Would'a Could'a Should'a…

I received the following e-mail a couple days ago:
Hi
I had been on Suboxone for 9 years. I was put on it the week it was approved by FDA. I found your posts in a blog. I was looking for a class action suit against this terrible drug. That man who said he was enjoying a Suboxone was right. I was on it almost 9 years and did get high and stay high all day, just like methadone. It causes depression and brain damage. I have been off it for 2 months now and am very sick with depression, panic attacks, and have not been able to even take care of myself. Please, if people want to get off drugs help them and send to treatment and AA NA.
thanks
nancy
Those of you who have read this blog for a while may remember the posts ‘back in the old days’—a few years ago—when I would get these kinds of messages often. Thankfully, I rarely get them nowadays, although every now and then someone stops by SuboxForum.com intent on harassing people taking buprenorphine.
I get your complaint Nancy, I really do—but I don’t agree with your thought process, or your conclusions. First of all, buprenorphine has been around for over 30 years, and has never been associated with ‘brain damage.’ The high doses of buprenorphine used for opioid dependence have been in around for 15-20 years overall, 8 years in the US. Several million prescriptions for high-dose buprenorphine have been written—without evidence for any significant harmful effects from buprenorphine.
Your description of how you felt while taking the medication are not at all consistent with the descriptions I’ve heard from the several hundred people I’ve treated over the past 5 years; people almost always report feeling nothing from the medication after being on it for a week or two. Every now and then a person will say that he/she notices opioid effects after each dose, but the sensations are always subtle, and people have to focus to tell if they are really feeling them. Frankly, given that the feelings usually come well before the 45-minute absorption time of the medication, I think that they are often imagined, or created by the mind, as a ‘placebo effect.’
Preliminary studies suggest a role for buprenorphine for treating refractory depression. I would not recommend that use for the medication in people who are not already addicted to opioids- but the findings of mood elevation in some people runs counter to your suggestion that the drug causes depression.
Buprenorphine is different from methadone in a number of ways, the most critical being the mu receptor profile, where buprenorphine acts as a partial agonist, and methadone acts as an agonist. This difference is responsible for the unique actions of buprenorphine, compared to methadone and other agonists.
But my primary disagreement with you is because you completely disregard the conditions that you had before starting buprenorphine. I assume that you were dependent on opioids, as that is why the vast majority of people take buprenorphine. And opioid dependence is not a benign condition. In fact, opioid dependence is often fatal, particularly over a span of ten years. When you blame your depression and anxiety on buprenorphine and Suboxone, where do you get the image that you use as a comparison for your current condition?
For example, if you didn’t take buprenorphine, what are you assuming would have happened? The success rates for ‘treatment’ without buprenorphine are very low—well below 10%. And many young people who have taken opioids for more than a year or so can list several former confidants who have died from opioids. In other words– you seem to be assuming that you would have been fine without Suboxone, when the odds are more in favor of you having significant problems from your addiction—and maybe death.
You may have scraped up $5K – $50K to enter treatment and been in the lucky few percent who ‘got’ recovery; in that case, the odds would have been high that you would relapse in the next few years. As for depression and panic, those are common symptoms in anyone with longstanding opioid dependence—are you just assuming that you would have been fine?
You may have gotten arrested for doctor shopping, shoplifting, or theft from your best friend’s medicine cabinet. You may have gotten disgusted with yourself and committed suicide. You may have lost everyone close to you, and ended up living on the street. We don’t know what might have happened—but I remember the days before buprenorphine was available, and remember the revolving door of treatment centers and NA meetings. Heck, those revolving doors are still in use by the people who will buy into your comments!
This is where my anger used to really well up… every person who you convince with your story — fueled by your lack of recognition of the condition you were in and your lack of appreciation for the substance that saved your life—every one of those persons will have a higher risk of mortality, thanks to you.
And—sorry for my French—that still pisses me off!

