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Unread 01-20-2011, 09:04 PM   #1
erikanh80
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Default Concerns Behind the Miracle....Suboxone Article

Hello Survivors.....My therapist made me a copy of an article from the trade magazine Addiction Professional, Dec 2010 issue, which is not available to the public, and since I myself found it extremely interesting, I wanted to type it so I could share it with you. **This article doesn't express my personal opinion...although it does bring up very valid concerns!!!!

Suboxone....concerns behind the miracle, by: Steven R. Scanlan, MD

One addiction may be traded for another as the FDA approved opiate addiction treatment Suboxone is becoming one of the most prescribed medications in the country. (#41 in sales in 2009 according to drugs.com)
Called a "miracle drug" by some, Suboxone is estimated to be 25-40 times more potent than morphine.

I am board-certified in psychiatry by the American Academy of Psychiatry and Neurology and board-certified in addiction medicine by the American Board of Addiction Medicine. I am the co-founder of Palm Beach Outpatient Detox in Boca Raton, Florida.
I once was addicted to Opiates during my medical residency in anesthesiology and was detoxed with the help of Suboxone. Now I successfully detox my patients from opiates using regulated amounts of Suboxone, and I also detox my patients from Suboxone addiction when that drug has been misused.

I have found that the optimal time to have someone on Suboxone is between 20 and 25 days, tapering down on the medication every few days. This makes the physical symptoms of detox very manageable, without causing the patient to become cross-addicted to Suboxone. I have found that Suboxone use for a longer period than this begins to cause a strong dependance on the medication.

Once a patient is stabilized with Suboxone and no longer getting high, he/she has to be convinced that recovery is possible. A detailed program is then created at the PBOD office, focused on abstinence and better coping techniques. PBOD prepares patients for the restlessness, irritability and discontent they will experience when they are off all narcotics, including Suboxone.

Suboxone detox makes the physical aspect of the disease manageable, but does NOT help with the emotional and spiritual consequences of addiction. Often patients are concerned about coming off Suboxone, but I educate them about how Suboxone is a tool to get them clean but not a suitable maintenance drug if a patient wants to get into recovery.

Suboxone is a powerful opiate-an anesthetic to emotional pain. It immediately alleviates anxiety & depression and makes a person feel more emotionally stable. A lesser dose of Suboxone (2 mgs a day) will block an estimated 80 percent of a person's feelings, while higher doses can make a patient practically numb. Patients often say they feel great on Suboxone and since they are not getting high they want to continue on it. I tell them, "You are not dealing with your feelings because you are still not feeling-you are still numb. You need to start to experience emotions to understand what you were trying to self-medicate in the first place. It's time to live life on life's terms."

When used in the short term, Suboxone is the best detox drug I have ever seen-it can immediately stabilize a patients life and this can be done in an outpatient setting. When used long-term though, it is the hardest medication I have ever dealt with in terms of detoxing a patient from it.
Suboxone does not work like natural opiates; it is created in a lab and interacts with the receptors in the brain unlike any other opiate. I speculate, based on treating hundreds of patients who have been on Suboxone maintenance, that when Suboxone is given long-term it causes abnormal adaptations to opiate receptors and other brain receptors. In my experience, long-term use can cause emotional deregulation, loss of libido, hair loss, and in abnormality in how the body regulates its response to stress.

Suboxone is a mixture of buprenorphine and nalaxone. Buprenorphine is a powerful opiate, and naloxone is an opiate blocker, used to resuscitate people in the ER from an opiate overdose. With no other opiates in the addict's system, in the last few days, he/she can either snort or intravenously shoot up Suboxone and become extremely high since it easily dissolves in water, making it easier to shoot up than heroin. The combination of there not being enough naloxone in Suboxone and the fact that Suboxone binds to the opiate receptor so strongly, means that there is no built-in deterrent to keep a patient from abusing Suboxone. Dozens of my patients have discussed using Suboxone intravenously and there are hundreds of reports about this on the Internet.

The misuse of Suboxone and the lack of attention to the problem are causing physicians untrained in addiction medicine to feed into overprescribing. Many do not understand the long-term ramifications of Suboxone addiction and it also is a very lucrative business for the prescribing physician. Many doctors charge $200 to $300 monthly, per patient, for a 5 to 10 minute checkup to renew a Suboxone prescription.

Most places prescribing Suboxone maintenance do not offer any addiction treatment because the doctor is not trained in addiction medicine and because it is not time or cost effective to do so. Furthermore, the lucrative nature of Suboxone on a maintenance basis creates a disincentive to tapering the drug and its income-generating potential.

As a point of comparison, I charge $2,000 for a detox from OxyContin or methadone, taking about three weeks. A detox from Suboxone dependance costs $5,000 because it takes four to five months, incorporating about 10 different medications to detox the patient successfully. The success rate for detox from Suboxone is much lower than that for detox from other opiates because the patients tend to give up hope during the lengthy withdrawal process.

Most Suboxone studies follow post-detox patients for only 1 month and are often funded by the drug company that manufactures Suboxone. There are no long-term studies of Suboxone maintenance. I learned myself about the potential disadvantages of Suboxone maintenance from meeting people in my practice who have been on it for years.
I am convinced that the medical profession has allowed this situation to develop. I wish I knew how to fix the probelm. I only know how to prevent it from happening to my patients in the first place or how to correct previous Suboxone treatment.

Only time will tell what role Suboxone will play in the field of addiction medicine. Will it one day be used only in the short term as a detox tool, or will it continue to be prescribed as a maintenance treatment?
Supporters of maintenance treatment will state that the manageability of an addict's life improves tremendously with Suboxone maintenance, and there is an abundance of research to back this up. Nonetheless, I believe that an individual on maintenance treatment is not experiencing the full range of emotions, good or bad. It is imperative in the least, that all physicians prescribing this medication become more educated about Suboxone and the pros and cons of short-term and chronic use. ~
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Unread 01-20-2011, 09:53 PM   #2
vhappy
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I found the article interesting but....as usual they are lumping us altogether. That might make sense for someone who has only been addicted a short time.

One of the biggest challenges I had after starting suboxone, was dealing with all the emotions and feelings that started flowing in, about 3 weeks after I started. I no longer feel that numb, I want to hide, I don't care about anything feeling. I agree it has helped my depression, but he didn't really adress long term recovery. What about a person like myself who was addicted over 10 years? Can you really fix that in 5 months? That might be a good fit for some, but they have to quit putting each individual all in one catagory.

J,M,O,

Thanks, for the article, I think we need to keep open minds as we recover.

vhappy
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Unread 01-21-2011, 06:35 AM   #3
gotoffmdone
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Number 41 in sales can be the most misleading of stats. That is a long way fron saying it is 41 on the list of drug being prescribed and thank God, else the DEA would see it as the new scurge of the ages.

As cost in sales as the measuring stick Sub, I would expect it to be among the top 1OO.

I equate this to the costly anitbiotics out there. The number of people who take the antibiotic is not proportional to the drug's sales.

But neither do the sales figures equate to the number of people that are on and should be on it. That's more worrisome.

wayne
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Unread 01-21-2011, 07:04 AM   #4
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this is a very interesting article but as some others have stated, there is no way a month on this medication would have done anythign for me. I was addicted to a high dose of pain pills for over 4 years and i needed to completely revamp my life. As Vhappy said they are lumping us all together into one disease eventhough the disease has many different faces. The thing alot of professionals dont understand is that when you get to the point that most of us have been to (the very bottom), trading one addiction for another isnt a concern as we are more concerned about getting our lives back.
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Unread 01-21-2011, 07:38 AM   #5
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I can only speak from my experience, and that is this: I would NOT have been able to stop abusing opiates without the aid of buprenorphine. I do not use it as a crutch. I am actively recovering, with the aid of counseling, 12 step meetings, and my psychiatrist, who is an addiction specialist, who prescribes any and all my medications.
Buprenorphine is allowing me to work my recovery program, without (putting it mildly) the distracting symptoms of withdrawl and cravings. I am not a "lifer" on Sub, but it makes sense to me that there are people who will need this medication for the rest of their lives, simply from a harm reduction, quality of life standpoint.
I am slowly and steadily reducing my dose, and am nearing the end of my medication assisted phase of treatment. My recovery is not "finished" when I'm done with this phase, it continues, as it has for the past seven months.
This medication has made my recovery possible, as I could not stop abusing opiates for any significant amount of time on my own.
My .01.

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J
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Unread 01-21-2011, 07:53 AM   #6
gotoffmdone
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Have you ever wondered if all those so called experts who write articles about something such as Sub have any firsthand knowledge of their subject matter. If I was to write such an article I would focus not on the falsehood that Bupe is 50 times more powerful than Morphine, unless I stated they were talking about receptor affinity. "Fifty times more powerful" leaves a powerful impression albeit an out of context one.

I would focus on Bupes benefits to the life of the user and to society at large and to the revolving prison door system. And, also, educate on the overlooked but very important differences between Bupe's potential for dependency and Morphine's vast potential for addiction.


wayne

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Unread 01-21-2011, 08:21 AM   #7
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Hi, first thing I'd like to point out is that Addiction Professional magazine is online free to anyone who would like to read it: http://www.addictionpro.com/ME2/Default.asp

Here's the article: http://www.addictionpro.com/ME2/dirm...A2EC0039BB9F4F

Below are my comments on this article.

He wrote: "Called a "miracle drug" by some, Suboxone is estimated to be 25-40 times more potent than morphine."

That is one of the most misused statements. Suture explained it well in this thread:
http://www.addictionsurvivors.org/vb...ad.php?t=14010

Quote:
Originally Posted by Suture View Post
Great point Sheryl. Buprenorphine is more complicated than regular opioids and itís easy for people to jump to conclusions without a full understanding. This is why we have some odd claims that contradict what the doctors and scientists say. Sub is potent but has a ceiling to its effects. At low doses (below 1mg.) bupe is 20-50 times as potent as morphine, (Tip 40) which is why it has been used as an analgesic. But then people mistakenly conclude that because of that it is harder to get off of, and that is wrong. Because of the ceiling effect at 16mgs it is much less potent than morphine. This can be confusing until the ceiling effect is explained. Direct comparisons between buprenorphine and other opioids cannot be made with any accuracy because it is different at every dose. Since bupe is a partial agonist it is in a category all its own and is very different than the full agonists.

