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PostPosted: Sun May 13, 2012 11:13 am 
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http://www.addictionpro.com/article/med ... ent-blends

This is an excerpt from an article in Jan/Feb 2012 issue of Addiction Professional. "A Medication Treatment Blends In. A Wisconsin center shares it's keys to integrating Vivitrol into a treatment program."; By Tom Fuchs.

If you follow the link and read the entire article you'll see it's about using Vivitrol and not suboxone, but the below excerpt is about their position as well as a generalization of the results of their treatment using sub. I thought it was quite interesting and merited some discussion. I especially liked how they said sub patients had one foot in recovery and one foot in addiction. I did NOT however like the statement that we're taking it and feeling something - actually they said we're taking it TO feel something.

I'd love for people to read this (at least just the excerpt) and let us know what you think. I think this summarizes the main problem with why some people want off sub and why we argue about whether we're clean or not. I don't want to discuss that question, but let's discuss what this short except is saying.


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We also use Suboxone, along with the other aforementioned medication-assisted treatments. Suboxone, while preferred by our patients, has generally fallen out of favor with our doctors, management, counselors and support staff. This is a result of difficulties in managing our patients in the program.

Initially our doctors prescribed Suboxone in their private office practices, but when the caseload proved difficult because of missed appointments, “lost medication” and dirty UAs, they collaborated with our facility to manage the caseload. We were seeing less than a 10% success rate, even with diligent oversight. Another complexity was that even with the patients we could successfully get on Suboxone, we found it increasingly difficult to move them toward abstinence and eventually off Suboxone.

We found that utilizing Suboxone essentially amounted to having a patient with one foot in recovery and the other in addiction. Our job as a treatment center is to enlarge the commitment to recovery. This is a difficult endeavor when the patient is still taking some sort of medication to feel something; this is not an issue with Vivitrol.

Our doctors have since moved in the direction of using Suboxone for opiate addiction as a short-term tapering replacement therapy and using Vivitrol on an ongoing basis. This seems to be working better and tends to create a better alliance with the patient. Long-term use of Suboxone is still applied in limited situations, such as with older patients (40-plus) with legitimate pain management issues. We will continue to evaluate other treatment centers’ experiences with Suboxone to see if there are ways to use it more effectively.

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Last edited by hatmaker510 on Mon May 14, 2012 7:09 am, edited 1 time in total.

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PostPosted: Mon May 14, 2012 2:50 am 
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Now that Vivitrol is starting to make inroads into the field of opioid addiction treatment, I think we're going to be exposed to a lot more of these oldschool backwards recovery ideas. Naltrexone has long been the favourite of the abstinence lobby. In my country, we often hear uneducated politicians and religious figures try and push the idea of forcing everyone on methadone and Suboxone onto naltrexone and getting rid of opioid replacement therapy altogether.

Sadly the moment I read that the author (Tom Fuchs) was a champion of the 12-steps, I could pretty much tell exactly where his opinions and ideas would lie.

What really scared me though was this:

Quote:
We began by using Vivitrol on patients who were the most difficult—those for whom we thought we had done it all. They are the reluctant ones, the ones who couldn’t seem to land on their feet, the frequent fliers. They are hard on staff and themselves, losing a little more hope with each readmission.


This is the OPPOSITE of how naltrexone should be prescribed. Basically they're forcing it on the people who are least willing to recover as a kinda punitive measure to prevent them being able to use. However this has been proven to be incredibly dangerous. People try to use massive quantities of opioids to override the naltrexone, however the naltrexone DOES NOT block the respiratory depression. So people can just go to sleep at night and stop breathing. Also once the naltrexone wears off, that person has ZERO tolerance to opioids. Many people die post-naltrexone because of this.

Naltrexone should be reserved only for those MOST willing to get clean. It should only be a safety net, not a pharmaceutical prison cell or something to be solely relied on.

I just find it a shame that politics and archaic religious cult mindsets can so easily polarise the addiction treatment world. It seems to be EITHER naltrexone or Suboxone, when both treatments have a significant place. A patient may end up using both options at different stages of their recovery. But the way politics goes, we may only be able to get one or the other. (Down here, we have an equally vocal group of doctors who are anti-naltrexone).

