and sometimes I can’t stand the look of him). I’ve read about vitamin D deficiency and wonder if that is my problem—all I know is that I am getting more and more depressed and tired. My sleep is crappy too. What should I do?

I have an answer to the first two messages, and the third message is a hint. Does anyone know how I would reply to the first two messages? What would I say? If you get my point and describe it correctly in the comments section—either describe the -general point, or write the reply that I would write– by 6 PM Central time tomorrow, Sunday, September 27, I will send you a free copy of my e-book ‘user’s guide to Suboxone’. EVERY person who gets it correct will get a copy. The ONE person who explains my point the best will receive the user’s guide plus a copy of each of these three recordings—stopping Suboxone, how long will you take that stuff, and opiate dependence treatment options. That’s like almost a thousand—or a hundred dollars—something like that. You don’t have to put your real name or e-mail address, but your comment MUST be entered in the comment section after this post. I might have to approve it if you haven’t written a comment before, but that’s OK—it will still count, as long as it is written and submitted by 6 PM. C’mon folks—take a shot!
JJ

New Formulation of Oxycontin– Will it make a difference?

Oxycontin was not my drug of choice so I don’t know the ins and outs of abusing the medication. But I suppose anything that makes the drug harder to abuse is a good thing. The other things that are being looked at for approval are combinations of agonist with antagonist in small doses– for example Embeda is morphine plus little beads of naltrexone, and orally-active form of naloxone. The naltrexone is only released if the pill is crushed, and there is not enough naltrexone to cause withdrawal, but only enough to reduce the ‘high’. I guess my thought is why limit to a small amount of naltrexone? The drug is not to be injected or snorted, so why not put enough naltrexone in it to make any tampering a very serious downer?
I thought I’d share the article below with you, so you can see how thrilled the FDA is with the new formulation.  Read on…
FDA Panel Recommends Approval of New Oxycodone Formulation
By Emily P. Walker
Published: September 24, 2009
Reviewed by Zalman S. Agus, MD; Emeritus Professor University of Pennsylvania School of Medicine.
GAITHERSBURG, Md. — An FDA advisory panel voted to recommend approval of a new formulation of oxycodone hydrochloride (OxyContin) that is more difficult to crush or dissolve, and which may deter drug abuse.
By a 14-4 margin, with one abstention, the panel recommended that the FDA approve Purdue Pharma’s application for a new, resin-coated formulation that it hopes will eventually replace the original version, which has been on the market since 1996.
The FDA does not have to follow the advice of its advisory committees, but it usually does.
The advisory panel’s endorsement was less-than-enthusiastic in this case, and members complained that there’s no proof the new version of the drug is any safer than regular oxycodone hydrochloride — one of the few drugs on the market that can be deadly in a single dose.
Purdue’s current pill is meant to be swallowed whole, but abusers can easily chew it or crush it and then snort it, smoke it, or dissolve it in liquid and inject it to achieve a heroin-like high.
Although there is no proof that the new formulation is safer, the panel agreed that making the pills harder to crush, chew, or dissolve into liquid may deter abusers. When the new version of the drug is dissolved into water, it produces a gel, which makes snorting the drug more difficult.
“Clearly the old [formulation] is worse than the new, although I think the difference is relatively small,” said panelist Randall Flick, MD, an anesthesiologist at the Mayo Clinic who voted to recommend approval of the drug.
“My feeling is that there would at least be some incremental improvement in the safety profile,” said panelist Stephanie Crawford, PhD, a pharmacist at the University of Illinois in Chicago.
Some 1.2 million people age 12 and older used OxyContin in 2006 for nonmedical purposes, according to the Department of Health and Human Service’s National Survey on Drug Use and Health.
Purdue originally sought FDA approval for low-dose versions of the new product in 2008, but the agency told the company to develop more clinical data and to apply the technology to all dosages of the drug.
Also, it took until 2008 for the company to convince the advisory panel in 2008 that the drug was any more difficult to tamper with than the original formulation, said panelist Ruth Day, PhD, director of the Medical Cognition Laboratory at Duke University.
This time around, the company convinced the panel that new tablet is harder to dissolve or crush and that the resin excipient might make it harder to take the drug in an unprescribed manner, said Day, who was also a member of last year’s panel.
In one lab test, Purdue researchers used 16 household tools to attempt to crush the tablet into small particles. All 16 tools handily crushed the original OxyContin tablets to a fine powder. Although four of the tools managed to break down the new tablet into shavings or particles, none could turn it into powder.
Even so, FDA staff reviewers concluded that the technology does not make a huge difference in OxyContin’s abuse potential.
Hardcore abusers are likely to devise new ways to break down the harder tablet or figure out which solvents will dissolve it fastest, within “day or weeks of the product’s release on the market,” Flick predicted.
The panelists who voted for approval said they were concerned that Purdue had not developed an adequate Risk Evaluation and Mitigation Strategy for the drug.
The new formulation will keep the name “OxyContin” and be used in seven available doses. Purdue said it will not market the reformulation as a “safer” version.
If it’s approved, Purdue will produce only the newer version and stop shipping the old one.
“Within six to eight weeks [of production] roughly 90% of drug in the supply chain will be the new product,” said Craig Landau, MD, Purdue’s chief medical officer.