It is very misleading for people to talk about the 20-50 times thing without a full explanation.

Sheryl hereís the explanation is the proper context:

ÖAt analgesic doses, buprenorphine is 20Ė50 times more potent than morphine. Because of its low intrinsic activity at the mu receptor, however, at increasing doses, unlike a full opioid agonist, the agonist effects of buprenorphine reach a maximum and do not continue to increase linearly with increasing doses of the drugóthe ceiling effect. One consequence of the ceiling effect is that an overdose of buprenorphine is less likely to cause fatal respiratory depression than is an overdose of a full mu opioid agonist.

Its partial agonist effects imbue buprenorphine with several clinically desirable pharmacological properties: lower abuse potential, lower level of physical dependence (less withdrawal discomfort), a ceiling effect at higher doses, and greater safety in overdose compared with opioid full agonistsÖĒ

(http://naabt.org/links/TIP_40_PDF.pdf page 6, last two paragraphs)

S-

--added in edit--
How potent it is at low doses is completely irrelevant to how hard it is to discontinue. That is determined by the amount of physical dependence one develops to an opioid. It has been PROVEN that people develop LESS physical dependence to bupe, making it easier to discontinue than full agonist opioids. This is why it was developed.
S-
-------------

He wrote: "I have found that the optimal time to have someone on Suboxone is between 20 and 25 days, tapering down on the medication every few days..."

We've seen people here be successful with very short-term treatment and those who needed very long-term treatment. Everyone is different, some patients need more time than others to change things that need to be changed, fix things that were damaged in active addiction and to treat any underlying condition for which they may have self-medicated with opioids in the first place. This process is as unique as the individual and should not be a cookie-cutter process.

-------------

He wrote: "...This makes the physical symptoms of detox very manageable, without causing the patient to become cross-addicted to Suboxone. I have found that Suboxone use for a longer period than this begins to cause a strong dependance on the medication."

The patient is already physically dependent on opioids - I wonder if the doctor knows the difference between addiction and physical dependence. Explained here:
http://www.naabt.org/faq_answers.cfm?ID=1

-------------

He wrote: "Suboxone is a powerful opiate-an anesthetic to emotional pain. It immediately alleviates anxiety & depression and makes a person feel more emotionally stable. A lesser dose of Suboxone (2 mgs a day) will block an estimated 80 percent of a person's feelings, while higher doses can make a patient practically numb. Patients often say they feel great on Suboxone and since they are not getting high they want to continue on it. I tell them, "You are not dealing with your feelings because you are still not feeling-you are still numb. You need to start to experience emotions to understand what you were trying to self-medicate in the first place. It's time to live life on life's terms.""

I'd like to see some scientific evidence to back that statement up. It really sounds as though Dr. Scanlan is an abstinent-only believer.

We've seen so many people here say that they become overwhelmed by emotion when starting Suboxone. Yes, if a patient is on too high of a dose for them, they can become lethargic and sometimes depressed or anxious. But a dose reduction generally handles that.

-------------

He wrote: "Suboxone detox makes the physical aspect of the disease manageable, but does NOT help with the emotional and spiritual consequences of addiction. Often patients are concerned about coming off Suboxone, but I educate them about how Suboxone is a tool to get them clean but not a suitable maintenance drug if a patient wants to get into recovery."

Suboxone IS ONLY indicated to stop cravings and withdrawals at the patient's correct dose. Period. Again, the rest is up to the patient. Once a patient stops the uncontrollable, compulsive behavior that IS addiction, they have entered recovery. Again, I think this doctor is abstinent-based.

-------------

He wrote: "I speculate, based on treating hundreds of patients who have been on Suboxone maintenance, that when Suboxone is given long-term it causes abnormal adaptations to opiate receptors and other brain receptors. In my experience, long-term use can cause emotional deregulation, loss of libido, hair loss, and in abnormality in how the body regulates its response to stress."

Instead of speculation, I would like to science-based factual information. Loss of libido can happen with any opioid. Hair loss? That's a new one. Emotional deregulation and abnormality - perhaps those were reasons that a patient started self-medicating with opioids. That is why therapy and behavior modification is an important part of the recovery process.

-------------

He wrote: "The misuse of Suboxone and the lack of attention to the problem are causing physicians untrained in addiction medicine to feed into overprescribing. Many do not understand the long-term ramifications of Suboxone addiction and it also is a very lucrative business for the prescribing physician. Many doctors charge $200 to $300 monthly, per patient, for a 5 to 10 minute checkup to renew a Suboxone prescription.

Most places prescribing Suboxone maintenance do not offer any addiction treatment because the doctor is not trained in addiction medicine and because it is not time or cost effective to do so. Furthermore, the lucrative nature of Suboxone on a maintenance basis creates a disincentive to tapering the drug and its income-generating potential.

As a point of comparison, I charge $2,000 for a detox from OxyContin or methadone, taking about three weeks. A detox from Suboxone dependance costs $5,000 because it takes four to five months, incorporating about 10 different medications to detox the patient successfully. The success rate for detox from Suboxone is much lower than that for detox from other opiates because the patients tend to give up hope during the lengthy withdrawal process.
"

Since he seems to be emphasizing on the financial here, I would suggest that it's a lucrative business for him. He keeps patients on Suboxone for 25 days - the rest of his $5,000 four to five month treatment he gives "about 10 different medications..." Theoretically, since he only prescribes Suboxone for less than a month, he can max out his 100 patient limit each month. At $5,000 would be $500,000 a month.

I would like to see how many 'return customers' he has and what his post-detox success rate is.

-------------

IMO, bottom line is that the patient has to do the research necessary to see if Suboxone treatment is right for him/her and find a doctor and therapist s/he can work with and trust. If there are a lack of doctors for the patient, then it's imperative to find a therapist who can guide the patient through the recovery process. Suboxone treatment is much more than taking the medication. The medication is only to stop cravings and withdrawals so that the patient can do the work needed to live addiction-free and eventually, medication-free also, if that is their choice.

Again, the above is all my opinion.

Nancy
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Unread 01-21-2011, 09:04 AM   #8
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Default Abstinence-based vs. Evidence-based

This article points out so many deficiencies in addiction education and exactly why patients need more options when choosing a doctor. The author has made so many mistakes, misassumptions, and what appear to be just made up things, that Iím not sure where to start. Well itís clear this doctor has a 1900s view of what addiction is and is unaware of the difference between physical dependence and addiction (what we know here is the #1 concept to understand) He appears to be abstinence-based and is having a hard time reconciling the evidence since it is contrary to his view.

A 25 day taper might be fine for someone who is only slightly physically dependent, and might give an uninformed doctor the impression of efficacy. But then when applied to a person who is actually addicted (which are the only people who meet the diagnosis and indication for Suboxone) they donít do well after a short taper and this doctor appears to make up reasons so that outcome fits his distorted world view of the disease. We know that addiction alters the brain in long-lasting ways that are not corrected with a 25 day taper. In fact, there is plenty of evidence that this short of a treatment (assuming it is given to someone who is actually addicted and not just physically dependent) is dangerous. Every study shows a higher relapse rate with this short of a treatment and some show higher mortality rates associated with short detox treatments. Because this doctor doesnít understand the difference between physical dependence and addiction he doesnít do proper triage while diagnosing and ends up with physically dependent patients (who donít need Suboxone at all and can successfully taper off of the opioid they are on) and addicted patients (who possess long-term brain adaptations that are not corrected by detox). By treating these two completely different groups of patients the same, he gets varying results which is confusing to him and he tries to justify with theories that donít jive with the evidence.

Abstinence-based vs. Evidence-based was settled years ago with scientific evidence. Hereís a some of that evidence.

http://www.addictionsurvivors.org/vb...light=evidence

This article shows that patients need to be educated about their treatment so they can determine if their doctor is competent and understands addiction. I'm not saying patients should continually second guess their doctor but they should gain enough knowledge from credible sources to at least make the initial determination that the doctor at least understands what addiction is.
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Unread 01-21-2011, 11:08 AM   #9
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I agree Tim, most of main points in the article are anecdotal, speculative and open to conjecture. This is to be expected in a relatively new field of medicine where indepth research has been lacking (but is now gaining momentum.) Time doesn’t permit me to address each of the points in the article but there some I can make. IMO this medication will allow the body to heal through its own inherent mechanisms. But only time will let the mind heal - an example of the mind healing is the fading of negative behavioral patterns. Bup facilitates fading by inhibiting a person from repeating those negative behaviors. This fading takes a lot time of time to happen consequently patients need to be on bup for a considerable period. In my practice I stabilize patients over 3-4 weeks then I slowly start to wean them to the lowest dose in the shortest TOLERABLE period and then maintain them at that dose( usually 1-2mg a day) till they feel they are ready to wean off. Weaning off is individualized and has occurred in 6 mths for a very, select few pts but most pt’s wean off in 1 Ĺ to 2 years (but never in 20-25 days as the physician indicates.) He does make one very important point though, that being the medication cannot become an end unto itself (IMO it must be a means to an end.)
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Unread 01-21-2011, 11:29 AM   #10
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I agree, jdjk. I continue to encounter those who view suboxone as "the cure", though they fight tooth and nail to deny this, a substitute for doing the tough work of recovery in whatever program they might choose.

Even with slow advances in understanding, I have to wonder if addiction treatment will regress, especially if Obamacare survives to fruition. When I was on methadone, 2002 was a big year. The regulations (Federal) relaxed somewhat, and there were innovations afoot, namely OBOT. A lot of that seemed to die as state regs tightened, RB got their suboxone monopoly that stinks of crony capitalism, and the hoops I had to jump through as a patient, began to increase.

