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PostPosted: Tue May 17, 2011 7:43 am 
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Lately there have again been posts where people coming off suboxone or wanting to come off suboxone have been stating that being off it is "finally being clean" - intimating that no one is clean as long as they are still on sub. This idea has been presented many times before, usually mixed in different threads. I refrained from saying anything in these current threads due to some sensitive...discussions of late (in other words I didn't want to piss anyone off). So I decided posting about it separately in the "Why the Anger" section was the perfect place to talk about it and to express my feelings about these comments always coming up.

We've talked many times about the whole clean vs not clean thing as well as addiction vs dependence (which is directly related to it). I'm just not understanding why so many people continue to insist that being on suboxone is equal to being "dirty". All of the self destructive behaviors of active addiction are gone. So what that we're still taking a partial agonist opiate! We're not abusing it and it's not destroying things or people in our lives. In fact our lives are finally coming together again. To me the difference is very clear and distinct. Besides, why is it up to one person to tell another person that they are not clean? It's a bit offensive to me to hear people constantly judging another person.

So what do you think? I believe it's time we discussed this topic on its own.

Are you "clean" while you're on sub? If so or if not, WHY?

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PostPosted: Tue May 17, 2011 7:56 pm 
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Hatmaker, great topic. It seems like so many people on here lately are trying to get off sub and get "clean."

I am on 8mg sub daily and I consiter my self "clean." I am taking a medication perscribed by my doctor and using it the proper way. I am not lying or stealing like I was during my active addiction.

Yes I know there is opiate in my blood stream....I guess to some people this is "not clean." But to me, its really the behavior that makes the difference between "clean" and "not clean." I really just hate the way the word is used....Am I "dirty" for taking suboxone? Am I some how less of a person? Is my recovery less valid? I don't think so.

I don't think being "clean" is possible for everyone. I don't think it should be the goal or the gold standard anymore. I know I would be using right now if it was not for suboxone. I am still learning ways to cope with life sober and deal with depression. Suboxone is giving me the chance to do this.


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PostPosted: Tue May 17, 2011 10:15 pm 
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I think for me I don't necessarily consider someone "Dirty" or "Not Clean" while on Sub, but the fact of the matter is you are still dependent on a medication. I think unless you have been a junkie for 15-20+ years and have fried your receptors to the point of no return, eventually getting off sub when the time is right should be everyones goal. We have been held hostage to medications for enough of our lives, so what is so wrong with wanting to get off after you have pieced your life together? If it doesn't work than go back on, but I think people just make excuses as to why they need to stay on it longer than 2-3 years because of their fear of getting off. Personally I won't feel "Clean" until I am off sub, but I do not discredit my nor anyone
else s sobriety by an means. Just cause we are on sub doesn't mean we don' t have to put in the work.


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PostPosted: Tue May 17, 2011 10:16 pm 
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I think for me I don't necessarily consider someone "Dirty" or "Not Clean" while on Sub, but the fact of the matter is you are still dependent on a medication. I think unless you have been a junkie for 15-20+ years and have fried your receptors to the point of no return, eventually getting off sub when the time is right should be everyones goal. We have been held hostage to medications for enough of our lives, so what is so wrong with wanting to get off after you have pieced your life together? If it doesn't work than go back on, but I think people just make excuses as to why they need to stay on it longer than 2-3 years because of their fear of getting off. Personally I won't feel "Clean" until I am off sub, but I do not discredit my nor anyone
else s sobriety by an means. Just cause we are on sub doesn't mean we don' t have to put in the work.


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PostPosted: Wed May 18, 2011 7:50 am 
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I don't believe it's up to any one person to say that everyone's goal should be to get off suboxone. Why should your goal be my goal? Why are your beliefs any better or more valid or important than mine (or anyone else's)? I'm not pushing my beliefs or opinions on you. I don't believe you should be pushing yours on us.

I'm no more being "held hostage" by being on suboxone than I am by being on my beta blocker or my antidepressant or my cholesterol lowering medication. It's just a pill that I happen to take. If I stop it, yes, I'll have w/d, but so will I if I stop some of my other meds. Big deal.

Like Orange doll said, being "clean" or "dirty" has much more to do with behaviors than it does with what medication a person happens to be taking.