This kinda article was always going to happen though. Naltrexone's biggest selling point is that, unlike Suboxone, it is not addictive. It is not dependence forming. Patients on naltrexone get to live abstinent of opioids. It's quite an attractive notion really. What kinda self-respecting pharmaceutical company wouldn't exploit that selling point? IMO we're going to start getting pharma reps for Alkermes pushing this idea onto their addiction docs, the idea that their patients on Sub are still addicted (an idea many people, including some doctors, still believe anyway)... that a patient can get high from Sub (has an element of truth, albeit little). Suboxone has the majority of the opioid addiction pharmacotherapy market. It's natural they'll use these arguments to try and expand their sales. It'd be completely in their interest to bankroll some interest group to push the idea that Sub / methadone should be banned as well.

Before Suboxone came out, it was pretty much widely accepted that methadone patients were still addicted to opioids. Methadone was considered "drug replacement", and the patients and doctors were in no real denial about it. They just accepted that opioid addiction is such a nasty beast and so damaging that it's better to manage it this way.

Then Suboxone came along, and over the course of a couple of years this idea was spread that people on Suboxone were somehow different, that they weren't addicted but they were only dependent.

Here's the thing right. If a person had an unlimited supply of pharmaceutical grade clean heroin, and injected themselves 3 times a day with a regular dose that kept their cravings at bay but not enough to get them high, and just went about their lives. They didn't have to chase and beg lie cheat and steal. They'd be functional, normal, healthy human beings. They wouldn't be obsessed with using and afraid of withdrawals, because their supply is secure, clean and legitimate.

Are these people addicted? Of course they are. They just have enough of what they need that they don't need to worry, or even think about it. Can someone please explain to me how we are any different?

This idea that we are only dependent on Sub, and not addicted, is ONLY reliant on the fact we have a secure supply. I'd like to see people claim they're not addicted, that they don't need to be obsessed with finding and using when that security is taken away from them. I think only people who've felt that panic of their Suboxone being taken from them can respect the vulnerable situation we really are all in.


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PostPosted: Mon May 14, 2012 3:47 am 
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very interesting. good point about the endless supply. i will need to think and read more about this. but in my opinion, with me being treated for pain and addiction wouldnt really matter because i believe the article is for addiction use only? thank you two for being quite informative and able to find resources,and articles that keep us all thinking.


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PostPosted: Mon May 14, 2012 10:51 am 
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Do you guys remember the thread here a while back where people were talking about finding Suboxone film wrappers?? In that thread, a lot of folks who are on Suboxone would pick up the wrapper and one of the first things they'd do is look inside to see if there was a film. Some of the folks even said when they found no film in there they were disappointed. That behavior kinda surprised me, it sounded like addict behavior to me. Since reading that thread, I've been wondering a little more about the whole addicted vs. dependent thing too and I've basically been running that exact scenario that Tear talked about (having a steady supply of our DOC) through my head. I don't have any answers, I just found the topic interesting and worth commenting on.

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PostPosted: Mon May 14, 2012 11:51 am 
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Although some, and maybe even most people on sub, might be only dependent and not addicted, I do consider myself both dependent and addicted still. And yes, I would freak out if my supply was not guaranteed every month.

I dose twice a day because I am on a low dose (4mg), and also because I use it for pain. If I only dosed in the morning, I would not be able to lay still in bed at night, due to my neck/shoulder pain that I have had for 20 years. But even if I didn't dose for pain and even if I were on a high dose, I would still cut it in half and dose twice a day because I don't want to have to wait another 24 hours before I get to take something again. I know that is addict behavior.

But even though I consider myself still addicted, I would much rather be addicted to sub because there are less negative aspects in taking sub than there were from taking Norco. It allows me to live life on better terms than I did on Norco. Aside from the fact that I don't have to stress on going to jail for posession of an illegal narcotic, there are other reasons why subs are better for me. I am not stressing daily on taking too much and overdosing. I am learning to accept living life without feeling high every day. And even though I do think about my sub sometimes throughout the day, I don't think about it nearly as much as I thought about Norco, so I have gotten used to not obsessing on my meds.

