Suboxone Detox is a Sucker’s Bet

First Posted 10/6/2013

I attended the US Psychiatric and Mental Health Congress meeting last week and actually attended the meetings (the event was held in Las Vegas), but I was disappointed by the absence of lectures about addiction.  There are other mental health groups geared more toward addiction, but one would think that psychiatry would maintain a strong presence in the field.  This was my first time at the annual meeting for this group, and so I can’t say that I’m witnessing a trend away from addiction by psychiatry—which would be a real shame.

At any rate, I had a very busy Friday and Saturday catching up with the office work I put off for a few days. So today I had to cram in a lot of non-work activities, to make sure that my life remains well-balanced.  That meant watching the entire Packer game, going to the movie ‘Gravity’ complete with 3-D glasses, and then catching the latest episode of Homeland, where psychiatrists continue to gain a bad name.  Thorazine injection, anyone?

So I’m beat…  but I’ve been intending to write something for the past couple weeks, and I think I can knock it off fairly quickly.  Readers know that I get many emails from across the country describing atrocious behavior by physicians.  The latest scam?  It appears that everyone with a medical clinic has a secret recipe for tapering off Suboxone.

I received an email from a person who wanted to stop Suboxone/buprenorphine for months, if not years.  For people who don’t know my attitude, I tend to believe my own eyes, and also what the research shows—that over 9 out of 10 of the people who stop buprenorphine are using opioids again within one year.  When people moan that ‘it is hard to stop buprenorphine’, I remind them that the reason they are TAKING buprenorphine is because they were unable to stop opioids.  Why would they expect that to change?  Oh- I know— counseling!  That’s the line from all of the addiction insiders—that patients take buprenorphine and do ‘counseling’, and the addiction goes away.

There are two scientific findings that keep trickling out these days that are driving some people crazy— and I admit to a bit of amusement with each headline.  The first set of findings concern the troubling lack of global warming over the past 8 years—including the recent headlines that polar icecaps, predicted by Gore et al. to be completely gone by now, have grown by almost a third in the past year.  The other interesting findings are the several studies that failed to demonstrate an increase in sobriety in buprenorphine patients engaged in ‘counseling.’    There is real danger for people who borrow science just in order to hide behind It for an argument or two; they risk getting caught naked when the science moves in an unexpected direction!

Anyway, the person wrote to tell me that after multiple failed efforts to taper off buprenorphine on her own, she had gone to a rapid-detox clinic that promised to ‘heal’ her receptors over a few days. The $7 grand was spent, and I had no desire to ruin whatever placebo effect she would gain from the silly cocktail of nutritional supplements she purchased.  So I told her that I hoped she felt better soon, not adding that she will feel better at about the same time she would have felt better without the rapid detox and nutritional supplements.

She wrote again a week later, struggling from withdrawal, and then again a few days after that to say that she went back on buprenorphine.  But the good news was that she found a different doctor who SPECIALIZES in getting people off buprenorphine.

A few days later she wrote to tell me about the hundreds of dollars the visit cost— and asked if his taper schedule appeared reasonable.  ‘He’s your doctor’, I explained, trying to sound neutral.  I shared my belief, though, that it was a conflict of interest for doctors to sell nutrient products that they themselves prescribed, and that opioid receptors are able to return to health without the addition of trace nutrients.

A week later she wrote about yet another specialist, who this time took $800 to tell her to take 3 mg for a few days, then 2 mg for a few days, then 1 mg for a few days.  She said she had to go back for another appointment for him to tell her what to do after that.

I know it sounds like I’m joking, but sadly, I’m not.  More sadly, I’ve read similar messages a number of times over the past few years.  I’ve stated that I would try to point out things I write that are based on science, vs. things based on personal experience, vs. what I’ve witnessed as a clinician.  What I’m about to say is based on all three.

I had my own nightmare withdrawal from potent opioids when I was in treatment 13 years ago.  I lost 30 pounds from my already-skinny frame at that time, having no appetite and without taking nutrient supplements.   But my withdrawal ended and my receptors healed in about 6-8 week, just as in every opioid addict who I’ve assisted through detoxification.  And when I’ve seen people go away for rapid detox, they complain about feeling lousy— the same amount of complaining over the same lousiness—for the same 6-8 weeks.  One would think that all of this would be enough to outrage the FDA, who usually get irritated at stories about high-cost, low-yield medical procedures.  But once again, the truth is even worse.  For those who do manage to white-knuckle through 6-8 weeks of withdrawal, guess how many are still clean a year later?  Wanna bet?

As for the warming of the planet, I’ll continue to read the science with an open mind.  Maybe Gore will be right in the long run, which would be bad for the planet but good for those who give out Nobel Prizes.  But we know one thing for certain now; that asserting the ice caps would be gone by 2014 was a sucker’s bet.  And the same is true about promises for a rapid or gentle path through opioid withdrawal.