Proglumide

Every chronic pain patient and opiate addict looks forward to the day someone finds the Holy Grail for opiates:  an agent that blocks or reduces tolerance and that eliminates withdrawal.  The two phenomena are linked and so the same agent may help with both problems,  or perhaps instead there will be a better understanding of the myriad interactions involved in opiate tolerance and not a single cure, but rather a number of medications beside the current, insufficient gold standard, clonidine.  A few weeks ago I decided to do some reading on opiate tolerance to see what we have learned lately,  and I started out with Google, searching the phrase “opiate dependence mechanism of tolerance”.  To my surprise, the first ‘hit’ was a NIDA monograph— try it for yourself, and see– then click on the link and scroll to the article in the contents a couple up from the bottom– see anyone there that you know?  That was the first research that I ever did, back in the mid-1980’s with nicotine.  You will see, though, the other articles about opiates;  that is what it was all about even back then, and we assumed that if we figured out tolerance to one drug we would understand tolerance to all drugs.  We now know that things are much more complicated.
The people at NIDA are going to wonder why one of their old monographs got 1000 hits tonight!
As I moved to more recent sources  I found that opiate tolerance is clearly much more complicated than we had hoped years ago.  A few years ago we almost got a drug called ‘morphidex’ that seemed to reduce tolerance in animals, but it didn’t work in humans–  for a minute or two it looked as if simply blocking the NMDA receptor with dextromethorphan would result in  significant tolerance reduction.   The fact that it doesn’t work has not stopped a number of compounding pharmacies from making and selling the combination at a tidy profit!  In reality there are probably multiple mechanisms for tolerance, perhaps different types of tolerance for different types of analgesia.  For example the tolerance that takes away oxycodone analgesia from shingles pain may be different than the tolerance that takes away oxycodone analgesa from broken bone pain.  Multiple transmitters and receptors and subtypes of receptors are involved– so much for brushing up quickly over the weekend.
I am generally skeptical of things– pretty much everything, to be honest.  I’m skeptical about cures for withdrawal because I have seen many of them come and go.  I’m skeptical of cures for baldness because I’ve seen many come and go!  I’m skeptical about global climate change because I remember worrying about the shortened growing seasons written about in the New York Times and Time Magazine in the 1970’s on account of ‘global cooling’.  I still have a clipping that describes the ‘growing concern among scientists that has reached a consensus’ that the earth was already being affected in the form of reduced crop production that surely was only a prelude to global famine…  the Time magazine article even mentioned some of the things that might be needed to ‘save’ the planet, including covering the polar ice caps with soot to absorb more of the sun’s heat! Yep– THAT was a good idea!  Here is a good prediction:  in a couple more years the movies about impending disaster will become cult classics.  Just as we now read the book ‘1984’ and think ‘that was silly’, we will watch movies predicting rises in sea level as we sit in chairs that were SUPPOSED to be under water years earlier.  Did I digress?
Back to opioids, with apologies to those of you who are convinced this is that beginning of the end of the planet.  But first, in case you are interested about my own beliefs, I once read a fabulous book called ‘the Song of the Dodo:  Island biogeography in an age of extinction.  What a fabulous book– it explains how things got to where they are today, and helps understand where things are going tomorrow– with occasional stories about the great explorers from hundreds of years ago, about what it was like for a white man to travel to South America to collect birds…  I can’t do it justice.  But after reading it you will understand very clearly that the Earth is fine.
Yes, we will go through a tough spell where the entire planet wildlife collection will consist of humans, squirrels, rats, grackles, bacteria, and a few plants…  but after humans die off, all of the forces that lead to speciation are still in place, and all of the diversity will return– bet on it!  So while we humans are clearly f#%@#ed, the planet will be fine.  The things that lead to extinction would surprise you until you read the book, then you will see how they are completely inevitable– and completely irrelevant.  This from a person who was a total ‘greenie’ in my younger days!   Read the book– you will stop worrying so much.