I'm staying on suboxone for various personal reasons, none of which I believe are because of fear. It has more to do with that person, their addiction history, any predisposition to addiction they may have, other issues in their life, etc. What makes you think it's fear that keeps people on it? And although you are saying you don't discredit anyone else's sobriety, it sounds like that's exactly what you are doing.

Oh and staying on suboxone has nothing to do with doing or not doing any other work. I'm still in therapy and it's got nothing to do with staying on or stopping suboxone.

I'm responding like this not to be adversarial, but to give people some things to think about. The bottom line, I believe, is that what's good for one person is simply not necessarily good for someone else. And I don't understand why people insist that their beliefs must apply to others. If I've misunderstood anything that was said, I do apologize. I only want to explore this issue with some depth. I fully respect those people who believe their end goal is to be off suboxone. I simply don't believe that person's goal should apply to everyone else.

More thoughts?

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PostPosted: Wed May 18, 2011 12:07 pm 
I'll throw in my two cents. I believe that this is a never-ending question with no real 'true' answer. I'm sure I'll just be repeating some things I've said before here on the forum. But I'll go ahead anyway.
Are we "clean" if we're on buprenorphine? I suppose it mostly comes down to how one defines "clean." Generally I think of "clean" being the opposite of "dirty." I think most people would agree with that loose definition. Going with that....I am definitely "clean" as compared to when I was using drugs illegally.
However, if I compare being on bupe to where I was before my addiction started (free from any dependency on any drug,) I'd have to say that "No. I'm not clean."
So maybe it's just a matter of degrees of cleanliness!! I don't know. I think Hatmaker is right when she says that it isn't anyone else's right to judge another person's status....."clean or not clean." It's up to the individual and that depends a lot on what the individual's goals are, what their drug history is/was, and whether they're truly practicing recovery in all areas of life or just taking bupe to stave off withdrawals while continuing on with many other unhealthy practices in life.
For me, being on bupe has not/does not insure that I will not fall back into drug abuse again. It has not/does not take away all the problems I still face in recovery and long-term sobriety.
Personally, if I get too far into my own head about this issue of "clean vs. dirty," it's not good! What I have come to realize is that even on bupe, I have to dig deep and work hard to stay on the right path. I don't discount mine or anyone else's road to recovery because we have chosen bupe to help us get better.
My goal is to use this drug as long as I need to and then try to come off. When I get off, will I consider myself "more clean?" Honestly, probably so.....just being honest. Will I think I'm better than someone who is still on it? Absolutely NOT! And I mean that from the bottom of my heart. After being on this drug for almost two years, I can testify that it is not a cure-all! I have had several 'lapses' even while on bupe. The drug cannot do all the work. People who are on it and are staying away from opiates and all other mind or mood altering drugs (not prescribed for them) are most definitely in recovery! Many of them are in a very healthy, life-changing recovery. That is what matters the most. I don't think I would even have a chance of that without bupe. I tried it and I didn't make it, so I know this is true....for me, anyway.
I guess bottom line for me is.....I just can't matter to me what anyone else thinks about whether I'm clean or not on bupe. We all can decide that for ourselves. Again, it just doesn't matter. Clean or not clean, by whose definition? Everyone has to answer that question individually. I think Dr. Junig has used the "clean enough" phrase and I think that's more what applies to me......For now, I am "clean enough!"


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PostPosted: Wed May 18, 2011 10:31 pm 
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[b][i]

I feel it's totally a personal decision. My decision may not be that of others but for me my life is a hell of alot better than it was before.
As long as I'm taking my meds the way I'm suppose to then that's way beter than i was doing before.
We all have opinions. My opinion may not be the same as others but it doesn't mean it's the wrong one.

For me....I feel it's a very personal decision


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 Post subject: Well
PostPosted: Thu May 19, 2011 10:10 pm 
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Well AA and NA says I am not clean........my sponsor who has 28 yrs sobriety says I am not clean. This medicine is not like any of my other meds. It's a narcotic......opiate. I get the look at the pharmacy just like I did when I was using. I have gotten grief when I have gone to urgent care because of suboxone. I worry about drug test if ever tested at work. Sure I don't have the same behaviors when I am using but if I was going to my PCP for high blood pressure medication I have no worries.....but my sub doctor.