Now, we still have no generic suboxone, and instead they simply offer new delivery systems for the NB. The real question seems to be: is better treatment becoming more available....or is it really the same old, same old?
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Unread 01-21-2011, 12:25 PM   #11
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well,,most probably will disagree,,BUT I THINK THAT IS THE BEST WRITTEN ARTICLE ON SUB I HAVE EVER READ!,,except he forgot to add the problem with damaging teeth over a long period. Ive been on sub for over 7yrs so some may wonder why i would agree with this article.
Well,,for one,,i cant get off it by myself,,and he really seems to know about the length of time it would take to get off,,if i could afford it i would be there in a heartbeat!,,someone who will understand the length of time it takes and i like the 10 medications,,not even knowing what they are as far as making the detox possible.
But for those who have read "my story", might think i need to be on sub forever,,and to be truthful you would probably be right,,but its nice to know that someone is working on helping those of us who want to try and be completely drug free possible.
I believe that his idea of a short detox with a recovery plan in place should BE TRIED FIRST with every paitient ,,and if it doesnt work?,,then go back on maitinence. What have you got to lose by trying it first,,i have only had 1 1/2 yrs totally clean from any drug while on the streets(prison dont count),,but if i could do it once i know i could do it again,,my failure came about one sday at work and someone offered me some hydro's and w/o thinking i took thwem,,made work so much better,,but i never stopped after just that one relapse. thats my problem,,is getting back up after a fall like that.
It all depwends on the person and how they feel about what they want in their life,,im tired of bein on sub so long,,im 54 and think i have one more chance at sobriety,,i wanna give it a shot anyway,,i just hope that my doctor ,,who is new and we dont know each other that well ,,but i would hope i could ask him if i get off and cant make it ,,would you take me back and put me back on sub ,,but it would have to happen fast,,cause if i relapse ,,there is no stopping me and the wrong things i would be doing to get drugs ,,so i would want my doctor to say,,"yea,,if you fall and relapse we'll get you right back on sub. Thats what i wish would happen,,but you know how that goes,,its just too scary to give up a doctor cause for me they are so hard to find,,i had to go out of state to get this one.
AnywY,,,HIGH FIVE FOR A GREAT ARTICLE ON SUB!!!!
TT
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Unread 01-21-2011, 12:59 PM   #12
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No one thinks a month of sub would have helped them,,they are giving up without even thinking it could possibly work, No flexability in their thinking, Hell as ****ed up as i am,,i would have given it a shot after reading an article like that, for me whats really a shame and ironic is i would never allow myself to get on methadone maitinence when doing heroin,,i would have rather robbed a ****in bank before id allow myself to get on maitinence,,and look at me now,,over 7 ****in yrs ,,if i had gotten on mthadone i probably never would have spent so many yrs in prison,,so now if i had the chance to do it over i would have gotten on methadonemaitinence,,,anything would have been better than prison and the shit that i seen or was involved in was madness,,thats the best way to describe living in a maximum prison+madness,,but you think its madness cause you adapt and it becomes normal,,its amazing how your body and mind can adapt to something so crazy,,im not talkin just about prison either,,other things in life,,where people have adapted to something you couldnt even imagine yourself doin,,but i think you would be wrong. I did it and i watched hundreds of people change and adapt to madness,,try a ****in arkansas prison if you wanna test your skills at adapting,,hell i almost couldnt do that one,,but i did ,,twice! So for me maitinence would have kept me outta of alot of places i didnt want to go to or do things i didnt want to,,from the age of 22 or 23 i forget,,i spent gettin hooked and goin to jail or prison,,i was in all of the 80's,,i got out and had never even seen a vcr!,,and sat at my sisters one day alone and they haD a big screen TV,,but i couldnt watch it cause i had never seen a rwemote before and i could nt figure out how to turn the ****in TV on!,,lol
Anyway,,i really like this article,,,and i hope more doctors like this become available.
TT
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Unread 01-21-2011, 01:25 PM   #13
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TT, sadly I am not at all surprised that you agree with the article. But the fact is anyone who would do fine with 25 days of bupe didn’t need it in the first place and should have just tapered off of whatever opioid they were on. And nobody should start buprenorphine before attempting to taper off of the opioid they are on. Buprenorphine is only for patients who meet the diagnosis of addiction, which by definition only consists of people who are unable to taper off.
Tim



General comment on the article,
For patients that meet the diagnosis of addiction, a short detox treatment leaves the brain changes that are associated with addiction unaffected, despite effectively resolving the physical dependence. These changes, or adaptations, cause symptoms beyond those most associated with addiction (craving and compulsive drug use)

The doctor who wrote the article doesn’t understand the purpose of buprenorphine for the treatment of addiction. Instead he thinks that it’s meant to manage withdrawal symptoms, because that is what he thinks addiction is about. So as a result he manages the withdrawal symptoms of physical dependence by tapering someone off of buprenorphine as soon as they begin treatment. This leaves the patient without a physical dependence to opioids but does nothing for the brain adaptations associated with addiction, the real issue, purpose of buprenorphine treatment and apparently unknown to this physician. This exposes the emotion issues he mentions because patients are clearly suffering from the symptoms that are no longer being suppressed with medication. Patients are depressed, are craving, anxious, stressed, lethargic and with a higher sensitivity to pain, all symptoms of the brain adaptations specific to addiction. (also referred to as PAWS) This is torturous for patients and is why historically only about 5% of patients undergoing detox maintain addiction remission. This course of treatment was more common prior to understanding of addiction and development of modern evidence-based medications. The treatment at this stage would be to help the patient alter their patterns of behavior from dangerous addictive behaviors to normal healthy ones. To do this requires the patient to make significant changes in their life. Counseling and therapy help the patient determine what those changes are and how to implement them. But the only real progress comes in actually making the changes which forces the brain to “rewire” and recondition and allow old unused brain pathways, associated with active addiction, to fade. The problem is, making such life transforming changes while feeling symptoms of depression, anxiety, stress, lethargy and higher threshold to pain, is very difficult and is why historically 95% of people can’t do it the degree necessary.

Enter - buprenorphine used correctly; A patient stabilized on the correct dose of buprenorphine, is generally not experiencing the symptoms of depression, cravings, anxiety, stress, lethargy and higher threshold to pain (at least those caused by the brain adaptations of addiction). This allows them to make those positive changes in their life that will undo the damage of addiction and rewire the brain and recondition it into a non-addicted brain, the same goal of post detox therapy, but without the suffering and with a much greater chance of success. It is much easier to put together a resume and go on job interviews while not simultaneously fighting depression, cravings, anxiety, stress, lethargy and higher threshold to pain. Common to both methods are time away from active addiction, gaining experience living life addiction free, developing new healthy patterns of behavior, and making significant changes in ones life, all combining to reverse the adaptations of addiction and hence eliminating or at least greatly reducing the associated symptoms that are the cause of relapse. Then once the buprenorphine patient has successfully completed this transformation, dealing with the remaining physical dependence is an easy task resolved with a slow taper off.

But without first understanding that addiction is brain adaptations and not simply the presents of withdrawal symptoms, its impossible to put together an effective treatment plan or understand why some patients can just taper off while others need longer treatment.

Purpose of buprenorphine treatment:
The purpose of buprenorphine treatment is to suppress the debilitating symptoms of cravings and withdrawal, which will allow the patient to participate in therapy, counseling and peer support, in helping them make the positive long-term changes in their lives that will translate to new healthy patterns of behavior and make sustained addiction remission possible.

Addiction: Addiction is a primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.

Physical Dependence: (Please note: Not "dependence" by itself.) Physical dependence is a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.
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Unread 01-21-2011, 01:28 PM   #14
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Most say that the short amount of time wouldnt be of help to them,,and those that said that are probably right,,your mind is already made up,,
I think it all depends on how the paitient feels,,,if you feel your gonna fail you probably will,
Now me,,im having alot of mixed feelings ,,but one feeling that is starting to emerge is that I CAN GET OFF SUB,,and i feel if done properly and getting back into meetings i feel i could actually make it,,i dont know how long,,but i feel i can give it a shot. I wanna try now that im at the age of 54,,im starting to feel a chance at living a drug free life and really getting into recovery like i did when i first started sub, of course it was easier cause i had no cravings but i looked forward to the meetings and the people there,,,at first my brother in-law had to take me and make me go,,but soon i was grabbin the keys and goin sometimes twice a day. i didnt do the steps or any of that,,but i still beniftted from goin. these feelings im experiencing i think come from the losses ive experienced in the last few yrs and im finally dealing with those and in doing that has given me strength
,not alot,,but im up and and tryin to take another step forward. and after a year of hardly even leaving my house and bad depression and pain ,,thats sayin alot for me.
Im just tired of takin pills. any pills.,,maybe i could use that naltrexone as a safety net if my old addict comes right back,,i dont know but i wanna give it a shot,,one more time,,and if i fail,,then i will do my damndest to stay on sub, it doesnt bother me,,except for the teeth problem,,the libido thing dont bother me at all since i lost my wife i have no intention of ever bein with anyone else and havin sex anyway,,besides when we were on speed for 2yrs we had enough sex to last a lifetime ,,here there and everywhere,,we were freaks alright and lots of fun,,,but as i look back i believe speed is one of satans biggest tool in his tool box of things to **** a person up and make them do things they wouldnt ordinarily do.
TT
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Unread 01-21-2011, 03:20 PM   #15
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Quote:
One addiction may be traded for another as the FDA approved opiate addiction treatment Suboxone is becoming one of the most prescribed medications in the country. (#41 in sales in 2009 according to drugs.com)
Called a "miracle drug" by some, Suboxone is estimated to be 25-40 times more potent than morphine.


I am board-certified in psychiatry by the American Academy of Psychiatry and Neurology and board-certified in addiction medicine by the American Board of Addiction Medicine.

Erika, once I read the above, I stopped. Not that the article isn’t interesting or that it isn’t worth sharing, it is. However, from reading just the above explained to me that the person doesn’t truly understand not just this medication, but, this disease.

If Suboxone is used correctly, then it is anything except “trading one addiction for another” ,,,,,,,, in fact, the medication Suboxone is purposely formulated and designed to do just the opposite.

It’s a shame that people are permitted to share such erroneous information, without being challenged or checked. The board who certified this person, might wish to reconsider their judgment.

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Unread 01-21-2011, 04:06 PM   #16
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IMO if the guy was writing an article about people being Sub for 25 days he would say that was not a long enough time to make an intelligent decision about the drug and thefefore not enough data could be gathered to do an article justice.

Hell, fresh air kept me off my opiate of choice for 60 days several times much less 25 the days talked about in the article. I could try to compare my intake of fresh air to Bupe but it would be rediculous to do. I could not do that anymore than I could compare different people taking different doseages of Bupe and have it work for them. Or, could I make good sense out of trying to make a direct comparison on how long one took Bupe vs the other.

This is about addiction remission, plain and simple.