Where the heck was I?  I got this message the other day about the medication ‘Afloxan’ and the chemical ‘proglumide’.  Actually, the message is a good fit with the other topics in the book, now that I think about it!  Here is the message:
I’m writing to get your opinion about an anti-inflammatory drug called ‘proglumide’.  This drug was used primarily for GI issues but has the unique characteristics of reducing opiate tolerance.  It works as a cholecystokinin antagonist, the wikipedia link is here.  I’d like to let you know, that whatever the opinion is out there about this drug, I can say that it really works.  I had to take a trip to canada for work, and while I was there I did a ‘cycle’ of Afloxan, which is not proglumide, but metabolizes into proglumide.  I thought this would be better than nothing and in going to canada, I took with me exactly 21 pills of afloxan, 12 10mg hydrocodone, 3 20mg oxycodone, and some number of kratom ‘pills’ i had made for myself (junkies can be real creative when they want to avoid dopesickness).

So the result was a very abrupt and rapid taper off of 160mg of oxycodone per day, and I was very very comfortable the entire time.  I might have lost about 2 or 3 hours of sleep a night but that was about it.  I realize this isnt exactly a ‘clinical’ setting and my observations are about as scientific as a subluxation, but the effects were definitely not placebo.
Have you heard of this drug?  And if so have you ever considered using it to withdraw people from opiates?
I do not know anything about the medication, and was not able to find out a whole lot about it either.  A guy named Brent has a web page about the drug, and I found some references to the drug on this interesting site.  I got nothing at clinical trials.gov.  I would like to look into doing a study of the medication but I don’t even know where I would find it;  the references I followed to track it down were expired.  So… if anyone knows if anyone is manufacturing this medication or related medications (it has been sold under the trade name ‘Wilid’ in the past, and a medication referred to in the message is converted to the drug– but I cannot find any of them!) please post a comment or send an e-mail to [email protected]  I figure SOMEBODY out there has the time to track this down!  Try Australia– I found a couple references to pharmacists in Australia that sold the medication back around 2004.  Thanks in advance for the help!
JJ

Buprenorphine (Suboxone) treatment of Refractory Depression

I can’t remember– did I ever point out this article about the use of buprenorphine for depression? I stumbled across it today while looking for something else.  The paper is from 1995, about a study done even earlier– well before Suboxone was around.
Here is the abstract:
Opiates were used to treat major depression until the mid-1950s. The advent of opioids with mixed agonist-antagonist or partial agonist activity, with reduced dependence and abuse liabilities, has made possible the reevaluation of opioids for this indication. This is of potential importance for the population of depressed patients who are unresponsive to or intolerant of conventional antidepressant agents. Ten subjects with treatment-refractory, unipolar, nonpsychotic, major depression were treated with the opioid partial agonist buprenorphine in an open-label study. Three subjects were unable
to tolerate more than two doses because of side effects including malaise, nausea, and dysphoria. The remaining seven completed 4 to 6 weeks of treatment and as a group showed clinically striking improvement in both subjective and objective measures of depression. Much of this improvement was observed by the end of 1 week of treatment and persisted throughout the trial. Four subjects achieved complete remission of symptoms by the end of the trial (Hamilton Rating Scale for Depression scores less or equal to 6), two were moderately improved, and one deteriorated. These
findings suggest a possible role for buprenorphine in treating refractory depression. (J Clin Psychopharmacol 1994;15:49-57).
Suboxone Talk Zone

