Tired and Sick on Suboxone: What Would Junig Do?

I recently receive e-mails or read posts at Suboxone Forum that go something like this:

I used all kinds of pain pills over the past ten years—Vicodin, then oxycodone, methadone, and even fentanyl patches. Then I got into heroin for a year and finally hit my rock bottom. I went to a Suboxone doctor and he put me on 16 mg per day. At first everything was great, but I don’t like the side effects. I get so tired every day. I’m not happy like I used to be. I wake up in the morning and don’t have any energy or excitement for life. I really don’t like what the Suboxone is doing to me and want to stop.

Sometimes it is a little different—the first part is the same, but then the person writes:

I really wanted to stop taking it so that my body is free of chemicals so I stopped. I was real sick for a month and now I don’t feel like myself—I am tired, I feel depressed and angry, and I’m wondering what the Suboxone did to my opiates—am I ruined forever?

I am a psychiatrist, and only about a third of my practice consists of addiction work. I get e-mails at times after people read the blog for my psychiatric practice at www.patienttimes.fdlpsychiatry.com. A typical message will be similar to this:

Dear Dr. Junig (they tend to be more polite to me there),
I used to be a very happy, energetic person. In high school I was outgoing and everybody liked me, and I had tons of friends. The problem? Now I am in my 30’s and I’m never happy anymore. I have worked at the same place for ten years (or maybe, I change jobs every 18 months) and every day I wake up and dread getting out of bed and going to work. I keep telling myself I should exercise, but I never get started actually doing it. I’m single and don’t have any interest in dating (or maybe, I’ve been married to the same person for ten years and sometimes I can’t stand the look of him). I’ve read about vitamin D deficiency and wonder if that is my problem—all I know is that I am getting more and more depressed and tired. My sleep is crappy too. What should I do?

I have an answer to the first two messages, and the third message is a hint. Does anyone know how I would reply to the first two messages? What would I say? If you get my point and describe it correctly in the comments section—either describe the -general point, or write the reply that I would write– by 6 PM Central time tomorrow, Sunday, September 27, I will send you a free copy of my e-book ‘user’s guide to Suboxone’. EVERY person who gets it correct will get a copy. The ONE person who explains my point the best will receive the user’s guide plus a copy of each of these three recordings—stopping Suboxone, how long will you take that stuff, and opiate dependence treatment options. That’s like almost a thousand—or a hundred dollars—something like that. You don’t have to put your real name or e-mail address, but your comment MUST be entered in the comment section after this post. I might have to approve it if you haven’t written a comment before, but that’s OK—it will still count, as long as it is written and submitted by 6 PM. C’mon folks—take a shot!

JJ

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7 thoughts on “Tired and Sick on Suboxone: What Would Junig Do?”

  1. Well the first quote the guy has been abusing opiates for years. How long is he on the suboxone? His dose is to high to. Maybe that is why he is so tired. Both quotes they sound like they are feeling sorry for them selves. They are responsible for there own recovery. They need to get with people in recovery or people who aren’t into drugs.
    The one in the second quote needs to get right back on the suboxone or he or she wil use again especially since he or she is in such a funk. He or she’s brain chemistry is still messed up. Sometimes it takes months. THe oppsession to use will come back and he or she is finished. Get back on the suboxone and get with recovery people. Start eating better join a gym. Stop feeling sorry for yourself and take your recovery seriously.

  2. I’ll take a stab. A recurring theme here is age. As one ages, one simply can’t be expected to feel the same as a 20-something partying single college student. At least, not without a lot of front end work. A we get older and more settled into things, life becomes more routine. So, age (an an independent factor), and time going by, is important. With the 1st poster, they relate on how they began abusing your typical mU (full) agonists. Opioids ALWAYS feel best when one first starts, so imagine the contrast between someone trying Vicodin for the 1st time (something notorious for causing euphoria), vs (fast forward years down the road to maintenance therapy and with an agent designed to NOT cause such euphoria). Not only have the brain receptors changed (over time), but the agent now used is less likely to cause a certain level of euphoria/increaseed energy. Suboxone was intended as an addiction treatment, and is not the highly sought after euphoriant this user was first taking. So we have the contrast between the types of opioid used (then and now), and we also have the changes which have occurred in the brain (using opioids) over time. And becaus these two factors are so closely related, they very likely would synergise with one another (increasing their additive significance). Then we have other changes and additional perspective (getting older, no longer a spring chicken, so to speak). Additionally, there may be endocrinological changes in the body (reduced testosterone for male, just as an example) which could possibly be exasperated by the chronic, high dosage buprenorphine usage (yes I know, buprenorphine is supposed to be far less debilitating in this regard in comparison to other opioids, but I still feel it may be part of the equation). Reading these posts, I keep thinking to my self, “life’s tough!”…perhaps the actual reality of what life is about (responsibilities, hard work, minor aches and pains) is something best dealt with by someone who is well disciplined and steeled by such realities. One can not expect to be passive, and just have niceties to just occur all the time…not unless one is incredibly lucky, and leads a “charmed life”, so to speak. some of what I am reading sounds like your typical “mid-age life crisis” type of thing. Also remember, chronic opioid use will always have a somewhat blunting effect on one’s emotions and affect. That is what they, amongst other things, are designed to do! Also, taking Suboxone as maintenance therapy is not supposed to be especially exciting, now is it? I guess what I’m saying, is that I am not surprised, and perhaps these people need to have expectations more in line (consistent) with the actual reality (detailed above) in hand. Hope this helps.

  3. Hello Doc. I know if I was you I’d be thinking that the 1st person is not ready to recover, and my guess would be that he/she is already using with the suboxone. Prob benzos, or because of the sobriety all they do is lay around feeling sorry for themselves. They need to get proactive about recovery, and stop blaming suboxone for everything bad in there life, and start blaming themselves.

    The 2nd e-mail- placing the blame on suboxone again? I’d say so. Self pity, yep. Relapse,immanent. Not following doctors orders and slowly tapering down, sounds like this person isn’t ready either, like both e-mails are the same person. You have to want to quit, be ready to quit, take responsibility for you actions. And most of all, be proactive about recovery, every day. Suboxone isn’t magic, it doesn’t cure you, it is there to help with the symptoms, so YOU can get up everyday and do something to stay clean, and just be happy your not living for something that’s killing you.
    `[email protected]
    `JSP4th suboxone forum
    -Jay Jay-
    P.S. sorry I’m a little past the due date-don’t care if I win anything, I’m just trying to give back some of the help people gave me, because they saved a life, mine. -Sober date 7-09-08-

  4. I think all three people have yet to address the underlying comorbid problem of depression. Addiction and other psychiatric problems often go together. getting off the drugs is one step; addressing the other problems is equally important. Or at least recognizing their origin.

    Life sucks. And, life is a gift.

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  6. I Just registered to the site today. Upon going through the older posts I was just wondering, was the ‘correct’ answer to this challenge ever given?

  7. Thanks, everyone–and to philliesphan for reminding me of this old post! I was thinking along the line of Vocoder- -but all of the comments are good points. My thought was just that life gets harder as we get older; we have more responsibilities, less energy, and a pile of things to worry about. We also tend to remember the good old days less accurately than we may realize, highlighting the good things and forgetting about hangovers and bad break-ups.

    Thanks everyone!