Suboxone Talk Zone: A Suboxone Blog Questions and Answers about Opioid Dependence and Buprenorphine Thu, 27 Aug 2015 21:19:34 +0000 en-US hourly 1 Blame Suboxone! Fri, 03 Apr 2015 02:58:25 +0000 Read more]]> 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.

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Opioid Withdrawal Treatments Sun, 22 Mar 2015 17:19:51 +0000 Read more]]> A post on the Forum asked about the best remedies for opioid withdrawal.   I will review the medications and other treatments for opioid withdrawal that I have heard discussed by physicians or by people on the internet.  Hopefully readers will leave comments about medications or approaches that they have found useful.  Likewise, if you are a physician, please weigh in with the approaches that you have found to be useful.

For readers, it is very important to understand a couple things about this post.  First, the medications listed here are not FDA approved for treating opioid withdrawal.  They have not been systematically tested for that purpose. Most of the medications that I will list are available only by prescription— and must be taken ONLY by prescription.  They all have interactions with other medications, and they all have toxicity in certain doses, and in people with certain conditions.  Do NOT take them other than through guidance by your doctor.  This post is intended to spark discussion with your doctor— and to help doctors learn about approaches that they have not heard about elsewhere.

I will encourage doctors or other contributors to this post to avoid discussion specific dosages.  These medications must be prescribed by physicians who understand them, or who know how to become knowledgeable about them.

One problem for doctors is that CME meetings generally discuss treatments that are FDA indicated.  I do not know of any medications that have been approved or marketed specifically for opioid withdrawal, and I do not have the sense that the field of medicine views opioid withdrawal as a pressing issue.  But I am aware that for buprenorphine patients, the treatment of withdrawal symptoms has the highest priority of any medical concern.

With those caveats, here are the medications that I have heard the most about, roughly in the order of what consider their usefulness:

– Clonidine:  Available by tablet or by patch.  The medication reduces CNS excitability, and relieves all opioid WD symptoms to some extent.  Side effects include sedation (which may be useful), dry mouth, and hypotension.

– Gabapentin:  An anticonvulsant that some people find relieves anxiety and perhaps the sweating during withdrawal.

– Benzodiazepines: A controversial topic.  They are potent sedatives, but they are also potent respiratory depressants when combined with opioids.  Most overdose victims have these drugs on board.  They relieve anxiety, insomnia, and muscle tension, and cause fatigue.  Should NEVER be combined with opioids unless under very careful supervision (i.e. ‘self treatment’ = NO treatment).

– Phenobarbital: A Forum participant wrote that his/her doc prescribed phenobarbital for opioid withdrawal with great success.  All barbiturates act similarly to benzodiazepines, and have potent respiratory depression, especially with opioids.  Again, must NOT be used except under close supervision.  Have effects similar to benzodiazepines.  Dangerous if combined with alcohol.

– Quetiapine: AKA Seroquel.  A potent sedative, used to treat psychosis, bipolar mania, depression… and off label, insomnia.  Side effects include dry mouth and sleepiness.

– Natural ‘remedies': A variety of withdrawal remedies are advertised on opioid-related web sites.  I’ve had patients who tried most of them, and I’ve never heard anyone say they were useful. Some come in ‘daytime formula’ and ‘nighttime formula’.  Always read the ingredients– and if you see a long list of herbs and roots, realize that there is NO oversight of the claims that are made.  You could put bundles of dandelions into empty capsules and sell them over the internet, making the same claims.  How hard do you think it would be to find a people to write ‘testimonials’ for twenty bucks? Or you could just write them yourself! Buyer beware.

– Amino acids:  Again, advertised on the internet, and offered at steep cost by ‘select’ doctors.  One of the ‘pioneers’ of amino acid treatments for withdrawal was convicted of fraudulent practice in Texas, and now offers the same as he did in Texas, but safely across the border, in Mexico.  He has clinics in the US, run by other doctors, who boast of using his methods.  The appeal of buying into a treatment that was proven fraudulent in court escapes me.  But the treatment of opioid dependence is strongly influenced by perception, and so is strongly subject to placebo effects.  The appeal of snake-oil remedies has created a living for many, many charlatans over the years, and a sucker is born (at least) every minute.

