Suboxone Talk Zone: A Suboxone Blog

For those of you who like to do some scientific reading, a recent meta-analysis looked at clonidine’s efficacy in reducing the symptoms of opiate withdrawal.  A meta-analysis, by the way, is when someone takes a number of studies that sometimes didn’t reach significant conclusions and combines the numbers, creating a larger study group that sometimes shows significant results that were missed in the smaller study.  There are limitations to such an approach, but it is still a common approach to looking at infrequent things.    The infamous ‘black box warnings’ on SSRIs about suicidal ideation in children came from meta-analysis of old studies of antidepressants.

Alpha2-adrenergic agonists for the management of opioid withdrawal

SuboxDoc

Many people who take Suboxone have heard this question at some point, from parents, friends, siblings, a spouse… well-meaning all. Unfortunately, the words are not so much a question as they are a statement: You should get off that stuff– that Suboxone.

Many patients tell me that the statement often leads to an argument that they cannot win, as the person is not interested in hearing a new perspective– particularly from the person who got into the whole addiction mess. The situation becomes a ‘Catch-22′ in that the more the addict argues over why he should stay on Suboxone, the more the other person says ’see– you can’t live without it!!’

I have prepared an hour-long recording in which I discuss the reasons for staying on Suboxone; at least staying on it long enough until the addict feels he or she is ready to stop, if that time comes at all. In the recording I review the treatment options for opiate dependence, the reason that Suboxone is, in my opinion, the most reasonable choice of treatments for most people, and the reasons why there should be no rush to stop taking the medication.

If you are being hit with this question, please consider purchasing the recording and sending it to the person who is badgering you. After purchase, you will be taken to a link where you can download the MP3 recording; you can then e-mail the recording, transfer it to your MP3 player, or burn it on a CD. Please consider the purchase as a donation toward my work on the blog and forum. You can make the purchase from the link in the column to the right,  or by simply clicking on the link below (one for PayPal, the other for Google Check-out)

Thanks!

How Long Are You Going To Take That Stuff?!: Education for those who love an addict on Suboxone. One hour MP3 audio recording, $19.99.

Purchase using PayPal:

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I was an anesthesiologist for ten years, before my opiate dependence destroyed that career. During the tail end of my time working with mega-substances I had occasional days where I was desperate for something to ease the symptoms of withdrawal, primarily on the weekends when I was unable to go to work– as work was where the drugs were! I had no aversion to needles; in fact, by that time I had a positive association with them (and still do– an example of simple classical conditioning at work, just like the salivating dogs of Pavlov). I ‘used’ a couple different medications to help ease the pain; midazolam, reglan for nausea, diazepam for anxiety… but I never had any desire to inject Diprivan (aka propofol), the anesthetic induction agent supposedly found on the premises of Michael Jackson’s estate, and the drug that his nurse claims he used to beg for.

Diprivan found at Jackson estate

I first saw a report a few days ago when one of his ex-nurses was being interviewed; she said he had severe insomnia and begged her for that substance, but she would not give it to him. She didn’t mention that it would have been very difficult for her to give it to him even if she wanted to– it is used only intravenously, and only in monitored settings, so I don’t know how she would have obtained it without stealing it from a surgical center. I can’t just call up a drug supply house and say I want propofol for my clinic! I then heard today about the police finding the drug at Neverland. Wow– I can’t understand how a person could get to the point of using that ‘medication’. Again, it is an ‘induction’ agent– not ‘induction’ like a Suboxone induction, but an ‘anesthetic induction’– the process where a drug is injected that initiates a general anesthetic. It is also used in intensive care units to keep people unconscious while they are on ventilators, or given for short surgical or painful procedures like shocking the heart to ‘convert’ an abnormal heart rhythm.

I remember reading years ago that there was some theoretical abuse potential among anesthesiologists because the drug, when injected IV, induced a state of ‘positive well being’. The downside was that the ‘positive well being’ only lasted a few minutes, until the hypoxia from not breathing killed the person. Overall, not the best drug to mess with. We had a very talented surgeon in my home town who committed suicide with the medication a few years back; there was no doubt about his intention with the drug.

I often find the witch-hunt mentality to be a bit much in these types of cases, when everyone is looking for a doctor to blame for getting Mr. Jackson to the state he ended up in. But in this case, if some doc turned Michael Jackson onto propofol as an agent to help him get some sleep, that doctor is so far ‘over the top’ that he deserves whatever he gets– and should never be allowed to prescribe again! I had assumed that the cause of death was opiates, and perhaps that will still be the case– and if that is the case, I am less inclined to condemn the doctor(s) who treated him. I can only imagine how hard it would have been to say ‘no’ to someone of his power, as he talks about how the years of dancing have caused chronic pain in his knees, hips, and back… it would have been very difficult to say ‘no’, especially since you would tend to assume that the King of Pop had people to watch out for his well being.

But he didn’t. And instead of finding joy and friends through the use of his remarkable talents, it sounds as if he was deeply troubled, to the point of requiring a general anesthetic in order to escape from wakefulness for a blessed few hours. I would guess that every addict has some sense of what Michael Jackson’s life was like; the feelings and thoughts of addicts being so identical from one person to the next.

Sleep well, Michael. Wherever you are, I hope you are finally sleeping well.

You’ll notice a link to a company that makes medical ID jewelry in the sidebar and below–  not a bad idea to wear one if you are taking Suboxone.  I think that a year ago it was less important, only because many EMT’s didn’t know what the heck Suboxone was!  But realize that if you have been in an accident and are in pain, it will take significantly higher doses of narcotic (usually morphine in an ambulance or ER) to get any pain reduction– sometimes as much as 10-fold higher doses!  Even if you are able to speak, a bracelet or necklace with the name of the drug will likely be taken more seriously than whatever words you are able to put together in the confusion of an accident scene.  I think an imprint of either ‘Suboxone’ or ‘buprenorphine’ is sufficient;  ambulance crews are in contact with local emergency rooms during care in the field, and the crew on the scene would radio the ER to get information about the medication listed on the ID, and to receive special instructions on how to handle such a patient (such as to give the person more narcotic than usual!).