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PostPosted: Thu Mar 31, 2011 12:03 pm 
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Does anyone here believe that suboxone/subutex can actually be harmful to a person if used to treat an addiction that doesn't require it?

I went on Subutex for the first time when I was 19. I'd been using heroin on and off for just 2 years. At one point I got a small habit, but quickly pulled up and cut back to weekend using. I also remember at one point I stopped using completely when I returned to do my final year of high school at adult ed. Pulling up at this stage was nowhere near as difficult as it is these days.

I picked up again while at school, and once again fell in love with the feeling. But I had no money coming in, and wasn't much of a criminal (at least back then), so decided the best way to be high all the time was to go on methadone. So I toddle down to the local drug user service (kinda like a methadone clinic) and see one of the docs, and she puts me on 4mg subutex daily. In hindsight did I need it? I don't think so. I could have pulled up.

For the first couple of weeks I'm really stoned on the subutex. I turn up 2 weeks later to see the doc and I remember she told me I looked like I was falling asleep - and that she shoulda just given me 2mg. I talk her out of dropping my dose though, of course.

It doesn't take me long to build up a tolerance, and I start getting fed up with needing to pick up my dose every day, so I do a slow taper. When I eventually come off, god I was hanging out worse than I ever had off the heroin. My cravings for heroin I felt ever since this period were much stronger than before I was on the treatment. It's as if the bupe actually made my brain more dependent on heroin in the long term.

Where do you guys think the point is that suboxone/methadone/drug replacement should be used as a treatment. How sick must a person be? And is it possible for it to harm someone who doesn't need it - ie someone who just discovered opiates and wants an easy way to be high every day?


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PostPosted: Thu Mar 31, 2011 12:14 pm 
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Personally, I think it doesn't depend on the length of the person's addiction, but how bad it is and how badly it has affected their life. It sounds like you didn't even want to be in recovery...you still wanted to get high. (Please correct me if I'm wrong.) That alone would have affected how sub treatment went for you.

Whether or not the person will benefit from sub treatment obviously depends on each individual. But other than increased tolerance, I don't believe it can actually harm a person. Buprenorphine has been around for a long time and is a very safe drug. There are simply way too many variables to each person, their personality, coping skills, addiction, etc, etc, to say just how "sick" a person should be before sub treatment is merited.

I think you were looking for a more specific answer, but personally, I don't think this is the kind of question that can have that kind of answer.

These are just my thoughts.

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PostPosted: Thu Mar 31, 2011 1:06 pm 
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Yes, I think Suboxone and Subutex can be harmful if someone doesn't absolutely need them. No doubt about it. Then, it can save someone's life if they do truly need it. I believe there needs to be a hell of a lot more caution put in to determining who does and does not need to go onto Suboxone. I think there are cases where it's very obvious someone needs this drug, because their addiction is severe and likely going to take their life. Then, there's everyone else. People just need to know what they are getting into. Unless you are going to take Suboxone forever, you are going to have to face getting off it. It's hard to get off Suboxone, and I do not believe most people are adequately informed when they start treatment. You have to know what you are choosing if you want to make a good choice. Yes, Bup has been around a long time. However, there's little research on what the long-term effects are of taking Bup at such high doses, as well as Naloxone. I just want people to really take the decision about whether or not to get onto Suboxone very seriously and I want doctors to do the same.

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PostPosted: Thu Mar 31, 2011 1:29 pm 
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laddertipper wrote:
Yes, I think Suboxone and Subutex can be harmful if someone doesn't absolutely need them.


With all due respect, may I ask what harm you think can come to someone who doesn't "absolutely need" sub? And what do you feel that's based on? Withdrawals can happen, yes. And opiate withdrawals can make a person feel like they're dying, but in and of themselves they are not dangerous. So I'm just very curious as to what you feel could be harmful. Again, no disrespect intended. I just want to understand where this is coming from and what it is based upon.

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PostPosted: Sat Apr 02, 2011 3:06 am 
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For me, I was more viewing it from a neurological perspective. Say someone wants to get off heroin or Oxy's after using them for only a brief amount of time - say 3 months - and the doc puts them on suboxone. They end up on Suboxone for 6 months, even a year, and consequently the PAWS they suffer coming off the suboxone is a lot worse than the PAWS they would have suffered had they just detoxed off their drug of choice without any form of drug replacement. Perhaps the period they spent on suboxone actually increased their tolerance to opiates more than it was as a result of abusing their drug of choice.