– General sedatives:  Insomnia is such a big problem that anything that helps with sleep will help during opioid withdrawal.  Meds include diphenhydramine and hydroxyzine (antihistamines), zolpidem and zopiclone (short-term sleep meds), and trazodone and mirtazapine (sedating antidepressants).   Cyproheptadine is a sedating antihistamine that reduces nightmares, and stimulates the appetite.

– Stimulants:  I’ve read of people using them to fight the depression and fatigue during withdrawal.  That use of a schedule II medication may be illegal in some states, and is probably frowned-upon by agencies that regulate medical practice.  The energy and mood effects from stimulants are temporary, and must be ‘paid back’ with fatigue and depression when the stimulants are discontinued.

– Naltrexone: An opioid antagonist that has been used to speed the reduction of opioid tolerance.  Naloxone and naltrexone are used during rapid detox, under strong sedation or anesthesia, but I believe that some have used naltrexone in very low doses in awake patients.  If you are a doc who knows about this approach, I’m all ears…

– Antidepressants:  Depression is one of the worst aspects of opioid withdrawal.  Antidepressants would seem appropriate… but I know of no antidepressant medications that have a chance against the severe depression caused by opioid withdrawal.  I’ve used them for patients after the withdrawal ends, when depression lingers… but I see little use for them during acute withdrawal.

Gosh, I thought my list would be longer.  Given how many people suffer through discontinuation of opioids, our approach to easing misery is pretty limited.   I will remind readers–  most of the medications listed above will cause serious harm, if taken without doctor supervision.

If you are a doctor who has found success with other medications, or if you are a patient of such a doctor, leave a comment to help spread the knowledge.  If you are not comfortable with leaving a post, send me an email, or a message through LinkedIN.


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Suboxone Side Effects Tue, 17 Mar 2015 04:07:54 +0000 Read more]]> I’ve received questions over the years from people claiming a range of symptoms from Suboxone or buprenorphine, from back or muscle pain to fatigue, depression, or irritability. I didn’t invent Suboxone, so I don’t take it personally when people blame commonly-occurring symptoms on the drug. But I get bored by the non-scientific thinking behind such claims— that since they started buprenorphine at some point in the past ten years, every symptom or illness that comes along must somehow be related to buprenorphine. No matter, apparently, that people who DIDN’T start buprenorphine often develop the same symptoms. And no matter that they themselves have done a number of things over the past few years BESIDES start buprenorphine. But over and over, people insist that they know, without a doubt, that buprenorphine has to be the problem.

I also get frustrated answering questions about these symptoms when people who complain about them are closed off to other explanations. When I point out that many non-buprenorphine patients have the same complaints, my comments provoke anger. Sometimes I’m accused of having a vested interest to keep people on buprenorphine (I don’t-beyond wanting to provide good medical care).

I have a long waiting list of patients and buprenorphine is only a small part of my practice, so I have no reason to compel use of buprenorphine. But I don’t like the risk that my own patients, or others, might be swayed by faulty logic and fret over problems that have no logical basis.

To the people who have written to ask about feeling depressed, anxious, irritable, numb, sleepy, wakeful, or dulled by buprenorphine, my answer is that in almost all cases, people on buprenorphine feel the same way they would feel if they were not on buprenorphine. People develop full tolerance to the effects of buprenorphine at the mu opioid receptor, so from a scientific standpoint, people on stable doses of buprenorphine should feel ‘normal’. Beyond the science, I can say that after treating over 800 patients with buprenorphine over the past ten years, I have seen no evidence that buprenorphine causes depression, irritability, chronic pain, emotional numbness, lack of interest in things, or personality changes. Honest.

Whenever I answer an email or forum post about buprenorphine I try to think of an explanation for the person’s perception. I try to give the person’s history the benefit of the doubt. I might have a couple of explanations for why someone might feel different on buprenorphine.

One case would be a person who is taking too little buprenorphine to stay above the ceiling threshold. Many doctors, and some patients, apply constant downward pressure to the dose of buprenorphine, I assume because of thinking that less buprenorphine is closer to total abstinence than a full dose of buprenorphine. But the benefits of buprenorphine are lost in doses insufficient to reach the ceiling effect of the medication. People taking too little buprenorphine will experience irritability, fatigue, sweating, and depression when the drug concentration drops below that level. The solution is to increase the dose enough for blood levels to stay above the ceiling threshold.