Monday Morning Anti-Suboxone Quarterback

I spend some time on this post at the forum so I will share it here as well.  First, a post from a person who uses the name ‘Suboxone7yrs’:
I was addicted to vicodin for 10 years popping 50 pills a day of Vicodin ES or NORCO, I then decided enough is enough, went to the ER and they gave me a list of doctors who deal with addiction. I went to see this female doctor who gave me the 3 hour consultation thing, then put me on 32mg of SUBOXONE, she sold me the suboxone out of her office for $5 per pill, rather then paying $8 a pill at a Walgreens I thought ok why not?…Well 5 years later this doctor STILL had me on 32mg of SUBOXONE! She then must have gotten caught because she was no longer in practice, so I found another doctor who was commited to getting me off, it took 2 years and my last dose of 2mg was March 2, 2009. I looked up all over the internet “How long will W/D’s be for this” some said 3 to 5 days some said longer. I am here to tell you I went through withdrawals for 31 LONG A** days and when I tell you this is the hardest thing in life I have ever ever done I an NOT kidding you. I was at the ER 8 times for the CLONODINE patch, I know every one is different but my god, I laid in bed crying…begging for god to take me, it was PURE HELL people PURE HELL!!! Leg twitches AND arm twitches for 31 days straight! Skin crawling, lost 40 pounds from going to the bathroom, weak, vomiting, sweating, depressed like I have never been I couldnt wash my hair for weeks, my best friend had to drive over and wash my hair and do my laundry, your useless!!! I will NEVER EVER recommend to anyone that they go on SUBOXONE even if it’s for 2 dam days. This is just MY STORY and MY OPINION. I am sure it had worked miracles for tons and tons of people but even the doctor couldnt understand why I was withdrawling for SO LONG! 17 years of putting a pill or several pills in my mouth took a blow to my body and I just wish I NEVER EVER would have gotten on SUBOXONE. It was the worst experience of my dam life. I just think about Suboxone and I feel like vomiting. Now I feel all the under lying problems I have that I never felt because I was on Suboxone, like 2 bulging disks in my back that are killing me and I need something, I cant even take a 15 minute walk and I am only 37 years old! I am stuck…dont know what to do? This is ny story and Im stickng to it. I hope others out there have a better road of recovery getting off suboxoxe, all I have to say to them is good luck and hold on tight for the roller coaster road to come!! Piece
Below is my response:
I’m a little disappointed in all you folks, after all the lecturing I do!! I’m kidding– sort of, anyway! I agree that the dose of 32 mg was too high– but the 7 year part is not ‘too long’. ‘Suboxone7years’ is doing what many people do; blaming Suboxone rather than blaming his opiate addiction. We don’t know what would have happened, had the person NOT had Suboxone, but read the history. The person was addicted to opiates for 10 years! My active addiction lasted only 6 months– and that was enough to give me cravings even after 7 years of being totally off medications or substances (i.e. not on Suboxone or anything else– just tons of meetings). So a person who has been on opiates for ten years is SERIOUSLY ADDICTED. After my 6 months of use, I went through treatment that consisted of 3 1/2 months residential (after a week of horrible detox), and then 6 years of aftercare (group twice per week for a few years, then once per week).
I must admit to a bit of skepticism over 7yrs report, just because Suboxone was not available in the US until 2003– so I don’t know how he/she got to 7 yrs of use followed by the time in withdrawal between 2003 and 2009. Yes, DATA2000 was the act that allowed ‘treatment of opiate dependence using opiates on schedule III through V’, but Suboxone was not approved or sold until mid 2003. Maybe ‘7yrs’ means ‘6yrs’– no biggie, as I tend to exaggerate as well.
‘7years’ had 10 years to quit opiates– and then thanks to Suboxone was finally able to get free. And after 7 years of freedom, she complains about 20 or 30 days of withdrawal?! She also blames that on the Suboxone– but you also have to blame it on the 10 years of using before Suboxone! What makes 7 years think that all the withdrawal is just Suboxone’s fault? 7years, let me point out to you that you COULDN’T quit the other drugs– but you COULD quit the Suboxone. What does that tell a logical person about which one is harder to get off?
I have detoxed more than I ever wanted to… and I have seen many, many people go off many things (I’m medical director of a large residential center in addition to my practice). As I have pointed out, I couldn’t walk during my detox! People going off Suboxone tend to go to work and complain about how sick they feel– people going off agonists tend to like in a bed in a detox ward or at home, and they don’t complain– because they are too weak to talk! I’m sorry you felt miserable, 7years, but have you ever ‘jumped’ from 30 mg of methadone? Or come off heroin? You must have at least seen the movies– they call it ‘kickin” because the legs kick constantly. That was MY detox– I lost 30 pounds, and for days I was up around the clock, legs kicking, body shaking and shivering, sweating like crazy, nausea and diarrhea at the same time– after a month I could walk about 50 feet without needing to sit down and rest– and that was a huge improvement!
But none of this even gets to the real issue. 7years, how do you plan to stay clean going forward? Given the time factors I mentioned above, you couldn’t have been clean for more than a couple months so far– opiate dependence is a relapsing condition. Everyone is certain it won’t happen to them, but… it happens to even those who are working a very intensive recovery program. That is why the recommendation, more and more, is to STAY on Suboxone! Yes, if you are a masochist who wants to watch your family get destroyed, go out on the quest for ‘pure sobriety’. But I recommend against it. My own relapse occurred after 7 years of very good recovery– I was ‘all AA and NA’ for years before my relapse. If anyone thought I would return to that life, I’d say they were crazy fools. But you know what? People DID say I was flirting with disaster when I stopped meetings… and they were right.
Now we have Suboxone, so people like 7yrs can enjoy freedom without the work of 90 meetings in 90 days followed by years of aftercare. That is fine– but it isn’t really fair, after enjoying the freedom the medication gave you, to claim that you didn’t really need it, and wish you hadn’t taken it. You very well might be dead or in prison had it not been there. In light of that, a month of feeling sick is a good deal– better than the work I put into my freedom. But your work is just starting, if you are so convinced you will never take Suboxone. Feel free to stop back in a year and boast, if you are still clean– and I hope for your sake that you are. But I often point out that the people who complain about Suboxone are usually people with a few clean months, as those people have themselves fooled into thinking they are all done with addiction… I have put offers out on some of the Subox-hater sites asking for someone with 5 years clean to talk to me– and so far, I haven’t found a soul.
SD

