Wow, what a mess. But I think all of this is good for me, because I’m typing better and making fewer mistakes.
Why can’t I upload files to my domains? Like plugins, or photos? Is that normally blocked by the host? I need to ‘contact the administrator’, which I’ve done all day. He (me) has no idea what to do.
As part of my goal of regaining good habits, I want to get everything up again. Yes, everything. I’m still ‘suboxdoc’ on youtube if you want to see my stuff from 12 yrs ago… but those are old and grainy, and many of my old sites are down. First priority is to get the Forum going. I used to be there every day, answering questions and arguing with the AODA counselors who said ‘oh, the orange stuff that comes out of their noses?’
Remember this? https://www.hmpgloballearningnetwork.com/site/addiction/article/out-change-attitudes-about-buprenorphine
The program I referred to in the article let me go the next day. So much for ‘all press is good press’! Later, the NYT story: https://www.nytimes.com/2013/11/17/health/in-demand-in-clinics-and-on-the-street-bupe-can-be-savior-or-menace.html
I worked with that reporter for almost a full year, making sure she got everything right. She never mentioned her angle though — that buprenorphine might be a dangerous ‘menace’, and ‘gasp’ many doctors who have experienced addiction, practice addiction medicine. For the latter I would have pointed out ‘because nobody else will, we realize what a raw deal those suffering addictions are getting, and because we know that with treatment, a new human being will emerge, maybe even for the first time!’
For the first part I would have said that yes. it is a potent opioid and like all opioids, it can cause overdose. BUT…. it is not an attractive medication to abuse, especially to people with established addictions. First, a person must wait at least 12 and often 24 hours after a prior dose of an opioid agonist, or he/she will become very ill. And if a person likes it and takes it daily, poof! They are now ‘on buprenorphine’ and no other opioids will work for days, maybe weeks. They are not ‘treated’, but they are better off.. and within a couple days they feel NOTHING from buprenorphine either. Is that a problem?
Listen to the guy with the sudden mojo….
Buprenorphine CAN kill people. That happens about as frequently as a person is struck by lightning in the US. Seriously – 40-50 per year, at least back when I did the NYT article (I probably Googled it!).
To kill an adult or teen almost always requires 1. no recent prior use of buprenorphine; 2. little or no opioid tolerance, like a first-time user, and 3. a second respiratory depressant, usually alcohol or a benzo.
There was a guy in the article who lost his son to overdose, and I am directing this at the author, not at him. His son was on buprenorphine for 2 years as he continued to abuse a variety of drugs, all non-opioids of course. Then he stopped buprenorphine and died months later. You all understand what happened. I LOVE helping people taper off buprenorphine, a process that usually takes 1-2 years. You cannot do it during a pregnancy, and you need LOTS of time, and lots of motivation. I’ve had several hundred patients taper off over the past 15 yrs. Many of my current patients want to stay on it for life, and that’s fine. It is a better drug to be on, than say… Coumadin. Or Amiodarone. I will never be off the first, but I hope to stop the second (which is for A Fib) in a few weeks. Hopefully.
I’ve had several patients die after being on buprenorphine for many years and then tapering off. Most recently, I believe, in 2018. I never see it coming, as I would never recommend such a thing for someone who hasn’t done well for a long time. But those cases are rare. I would guess that the fatal overdose rate after 5 yrs or more of good living, no other addictions (including alcohol) is around 1%. Relapses happen, but (from my view) more often in stimulants like meth than in opioids. I’ve had a few (maybe 2-3%) of former buprenorphine patients who returned and asked to restart the medication, for a range of reasons.
The poor young man who lost his life in the NYT story never estabished recovery, or even abstinence, from any of the drugs he was using. Very sad, but nothing that makes buprenorphine a ‘menace’.
Sometimes I wonder if the people who write news stories, divide us, anger us….. are the real menace. Just one man’s opinion. Hey, can I even say that anymore???!
Mojo feels good. Just need to keep it in moderation. You folk let me know if I’m going off the rails!!
3 Comments
Stephanie Jane · September 13, 2022 at 1:34 am
I read that NYT article for the first time today – hadn’t been very involved in TalkZone until now. Wow- that must have burned bad. If it frustrates and angers me as a patient, I can only imagine how an addiction doctor like Dr. Junig feels.
When I worked in mental health I’d run into other professionals who would talk of their clients being prescribed Suboxone for a few months and then a quick forced taper. Quite a few believed that Suboxone was just one drug replacing another. I’d scream inside and try not to let it show on my face. And these were smart people, but they just… weren’t addicts. They certainly didn’t know the torture of withdrawal. “Oh it’s like getting the flu right?” Fucking NO. And I suppose not being an addict isn’t really that great of an excuse for a social worker or mental health professional anyways.We’re supposed to be open minded, empathetic and most importantly, advocates for our clients. But I digress.
A friend I’ve known since 1st grade went into the social service field around the same time I did. Our agencies worked closely together. In one of her first jobs a majority of her caseload were addicts. She’d volunteered to be one of the first case managers in her non profit to get clients into a Vivitrol program. Unfortunately she only had 2 clients who got through the program successfully. Because we we are best friends she knew that I’d been on Suboxone so I could talk to her from that point of view. I wanted to support her because I think she really believed she could help people with that particular type of therapy AND she’d been the only case manager to express interest in taking on this trial run opportunity the agency was interested in. It was HER project and if course she wanted it to be successful. It was a fine line between trying to support something she believed in, while telling her I didn’t see it being something that’d work out well for her clients. Did I mention that her clients were mostly homeless with years of addiction and chronic mental illness?! I’d even asked her if her agency might consider helping clients get into Suboxone programs and she said “no, they weren’t comfortable with that.” I won’t go into the supposed reasons for this but you’ve heard them all before. I never said it, but I wanted to say-then your agency will have to become more comfortable with their clients dying. I’d been part of a committee that put together a memorial service once a year for the homeless. So I actually had the “data” to back that up.
Good news is that this was nearly a decade ago and although I’m no longer working in that field, I’m certain those attitudes have finally changed. It just took a deadly national opiate crisis to get there 😔.
I could be wrong about my opinion on Vivitrol, maybe Suboxdoc could inform more?
Stephanie Jane · September 13, 2022 at 1:53 am
Real quick added thought from my previous post re: Vivitrol. I don’t want to talk negatively about Vivitrol as a whole. I’m sure it’s saved lives and worked well as a deterrent for people who are participating in recovery and are serious about taking the next step forward. But I did not think it was the right fit for her clients- mostly people who were in housing crisis, active addiction and suffering from chronic mental illness.
admin · September 13, 2022 at 7:53 am
I’ve injected Vivitrol for other docs, but never used it in my own patients. I see uses for it– for example in people being released from prison who have extensive AODA histories and are going back to familiar neighborhoods. Maybe, too, in drug courts for some people. My home town is… annoying… in that they don’t accept Federal drug court funds because they don’t want to use buprenorphine. But we need DATA. How many people stay clean after stopping Vivitrol?
My main issue is that most people stop it too soon. The last I saw (a year or two ago) was that the average time on Vivitrol was 4 months. That is NOT near long enough. We know a year on MAT still has relapse rates in the mid-90s.
Also an Australian study, years ago, pointed out the inverse tolerance caused by naltrexone (not the shot, but the tabs) and the higher overdose rate in people after stopping naltrexone… 12 times higher than in people who stopped methadone.
I worked in a methadone program for 6 years so one of these days I will have MUCH to say. The nurses were fabulous, which is why I lasted so long..