Another possible cause of irritability requires some speculation on my part. Actively-using addicts have very straightforward problems, which boil down to having enough narcotic to avoid getting sick every few hours. I’ve noticed that my own patients sometimes feel stressed or anxious in early buprenorphine treatment, as they become aware of all of the problems that were less-visible during active addiction. Most of that anxiety is only temporary, resolving as patients catch up with bills, settle legal issues, and feel less shame about behavior during active addiction.

Along the same line, active addiction sometimes allows people to postpone changes that really should be made, but were not possible during active addiction. Bad marriages seem less bad when surrounded by misery and chaos. But when a person finds happiness and moves forward in life, a miserable or abusive partner becomes more noticeable. Or maybe a marriage seemed ‘healthier’ when the partner was making the money necessary to support a drug habit. Effective treatment of opioid dependence empowers patients to make positive changes. But even positive changes come at the cost of emotional pain.

The people who remain convinced that buprenorphine is causing side effects would be best served by an open mind. Most of the complaints that I read about are identical to the complaints of my non-buprenorphine patients, and the most successful interventions include healthy living, stress reduction, and moderate exercise. Stopping buprenorphine is not going to be helpful in the absence of these interventions.

There is also the risk that the symptoms are caused by something other than buprenorphine—something more serious. An extreme example would be blaming buprenorphine for fatigue that in reality is caused by anemia, thyroid dysfunction, or heart disease. That situation is made even worse by the common behavior of doctors, who tend to blame any unexplainable symptom on the medication the patient is taking that the doctor knows the least about. Too often I’ve told patients to go to their GP because of unexplained muscle weakness, numbness, headaches, fatigue, or weight loss, only to have the doctor send them out without any tests or treatments, other than telling them to ‘stop Suboxone!’

Anyone reading this post, who truly suffers from adverse effects from buprenorphine, should report the side effects to the FDA web site so that clusters of symptoms, if present, can be identified.

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Menzies Gets it Wrong Thu, 05 Mar 2015 04:00:49 +0000 Read more]]> In Opioid Addiction Treatment Should Not Last a Lifetime, Percy Menzies resurrects old theories  to tarnish buprenorphine-based addiction treatment.  Methadone maintenance withstood similar attacks over the decades, and remains the gold standard for the most important aspect of treating opioid dependence:  preventing death.

Menzies begins by claiming that a number of ideas that never had the support of modern medicine are somehow similar to buprenorphine treatment.  Replacing beer with benzodiazepines?  Replacing morphine with alcohol?  Replacing opioids with cocaine?  Where, exactly, did these programs exist, that Menzies claims were precursors for methadone maintenance?

Buprenorphine has unique properties as a partial agonist that allows for effects far beyond ‘replacement’.  The ceiling effect of the drug effectively eliminates the desire to use opioids.  Seeing buprenorphine only as ‘replacement therapy’ misses the point, and ignores the unique pharmacology of the medication.

Highly-regulated clinics dispense methadone for addiction treatment., and other physicians prescribe methadone for chronic pain.  Menzies claims ‘it is an axiom of medicine that drugs with an addiction potential are inappropriate for the treatment of chronic conditions.’  For that reason, he claims, methadone treatment is ‘out of the ambit of mainstream medicine.’ The 250,000-plus US patients who benefit from methadone treatment would be amused by his reasoning.    I suspect that the thousands of patients who experience a lifetime of chronic pain—including veterans with crushed spines and traumatic amputations—would likely NOT be amused by his suggestion that ‘opioids… were never intended to be prescribed forever.’   Those of us who treat chronic pain take our patients as they come—often with addictions and other psychiatric baggage.  Pain doesn’t stop from the presence of addiction, neither does the right for some measure of relief from that pain.

Menzies cites the old stories about Vietnam veterans who returned to the US and gave up heroin, as evidence that prolonged treatment for opioid dependence is unnecessary for current addicts.   But there is no similarity between the two samples in his comparison!  US Servicemen forced into a jungle to engage in lethal combat use heroin for different reasons than do teenagers attending high school.   Beyond the different reasons for using, after returning home, soldiers associated heroin with danger and death!  Of course they were able to stop using!  And that has to do with current addicts… how?

Teens in the US have no mainland to take them back.  Their addiction began in their parents’ basement, and without valid treatment, too often ends in the same place.