Can't Find Long-Term Suboxone Doctor

An e-mail:
I’m stuck in methadone-land, no one will write long term for Suboxone.  I feel trapped and utterly helpless. I’ve been on methadone for a year and a half, and just see no real end in sight.  I am tired all the time, and my friend said that he got on Suboxone and it changed his life.  I’ve been reading about it and trying to find someone in my city to do it but they all only do 90 day detox programs.  What if anything can I do?  I’m out of options short of driving several hours to doctors in other big cities.  I’m in Wichita Ks and the next closest is OKC or KC.
My reply:
I assume you have tried the physician-finder web sites;  in case you haven’t, one is here at Suboxone.com, and the other here at naabt.com.  If you haven’t investigated the local practices lately, I encourage you to check them out again;  practices have changed, and more and more docs are realizing that Suboxone is best used long term.  A few years ago 70% of scripts were for detox/short-term;  now 70% are for long-term use.
Consider posting at SuboxForum.com and maybe someone from your part of the country will have some ideas about docs in your area.
SD

Baclofen and Alcoholism

I had a follow-up visit today with a patient who is being treated for anxiety and alcoholism.  He has attended AA in the past and he has no problem with the message, but at the same time the message has never really grabbed hold of him in a significant way.  His use of alcohol and anxiety are related to each other, as is typically the case.  As with other patients I have treated, he sees alcohol as treatment for his anxiety; giving up alcohol is a frightening idea when he thinks about the interactions with the public that are necessary as part of the business that he owns and runs.  From my perspective when working with such patients, I know that they will be much better somewhere down the line when they have been sober for a few months.  The hard part, though, is getting them there!
This particular patient contacted me awhile back about something he saw on TV one morning– a doctor who had written a book about using baclofen to treat alcoholism.  The patient asked if we could try that approach.  After doing some reading, I found that there are anecdotal reports describing positive results with baclofen, but no controlled studies.  In other words, there is no real evidence that baclofen works– only rumors.  And in medicine, there are ALWAYS rumors– and most of them are garbage.  Still, the risks of taking baclofen are low, and the medication is readily available and not terribly expensive.
I recently wrote about supplements and nutrients, and about how I consider taking supplements to be a waste of time and money.  Moreover by delaying more appropriate treatment they increase the chance that a person will have more negative consequences to his/her illness.  I am a skeptic about things that don’t have the support of CONTROLLED studies (anybody can do an ‘uncontrolled’ study– and such studies are worthless).  So while I did go ahead with the baclofen treatment, I certainly didn’t talk in a way that would add a positive placebo response.  If anything, I did the opposite;  I said that we could try it, but that it probably wouldn’t do anything positive.
I was pleasantly surprised to hear today that the patients has been sober for the past three months, while taking baclofen at a dose of 80-100 mg per day!  He reports that he feels more relaxed than he has felt in a long time, and that unlike his experience with AA, he has little in the way of cravings or thoughts about alcohol.  He said “this is no ‘dry drunk’;  I feel like I don’t need alcohol at all anymore.”  This is a person who has higher than average insight into his thoughts and feelings, and I trust his comments about his subjective experience with baclofen, anxiety, and cravings.
I don’t think this is a placebo response for the reason I mentioned, and also because it has lasted for several months with no ‘wearing off’ of effectiveness.  Placebo responses tend to fade over time.  I think about the tense muscles, anxiety, and insomnia experienced by many alcoholics in early sobriety, as if their systems are revved up a bit too much;  there is none of that with this person.  He appears to be calm, relaxed, and comfortable.  He is sleeping well;  he takes three doses of 20 mg of baclofen each during the day, and 40 mg at bedtime, and the bedtime dose helps him to fall asleep.
I don’t know if baclofen is for everyone, but it seems to be helping this individual.  I’d love to hear your experience with baclofen if you have used it for alcohol dependence.
SD