Blame Suboxone!

First Posted 3/24/2014

I recently came across the blog of a person who has dedicated his life to trashing buprenorphine treatment.  I won’t provide the name or link, as I don’t want to waste my own ‘page rank’ on supporting his misplaced anger.  But I suspect many readers of my blog have stumbled across that one as well, given the similarity of our keywords.    His blog doesn’t contain personal comments, I suppose because there are only so many ways to say ‘darn that Suboxone’.  Instead he auto-posts stories from across the country from newsfeeds, with keyword combinations of ‘Suboxone’ or ‘buprenorphine’ plus ‘robbery’, or ‘death’, or ‘overdose’, or ‘real bad person.’  I made the last one up, but you get the idea.

The person lost his son several years ago, a tragedy that would usually keep me from adding my own commentary.  But in the several years since his son’s death, he has written a number of diatribes on other anti-buprenorphine web sites.  In other words, he has contributed to the deaths of enough young people that by now, counterpoints are long overdue.

In his ‘about me’ section, he writes that his son took Suboxone for about 18 months, and died over two years after stopping buprenorphine/Suboxone.  He explains, in twisted logic, how the death is not the fault of his son’s drug addiction, or the drug dealers, or easy prescribing of prescription opioids or diversion of opioid agonists, or poppy policy in Afghanistan… but because of Suboxone.

He argues that his son’s Suboxone treatment was a ‘waste of time.’  I don’t understand that argument.  Suboxone added 18 months to his son’s life—and if his son had continued taking it, would likely continue to keep his son alive.  Hardly a waste of time.

I’m always impressed by how two people can see the same information and come to opposite conclusions.  He writes that during his son’s time on Suboxone, his son was prescribed over 13,000 pills, including opioid agonists and benzodiazepines.  He doesn’t say who it was who prescribed those 13,000 pills, and doesn’t apparently hold any ill will toward the people who did.  Instead, he blames Suboxone for not keeping his son from doctor shopping, for not keeping doctors from being duped by his son, and for his home state not having the type of database that tells doctors about problem patients.  If a ‘good medication for addiction’ is going to have to do all of those things, I wouldn’t hold out much hope for a new drug approval anytime soon!

The logic he uses on the web site brings to mind a recent encounter with a patient who has successfully stopped opioids, but who is struggling with other addictive substances.  Suboxone (or buprenorphine) is one piece of a person’s recovery, and does that one thing remarkably well.  Suboxone reduces cravings for opioids, making it much more likely that a person willing to do his part of the work will be successful in stopping opioids.   But it doesn’t do everything!  It doesn’t create an interesting life. It doesn’t keep a person from lying.  It doesn’t CURE addiction.  Buprenorphine is a tool that helps people who are ready to help themselves.  Our job as doctors is to try to match the limited treatment slots with the people who are serious about sobriety.  If the doctor treating his son was wrong about anything, it was in that regard—for taking in a patient who was not serious about staying clean.

The other thing that Suboxone or buprenorphine does, remarkably well, screams out from the tragic story.  His son stayed alive while taking buprenorphine, despite taking over 13,000 doses of other dangerous, controlled substances.  Despite the reckless drug use, buprenorphine kept his son alive.  As I’ve written many times, it is very difficult for someone taking buprenorphine or Suboxone to die from overdose.  But when the medication is stopped, that protection goes away.  Should we blame nitroglycerin for NOT stopping heart attacks because a patient chose not to take it?  When a person refuses chemotherapy and then dies from cancer, do we blame the chemotherapy?

The person with the blog writes that he is ‘all about detox and abstinence’.  Who isn’t?!  I’m ‘all about having shorter winters in Wisconsin.’  Should I blame the heating oil companies for the weather we’ve had?   He is angry that doctors who prescribe buprenorphine are not more interested in STOPPING the medication.   He is angry at RB for their lack of interest in detox, and their goal to maintain compliance with their medication.  He wants more people to be in his son’s position—fighting opioid addiction without the benefit of a medication that reduces interest in opioids and prevents overdose!

Those of us who prescribe buprenorphine know the value of the medication for keeping people alive.  I have known a number of family members who bullied patients over their use of buprenorphine.  In at least six cases, those family members won out, and the patients stopped buprenorphine.  In at least six cases, they stayed off buprenorphine, all the way up until their overdose death was announced in the obituary section.  I’m not pointing any fingers…. but I certainly wouldn’t blame the outcome on Suboxone.