Addiction is life long & permanent. Once we create new opiate receptors when our tolerance builds, those receptors stay with us for the rest of our lives. However, in a period of abstinence they do "heal over" and become dormant. However, the moment we introduce an opiate back into our system they all open up again, hence why we "take off where we left off".

All I'm saying is that in my case, I feel I didn't require buprenorphine as an intervention, and unfortunately it may have increased my dependence on opiates in the long term. And I'm not alone. I know a guy who abused OTC ibuprofen & codeine pills who are now on 90+ mls methadone, another recovering alcoholic who started dabbling with the same pills & she's on 16mg suboxone. What do you think's caused a greater progression in his disease of addiction. Messing with codeine, or climbing to their present dose of their "drug replacement"?


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PostPosted: Sat Apr 02, 2011 9:12 am 
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A question about damage to opiate receptors was once posed to Dr. Junig and his response was that suboxone (or any other opiate) cannot damage the receptors. He said that once the opiate is taken away that the tolerance goes back to normal. Obviously there's a period of time involved.

I would agree with you that if a person's addiction was, say, 6 months long and they were on suboxone for 3 years, then their PAWS could be longer/worse than if they hadn't chosen suboxone treatment for that length of time. But remember, not everyone suffers from PAWS - many do, but not all. And usually doing the "correct" (for lack of a better word) type of taper - long, low, and very slow, can seriously reduce the chances of having PAWS. Sometimes people get impatient to get off sub because they just "want to be off everything" and jump quickly, rather than doing a slow taper. They then increase their chances of having PAWS that way. Unfortunately, I cannot quote any sources to back that up, so call it anecdotal based on people that have done very slow tapers to people who haven't.

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PostPosted: Sat Apr 02, 2011 12:25 pm 
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hatmaker510 wrote:
A question about damage to opiate receptors was once posed to Dr. Junig and his response was that suboxone (or any other opiate) cannot damage the receptors. He said that once the opiate is taken away that the tolerance goes back to normal. Obviously there's a period of time involved.


I didn't suggest that opiates damage receptors at all, rather that the brain creates more opiate receptors to cope with the constant barrage of opiates put into our body, regardless of which we use. This is what I was taught in a lecture on addiction by Prof Whelan @ the Victorian Addiction Centrel. Apparently this is how the docs view opiate addiction these days instead of the old "body stops making endorphins" adage.

He also said that while our tolerance does return to normal with abstinence as the extra opiate receptors become dormant (or grow a thin membrane or something of the sort), they quickly open up again when we relapse. This is why our tolerance rapidly returns to where it was when we were using previously.

He used this "model" as a way to explain why addiction is progressive.


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PostPosted: Sat Apr 02, 2011 7:33 pm 
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I think this is a very interesting question. I certainly think there should be caution in using suboxone. If it were someone with a relatively "young" addiction, I might try using it for a short term detox. I don't think suboxone is evil by any means. I do wish that I had at least tried a short term detox with it because my addiction to opiates was relatively short term (2 years) and because I had no means by which to obtain opiates at the point that I quit. So I think that I may have been miserable for a while but I also think I would have made it through. Hindsight is 20/20 right? But this is just what I SUSPECT may have happened. Something totally different may have happened too.

I wish there was better education about suboxone. I wish someone would have explained to me the long taper, difficulties getting off, what kind of withdrawal there is with it, etc. I wish they would have set me up with a choice to do an immediate taper. I wish they would have explained more about the drug. I don't know if it would have changed things, but it may have.

I don't feel harmed by suboxone by any means. I am the one who has chosen to continue it. I can choose at any time to go through a long, slow taper. I consider it almost every day. I continue taking the easy route. It's a choice. I do not think suboxone has made my "addiction" worse. When I went off suboxone, I did not want to get high. I wanted the withdrawal to stop. I didn't want to feel bad. But I didn't want to be high either. I certainly don't think it harmed me.

Jack

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PostPosted: Sun Apr 03, 2011 6:39 am 
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I agree that we never know what could have happened. Perhaps if I kept using in the period that I was on suboxone, I may have fallen victim to the glut of toxic gear that floated around for a while there in the early naughties... ?