Relpase was inevitable for me without Bupe, and while on Methadone it became my opiate of choice. If you have ever been on MMT for ten years at a dose as high as 400mgs and have that drug replace your addiction and addictive ways, then switching to Sub and seeing the difference between it and virtually every other opiate could easily cause one to be offended by the expert's ignorance of some of the matter.

Unfortunately as painful as it can be experience is the best teacher. Not everything can be learned sitting in a seat in a class room. There has to come a time when you get out and apply all that book knowledge and combine it with gaining actual expereince. Without that second layer of education, it would take less than half the time to produce the kind of M.D. or Ph.D I would not put my trust in. In some cases even firsthand experience of actually using drugs is needed. I am waiting on a good article written by a MD who happened to be a former user of Bupe. Not just someone who abused opiates then got clean.

wayne

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Unread 01-21-2011, 04:10 PM   #17
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Its been interesting to read everyone's responses!! Like I said...I only wanted to share it, its not all of my personal opinion. Just wanted to make a few personal opinions I do have on it though....

I don't think, Ohio Mike.....that he is saying every person on it long-term should be considered addicted. Well actually...he did not say that at all....only that there are definately instances where people have become addicted to Suboxone...which is true.

Later in the article, at the end...he does state very clearly that it is not known at all....the long-term effects of being on Suboxone for a long period of time. So thats just it....nobody knows. Thats not to say it doesn't HELP some people in the long-term, as it absolutely has, which we have seen here....and there are also others we have seen here, who have been on it long-term and are emotionally crippled to the thought of even tapering at all. I think thats the fear of physicians.

Tim.......you said if someone only was on forthe short period he mentioned, then they probably didn't need it. I think that is a strong statement, as if someone follows a program that entails all avenues of treatment, ie: therapy, groups, meetings...it is obviously possible, as his clinic provides that type of program and has had success, and I think if there were more clinics which did offer all of the modalities of treatment in 1 place, that we might see more people actually becoming successful in such a short time......but we all know that these types of centers just are not available to most people!
I think it'd be nice if they were, but as he states...its just not cost or time-effective.
So I think he does relay that its true what you say...that its NOT possible in that short period of time....when you don't have immediate access to all those tools & methods of treatment (besides sub).
But I think saying you didn't need it all together....is actually placing people in the cookie-cutter light, placing a stigma that its not possible, when it has been possible for people....but the types of places simply don't exist like he has.

SoCal: I agree with what you stated about to just say it wouldn't be possible, is putting it in your mind its not, and as he also stated in the article, for one to fully be recovered, you have to BELIEVE its achieveable,....and that is true. Of course someone on Suboxone for 2 years or 1 year or even 6 months would say its not possible....but if you entered treatment, knowing nothing else but that it WAS 30/odd day program....then you'd have it in your mind as your goal and that you would work that specific program. I do think its possible, but NOT for EVERYONE!!!!


All in all....I DO NOT agree with some of what the article says...I think everyone's recovery IS different and people will never fit into the same exact time frame.
However I do think that in the future, if more clinic were available such as his, which included all tools that we usually have to get in several places...in 1 place, and you could afford the cost of it...then I think it WOULD BE great for an addict to be able to be physically recovered from need of medication in such a short time.

It can't be denied that there ARE people out there "addicted" to Suboxone, because it is something real. BUT I DO NOT THINK THE REST OF PEOPLE ON SUBOXONE THERAPY, SHOULD BE LOOKED AT, TREATED AS, OR THOUGHT OF-AS ONE OF THESE SMALLER OCCURENCES!!

I think it'd be interesting for someone to contact him with some questions.......as he did provide his email address for contact! Maybe Nancy, as one of the admin? Interesting I think to see his response to some of the statistical questions.....
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Unread 01-21-2011, 04:59 PM   #18
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As I stated before,,and i think its very important,,that it wouldnt hurt for people to try this method,,whats to lose,,if every sub doctor did this with the understanding that if it didnt work ,,he would continue giving you sub ,,and just go from there.
As for trading one addiction for another i know people on this forum are very protective of making sure and posting that ,,that it's not the case with sub,,but for me,,after so many years i would have to admit that there have been times when i wasnt living the way i should as far as doing what i should in my recovery plan and felt i was doing just that,,trading one addiction for another,,didnt do anythingas far as addictive behavoir such as i would on my doc,,but then im just sayin when taking sub and doing nothing else it can be for some like trading one pill you become dependant on for another. Its easy to just get up in the morning and take this drug instead of another one,,,its when it becomes habit forming and you take it ,,and become so overly protective of it that i think i feel that way,,I'll probably get a whole bunch of posts because of what i said,,and i understand that,,no one wants to admit that they may have traded one drug for another,,but before you get upset or anything,,remember ,,im talking about how i felt i was trading one drug for another at different times during the years on it.
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Unread 01-21-2011, 05:04 PM   #19
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Quote:
Originally Posted by erikanh80 View Post
Tim.......you said if someone only was on forthe short period he mentioned, then they probably didn't need it. I think that is a strong statement, as if someone follows a program that entails all avenues of treatment, ie: therapy, groups, meetings...it is obviously possible, as his clinic provides that type of program and has had success, and I think if there were more clinics which did offer all of the modalities of treatment in 1 place, that we might see more people actually becoming successful in such a short time......but we all know that these types of centers just are not available to most people!
I think it'd be nice if they were, but as he states...its just not cost or time-effective.
So I think he does relay that its true what you say...that its NOT possible in that short period of time....when you don't have immediate access to all those tools & methods of treatment (besides sub).
But I think saying you didn't need it all together....is actually placing people in the cookie-cutter light, placing a stigma that its not possible, when it has been possible for people....but the types of places simply don't exist like he has.
My point was people who don’t meet the diagnosis for addiction shouldn’t be given addiction treatment for any time. Those people who emerge symptom free after 25 days of detox were likely not addicted in the first place and therefore shouldn’t have begun buprenorphine treatment. But because this doctor is unaware of the distinction between physical dependence (withdrawal upon cessation) and addiction (uncontrollable compulsive behavior) he has both addicted and physically dependent patients in his pool of experience. This undoubtedly has contributed to his confusion about the different outcomes.

Therapy counseling and peer support are essential parts of the treatment, but only to those who are addicted, it’s unnecessary and a waste of time for someone only physically dependent. By not recognizing the difference this doctor most certainly is forming his opinions from patient outcome some of which didn’t even have the disease he is treating them for.

IMO- this doctor is dangerous and his advice is in opposition of the evidence and his advice of short 25 day treatments increases the risk of death. Myself and few frustrated doctors have tried to educate people like him with similar mindsets but they don’t budge. I sent him an educational package a year or two ago after he made even more erroneous statements on a recovery radio show, but it doesn’t look like it helped. The main problem is this doctor doesn’t know what addiction is so he can’t effectively treat it or understand the existing treatment modalities.

Very few people become addicted to Suboxone, which is amazing since virtually all of them (at least those correctly diagnosed) have shown they have a higher than average predisposition to addiction. Instead nearly everyone gains control of their drug use, stops craving, ends compulsive use and use despite harm, and can suddenly and amazingly take the medication as prescribed something they were unable to do with all other opioids no matter how hard they tried. Yes, a minority may become addicted to the buprenorphine itself and not have this control and need daily dispensing and supervision, but that is a very few.

Yes it would be nice if all of the necessary services that match the patient’s needs could be available in one place, I agree. But how rare would that be? This article shows that even finding a doctor who understands addiction is difficult, never mind a counselor or therapist and a support group. I think patients are better served seeking out the treatment that matches their needs.

Addiction is a physical disease of the brain. Portions of the brain have become corrupt. This is a biological process and isn’t corrected by trying real hard for a month, it takes more time, how much varies from person to person and includes how severe of an addiction they have and how effectively they are able to implement the changes necessary to reverse the damage. This is possible with or without medication, but medication makes it a lot easier and is why the success rate is much better for longer term treatments than for detox treatments.

Buprenoprhine was first patented in 1969 it is not new to science. It has been used in France for addiction since 1995. It is one of the most studied drugs. It also shares some similarities to full agonist opioids that have been used for thousands of years. So when someone says it’s so new that we should be unreasonably suspicious of it, and implies there is some likely yet unknown risk of longterm use, I don’t think they are considering the body of evidence. Because by their logic there isn’t a single drug that has been studied to their standard and we should hold the same unreasonable suspicions for all drugs.

Tim
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Unread 01-21-2011, 05:50 PM   #20
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This doctor is clueless in my opinion, or he is trying to justify his quacky program to get around the Suboxone patient limits. Like Nancy said by only treating patients with Suboxone for 25 days he can max out his 100 patient limit 14 times a year, thatís 1400 patients at $5000 each = $7,000,000/year. While if he treated them longterm like the studies show is better for the patient, that works out to $300,000 if heís charging them $250/visit (which is high) no wonder he has selective learning, with 7 million to spend each year who has time to learn?

I did a 30 day sub detox first and I relapsed soon after, then I did a 7 year treatment and tapered off fine, so nothing this guy is saying remotely matches my real life experience.