Menzies refers to buprenorphine treatment as ‘a conundrum’ that has not had any effect on deaths from opioid dependence—a claim impossible to support without an alternative universe and a time machine.  He claims that buprenorphine treatment is unsafe and plagued by diversion.  In reality, most ‘diversion’ consists of self-treatment by addicts who are unable to find a physician able to take new patients under the Federal cap.  In the worst cases, some addicts keep a tablet of buprenorphine in their pockets to prevent the worst of the withdrawal symptoms if heroin is not available.  But even in these cases, buprenorphine inadvertently treats addicts who take the medication, preventing euphoria from heroin for up to several days and more importantly, preventing death from overdose.

Just look at the numbers.  In the past ten years, about 35,000 people have died from overdose each year in the US with no buprenorphine in their bloodstream.  How many people died WITH buprenorphine in their bloodstream?  About 40.  Even in those cases, buprenorphine was almost never the cause of death.  In fact, in many of those 40 cases, the person’s life would have been saved if MORE buprenorphine had been in the bloodstream because buprenorphine blocks the respiratory depression caused by opioid agonists.

Naltrexone is a pure opioid blocker that some favor for addiction treatment because it has no abuse potential.  Naltrexone compliance is very low when the medication is not injected, and naltrexone injections cost well over $1000 per month.   Naltrexone may have some utility in the case of drug courts, where monthly injections are a required condition of probation.  But even in those circumstances, the success of naltrexone likely benefits the most from another fact about the drug, i.e. that the deaths from naltrexone treatment are hidden on the back end.  Fans of naltrexone focus, optimistically, on its ability to block heroin up to a certain dose, up to a certain length of time after taking the medication.  But Australian studies of naltrexone show death rates ten times higher than with methadone when the drug is discontinued, when patients have been discharged from treatment, and short-term treatment professionals have shifted their attention to the next group of desperate but misguided patients.

The physicians who treat addiction with buprenorphine, on the other hand, follow their patients long term because they see, first-hand, the long-term nature of addiction.  Menzies’ claim that ‘the longer you take it, the harder it is to stop’ has no basis in the science of buprenorphine, or in clinical practice.  Patients often get to a point—after several years—when they are ready to discontinue buprenorphine.  And while buprenorphine has discontinuation symptoms, the severity of those symptoms is less than stopping agonists—and unrelated to the duration of taking buprenorphine.   Until that point in time, buprenorphine effectively interrupts the natural progression of the addiction to misery and death.

The physicians who prescribe buprenorphine and the practitioners at methadone clinics are the only addiction professionals who witness the true, long-term nature of opioid dependence. In contrast, too many addiction practitioners see only the front end of addiction, discharging patients after weeks or months, considering them ‘cured’…  and somehow missing the familiar names in the obituary columns months or years later.

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Media Bias Against Suboxone Mon, 02 Mar 2015 05:01:25 +0000 Read more]]> First Posted 2.8.2014

After Philip Seymour Hoffman’s death, I anticipated a flood of articles describing the ineffectiveness of non-medication treatments for opioid dependence.  I assumed the media would finally report on the need for long-term treatment of a long-term illness.  Instead we read more articles describing Suboxone (i.e. buprenorphine) as a ‘bad drug’, since Hoffman may have used the drug to reduce withdrawal between heroin binges.

Taking buprenorphine within a few days of using heroin blocks most of heroin’s effects and makes overdose much less likely– a fact rarely reported.  Out of about 400,000 overdose deaths over the past ten years, only 400 deaths included buprenorphine as one drug in the fatal mix– a stunning statistic that calls out for more life-sustaining buprenorphine treatment, not less.  In most of those cases, death would not occurred had there been more buprenorphine in the victim’s bloodstream.

Vivitrol is the brand name for a monthly, injectable form of naltrexone that appeals to a superficial approach to opioid dependence.  Naltrexone advocates focus on the months of abstinence when patients are taking the medication, often during forced compliance mandated by drug courts. Rarely questioned is the long-term effectiveness (or lack thereof) of naltrexone for reducing the morbidity and mortality of opioid dependence.

The uncritical acceptance of naltrexone by some prescribers begs some important questions.  If short-term use of a treatment causes an increase in long-term mortality, is the treatment ethical?  If patients mandated to receive a course of treatment only relapse and reoffend a year later, is the treatment an efficient use of resources?

