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PostPosted: Sat Nov 05, 2016 6:36 pm 
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Hey guys. Haven't posted for a bit so here goes. This has been on my mind a bit.

Looking back over my using history, there were periods I was on opioid substitution therapy while I was still using. And looking back, being on ORT in those periods likely kept me alive.

One obvious example of when ORT saved my life was when I was severely depressed, and used an intentional overdose of a cocktail of pills and a massive amount of heroin. To this day the only reason I feel I survived that without needing resuscitation was because I'd taken a dose of Suboxone about 36 hours prior, and had a tolerance that was largely maintained by daily use of Suboxone. Instead of never waking up, I woke up over 12 hours later in the cold with a brain that was never quite the same. But alive nonetheless.

I've relapsed a number of times over the years, and the difference between relapsing WITH an opioid tolerance maintained by Suboxone / methadone, and relapsing without any opioid tolerance, is massive. If I had no tolerance, the first week or two of using I'd black out, sometimes waking up hours later elsewhere in my flat on the floor or even in the corridor of my apartment block. At one stage I recorded me using on a webcam to see exactly what I was doing. That was EXTREMELY confronting to watch. Especially the fact that I couldn't notice myself breathing at all in that video for over half-an-hour.

Juxtapose this with a lapse experienced with a tolerance maintained by Suboxone, where I could still walk around and function like a semi-normal dude. No blackouts, no overdoses.

We do pillory people on here who continue to use while on Suboxone at times. But at the same time these people need support. They just ain't at the point in their recovery where they're willing to give it up, so it's important that they stay alive until they are ready.

I seriously do not see the medical merit in kicking people off Suboxone who test positive for illicit narcotics. I know I wouldn't be sitting here today if I was living in a country where that is the known practice. Recovery is a long road and some people are further along than others. When I wasn't ready to quit heroin, Suboxone and methadone kept me alive and breathing until I was ready.

Where I'm from, the only things that get you booted off a Suboxone or methadone program are missed doses (we have to pickup our doses at least once a week from the chemist). If a person misses 5 doses in a row, they have to see their doctor and get another script. Even if the patient admits that they "went on a bender", they won't be booted off the program.

Suboxone (and to a lesser degree methadone) are life-saving medications. And those at greatest risk of death are those who are still using. Why are they being left sitting-ducks for overdose by being kicked off their programs?


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PostPosted: Sun Nov 06, 2016 12:42 am 
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Very good points, TJ! Yes, I think we tend to look down upon those who haven't made the decision to be completely off their drug of choice. Yet, this is a normal part of addiction. People go through change in stages.

This is why a system of harm reduction is crucially important in the treating of addicts!!! While they are getting themselves together (also known as the contemplative phase), they still need the protection that buprenorphine will give them. Otherwise they may never reach making a positive decision about stopping their drug abuse.

Maybe instead of the "Still Messing Around" category, we should call it the contemplative stage. Just an idea.

Amy

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PostPosted: Sun Nov 06, 2016 11:07 am 
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Gosh that's great points and I agree with everything both of u have said. If ppl are still using while on suboxone treatment, suboxone can help them not overdose and hopefully change those ppl into recovery over time. But one thing that does bother me a little bit is with the patient cap, I see lots of ppl that aren't serious about recovery that sell their medicine to get their doc. That's keeping an opening away from someone who possibly needs it & who is ready to completely change. U know what I'm saying? I don't think patients should get kicked out over relapsing though. We're addicts and it's going to happen with some ppl. Kicking them out after a relapse would be the worst time to send bk out to that life again. So I definitely agree with that 100%.

The thing that does bother me though is ppl that don't have any plans on stopping and have about 4 ppl waiting in the car for them to come out and go fill their script to sell them. I see it over and over. I see ppl on their phone's talking in code to someone saying.....oh well I'll yell at ya as soon as I'm out of here to meet up, how many did ya want....like dude, I know what ur doing. I can almost immediately sniff those ppl out.

There is a difference though in ppl that's on suboxone treatment that's still using while taking it, and those ppl I do think still should remain on treatment. But the one's that have no intention on anything but selling everything they got to get their doc I have issues with supporting them. Those are the ppl that sell everything but maybe 4 strips of suboxone so that they have enough to pass a drug screen again before the next refill. I see all these ppl outside smoking or in the corners talking and I'm thinking.....dude u could commit to this treatment and change ur life.

But there's a difference in just not totally being there yet and those that have no intention on changing and won't even give it a chance, ya know what I'm saying? Because of u go and sell ur entire script except the amount u need to have in ur system before u come bk, ur not even taking suboxone enough to even see what a blessing it really is.

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PostPosted: Sun Nov 06, 2016 11:11 am 
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Now your talking! Great post TJ!! Some very good points made here. And it does seem that Dr's have become a bit snooty and will kick someone out of a program if they mess up on Suboxone where as on Methadone, they are more lenient. I known of people to mess up while taking Methadone numerous times, and still be allowed to participate with the Methadone clinic. Where as it seems the Suboxone Dr.s are quick to release a patient. I know my Dr. told me I have 2 chances and that is it. No questions asked. I wonder why this is. Especially with opiate addiction having such an alarming relapse rate.


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PostPosted: Mon Nov 07, 2016 7:44 am 
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I get that things are different in a country where there are ridiculous patient caps. The patient caps just make ZERO sense in terms of public health policy. It's not like Suboxone is being prescribed to people that aren't already addicted to opioids, and as long as Suboxone and methadone are reserved for those patients for whom abstinence based approaches haven't worked, making sure everyone can take Suboxone who needs it is effective harm minimisation.

I understand that there's a culture of people selling their Suboxone in America, which is pretty silly. But even when that happens it's still doing the public a favour. Those people for whom are buying the illicit Suboxone probably won't have to do crime to buy heroin to keep their withdrawals at bay. Having Suboxone on the streets reduces demand for illicit opioids.

The only thing is it gives Suboxone a bad name, which gives the DEA more reason to impose those stupid patient caps. Ugh.

My prescribing doctor probably sees 30 patients a day of whom he prescribes Suboxone or methadone. 30 patients a day over 5 days a week is 150 patients per week. I won't even type my calculation for a month but it's a LOT more than the DEA cap.


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PostPosted: Mon Nov 07, 2016 9:20 pm 
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https://janaburson.wordpress.com/

A very nice post from Dr. Burson that speaks directly to this topic.
An interesting post TJ, certainly agree and have seen that having Buprenorphine on board has been life sustaining during a couple of relapses.
I hope I am remembering this and paraphrasing correctly but Dr. Junig once said that if we were truly serious about addressing the opiate epidemic we would put Suboxone behind the pharmacy counter for distribution similar to Sudafed.
Every practice has to decide how much can they tolerate. If I had a two and out policy I sure wouldn't get many to their 6 month medallion or beyond.
PAX


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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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