I hate to admit it but he is cash only....no insurance ...no codes. He even sells suboxone out of his office. You have to be buzzed in to get in the waiting room. Even if I thought I was clean he makes me feel dirty......he has even asked me if I would be willing to be a pain patient so he can take on a new patient because he is at his cap of 100.

We have read so many stories about doctors that do not know what they are doing. I read one where the patient met the doctor in his home in the kitchen where the doctor asked "Do you have the cash"?......then wrote the script.

I am not sure it is our decision on whether we are clean or not......if we wish to do the 12 step program we have to keep it to ourselves or else we will be told we are not clean.

Dr J. recently wrote that if you are on suboxone you don't need AA, NA or counseling because it is not necessary........I have to wonder if that is because those people will convince us that we are not clean and talk us into getting off suboxone. There are so many threads on this forum and others they say long term or taper.......the bottom line is it is up to us.

For those that say we are not doing addictive behaviors while taking suboxone is true......every month I panic right before my sub appointment because I worry that this is the month he gets shut down. Ask yourself if you went without suboxone for 10 days would you do whatever to keep the w/d's at bay? I went 4 days once ...........I know I would be using.

I am not clean while taking suboxone.

Jim


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PostPosted: Fri May 20, 2011 1:01 am 
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In the medical and mental health field there are two terms used when talking about recovery: Abstinence vs harm reduction. Abstinence means someone in recovery takes nothing at all. They are clean and sober from all mind altering substances. Harm Reduction is just that. A means to reduce the harm done by addiction. Methadone is harm reduction. Suboxone is harm reduction. Handing out clean needles is harm reduction, having clinics where people can go to shoot up (Europe, Canada) is harm reduction.

The field changed when the War on Drugs movement was unable to make much of a change. In order to reduce crime, and the drain on society of using addicts stealing, over using the medical system, and the increase in diseases the CDC, NIDA and others in the field began to look at ways to help reduce these issues. Harm reduction, however, has a bit of a qualifier to it....at the beginning the end goal was still abstinence. Harm reduction on the road to abstinence. Realistically, that was an impossible goal for many. For instance many pts on Methadone are on it for life. The same is true for Suboxone.

In 2000 when I finally got 'clean' and sober for five years I was adamant that abstinence was the ONLY way to go. I never dreamed I would be on Methadone. In grad school I ended up doing a debate about harm reduction vs abstinence and debated for harm reduction. Researching the reasons for harm reduction and my own relapse history changed my perspective on harm reduction. I began to see the benefit of having a harm reduction model in the treatment of addiction. What I found interesting later on was that many addiction treatment centers would not allow their patients to be on Suboxone, and for sure, Methadone. One agency I worked at would not allow any patient to be on any benzo even if their physician prescribed it and even if their addiction physician or psychiatrist prescribed it. I began to see how harmful this outlook was. It was very myopic. and deadly. This clinic finally allowed opiate addicts to be on Sub but they had to be working on tapering off of it within 6 months. I never made my patients do this, however. Yet this same clinic would not allow any patient to be on methadone. Even if they had been following in a methadone clinic with clean ua's etc. Another residential program I worked at DID allow patients on methadone and Suboxone...but they still got a lot of grief because many patients new on methadone would 'nod' and it triggered other patients. Also, in many states medical personnel cannot be on Suboxone and work in their field of practice. To me this is paradoxical...and a weird double standard....they want their patients on Sub but if you work in the field you cannot be on it...yet they say their patient is in recovery and can work, parent, etc while on sub and methadone...Even DHS in my previous state I lived in states that methadone is the first line of treatment for opiate addicts and parents who have lost their children who get on methadone at a clinic can then regain custody of their children. It's a very confusing message....and i've personally experienced this while on methadone...I lost custody of my child due to being on methadone despite 2 1/5 years of clean ua's, a letter from my doctor and my counselor stating I was a model patient and had a months take outs (which only happens if you are in complete compliance to the program). It makes sense we would end up debating this issue when those in the medical and mental health field cannot even agree and all have differing opinions. I call that ignorance actually....

I think the term "clean" needs to be replaced. it's a horrible description of a very complex disease process. I do not believe it is any one's business what is between one patient and their physician as to what is best for them medically. Some of us need to remain on Sub for life. Some of us need it to detox only and some of us need it for a few years as a way to stabilize our brains and our behaviors...find new tools in which to live a life of quality. Everyone's definition of their own quality of life is different as well. I think trying to fit us into clean or not clean is looking at this from the wrong stand point. I think looking at it from a quality of life standpoint is better...but that still is between each person individually to define.