Naltrexone appeals to the same people who push abstinence programs that have long-term success rates well below 10%.  Current abstinence treatments often center around programs developed in the 1920′s, that ignore the advances in our understanding of neuroscience and addiction since that era.  Abstinence programs blame failures on patients rather than recognizing failed treatment approaches. The case of Philip Seymour Hoffman should call out for a new paradigm, where patients are treated with medication that works and continues to work over the years of a person’s life.

Naltrexone is a ‘blocker’—a great thing for the anti-drug attitudes in all of us.  But does it matter that people treated with naltrexone die from overdose at a rate 7-fold higher than people on methadone?   Proponents of naltrexone ignore the long-term nature of opioid dependence.  And whether naltrexone is administered by shot or by tablet, patients inevitably stop taking it.  The ‘naltrexone paradigm’ calls for only 6-12 months on the medication, and many patients drop out even sooner, when their probation ends.

Many patients learn from the internet or elsewhere that naltrexone increases their sensitivity to heroin, a ‘reverse tolerance’ effect that makes relapse impossible to resist. The same hypersensitivity causes greater risk of death, making ‘one last time’ a self-fulfilling prophecy.

On the other hand, headlines that decry ‘abuse of buprenorphine’ greatly exceed true harm from buprenorphine. Most buprenorphine abuse consists of self-treatment by addicts who have no access to the medication, because of limits on patient enrollment and regulations that discourage physicians from prescribing the medication.   ‘Abuse’ of buprenorphine is far more likely to prevent overdose than to cause harm.  Even one dose of 8 mg buprenorphine prevents death for several days by blocking opioid receptors.

Given the safety of buprenorphine, it is hard to justify the use of temporizing measures or ineffective step treatments.  Addiction deserves proper medical treatment—not superficial approaches that delay death for a year or so.

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Another Suboxone Argument Sat, 14 Feb 2015 17:11:02 +0000 Read more]]> It has been awhile since I posted a give and take with a misguided reader. I’ve taken that interval as good news that education is winning over misinformation.

But then I read this comment.  I didn’t fix her typos, as I think they provide insight into her opinion:

My daughter was on Suboxone, because she was a heroin addict, when she could not afford this med, the withdrawal lasted for mnths, and was far worse than I have ever seen her go through Heroin withdrawal. These are a Psyhiatrist facts, I absolutely hate Suboxone, YES peple do get high on Suboxone, Yes they absolutely can and do inject this garbage. This medication may have helped people who were not addicts for pain, or addicts who truly took this drug to remain clean, and that’s o.k BUT NO THE DRUG COMPANIES are not going to put the facts out about this dug, and about the deaths caused from overdosing on this drug using it in combination with other drugs. They will not report the abuse of this drug, and the effects of this drug on the bodies organs or how it causes Bone Marrow depression. THE TRUTH WILL COME OUT NO MATTER HOW THE DRUG COMPANIES AND GOOD OLD DOCS, TRY COVER IT UP. Half these Suboxone Dr’s are addicts themselves, I took my daughter to one who’s pupils were so pinned, he was slurring and could hardly stay awake, HMMM Could it be he was abusing the same drug he was supplying. They had a great plan for getting people on it but none what so ever for getting people off of it. The Truth about Suboxone will come out. It should be used only for detox only taken no more than for 10 days. I am a Drug and ETOH detox Nurse, so I have seen not just with my own child, but with clients who, by the way do abuse the drug sell it on the street, so they can buy heroin. IT’S A MONEY MAKER FOR BIG PHARMA, AND THE MAKER OF THIS DRUG PAID DOCTORS THOUSANDS TO BECOME CERTIFIED TO PUSH THIS POISON. I will get the true facts of this drug, but Do NOT JUST PUSH THE PRETTY SIDE TELL THE TRUTH ABUT THE UGLY AND YES SOMETIMES DEADLY SIDE. DR. My daughter committed suicide January 4th 2015 overdose of heroin, among other substances. She went to heroin again because she started going through post SUBOXONE withdrawal. The withdrawal last weeks to months with post withdrawal. So please do make this sound like a miracle drug that saves lives, it also kills and that truth will come out. I am sick of these companies, hiding the facts! Facts to me because I have lived it and have seen personally the effect of this drug.

I responded as follows:

I wish you were at least partially correct, given that you work in the field, and have the potential to spread such inaccurate information.

Deaths…  in the past ten years there were about 35,000 overdose deaths in the US.  None of those people had buprenorphine in their system when they died.  What number of people had measurable amounts of buprenorphine in their bloodstream when they died from overdose?  40 per year.  Most of those 40 people would be alive if there had been more buprenorphine in their bloodstream– the only exception being the few cases each year where a young child ingested the drug.