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Unread 01-21-2011, 05:57 PM   #21
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Hmmmm....interesting. I just got this email from Dr. Scanlon. I wrote him and told him about this site.
-----------------------------------------------------------

Hey, thanks for the reply. I wrote this article to maybe spark some dialogue about what is the correct way to use Suboxone/Subutex. Obviously I have been getting a mix of positve and negative email. I have probably done about three thousand opiate detoxes so my thoughts and experience come from what I have seen. I was addicted to opiates in the past and got clean with Suboxone. The doctor who got me clean seven years ago warned me that the medicine was addictive and I would only be on it as a tool to get clean. I now perform evaluations for doctors and nurses who want to return to medicine. No health care professionals are allowed to return to work still on narcotics. When I first got clean I would have loved to stay on Suboxone as I felt great on it. I had a raging opiate addiction and was shooting up at least ten times a day. It was tough coming off, but I was directed to AA and got a sponsor. My clinic has helped hundreds of people get clean, but some people do relapse. The critics of the article are either on Subutex/Suboxone still or work at a maintenance clinic. I had a doctor right me an email that the addicts brain is like a diabetic needing insulin. They will always need opiates. Well do we continue to give a benzodiazepine addict benzodiazepines or a cocaine addict cocaine.
---------------------------------------------------------------
Sorry, I sent the email to you too soon by accident. The point of the article is that I don't know what is the right approach. My approach is helping a lot of people, but still less than 50% are staying sober. Everyone who comes to my center gets therapy, urine tests, and is helped to get started in AA. I see my old patients at meetings all the time and it is gratifying as they are now sponsoring people who are sponsoring people. My approach is not the way for everyone. It is definetly not the easier softer way. I have probably seen more people detoxed off Subutex/Suboxone than anyone else as this is all I do. I am an addict in recovery and it is challenging. I am glad that I did not go to a doctor who whipped out a radiology study and tell me I need opiates for life. Next month in the journal that I wrote this article there will be two articles that take the other side of this argument. This is a planned debate by the magazine which I think is cool. I am excited to read the opposing side and that will hopefully spawn more research. I am involved right now with research that will hopefully provide more information. You can cut and paste my emails on the blog if you like. I prefer not to answer directly as the criticism is pretty intense. I do like to see people passionate about this. I hope it is not the article disrupting someones ego who is still on suboxone/subutex or a maintenance provider. I totally agree that chronic suboxone has probably saved lives, but a change in behavior and doing the steps has saved more.
Of final note, the medical changes I have seen in chronic users are just from meeting dozens of people on chronic suboxone. I cannot prove this. It is speculation and that is why I used the word speculation in the article. I receive emails weekly from people reporting symptoms also.

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Unread 01-21-2011, 09:28 PM   #22
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Quote:
I don't think, Ohio Mike.....that he is saying every person on it long-term should be considered addicted. Well actually...he did not say that at all....only that there are definately instances where people have become addicted to Suboxone...which is true.
No, he stated that it is an addictive medication, worse yet, trading one addiction for another. That was were I stopped, as that in it's self explained to me what his understanding and/or opinions are.



Quote:
As I stated before,,and i think its very important,,that it wouldnt hurt for people to try this method,,whats to lose,,if every sub doctor did this with the understanding that if it didnt work
I agree! That is why I am so thankful for this site, as that is explained very well here, as with the different factors to help people understand where they might be at!
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Unread 01-21-2011, 10:09 PM   #23
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Default thx scooter! interesting...

Quote:
Originally Posted by scootergalp View Post
Hmmmm....interesting. I just got this email from Dr. Scanlon. I wrote him and told him about this site.
Quote:
Originally Posted by scootergalp View Post
-----------------------------------------------------------

The point of the article is that I don't know what is the right approach. My approach is helping a lot of people, but still less than 50% are staying sober. My approach is not the way for everyone. . .



I think what he says here is exactly right......I am glad he said that so clearly.
Of course anyone would be crazy to think just ONE method worked for everyone...and he obviously does not think that way....and I think the article was written so you DO see that.......but he just brings up negative affects its had for some people, and people on it of course want to see the positive side of it I think.....but we all know the people whom are considered addicted are definately fewer than people who are able to successfully taper down, even if it is over a long period of time!
Thanks scooter for doing that, I think its great he responded so quickly! wow! I will get that opposing article he mentions in next month's issue from my therapist so everyone can read that as well!! I know I look forward to reading it!!! I can't wait now to see that article and who writes it as well! Curious.......Ive seen a lot of people on here from Florida...anyone ever been to him? or have him for your doc?


Ohio Mike....I totally value your opinions & insight to everything....and I can DEF see how that statement could turn some people off....as I personally comprehended the beginning, was that the cases where people have indeed become addicted to Sub, leads for some to think it may be a negative effect for those people who it happens to, and seen as a possible "trading". I myself, do not like that specific "term", "trading" either....I think it could have been stated many different more objective ways for sure!
But I guess articles are suppose to start with that "gotcha effect", which gets people to want to read more....but with you it had the opposite affect, NOT wanting you to read it, lol...and thats fine. I think its the attention getter, but he does describe very well I think, exactly what he means by that, and without putting EVERYONE on sub into that category, which is why at the end, I did not find it offensive. Thats just me...I love ya!!! <3 <3
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Unread 01-21-2011, 10:57 PM   #24
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The problem is, I found the article misleading, or at least to 50% of us. He stated the actual facts much clearer in the e-mail.

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Unread 01-22-2011, 03:26 AM   #25
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People that can do fine of bupe for 25 days then not need it may be so but I think I am of the other spectrum. Although I ws on Methsdone so one it had stolen what little spirit and soul I haft due to this sddiction mess. It had beaten me so low phyicslly I had to reach up to touch bottom.

I started Methdone as it seemed the only Kryptonite to Methadone. I went through precipitated wds and not only my eyes were opended so was every oriffice in my body.

I was thrown in wd hell, but survived. Started coming round within two weeks. One I had surpasses those wd my craving days and using days were at an end. Don't ask me how I knew that I just somehow I was tired. I wanted it to be something else that took me off this planet. Something a little faster than being on the pill day by day plan.

You don't get do be a nonsignificant opiate abuser and be able to take 400mgs of Methadone per day. Still I fel it was a foolish thing for me to have been on Sub for over 4 year, when the cravings and any and all desire to us had already been taken out of me.

I should have taken Sub for that day period of time(about ten days) it took me to sit in my chair without tumbling over.

Some people need more Sub, some need less. Some need it for years, some months, some days.

When you start rationing out Sub treatment you start taking options away from patients and give it to Drs, and they will base treatment on the latest accepted peer reviewed journal they read on the 19th Tee while having cocktails. Or worse, empty suits sitting thousands of miles way down in the bowels of some insurance entity.

wayne

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Unread 01-22-2011, 03:45 AM   #26
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Aside from the fact that this article cleary states his personal thoughts instead of the scientific fact that has been proven again and again, he seems to be lost in his own field of expertise. He openly admits that less than 50% percent of his patients stay sober, yet instead of looking into other avenues of treatment he remains firmly planted in his 25 day detox, which as stated for those who are truly addicted to opiates 25 days simply doesn't give them the time to make the needed changes.

There are several things both in the article and his e-mail which bother me and send up red flags. One is that he continues to state that suboxone is an addictive medicine, which yes for a very few it can become addictive but he states it in a way that implies that anyone who remains on this medication for more than a month will become addicted, which is simply not the case. Secondly, he seems to see no middle ground. Why is it that he goes from talking about his 25 day treatment to giving all the reasons as to why he didn't want to and why he advises his patients against taking opiates for life. Why must it be one or the other? Most of the time people aren't served well by either extreme. Just because someone chooses to use suboxone as part of their recovery for more than a month doesn't mean they are looking to be on it the rest of their lifetime. The third point that bothered me more than anything is him saying that his way certainly isn't the easier or softer way out, implying that those who choose longer courses of suboxone treatment are taking the easy way out. Nothing about recovery is easy and you earn no badges along the way for being tough and doing it without medical assistance. Not that there is anything wrong with that but in the end if two people are in recovery does it matter how either of them got there? Those who use such terms as easy or softer when they refer to longer terms of suboxone treatment normally do so with judgement and though this doctor does have a few interesting points there is a judgemental tone to his views that detract from the article as a whole.

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Unread 01-22-2011, 07:00 AM   #27
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I agree! That is why I am so thankful for this site, as that is explained very well here, as with the different factors to help people understand where they might be at!
You agree with me???,,you havent been slippin in a little rum in your coffee this mornin when wifey wasnt lookin have you??..lol..ive actually tried that and i just diont get it,,how people do that on TV anyways,,it tastes nasty,,in coffee?? yuck!
anyway,,ive just come back from my journey to the other side and found a gem,,yea,,it sparlkles a bit and sure this guy is makin money,,but i sure would like to go to one of those in-paitient facilities that are shown on this podcast with the doctor,,he comes at ya straight up and honest and it would be difficult not to give back the same with him,,i dont know,,i like the dude,,and people that are self paying paitients,,and add that to gas and fillin script it wouldnt take long to reach 5 grand and the surpass to i dont know how much money.,, but he isnt sayin take it for 25 days and get out of here,,he;s sayin ok now lets do some work for 5months.

http://afflictedandaffected.com/index.php?option=com_content&view=article&id=248:s teven-scanlan&catid=40:shows2008





mlk2900,

hey ,,how ya doin? good i hope,,i just read your post and a few things i would comment on is his use of the word addicting in my opinion is alot better than going to a doctor and him not even telling you that you will become depedant on it. How many here had a docxtor tell them that the first time you seen hin/her?
and scientific fact??over actual experience??,,i go for the actual experience and would be so much better having a doctor who knows what wd's feel like and addiction ,,than some scientific fact,,i hate that as much i haTE hearing sub bein compared to freakin insulin!
ok,,thats all i had to say about your post,,and im not judging your feelings,,or arguing,,just ex[pressing my feelings. I think this might turn into another one of the long threads,,,what do you think mike?,,MIKE! Put the freakin bottle of rum down!!,,and eat yer eggs ,,there gettin cold!,,lol
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Unread 01-22-2011, 09:21 AM   #28
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Tommy, do you really understand what Suboxone was designed for and how it works within that frame work?

I'm serious!
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Unread 01-22-2011, 09:35 AM   #29
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Sub and insulin,,,in a very simple way o phrasing this ,,is if your body is lacking what it needs and you dont take your insulin you might die!!!!yea,,you have to take it!! or dead!!!!
very simple ,,now sub,,not so simple,,your body may be lacking something ,,but if you dont take your sub ,,you wont die!! you might die if you go out od on heroin,,but you cant compare the two.there are other options to take if you dont take your sub,,there are no other options for diabetics,,i really wish someone would come up with a coparrison that doesnt sound so rediculous.,,i mean seriously,,dont take sub and you die??
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No mike,,ive taken sub for over 7 yrs and have learned absolutely nothing,,,everybody on this forum knows it all! ,,be freakin serious!
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Unread 01-22-2011, 10:10 AM   #30
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mlk2900,

hey ,,how ya doin? good i hope,,i just read your post and a few things i would comment on is his use of the word addicting in my opinion is alot better than going to a doctor and him not even telling you that you will become depedant on it. How many here had a docxtor tell them that the first time you seen hin/her?
and scientific fact??over actual experience??,,i go for the actual experience and would be so much better having a doctor who knows what wd's feel like and addiction ,,than some scientific fact,,i hate that as much i haTE hearing sub bein compared to freakin insulin!
ok,,thats all i had to say about your post,,and im not judging your feelings,,or arguing,,just ex[pressing my feelings. I think this might turn into another one of the long threads,,,what do you think mike?,,MIKE! Put the freakin bottle of rum down!!,,and eat yer eggs ,,there gettin cold!,,lol
TT
I am doing good TT, apart from having strep throat which is no fun but that is the fun stuff that comes along with cold and flu season. I hope you are doing well!