What I find very ironic is that AA uses a slogan "live and let live" yet that is NOT what they are doing when they tell someone on Sub that they are not clean. I've seen many people in AA, including someone with 15+ years in the program say they are sober yet their behavior is not indicitive of recovery. One woman I know steals things, drinks "nonbeer" beer, uses more xanax then she is prescribed when things get emotionally challenging for her, etc. She believes she is sober and in recovery. Personally, I find someone like this much less "clean" than someone on Suboxone who has changed their life, not in active addiction, working, working a program, being accountable for their behaviors and stopping the lying, cheating and stealing that addicts do.

Yes we are dependent on Sub. physiologically. And for some of us psychologically as well. It's the nature of this medication really. If I was unable to get Sub for whatever reason I would probably revert to some active addiction behaviors in my fear of w/d. I consider myself to be in recovery while on Sub. I also felt I was in recovery while on methadone. I had a months' worth of take outs, I was doing what I was supposed to, had clean ua's, etc. My life has a quality to it that it didn't have when I was in active addiction. It even has a quality it didn't have when I had those five years "clean and sober" with nothing on board to help with my addiction. The reason is because I still had intense cravings at times back then...and those cravings interferred with my life. The cravings did subside after a while...but they were still there. Now on Sub those cravings are gone. and it has allowed me to live my life, taking my medication once a day, and not think about it again. I do know that when I begin to seriously taper that that will probably change some....esp as I go through w/d as I stabilize at each new taper dose....but i won't consider myself not in recovery...unless I relapse on other opiates such as lortab, vicodin, oxycodone, benzos, pot, or whatever other mind altering medication is out there...One thing I do believe is that we cannot "dabble" using opiates while on Sub...meaning we take a few vicodin once in a while and say we are in recovery. Nor do I believe we should drink, or use other mood altering medications unless prescribed by a physician who knows we are on sub. and that we are taking those medications as prescribed, not dosing ourselves at a whim.

If someone wants to believe they are not "clean" on sub that is their perogotive. Yet when I hear someone say that they don't feel 'clean' on Sub it makes me feel like they are punishing themselves for some reason. Maybe they feel they are not doing enough in recovery or something...I just can't wrap my head around why someone feels they are not clean on Sub. I understand the idea that a partial opiate is still in their system...but the alternative is so much worse. These medications are there for us to utilize. Why debate this idea of 'clean'? I think talking about what we do in our recovery is much more important. What are we doing to change our lives? Our behaviors, our thinking, our attitudes...how we get along with other people, are we accountable, do we work on being honest daily, do we make amends, forgive, think about how we may have harmed someone and review how we live on a daily basis.....are we helping others, or are we selfish with our time and ourselves...Is our life full? Are we living or existing? These are the things that are important to think about and talk about I believe. I've spent many years in and out of AA and recovery getting to this point. I've learned some valuable lessons with a lot of loss that I wish I hadn't had to incur. But today, even with those losses, and losses I am still dealing with, I have joy. I don't ruminate and worry and waste a lot of time in my head any more. And because of recovery and Sub my life today is 'clean'.

I think the harm reduction model has saved lives and allowed for opiate addicts especially to have a running chance at getting into a quality recovery. It takes time to unlearn old behaviors and relearn new tools....like they say we didn't get here over night and it won't change over night....Sub and methadone give us a chance to get our lives together....and just because we are on it doesn't mean, to me, that we are not clean. I just think that word clean is not helpful. We should be focusing on recovery and what that means in our lives instead. IMO.


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PostPosted: Fri May 20, 2011 5:45 am 
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ReRaise....I wasn't speaking directly about what you wrote when you said you are not clean on Sub. I was speaking generally...that I have a hard time wrapping my head around the idea that someone would think they are not clean on Sub....just a clarification. I understand what you are saying. I respectfully disagree, however. I think you ARE clean. It sounds like you have a program, the way you respond on the forum sounds like you are in a good space overall...but I have to say your dr sounds pretty sketchy. Bars on windows, selling sub out of his office....feeling afraid to see him every month not knowing what he might or might not do, asking you to be a pain patient...it smacks of illigetimacy, although there is nothing blatant he is doing "wrong", it feels and sounds wrong, KWIM? Well, yes, you do know what I mean!