Note that 400 people die from Tylenol each year in the US– compared to 40 deaths of people who had buprenorphine in the bloodstream.  It is very hard to die from buprenorphine;  those who die must have little or no opioid tolerance, and must also take a second respiratory depressant that they have little tolerance to.

Bone marrow depression?  Really?  Buprenorphine has been in use for almost 40 years.  It has a better safety profile than most meds out there.

‘Plans for getting people off’?  The whole point of buprenorphine is to provide chronic treatment for a chronic illness.   You apparently want something that instantly changes the brain and erases addiction, but that product is not invented yet– and I wouldn’t hold my breath for it.  Your daughter developed a condition that will last the rest of her life.  She will treat it for the rest of her life.  She can take a medication each day, or she can attend meetings several times per week. The latter approach works, mind you, only in the relatively few people who are moved by the 12-step message.  Both approaches must last for years and years, if not a lifetime.  Many people do well on buprenorphine, but some survive without it.  But if she isn’t attending meetings or doing something with similar intensiy, her prognosis off buprenorphine is not good.

The withdrawal from the partial agonist buprenorphine is less severe than from agonists.  ALL opioid withdrawal lasts for 2-3 months, and is followed by post-acute withdrawal.  On buprenorphine, a person’s tolerance is equal to 40 mg methadone per day.  Realize that heroin addicts typically have tolerance that is several times higher.  Your daughter developed a high tolerance to agonists, and then continued to have a high tolerance on buprenorphine.  Any addict, including your daughter, is facing months of detox.  Buprenorphine delayed the detox, giving her the chance to get her act together first.  Many people are successful with that approach, but some blow the chance and keep up the negative behavior.  Buprenorphine relieves cravings;  it doesn’t fix personalities all by itself.

I suspect that the reason you never saw such bad withdrawal in your daughter coming off heroin is because she could never stop heroin long enough to demonstrate 2 months of withdrawal.  Nobody just stops heroin; they stop for a couple weeks and then use again.  On the other hand, many people taper off buprenorphine, and have the chance to experience the full course of opioid withdrawal.

The cost…  The drug companies make much more money from chemotherapy, anti-hypertensives, pain pills, and other meds.  Reckitt Benckiser, the biggest maker of Suboxone products, recently spun off the drug because of the anticipated losses.  Even if buprenorphine was a blockbuster, though, I have nothing against drug companies being rewarded for the risks they take to develop new meds.  There is no doubt that the efforts to market buprenorphine have saved thousands of lives.

If your daughter sold her buprenorphine to buy heroin, that’s her bad.  Most people do not do that, but some probably do.  Understand that heroin is very addictive, and drives all sorts of bad behaviors– theft, prostitution, robberies, etc.  I guarantee you that selling her prescription of buprenorphine alone did not make enough money to pay for a heroin habit.

There are so many things you have wrong…. ‘the drug companies paid doctors to push this drug’… I’m sorry, but you are clearly a zealot, and I can’t even take you seriously with that argument.  If you know of a single doctor paid to prescribe a drug, call the Feds, as that would be a crime.  There are some doctors paid to WORK for pharma— to give lectures about new drugs, for example.  I have done that in the past for drugs I believed in.  Some people seem to hate it when doctors take any money from pharma, but when they do, it is for work–  for travelling to some cheap motel in the middle of nowhere and giving a talk to a group of doctors.  The work is highly regulated, and just like TV commercials, docs are required to stick to a very narrow script that educates, rather than promotes.

‘Detox’ has been marginalized (thankfully) because of recognition that it does nothing to treat addiction.  Likewise, non-medication treatment has very low success rates, especially if you count everyone who enters the door, instead of blaming those who fail for ‘not wanting it bad enough’.

I’m sorry about your daughter.  But one thing many parents eventually realize is that even when a kid is acting irresponsibly, buprenorphine at least keeps them alive.  Buprenorphine allows people to stay alive, even if their recovery is imperfect.  And relieved of most of the cravings to use, many of those patients eventually get it right.

Back to the present…  I’d like to think that I cleared up some misconceptions.  But two days after my comments, I received a very similar set of comments from the same person—except that most of the words were capitalized.  That is the reason I’ve tired of these types of posts….

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