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 Post subject: Re: Please help me
PostPosted: Sat Oct 03, 2015 6:20 pm 
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I want to clarify what I've posted here because it was a poorly-thought-out addition to what I posted on another thread where someone was asking about jails or prisons where Sub or MMT was dispensed.

New Mexico is historically very permissive when it comes to drug policy and in light of the state being poor, it ranks at the very top in largesse and permissiveness for Harm Reduction, such as unlimited #s of needles being exchanged and free acupuncture beyond just ear-seeds at needle-exchange sites, free vaccinations for both Hep. B and Hep. C, dispensing Narcan to Exchange users, etc. etc.

We've have had very large numbers of heroin OD deaths which included jails and prisons so at least at the Albuquerque MDC they have a very permissive policy that provides free Suboxone and methadone for anyone who was receiving it before their arrest. And they do have something in place to somehow increase a person's dose while in jail. And the only people who can't get it are people held for feds or for other jurisdictions, because the city pays for it.

All of that is beyond dispute. But I'm unsure of exactly what would be required for a person not on MMT to begin receiving it while in jail. Say a person is in there who wants it after seeing a number of people getting dosed. They need to have something in case it's really needed. They don't want a situation where someone asked to go on MMT and they refuse him only to have him die later of an OD while still in there, amidst all the people getting a free daily dose.

But I think the facts of Suboxone as a drug of abuse may not be the rosy picture painted by many here. Suboxone films at least here in Albuquerque is becoming a true gateway drug that leads some on a path straight to brown-tar heroin. Kids in high school are buying the films for $2 each because it's given out so readily in the push to get people into treatment but these programs offer no monitoring and the behavioral support is laughable e.g. telling people they need to go to NA where the slightest mention of ORT makes them an instant outcast.

It's the opioid-naïve people who get the biggest rush from IV'ing Suboxone. With "virgin" mu receptors and at $2 per film for getting high all weekend, I can see that this drug could be a young person's first taste of the "rush" of IV injection.

Maybe you've never see cheba but the idea of putting something black and sticky into one's veins should give one pause. And some of its aficionados here have a disgusting habit of blowing on the brown powder to make it congeal into a sticky mass. But the Suboxone film is a small piece of what looks like a small piece of orange plastic. The film is clean!

And where do they go from there? What else is cheap? Brown-tar heroin of course. And once there they won't go back to Suboxone because it's not just the blockade effect but it's the humongous Narcan dose in each film.


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 Post subject: Re: Please help me
PostPosted: Sat Oct 03, 2015 8:50 pm 
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Thanks for the well-written and interesting post. It's changed my mind a bit; I'm enlightened, you might say: I didn't know the situation was quite so different, compared to my area! I think you're right that the picture isn't all roses, but allow me to defend slightly further the intuition that it's at least more roses than weeds.

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It's the opioid-naïve people who get the biggest rush from IV'ing Suboxone. With "virgin" mu receptors and at $2 per film for getting high all weekend, I can see that this drug could be a young person's first taste of the "rush" of IV injection.

Maybe you've never see cheba but the idea of putting something black and sticky into one's veins should give one pause. And some of its aficionados here have a disgusting habit of blowing on the brown powder to make it congeal into a sticky mass. But the Suboxone film is a small piece of what looks like a small piece of orange plastic. The film is clean!

I could definitely see that. We get chiba around here too, and that's probably why I only injected in the final year of my addiction, and only a few times, right before I got on bupe -- it's just really a disgusting idea to push that stuff into the blood. If buprenorphine is more readily available, and so astoundingly cheap, it will undoubtedly see abuse.

But I can't quite see it taking too much market share from heroin and company. Around here, even addicts don't really like it, and it isn't even on the radar for non-addicts. Add to that that I don't think most people will inject until they're already desperate -- I don't know anyone, online or off, who started off by injecting, anyway -- and that $2/film is affordable to pretty much anyone even without injecting... yeah, it definitely looks "cleaner", but I would still think that most people aren't coming to buprenorphine injection without getting close to bottoming out.

With availability that high, it makes sense that you'd see more abuse than we do over here to the west. I don't doubt that people are abusing buprenorphine, after reading this, and maybe even as a first opioid -- but I do still doubt that it seduces very many people into drug use who wouldn't/don't already do other stuff. (I doubt many think "it's so cheap, I'm no longer afraid of being a junkie!", heh.) If a full agonist is available and affordable, surely anyone who would use bupe would use it in preference -- although you're right that maybe tar deters injection more than "clean" buprenorphine.