No problem, I like it when people express their feelings. I agree with you that it is negliant on a doctor's part to not mention the dependency that Suboxone will create. It does not give the patient the full information to make their decision. Although I must admiit if I had to choose between dependent on a medication or being addicted I personally would choose dependent. I understand what you mean by personal experience and it is good to have some knowledge of others experiences, however I must admit in the end I personally would give more backing to the science because personal experience can be so different in each individual but facts do not waiver.

Suboxone is certainly not a medication for everyone, neither is treatments such as this doctor is endorsing. To me anytime a doctor creates a one size fits all treatment plan there is a huge problem because it likely only truly fits a few. I personally wish all sub doctors were more qualified in addiction because it would help them fit the treatment to each individual's needs. I am lucky to have a doctor who does that. He specializes in addiction and aside from his suboxone patients he also sees patients that aren't on suboxone for whatever reason. However, in my assessment of this doctor's writings he is no better than the suboxone doctors that are just throwing sub at their patients, since in both instances they are unwaivering in their policies and treatment.
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Unread 01-22-2011, 11:51 AM   #31
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[Suboxone....concerns behind the miracle, by: Steven R. Scanlan, MD

One addiction may be traded for another as the FDA approved opiate addiction treatment Suboxone is becoming one of the most prescribed medications in the country. (#41 in sales in 2009 according to drugs.com). Called a "miracle drug" by some, Suboxone is estimated to be 25-40 times more potent than morphine. (Potency is a misunderstood term. In comparison to a similar drug, it basically means less is needed to achieve the desired effect. It does not mean it is more powerful because both drugs at the APPROPRIATE dose will produce the SAME effect.)
I am board-certified in psychiatry by the American Academy of Psychiatry and Neurology and board-certified in addiction medicine by the American Board of Addiction Medicine. I am the co-founder of Palm Beach Outpatient Detox in Boca Raton, Florida.
I once was addicted to Opiates during my medical residency in anesthesiology and was detoxed with the help of Suboxone. (It would be interesting to know the protocol used in your detox.) Now I successfully detox my patients from opiates using regulated amounts of Suboxone, and I also detox my patients from Suboxone addiction when that drug has been misused.
I have found that the optimal time to have someone on Suboxone is between 20 and 25 days, tapering down on the medication every few days. This makes the physical symptoms of detox very manageable, without causing the patient to become cross-addicted to Suboxone. (Perhaps you meant cross dependant rather than cross addicted) I have found that Suboxone use for a longer period than this begins to cause a strong dependance on the medication. (Without a formal study this is speculation and scientifically worthless.)
Once a patient is stabilized with Suboxone and no longer getting high, he/she has to be convinced that recovery is possible. A detailed program is then created at the PBOD office, focused on abstinence and better coping techniques. PBOD prepares patients for the restlessness, irritability and discontent they will experience when they are off all narcotics, including Suboxone. (Appropriate points.)
Suboxone detox makes the physical aspect of the disease manageable, but does NOT help with the emotional and spiritual consequences of addiction. (Agreed.) Often patients are concerned about coming off Suboxone, but I educate them about how Suboxone is a tool to get them clean but not a suitable maintenance drug if a patient wants to get into recovery (Conjecture - if sub is not suitable is there any drug suitable?).
Suboxone is a powerful opiate-an anesthetic to emotional pain. It immediately alleviates anxiety & depression and makes a person feel more emotionally stable (an obvious observation since sub has relieved the symptoms of withdrawal but doubtful an anesthetic to emotional pain.) A lesser dose of Suboxone (2 mgs a day) will block an estimated 80 percent of a person's feelings, while higher doses can make a patient practically numb ( I am extremely curious as to how you came to this conclusion especially the 2mg/80% figures and at greater than 2 mg they feel numb????? Wow what a strange statement). Patients often say they feel great on Suboxone and since they are not getting high they want to continue on it (they want to continue on the med because their life no longer is consumed by opiates .) I tell them, "You are not dealing with your feelings because you are still not feeling-you are still numb. You need to start to experience emotions to understand what you were trying to self-medicate in the first place. It's time to live life on life's terms." (we all need to understand how to deal with our emotions but do you advise bi polar patients to stop their meds because they need to live life on life’s terms.)
When used in the short term, Suboxone is the best detox drug I have ever seen-it can immediately stabilize a patients life and this can be done in an outpatient setting. When used long-term though, it is the hardest medication I have ever dealt with in terms of detoxing a patient from it.
Suboxone does not work like natural opiates; it is created in a lab and interacts with the receptors in the brain unlike any other opiate. I speculate, based on treating hundreds of patients who have been on Suboxone maintenance, that when Suboxone is given long-term it causes abnormal adaptations to opiate receptors and other brain receptors. In my experience, long-term use can cause emotional deregulation, loss of libido, hair loss, and in abnormality in how the body regulates its response to stress. (As you stated the above is only speculation.)
Suboxone is a mixture of buprenorphine and nalaxone. Buprenorphine is a powerful opiate, and naloxone is an opiate blocker, used to resuscitate people in the ER from an opiate overdose. With no other opiates in the addict's system, in the last few days, he/she can either snort or intravenously shoot up Suboxone and become extremely high since it easily dissolves in water, making it easier to shoot up than heroin. The combination of there not being enough naloxone in Suboxone and the fact that Suboxone binds to the opiate receptor so strongly, means that there is no built-in deterrent to keep a patient from abusing Suboxone. Dozens of my patients have discussed using Suboxone intravenously and there are hundreds of reports about this on the Internet. (It is impossible to stop any person from abusing a substance if that is their desire – but that should not diminish the use of the drug in those seeking help.)
The misuse of Suboxone and the lack of attention to the problem are causing physicians untrained in addiction medicine to feed into overprescribing. Many do not understand the long-term ramifications of Suboxone addiction and it also is a very lucrative business for the prescribing physician. Many doctors charge $200 to $300 monthly, per patient, for a 5 to 10 minute checkup to renew a Suboxone prescription.
Most places prescribing Suboxone maintenance do not offer any addiction treatment because the doctor is not trained in addiction medicine and because it is not time or cost effective to do so. Furthermore, the lucrative nature of Suboxone on a maintenance basis creates a disincentive to tapering the drug and its income-generating potential. (Wholeheartedly agree and that is why some fixes need to be applied such as removing the 100 pt limited, requiring more education, etc etc etc)
As a point of comparison, I charge $2,000 for a detox from OxyContin or methadone, taking about three weeks. A detox from Suboxone dependance costs $5,000 because it takes four to five months, incorporating about 10 different medications to detox the patient successfully. The success rate for detox from Suboxone is much lower than that for detox from other opiates because the patients tend to give up hope during the lengthy withdrawal process.
Most Suboxone studies follow post-detox patients for only 1 month and are often funded by the drug company that manufactures Suboxone. There are no long-term studies of Suboxone maintenance. I learned myself about the potential disadvantages of Suboxone maintenance from meeting people in my practice who have been on it for years (although perhaps not adequate a 1 month study is better than pure speculative conclusions.)
I am convinced that the medical profession has allowed this situation to develop. I wish I knew how to fix the probelm. I only know how to prevent it from happening to my patients in the first place or how to correct previous Suboxone treatment. (Agreed)
Only time will tell what role Suboxone will play in the field of addiction medicine. Will it one day be used only in the short term as a detox tool, or will it continue to be prescribed as a maintenance treatment ? (Agreed)
Supporters of maintenance treatment will state that the manageability of an addict's life improves tremendously with Suboxone maintenance, and there is an abundance of research to back this up. Nonetheless, I believe that an individual on maintenance treatment is not experiencing the full range of emotions, good or bad.(Speculation but even if they are at least they are not. Medicine is about risk( not experiencing the full range of emotion) verses benefit (halting a self destructive course.) It is imperative in the least, that all physicians prescribing this medication become more educated about Suboxone and the pros and cons of short-term and chronic use.( Absolutely agree)


My major concern is that Dr Scanlon has written an article in a publication read by individuals who treat substance addicted patients. Since he has solid credentials his speculative statements could be misconstrued as fact. I hope I have not appeared sarcastic or disrespectful to a fellow colleague. The field of addiction is new in comparison to other fields of medicine. Dr Scanlon has made some important points and at least he has put some thought process into treatment which is more than some physician I have encountered. It will be interested to read the other articles.
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Unread 01-22-2011, 02:13 PM   #32
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mlk2900,,

Thanks for not taking anything i said personally cause it was not my intent,,but on the subject of the 25 day thing,,I dont see a problem with him treating all his paitients the same ,,why?,,cause its the paitients choice,,the paitients mental reaDINESS TO SAY HEY,,I WANT THE **** OFF DRUGS ,,ALL DRUGS AND I WILL DO WHATEVER IT TAKES TO DO IT,,IM TIRED OF DRUGS AND IVE MADE UP MY MIND THAT I AM QUITING AND NOTHING IS GONNA STAND IN MY WAY!!!,,Now those are the paitients who may fit with his way of doin things. They dont need to be on a drug for any substantial amount of time so they can heal and get things in order in their life,,not if when they knock on his door they have already done that and are more determined than they ever have been in life to get off drugs!! They are ready.
But then there are the other type paitients that are lacking in even knowing whether or not they want off,,maybe they just want to get on sub so they can stop being in an addictive state and abusing drugs everyday,,for them,,they may get on sub,,and it feels so great they do what addicts do and keep with the feelin great and use whatever reason to stay on sub,,I did,,i still am,,over 7yrs ,,its nice not to have cravings and all i got to do is take a pill and i dont think of pills or anything else like i did as an addict. you couldnt get me to go out and commit a crime or steal someone elses pills ,,i have absolutely no desire to do any of the stuff that i did for so long in my life,,so why would i wanna quit something like that?,,,See,,me and others may not benifit from his way of trying to get a patient off drugs,,including sub. I dont think he has to change a thing,,its up to the paitient to find the right kind of doctor that fits his/hers needs.
But personally,,im getting this feeling ,,and its growing stronger that i do want to try one more time to get off all drugs. And i know the only way i could do it would be in-paitient,,and from the looks of his place i wouldnt mind stayin for 5 months,,if i had 5,000 bucks i might be knockin on his door,,,and sure,,he's making the big bucks just like the rest of em,,but i like him!

http://afflictedandaffected.com/inde...d=40:shows2008

this is a podcast when you have time to listen. and look at that place!,,if i was gonna be sick might as well be in a mansion huh?,,lol

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Unread 01-22-2011, 05:11 PM   #33
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IMO the thing that can do as much harm to notion of treating addiction to an opiate with Sub is this notion of it being "50 times more powerful than morphine". That kind of a statement will get everyon'e attention. Law enforcement, as well as people thinking it will get them high and make a huge mistake bringing on the onset of wds. Then take even more of their drug of choice to stop the wds which can be very dangerous. When that statement is offerred without any qualifiers it appears that your are treating addiction to opiates with the most powerful opiate of all. Had I not known better, that would have scare the hell out of me. That is what happened with me and Methadone. I was told to believe it was even more benign than Hydrocodone. Had I known I was getting ready to put a more lethal opiate in my body I would have not taken the Methadone.