And if I do decide to taper off eventually, I know it is possible. I could not taper off of hydro. I tried many times and failed, since taking more would result in feeling better. Since this doesn't happen on subs, it seems like it would be more feasible to taper off subs.


Last edited by Taurus on Mon May 14, 2012 12:22 pm, edited 1 time in total.

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PostPosted: Mon May 14, 2012 12:01 pm 
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Taurus, you just gave many of the reasons that are given for staying on suboxone long term....and of course the chance of relapse and death. And I believe these are excellent reasons. It's pretty much how I feel about sub, except I never think about it between doses. Lately, in fact I can't even remember if I've taken it, except for when my pain kicks in.

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-I'm only responsible for what I say, not for what you understand.


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PostPosted: Mon May 14, 2012 12:21 pm 
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Yeah, I started out thinking I was just going to use sub to detox, but once I found out that it helps with my depression and pain, I decided to stay on it long-term. These two reasons alone are making a huge difference in my quality of life... it is much better than it has been in many years.

Plus, I know I would be searching for something else to take if I quit sub, whether it be Rx meds, OTC meds, alcohol or illegal drugs...or probably all of the above, all at one time! So I'd rather just stay on Suboxone. It keeps me from craving other things besides opiates too.


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PostPosted: Tue May 15, 2012 8:31 am 
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taurus thank you for being honest. i too know that this is a better way of living being on subs by far. these posts here are the reason i keep coming back for more. so much is discussed that pertains to myself and my new life. i really appreciate the fact that others here are open with their thoughts and experiences. it helps my recovery knowing some of the things i think or do is kinda in the norm of others. romeo that is a great point and wonder if that i will ever change that thought process. i feel as if this new life is so ... new.. that i want to savor it and only know that its going to take time (if not forever) to learn how to deal with old behaviors. thanks again to everyone here and suboxone.


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PostPosted: Tue May 15, 2012 10:00 am 
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Hey wish-sharer (I can FINALLY pronounce your name!!),

I understand your concern about whether your thoughts will ever change and from what I've seen, they do indeed. For the longest time, any time I passed a medicine bottle I just HAD to stop and check out the label to see what was in it. I even did it at home with my wife's meds, even though I knew exactly what was in the dang bottle. It wasn't that I necessarily wanted to take any meds, but for some reason, I couldn't help checking out those dang medicine bottles.

Here over the last year or so, I've found that I don't do that anymore. I think DoaQ is the one who wrote about how being in recovery strengthens or reinforces our "good" neural pathways and weakens our "bad" neural pathways.

An analogy I've used before is comparing quitting drugs to ending a long term relationship. Even if the relationship was a bad one, you still miss that person a lot, you still think of that person a lot, we tend to remember the good times we had with that person instead of the bad times, etc. But, as time goes on, we get better and better at dealing with those memories. The memories become less invasive, less powerful and then one day we realized we've moved on.

Give it time, be patient with yourself and I think it'll get better for you.

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PostPosted: Tue May 15, 2012 12:21 pm 
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Earlier I said, "I could not taper off of hydro. I tried many times and failed, since taking more would result in feeling better. Since this doesn't happen on subs, it seems like it would be more feasible to taper off subs."

I meant to say, "taking more would result in feeling high", not "better". Because I know that when people are at low doses of sub while tapering, taking more sub DOES make you feel better, which would still probably make it difficult to taper off of. But just not as hard as tapering off of something that actually gets you high.

I haven't tapered, so I can't say for sure. I was just speculating based on posts from those who have tapered off, and based on knowing that I am not getting high on sub.

Just thought I'd clarify. :)


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PostPosted: Sat Jun 02, 2012 10:46 pm 
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With Sub, when people are on those low doses far below the ceiling, taking more does actually make them feel high. I think that's what Dr.J's getting at when they say under the ceiling that Sub starts acting like an agonist again.


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