Suboxone has been both a blessing and a curse for me. While I am studying, have a great partner, have the support of my family and am accepted by society today, I also have to live with the feeling of being dependent on a chemical every day. This feels like just another weakness I must live with.

You're spot on re disclosure of the facts. That's the only qualm I have with suboxone, and to a lesser degree methadone. The more studies on suboxone that are made by the company that manufactures it, and the more my own experiences differ from that which the doctors tell me, the more I feel our health is simply at the mercy of some kinda pharmaceutical lobby whose only interest is to make $. Call me cynical.

I just so want to be free of my dependence on this stuff - to be able to have the freedom to pack my bags and travel anywhere in the world should I feel like it...


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PostPosted: Sun Apr 03, 2011 9:41 am 
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I think you ask a very good question...something I've been thinking about a lot lately.
There are no long term studies showing the cognitive/neurological effects of Sub...and I do think there is a lot we don't know and a lot the doctors don't know...I also think there is a lot that is hidden from us. Cynical maybe...but its my opinion. I know how drug companies work....

I also have an issue with many of the prescribers being family doc's or internists or pediatricians....that take this short course and can prescribe sub. I think sub should be prescribed by psychiatrists and addictionologists...but again my opinion. I know there are not enough prescribers as it is but I have seen way too many doctors who do not know at all what they are doing with Sub. I've known people on Sub at 32mg for 2 years....unnecessary. I've heard doctors talk about the ceiling effects and not knowing what they are talking about nor do they know what the actual ceiling mg is. I think too many of them are in it only for the money and they do not know how to correctly dose or taper a patient. I know a pediatrician who prescribes sub. he can only prescribe, because he is a pediatrician, for those age under the age of 30. It's just bizarre in my opinion. I question the agenda there...but it is me being cynical....money is a great motivator, however.

You are right about the receptors, tearjerker, that is why when someone returns to use they can very quickly get back up to their previous tolerance level...most have heard this...that when you start again you can almost start where you left off....within a very short amt of time.

I also think you ask a good question about how to use sub. I have been able, in the past, to get off of vicodin fairly quickly...not always fun and the fatigue would be the lingering symptom....and at times I've regretted going the methadone route, (thru a clinic with a dr and counselor, not off the street) which then brought me to getting on Sub. I feel better on Sub then i did on methadone, but I wish now i would have just gone through the vicodin w/d and not gone on anything. That said, who knows though what would ahve happened. I do know that methadone and sub have kept out of active addiction and given me time to do some work i needed to do in order to live without opiates. I now feel I am ready to live without sub, but at the time that I went off vicodin I am not sure I would have been ready to live without opiates...so....its a toss up right now. I recently tried to drop 2mg and it wasn't easy...so that tells me that even though I've only been on this four months I'm going to have to do a slow taper.

Sub works but it is not a miracle drug.And it's not benign. It has the potential for harm...our brains are not made for partial agonists....and sub is a partial agonist. We do not know what could happen with long term Sub use...I know many who are suffering varying side effects and the thing is the pro sub people, esp. ones who are making money off of it, will jump and negate someones symptoms very quickly when in fact no one knows for sure. I hear so many people struggling to get off of Sub and having a very hard time. Even down at microgram doses....and that is scary.

Bottom line is I think that as a group we do need to do our research and we need to ask questions and demand better care. I hear doctors who will come back and say, "whoops! I didn't know how to dose for sure" or they don't know how to get patients off of Sub and they won't admit to it either...so we have to be diligent in taking care of ourselves in this....keep studying, keep researching, ask questions, demand your doctor become more aware. How many of us have had to bring information to our doctors? and teach them? Why are they not that interested? Some are...but more aren't. I do know of a few, very few, doctors who are realizing that this drug is super potent and that a lot of patients are suffering not being able to get off of it and those doctors are at least trying to do some research and help patients. My dr. says the same....I go to him because he is a psychiatrist, understands addiction and mental health, doesn't charge unconsionable fees to see him, and does not sell sub out of his office. I trust him. and he also admits to not knowing the answers to my questions. He doesn't pretend....or bullshit me. So, I do what I can...and that is constantly ask questions and read as much as possible.

Just my opinion


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