Even those of us have taken Tramadol or Darvocet unsterstand's Bupe's lack of ability to produce and sustain an opiate like high. People who work in field of addiction should be the first to explain to the average lay person how receptor affinity is far from the ability to creat a high or buzz. I would compare Narcan with Bupe before I would Morphine.

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Unread 01-22-2011, 05:37 PM   #34
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yea,,maybe he could have worded it better,,but ive been hearing the same thing on this forum for yrs. when its said that way an addict automatically thinks higher as in buzz. So people who arent on sub dont really understand,,but those of us who have been on it awhile know we can cut our dosage down,,,as i believe,,jmo,,that most ,,if not all of us are prescribed too much.
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Unread 01-23-2011, 02:45 AM   #35
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C'mon everyone lets get together and send Tommy to that mansion (I hope it's on the beach) Better yet we could all fund raise. I know..... I'll do car washes between blizzards, we have really dirty cars in Alaska. the last one I was involved in we made 800.00 in 2 hours and wal-mart doubled that. (policy if you have it at their store) At that rate it should only take me 4 or 5 !! I can't think of anybody who deserves all that luxury treatment more than him!
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Unread 01-24-2011, 10:11 AM   #36
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Here is some real evidence that again (like all the evidence) shows that shorter treatments are less effective and dangerous. Each relapse is a potentially fatal event, with an unknown and lower tolerance following treatment, patients won’t know what the fatal dose threshold is. A relapse to even the same dose of DOC that they were familiar with could be a fatal dose after treatment. Increasing the odds against relapse is essential and physicians who purposefully steer their patients in the direction of higher risk are irresponsible, and since they are doing it in complete opposition to the current body of evidence might be subject to lawsuits.

This study follows patients AFTER TREATMENT. And compares a 2 week treatment and a 12 week treatment. Even the 12 week treatment is shorter than other studies indicate is necessary. Even though, the 12 week group had twice as good results, and were doing much better before they were forced to taper.

http://www.nida.nih.gov/NIDA_notes/NNvol23N1/Young.html

Check out how good the treatment group was doing before starting their taper.

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Unread 01-24-2011, 10:27 AM   #37
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That is a good reminder, thanks, Tim. I wonder how often many of us harbor the notion that, if I *should* use, I can always go back to....whatever? I played that game a long time, always thinking (in hindsight) "if only I had....."
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Unread 01-24-2011, 10:43 AM   #38
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So true- Sometimes the fatal threshold is substantially lower than what the person was used to. We’ve seen this with methadone too, where someone was used to taking 60mgs, had been out of treatment for a while, then bought 60mngs of methadone and OD on it. It’s a very dangerous time [just after ending treatment]. How many times have we read, “he was doing so well, then all of a sudden….” Relapse is not part of the treatment, as some say, and steps should be taken to minimize the risk of relapse, one being not discontinuing treatment prematurely.

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Unread 01-24-2011, 10:57 AM   #39
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Here's a quote from that study I linked to:

"The results of our study suggest that there is no hurry to stop providing buprenorphine-naloxone, an effective medication, regardless of a patient's short duration of opioid abuse," says Dr. Woody. "In my experience as a clinician, most opioid abusers—adolescent or adult—prefer to get off medication eventually. When to stop medication is an individual decision that depends on a patient's response to treatment, his or her commitment to achieving full remission without medication, and whether he or she has attained a sustained period of abstinence and a stable overall living situation."

link to full study:
http://jama.ama-assn.org/content/300/17/2003.full.pdf
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Unread 01-24-2011, 12:25 PM   #40
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Might just be my body, but I started to cut the 8mg tablets into 1/8 and took one/eighth at at time. Very small piece. If I remember correctly with in a reasonable amount of time, I do not think it was a month. But there were a few days that I evern forgot to take the medication a good number of times.

When I walked out on it, I did not feel an iota of symtoms of detoxification. One time a long time before, while I was taking an 8mg or more, I ran out and I got a bit anxious, but not going thru the withdrawls as I did thru methadone or heroin.

With all due respect to Steven R. Scanlan, MD, I find that he is only talking from his experience and making all kinds of personal pronouncements (very typical of a lot of people in the psch. field. liek "I have found that the optimal time to have someone on Suboxone is between 20 and 25 days, "

I did not see him make one statement related to any studies.

Seen it 100 times if not more that they make statements such as this not only to create some credability, but to imply that some kind of science is behind what he is saying.

One time I heard a therapist state that there was substantial research done on Self Esteem, and went one to make a extensive presentation about Self Esteem, Self Concept etc etc. During his 1 hour monolog I kept rolling my eyes backwards. As he was correct. I learned that there have been about 15,000 plus studies done on Self Esteem. What erked me was that not one of the statements he was making was associated with any of the studies. He was bull S... the audience (very unethical but not rare).

Double check it, there is no correlation between Self Esteem and alcholism, addictions, bad grades, rape, trauma etc etc. There are a lot of pronouncements made by professionals that are not backed up or supported by studies. Dangerously enough is that frequently they make claims that are the opposit. That can be dangerous and debastating.

There are two terms I have learned lately one is Psychomythology and the other is Syndromorphelia, this is a therapist that have not found a behavior that he can not diagnose as a mental disorder, identify it, treat it, and train other sto be aware of the signs of this conditions.

I suggest we start looking at the distinctions between science and pseudoscience which I think is becoming epidemic with in the profession specially in Substance Abuse.

I hate to disappoint anybody, but not much was ever studied on the 12 Step programs. That is why they have such pisspoor outcomes and have come up with all kinds of reasons (or excusees) of why the patient has not gotten better.

This is puting a bad name to psychologiest and other people in the mental health profession that do stay up to date with the reseach available. and if they do not know much about the subject rather than create all kind of conjestures that are not accurate, they look it up. In the absence of data it does not given the the right to do anything
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Unread 01-24-2011, 01:47 PM   #41
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Geeze, I just re-read this doctors articles and I realize more than anything that his attitude toward Suboxone maybe the bigger problem than the medication itself. Statements like:
"The success rate for detox from Suboxone is much lower than that for detox from other opiates because the patients tend to give up hope during the lengthy withdrawal process. "

I am sure he did a double blind study so he can reach this conclution!!

"Once a patient is stabilized with Suboxone and no longer getting high, he/she has to be convinced that recovery is possible."

Generalized pronoucements like this with over confidence of what he is saying drives me crazy.

"Often patients are concerned about coming off Suboxone, but I educate them about how Suboxone is a tool to get them clean but not a suitable maintenance drug if a patient wants to get into recovery."

This guy is a QUACK, is good for both, as far as I have read the studies. My experience bla blaba




If this guy is a Florida Doctor I better rruuuuuuuuuuun
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Unread 01-24-2011, 04:18 PM   #42
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So Tim,,a paitient going on suboxone should pretty much decide they are makin the choice to go long term and have A REAL HARD time getting off,,if at all.?,,at least that doctor gives you the chace to try if you are really set in your mind you dont want to take anymore drugs,,
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Unread 01-24-2011, 04:28 PM   #43
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So Tim,,a paitient going on suboxone should pretty much decide they are makin the choice to go long term and have A REAL HARD time getting off,,if at all.?,,at least that doctor gives you the chace to try if you are really set in your mind you dont want to take anymore drugs,,
TT

Not IMO Tommy, that is merely the propaganda youíre pushing!
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Unread 01-24-2011, 05:09 PM   #44
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Here's a quote from that study I linked to:

"The results of our study suggest that there is no hurry to stop providing buprenorphine-naloxone, an effective medication, regardless of a patient's short duration of opioid abuse," says Dr. Woody. "In my experience as a clinician, most opioid abusersóadolescent or adultóprefer to get off medication eventually. When to stop medication is an individual decision that depends on a patient's response to treatment, his or her commitment to achieving full remission without medication, and whether he or she has attained a sustained period of abstinence and a stable overall living situation."link to full study:
http://jama.ama-assn.org/content/300/17/2003.full.pdf

I think that this paragraph sums it all up. Especially the last sentence......a stable overall living situation is imperative to being successful, before one discontinues treating their disease with medication!
And although a lot of people are great at doing this for themselves....there are still those that are either scared of "change", anxious about avenues such as counseling, therapy or meetings, or people in a dysfunctional or unhealthy relationship. When those issues are not resolved, I think everyone would agree that the overall success rate if discontinuing meds at that point, would not be good, or achieveable. We all know that recovery involves much more than meds, and I think before anyone discontinues their addiction meds, that they REALLY have to make the effort to 1. Resolve other issues that are causing anxiety in their life, or 2. Find a way to at least cope with those issues!! Until that point is reached, or one feels as they have a higher percentage of control over their life, versus being vulnerable during stressful times.....then dicscontinuing medication on a "certain day", would not be beneficial.