Hopefully you can either find a new dr so you don't have to go through these feelings any more...find a dr you can trust and talk to, who gives you your money's worth, and doesn't have this monetary only agenda which obviously I don't know is true about your dr but seems to be true....appearances and all that....

I feel really sorry for those of you out there who have a similar experience as Reraise...that you are afraid of your doctor, or are on such strict contracts with them. I have had two sub dr now, both psychiatrists who understand addiction and neither feel the need to drug test me saying "I will know it by how you act and behave when I see you" and to me that means they will take enough time at each visit to talk to me and really look at me. Both of these sub dr charge a reasonable fee $130/visit and spend 30 min with me every single visit. neither sells sub out of their offices. Both allowed me to be on Subutex due to my financial issues. They have been caring and compassionate and I was never afriad to see them. and i didn't have to deal with a front office staff who gave me grief or judgment. THIS is how it should be for all of us. And that is why I believe we need to fight back when we are not getting this kind of service.

Ok, getting off on another subject...just wanted to add these thoughts.


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PostPosted: Fri May 20, 2011 7:37 am 
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Like cajunmeme said, I, too, feel it's a very personal opinion that we determine for ourselves. I also agree that the terms "clean" and "dirty" - which I abhor - aren't in the least bit beneficial and if it were up to me wouldn't even be used anymore. Everyone is unique as are their lives and circumstances and of course their remission/recovery. Only they can determine the state of their recovery/remission based on what their life was like to begin with. At least that's my opinion.

I didn't start this thread to start a pissing contest or anything adversarial. It's just that since these terms come up so much on the forum, I thought it would be a good place to discuss it. That's all. I'm glad to see people participating in the discussion.

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PostPosted: Fri May 20, 2011 8:08 am 
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Where's the 'pissing contest?' I don't see that. I see everyone writing their thoughts and ideas.


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PostPosted: Fri May 20, 2011 8:16 am 
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I only said that because I looked over my response to RMAC and I realized I may have been a bit antagonistic and I wanted to clarify my intentions. That's all. Nothing more. I should have directed my comment to him/her for the sake of clarity.

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PostPosted: Fri May 20, 2011 12:49 pm 
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Great response China,

I completly agree.


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PostPosted: Fri May 20, 2011 3:54 pm 
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I've been meaning to add to this thread. And today is the perfect day...Im so FIRED UP!! I got into a heated argument w/my husband just this morning. Today, as he does every few months or so, my husband proceeded to tell me that I don't NEED my Sub. He said " Im addicted to it, and that Im no better than a drunk on a bar stool whom keeps saying he's gonna quit...one day" Those words hurt so bad. Especially since I just went through a c-section/postpatum w/virtually no pain medication besides nsaids. I didn't even have Fentnyl in my spinal (at my request).
Im so tired of people pushing their opinions and beliefs onto others. Am I DEPENDANT on this medication, sure. IMO, there's a BIG difference between being addicted to a medication, and being dependant on one. I feel RECOVERY from addiction is changing your behaviors, habits, and lifestyle which were harmfull/unhealthy to yourself and those around you. I truly look @ Suboxone/Subutex no different than any other med taken to improve a condition or disease. So, if I were taking an SSRI, would I also be considered to be in active addiction?
The fact is....NO-ONE knows how a person truly feels inside besides THAT PERSON!! I believe the length of time one takes Sub to be a very personal/private decision that only THAT PERSON can/should make. I also believe no-one is better/worse, or more recovered, or whatever based on whether or not they choose to have a medication assisted recovery. This is just another medication in which we have @ our disposal to help us lead a healthy, productive life. As long as we're living our life right, and taking our medication as prescribed....I feel we ARE RECOVERED.