4 Comments

  1. DonnaD717

    All I kept thinking as I read Nancy’s letter is, “Well, why in the world would you assume that depression and panic attacks aren’t exactly what drove you to whatever opiate you did to begin with?” I’m on long-term Sub myself, and whenever I try to come off, I end up with overwhelming — guess what — depression and panic attacks. I never made the connection myself. I just switched to a doctor who would “do it right this time,” as far as helping me get off the Sub. It wasn’t until I was honest with myself and my doctor about what I was feeling that the correlation was made. He said he wasn’t surprised that that was happening and that I probably have a very long history of both, but they’ve been quieted by the opiates first, then the Suboxone.
    As far as brain damage, again, I’d look to the drug of choice as the culprit for any of that. I did more than my fair share of opiates and have been on Sub since 2006, and it appears I can still put a coherent sentence together, tie my shoes, and feel (as evidenced by the aforementioned depression and panic attacks – LOL).
    Look, I don’t know if Suboxone is causing/has caused brain damage or depression or panic attacks, but I do know that it has enabled me to function in this big, scary world for the past five years, and as for me, I’m grateful it is available. I raise a special needs son by myself (and no, my opiate use kicked in after he was born), and without it, I couldn’t meet his daily needs (or mine either, truth be told).
    I’m so sorry that you’re having these problems, but please don’t make blanket assumptions about something that is helping and has helped so many other people, myself included. I wish you the best, Nancy, and I hope life gets better for you very soon – ‘cuz honestly, it’s not all that bad!!!
    Donna D

  2. JohnB007

    Yeah, and it gets into your bones, and causes lot’s of other hideous stuff. Oxycontin etc never did that. Oh dear, Nancy. How on earth did bupe make you high? Actually, there is a correlation between long term opiate use and osteo. Someting to do with Vit D conversion and more that the endocrinologist explained that went way over me and Kansas City. Any brain damage done was me and my use of everything BUT bupe. A little quiet and honest recollection of our actions before treatment might be in order before finding a lawyer for a class action. Having said that, Nancy – you are not alone with some of your ideas. Methadone was considered in much the same way, worse for you than Heroin. harder to come off etc. Bupe allowed me to function. Thought I was functioning just fine on 180 to 220 of Oxycontin a day – apparently I wasn’t. For some reason, the house was spotless though. Became a real neat freak. Not sure why that is. I’ll google class action against reckitt. That would be better than the OJ case.

  3. sco617

    Oh Nancy, you are a very misled and confused individual. I have been taking bupe since 2004 and was on heroin and any other full agonist I could get my hands on prior to that beginning in 1995. I have been to prison three times in pursuit of keeping that sickness off my back, lost everything tangible and spiritually/emotionally. Because of DATA 2000 and bupe being available as an option, I am now in my junior year of college for my Bachelors as an Addiction Specialist, have a wonderful woman I plan to marry(who also overcame an oxy habit because of bupe and is now an LPN), I have trust and a relationship with my family again. I could go on and on about the wonderful things I have in my life now because of what you are calling a horrible medicine. Opiates as a whole when used in moderation are one of the safest medicines known to man. It is the street contaminants and abuse/overuse and their addictive nature to us few whose “lights come on” when we take them that make them dangerous. I have to agree with JJ here. It does make me quite angry knowing that there are some folks out there that may buy into your misguided and evidence-lacking bashing of bupe that may never try it as a way to recover and become another statistic of opiate related death. People die because of this dehibilitating and progressive disease. This is serious business. We do not need inaccurate information and accounts of people using bupe as a scapegoat to their “issues” they have not sincerely and humbly looked into themselves for reasons of their condition. If it did not work for you, then try another route but it has and is working for thousands of people, so please, do not discourage that. Also, a lawsuit against RB?? Are you kidding? I think it is time to get real with yourself Nancy. If it was so horrible, why 9 years? That is quite a long time to be in such a terrible state of being. Quite frankly, your letter is just baffling to me. I truly wish the best for you and hope you can find peace, however blaming bupe is not the right direction. Thank you JJ and keep up the priceless work. You are helping save lives.

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