The Foolish Pharmacist

Today I had a follow-up visit with a patient who takes Suboxone.  She is a 55-y-o married woman;  I remember when I first ‘met’ her during a frantic telephone call to my practice about 5 months ago.  At the time, she was on a high dose of pain medication from her doctor for a variety of ailments, and more worrisome she was on high doses of benzodiazepines– Valium-related medications like Xanax, Klonopin, and Ativan.  As I have mentioned before, benzodiazepine withdrawal can be fatal… but with opiate withdrawal you only wish you were dead!  Anyway, she had been through traditional treatment a number of times;  had attended meetings over the years and worked a program as hard as anyone… and yet she had little sobriety to show for her efforts.  She was crying, afraid, depressed… and for good reason, because from her perspective life appeared to be over.  I have met many people in the same condition over the years, and have been in her condition myself– as have many of the readers of this blog.
A few years ago I would have been afraid for her, and would have given her poor odds for surviving ten years, let alone for finding sobriety or any degree of happiness.  I would have offered her residential treatment, but she would have had trouble coming up with the $4000 required to get in the door to a 30-day center, and the open-ended treatment center where I went years back wouldn’t even be on the table, as costs there run to $30,000 and more for three months of treatment.  Insurers don’t usually pay these bills, as the treatment is considered ‘residential’, and not ‘inpatient’.  I could have offered her psychotherapy– which doesn’t work particularly well for opiate dependence.  I could have recommended NA or AA meetings… something she was already doing.
I set up an appointment, and we discussed the options, including Suboxone.  She warily agreed to give it a try.  Three months later she sat across from me in my office, smiling and grateful.  She was employed for the first time in years;  she was exercising and had lost over 15 pounds;  she was attending NA meetings once or twice per week;  her relationships at home were improving;  most importantly, she felt something that she hadn’t felt for years: that life was worth living. Cost for three months of treatment?  Several hundred dollars after her insurer (the cost for a person without insurance would have been about $1200 for medication and appointments).  She looked great and felt great.  Everyone who knew her was surprised by the sudden change in her demeanor, and most were happy for her.  Most, but not all.
Today she was crying at the start of her appointment.  Everything had fallen apart– ever since she took the advice of the people at NA who told her to ‘get rid of her crutch’ and stop the Suboxone.  The doctor is (gasp!) making TONS of money off you!  You aren’t REALLY sober!  And so she took their advice and stopped.  She had passed through the withdrawal– not the worst she has had– but things kept getting worse.  She was on the verge of losing her job– the job that she was so proud of a month earlier.  She was at odds with her family, and her son had announced plans to ‘write her out of his life’.
During our discussion she told me about the advice she had been given.  I usually attend AA meetings myself, and am not familiar with the NA meetings she attends– and plan to keep it that way!  Taking each other’s inventories, giving medical advice counter to a person’s physician without knowing anything about her history, accusations of ‘inferior recovery’…  what a bunch of self-righteous jerks!  They had taken this trusting woman and turned her into a basket case.  We discussed the difference between ‘honesty’ and ‘inappropriate self-disclosure’; we discussed boundaries.  And we got her back on Suboxone.
A bit later in the day I get the usual message from some idiot– only this time, the idiot is a pharmacist.
His message:
Perhaps you charge differently than my local docs do that prescribe this junk, but they charge $200 to $300 every 2 weeks. Thirty patients times $400 a month is $12000. Sounds like a nice chunk of change to me.
I’m a pharmacist in recovery now for 8 years.
I think Suboxone could have a place in treating addicts if it were prescribed and managed properly and ethically. What I’ve seen doesn’t fall along these lines. What I’ve seen is doctors taking the place of the dope dealers. You get them off narcotics so that they can be on narcotics? OK…? That would be okay if the Suboxone were used for a short period of time and then tapered. I have yet to see anybody get tapered. Why is it necessary to keep these patients on this new narcotic for so long? Put them on it, let the fog clear, point them to some AA/NA meetings, and taper the junk so they can learn to live.
I’ve seen the guys coming in the pharmacy week after week for their Suboxone fix. They’re not changing anything but their dealer. They are living with this false suboxone hope that everything is better. If they are actually taking only Suboxone and not using illicit drugs too, then I’ll admit that could be a step in the right direction. At least they aren’t involved in illegal buy and selling of narcotics.
Why do I care? I care because I am passionate about recovery and guiding people there. I see these people weekly and I hurt for them because they are spinning their wheels by continuing on these narcotics while recovery is available. I care because I hate addiction and what it does to people and their families (I’ve been there), and I don’t want anyone else to be fooled by this so-called opiod treatment. There are better ways to live than being a slave to narcotics, including Suboxone.

Fairly civilized.. but keep reading:

Keep kidding yourself about Suboxone while you rake in the money from these people who don’t know you’re nothing more than a pompous ass pusher with a great degree that’s being wasted by greed. You offer these people an answer that’s not real- a fucking band aid for a gaping wound.
How much do you charge these people to write these prescriptions for them? Is it a regular office fee? Or do you rape them like the con artists around here? Just curious.
Jared Combs
My comments:
I don’t know where this idiot works, but I feel for you folks out there who have to see such a self-pretentious jerk in order to fill a prescription.  I urge you to count your pills closely– someone who thinks on this level– who has such disdain for doctors who prescribe Suboxone– can justify who-knows-what for the ‘good’ of others!
I have talked about all of his ‘cussing points’ over the past year;  I have never met a doc who charges the fees he quotes (I suspect he made the numbers up), and you would hope that a pharmacist would know at least some basic biochemistry– such as the difference between an agonist and a partial agonist.
What bothers me the most, though, is the attitude.  I left out the part of his message where he boasted about his 8 years of recovery and (for some reason) belittled my own– as I have written a number of times, I found recovery through the steps in 1993, relapsed in 2000, and have done well since 2001– but like the others at my meetings I consider myself as ‘sober’ as anyone else in the room!  And yes, I am angry– angry because of patients like the one I saw this morning who listen to idiots like this guy.  Some of those patients die.  An idiot like this pharmacist caused a great deal of pain for a woman in my practice, and that makes me angry.
As for the woman in my practice who has ‘inferior recovery’ according to this guy?  I would put her level of honesty, decency, and respect for others far above his!  If that is the difference between ‘true recovery’ and Suboxone, I know which one I like better!