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Chinagirl, I am in the same boat as you, in that I don't get people thinking they are " dirty" while taking sub. I think alot of people feel that they are "weak" because they need to take a medication to get thier life under control. I also hear and speak with quite a few clients on sub. saying thier family does not approve of them taking sub. Just like the post directly above. My family could not be happier I am taking sub. and being a productive member of society after 25 years of active addiction. I also believe the harm reduction model is good. Steve


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I think there is a difference between pushing opinions on people and having one. I was merely stating my opinion in that I don't believe people need to, or should be on Subs for more than 3 years other than the extreme cases of addiction where it is not really plausible to ever get off. Am I telling you this is the way you must do things? Not at all. Just what I think. You do what you need to do. As far as I understood Hat was asking for "Opinions" when she started this thread. It seems getting off subs is a sour subject for people at high doses, and on it long term so I am sorry I even brought it up.. Subs does suppress emotions and have narcotic like effects from time to time. Maybe not in everyone but I know a lot of people who do experience this stuff. People I know who are on it are not their complete selves while, me included. To me, something that changes personality, even though it may be suttle, and is a Narcotic... well you do the math. I still consider myself sober, but I can't wait for the day I experience sobriety naturally. That is just me.


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 Post subject: Ok
PostPosted: Fri May 20, 2011 9:47 pm 
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I think it is ok for everyone to have their opinion about being clean on suboxone.....but the only game out there besides AA and NA say NO to suboxone. So we go to meetings and either keep our mouths shut or speak out about being on maitenence and face the back lash from the old timers. It just is what it is....

chinagirl I hear you talk about AA alot and that your sponsor knows your on subutex but come to some of my meetings and bring up sub and see how you are really treated and this is by alcholics and drug addicts just like us.....

We can all sit back and say I am clean I am not doing addictive behavior but that is us......unfortunately I don't have any Suboxone Meetings in my area I have AA and NA and we all know at least Nationally they do not see people on sub or meth as clean. So we try to live an honest life and go to meetings and not disclose........trust me in some marriages failure to disclose is just like lying. So we can debate it all we want but until the people of AA, NA, the medical community sees us as clean we will always have that stigma follow us.......even though most of us do not deserve it.

Again it doesnt matter about our doctors but our own choices......we chose sub maintenance and if those out there consider us dirty or junkies or clean or trying........it is up to each of us to set the example for ourselves and no others unless we are on a campaign to convince AA and NA to change the way they have been running things for 70 some years......

Jim


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PostPosted: Fri May 20, 2011 11:11 pm 
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Rmac,

I wasn't referring to YOUR opinion in my thread. Of course Hat wants the opinions of Everyone. The passion in my post comes from my husband or anyone else whom believes their way of thinking is absolutely correct and discounts the beliefs/feelings of others. Im actually intrested to learn how everyone feels about this subject.
As long as we're respectful toward one another....I think we can agree to disagree.


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 Post subject: doctor's opinions...
PostPosted: Sat May 21, 2011 8:14 am 
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ReRaise...you brought up a good point when you mentioned the medical community and if they consider those of us on sub clean or not. I would love to know how many of our sub doctors believe we are 'clean' on Sub. I have not asked my dr that question because I assumed he sees me as clean and sober. He knows what I do in my program of recovery and is very supportive of me. However, at my last visit as he was following up on what work I was doing he asked me if the nursing board in my state knew I was on Sub. It was a question that caught me off guard and I had a weird feeling when he asked it. I can't quite pin down the feeling....fear possibly....what he didn't realize is I'm not working in anesthesia any more. He thought I was going to be and told me that in this state I cannot be on Sub and work in that (anesthesia, nursing, medicine). I knew this but I still am shocked that someone working in this field cannot be on Sub. Especially with the high incidence of anesthesia providers who are currently using...opiates are the drug of choice for most anesthesia providers who are addicted....being on Sub is, in my opinion, an important tool for those who are working in that field...esp. since in approx. 80% of anesthesia providers who have returned to work after txment the first sign of relapse is death. Being on Sub in my opinion would NOT impair my ability to do that work....as long as taking the correct dose and doing what I needed to be doing in recovery.

I do NOT talk about my Sub use at my AA meetings. I KNOW what they will most likely say. I'd love to change the thinking...but we can't convince anyone by talking...I think our actions will speak louder. But first we have to continue educating those around us about Sub. I'm sure half of the people in AA meetings have no idea what it is.

So, I'd pose this question to anyone who cares to answer: Does YOUR Sub dr believe you care clean while you are on Sub?


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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

  • Board Certified Psychiatrist
  • Asst Clinical Professor, Medical College of Wisconsin

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