Thx Tim for that post....
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Unread 01-24-2011, 05:37 PM   #45
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As far as the article goes, it's easy to see that this doctor is one of the many who find short term Sub use the best and only way for patients to have success in putting and keeping addiction in remission. We are lucky enough to know that he's wrong and have a number of members here on AS to prove that he's wrong. I was one of those people who got sucked into a short term detox with Sub while in rehab, along with their 12 step program based treatment, and was brain washed in thinking that long term Sub use only leads to relapse and failure, and short term use was the only way to go. It was my choice to go into the treatment center,m but when you're in full blown WD's after 18 hours without your DOC, you'll do whatever it takes to make the stuff go away! After 6 weeks out of active addiction, I became just one more statistic proving that using Sub as a detox tool is not the best way for many. I'd also like to add that EVERY person I met in rehab who were there for opiates and kept in contact with was back out in active addiction within 4 months of being released from treatment. I was very lucky to make it thru that active addiction one last time, and be able to find myself and put myself in remission one last time. Not all of those people I met in that 30 day treatment stay was so lucky, and are either still out there in active addiction, or not alive at all. So when it's said that maybe everyone should attempt a short term Sub, I have to disagree.

It's obvious that this doctor believes his way is the only way, but has nothing backing up the statements he's making. He def falls into the catagory of one of those money hungry doctors who care more about getting patients in and out and making that money vs actually treating each patient as an individual and tending to their individual needs. The words he uses makes him seem as tho he's uneducated with the disease of addiction and Suboxone in general. Anyone can take the extra courses they need to recieve the extra credentials that he has, but it doesn't make them an expert, it just means they spent that extra time learning about that certain subject. This is just one more reason I think it's important for us as individuals to educate ourself and not just listen to what these doctors have to dish out to us.

IMO, anyone going on any medication should inform themself and ask the prescribing doctor to inform them as much about the medication as possible before deciding if it's right for you. I know that when I was in active addiction, any pill was a good pill for me. If it said "May cause drowsiness or blurred vision" it was for me. I tried to take anything when I ran outta DOC.

When I had my daughter, I became educated on any and every medication they tried to put her on. Even tho for a long period of that time I was in active addiction myself, my daughter was a different story. After active addiction, I went from being on 13 prescribed medications, down to 6, and did my research on all of them, including Sub. Pharmacies give you a hand out (or at least are suppose to) with every medication they give to you. Your doctor IMO should also explain to you why he is giving you the medication, as well as general info on what to expect, and common side effects, and be able to answer any questions you may have. The pharmacist should do the same, unless you deny consult. The pharmacy I use now always has the actual pharmacist come to me and hand the medication to me AFTER she's already done her consult with me. I often get annoyed when she does this every time, knowing I have been on the medication for a period of time, but that is their job. Not only do I ask my doctor and pharmacist about the medication, I often go to the internet and do some research on it as well if it's a medication I've never heard of. I also have to keep in mind that everything you read on the net is not always trustworthy. If you educate yourself about these medications, you aren't going into it blind. It's a good idea for everyone to research any medication they are going to be starting. I do understand that when you are in active addiction, or going thru WD, and you hear about this "miracle drug", most people don't think twice (including myself) before jumping right in. I do think that doctors should go into more detail once a person is stablized on Sub as far as what to expect from the medication and what is expected from you as a oatient in order to get the full beneifits from the medication. To try and go into full detail on all of that while doing an induction on a person going thru WD's would probably be pointless at that point, and the basics should be talked about. The ideal situation would be for one to research about it before hand, and maybe have an appointment before actual induction to go over all questions and concerns and give out all the info the patient will need. I do believe that as a patient, it's just as much our responsibility as it is a doctors to educate ourselfs on all of it.

I kinda went off rambling about some things that weren't exactly part of the post to begin with, but felt it was a good thing to add.
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Unread 01-24-2011, 09:59 PM   #46
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Not IMO Tommy, that is merely the propaganda youíre pushing!

No not propaganda,,i know a hell of alot more people stuck on sub and cant get off than people who had no problems!,,ITS CALLED REALITY!,,not propaganda,,and you have been around other sites and witnessed the trouble people have,,instead of just "all is well and fine" forums like this one",,you cant plead ignorance,,cause you know damn well what im taklkin about!
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Unread 01-24-2011, 11:06 PM   #47
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Well all in all- if this is true, what this Dr says (not that I believe him) I would rather be addicted to Sub than Lortabs!! LOL At least there is a ceiling with Sub so you can't abuse it, as far as my knowledge when taking it sublingually, but with lortabs and any other opiate drugs, you can abuse it and actually die from taking large amounts. I am a lot safer taking Sub than I am lortabs. I can control the Sub where I could not control the lortabs. Just my 2C worth!! Jamielee
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Unread 01-25-2011, 09:21 AM   #48
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I did a 30 day detox with bupe first and I struggled was miserable, depressed, borderline suicidal, and relapsed a couple weeks after. Then I did a 7 YEAR treatment, changed my life, reduced stress anxiety, eliminated problems, rebuilt relationships and finances, all the things this doctors says can't be done while medicated. Then after all that I slowly tapered off. It was not a struggle, as I often forgot to take my medication. Now years after my last dose of bupe, I have NO cravings life is NOT a struggle, I don't go to meetings, and I live a happy and productive life free from addiction. I know that had I kept doing 30 day detoxes I'd be dead, and there is no way I could have made the big changes in my life while fighting cravings and withdrawal, and feeling like shit, or "in touch with my emotions" as the doctor writes. I'd rather do a long treatment right and be done with addiction, than a short detox and fight cravings for life, but that's just me.
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Unread 01-25-2011, 10:20 AM   #49
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So Tim,,a paitient going on suboxone should pretty much decide they are makin the choice to go long term and have A REAL HARD time getting off,,if at all.?,,at least that doctor gives you the chace to try if you are really set in your mind you dont want to take anymore drugs,,
TT
Not at all TT, since the beginning weíve said nobody should be on any medication any longer than necessary. The correct dose is the lowest dose that suppresses cravings and withdrawal. That dose changes with time and eventually the medication may not be required. But how long that takes isnít determined by a patientís or doctorís schedule, itís determined by reversing the brain adaptations caused by addiction.

The reason it is hard to get off of for some people is the same reason that they started it in the first place because they possess the brain adaptations of addiction. These brain adaptations cause cravings among other symptoms. If someone tapers off before they have corrected the cause of these cravings, why would anyone expect not to have symptoms return? But thatís not a consequence of the treatment medication, itís a consequence of not understanding the condition and stopping prematurely.

How long someone needs to stay on depends on how severe the brain adaptations are, what they do to correct the damage, and many other factors like age, genetics, co-occurring disorders, and general health. If someone just takes the medication, doesnít make changes in their behavior, thinking, environment, then they havenít corrected the problem, only suppressed the symptoms with medication temporarily. If a person decides not to make any changes or fix any of the problems or behaviors then the medication is just being used as a prophylactic and when itís removed it stops suppressing symptoms so they return. This type of person [someone unwilling or unable to make changes in their life that will reverse the brain adaptations of addiction] can either keep taking it to suppress symptoms and live a normal life, or stop taking it and fight cravings and other symptoms.

It all comes down to this: Brain adaptations cause the symptoms of addiction, not the drugs directly. As long as these changes remain so does the potential for cravings and other symptoms. Buprenorphine suppresses these symptoms, while taking it. If the brain adaptations are corrected while in treatment, a patient can taper off and not have long-lasting symptoms, however if the brain adaptations have not been addressed, they will causes symptoms when the buprenorphine is no longer there to suppress them.

Tim
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Unread 01-25-2011, 11:31 AM   #50
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im not saying what you said is untrue,,,in fact ive been on sub for over 7yrs myself.,, i just get a little mad when some people arent always telling everyhing they know about sub, this is the first doctor ive ever heard telling his paitients you will or can become addicted/depenent on sub, and if his program dont work THEN go for maitinence if thats your choice,,,he at least gives you a shot at making it w/o maitinience first.
if you read my story you will understand why maitinence has been probably the best treatment for me,,i was always either hooked and commiting crimes,,or in the hospital almost dying ,,and actually did die for a minute while in a coma. Im not saying that sub maitinence isnt the right choice for some,,and if you know me at all ,,then you know all ive ever had to say about sub doctors has been BAD!
But it has always been my way of thinkin ,,way before this doctors posts that a paitient should be told EVERYTHING about sub and if that paitient wants off all drugs ,,sub included then they should try a short detox first,,then with the understanding with their doctor that if it doesnt work,,then they will stay on sub longer,,it all depends on what the patient really wants. But they should know that in the long run if they change their mind ,,there are alot of people who couldnt get off. and thats a fact that this forum wont admit to , when i try and tell that they will start tryin to down me with the few that have gotten of rlatively easy,,but they dont post they ones i know about who are still trying to get off,,these are people that dont come to this forum because all the facts are not told and they are living proof that sub is a sonofa b$tch to get off. Now people will start to try and make me look as though im sayin something wrong,,but they wont let me post the name of a site that has a crisis forum just for people who are struggling with tryin to get off sub,,and thats sad in way ,,cause maybe someone here could help those poeple. and vice versa!
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Quote:
Originally Posted by Sub-Zero View Post
I did a 30 day detox with bupe first and I struggled was miserable, depressed, borderline suicidal, and relapsed a couple weeks after. Then I did a 7 YEAR treatment, changed my life, reduced stress anxiety, eliminated problems, rebuilt relationships and finances, all the things this doctors says can't be done while medicated. Then after all that I slowly tapered off. It was not a struggle, as I often forgot to take my medication. Now years after my last dose of bupe, I have NO cravings life is NOT a struggle, I don't go to meetings, and I live a happy and productive life free from addiction. I know that had I kept doing 30 day detoxes I'd be dead, and there is no way I could have made the big changes in my life while fighting cravings and withdrawal, and feeling like shit, or "in touch with my emotions" as the doctor writes. I'd rather do a long treatment right and be done with addiction, than a short detox and fight cravings for life, but that's just me.
Sub
Im sorry the 30 day treatments didnt work for you,,but i am glad that you tried them first,,then,,as you did you could go and get on maitinenece.
but there are some on low doses of say lortab who could benifit ,,but only if their desire to hget off is strong enough,,,i stayed clean from all drugs for a yr and a half but only because i went into a drug program first, i admit,,the success rate of a short term detox isnt high,,but i still believe people should give themselves the chance at it before maitence.
TT
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