So in other words, it's there and it's cheap, but it's not the most fun (and not the most dangerous). I'd bet that the total number of opioid users isn't increased by its presence -- i.e., if someone is using bupe they'd likely just be using cheap heroin, rather than being clean, in its absence -- but I admit that I have no numbers on that.

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And where do they go from there? What else is cheap? Brown-tar heroin of course. And once there they won't go back to Suboxone because it's not just the blockade effect but it's the humongous Narcan dose in each film.

That's an awful and plausible scenario, but I submit to you that the other direction is more probable! Once you can't afford heroin but still have a taste for opioids, you go to Suboxone.

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and the behavioral support is laughable e.g. telling people they need to go to NA where the slightest mention of ORT makes them an instant outcast.

Yep, that's pretty unfortunate/ignorant. It's one of the few widespread and free services for addicts, so I can understand why it's recommended, but doing so is unhelpful to say the least. I sometimes want to grab those people -- the ones saying "no, you've got to be clean from everything ever!!" while sucking down their third cigarette in thrice as many minutes -- and shake some sense into them, shouting "don't you understand why addiction is harmful? don't you know the success rate for ORT vs 12-step meetings?!" I mean, what works for them works for them, and I wish them the best and will gladly applaud their success, but the disdain for even trying to understand other methods is just maddening.


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 Post subject: Re: Please help me
PostPosted: Sun Oct 04, 2015 2:46 am 
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Thanks to all who have welcomed me here. Feel free to PM me about my posts. It's nice to have found a place where there is intelligent life. I've turned into a hermit philosopher and it's really cool to see through all the lies and all the delusions that fill the minds of "normal people" but then again it can be extremely lonely to live in a world where my cat is smarter than most of the people I might see.


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 Post subject: Re: Please help me
PostPosted: Sun Oct 04, 2015 8:33 am 
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Yes! There's an NA group that meets near the university at noon six times a week and it's a group I used to be a part of more or less. And the guy who was my "sponsor" at least ten years ago is now one of their main honchos. Back last year there were some of them who would instead of sharing about themselves they broke the rules by speaking to the group in complaint about people "coming there loaded after getting their dose of methadone" from my clinic which closes at 11 AM. Well, actually it was just ONE GUY, an old-timer who can hardly breathe for what cigarettes have done to him and he still smokes.

But they shut him up! And I was invited to be their Speaker on a Monday when they let people with at least a year "in recovery" to speak the entire meeting. So after I was invited to be Speaker I started emailing my former sponsor and it was by email that I told him why I was reluctant to be Speaker. He's fine with it. So it'll be up to me if I want to go through with it. But I don't know because the group is almost all composed of very obvious ex-cons with everybody tattoo'd up the wazoo and some of them have great difficulty in reading and pronunciation, like one who leads the Saturday mediation meeting and he can't pronounce the word "anonymous." It's just not me.

And, hey, I was up early this morning and after a scrubbed Saturday the weather is better for the balloon launch, which I'm watching on KOAT-TV.

crossfinger wrote:
Yep, that's pretty unfortunate/ignorant. It's one of the few widespread and free services for addicts, so I can understand why it's recommended, but doing so is unhelpful to say the least. I sometimes want to grab those people -- the ones saying "no, you've got to be clean from everything ever!!" while sucking down their third cigarette in thrice as many minutes -- and shake some sense into them, shouting "don't you understand why addiction is harmful? don't you know the success rate for ORT vs 12-step meetings?!" I mean, what works for them works for them, and I wish them the best and will gladly applaud their success, but the disdain for even trying to understand other methods is just maddening.


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 Post subject: Re: Please help me
PostPosted: Sun Oct 04, 2015 1:26 pm 
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Hey wishdoctor, I think you should take a look at a bunch of threads in stopping suboxone if you think we only allow happy suboxone thoughts on this forum.

It's true that most of us who stick around have had a successful recovery with the help of suboxone. Those of us who have had a positive experience with sub deserve a place to express our gratitude as well as work out problems and get information by those who are more experienced. That doesn't mean that we are unaware of diversion and abuse of the medication.

The question is, should we be blaming the tool or putting the blame on why so much of the tool is being diverted? There are so many doctors who are prescribing suboxone in cash clinics who don't give a rat's ass about the patients. They will prescribe 24mg or 32mg per day, even though that is much more than most opiate addicts need. There is really no reason that a dose should be above 16 mg per day, and then, depending on the patient's history, many patients can be tapered down to closer to the ceiling level, maybe somewhere between 6mg and 12mg a day. The only exception would be for the patients who have decided to switch from methadone to suboxone. They often need a larger dose to start with.

Additionally, sub doctors have to be diligent yet compassionate. Diligent in calling patients in for random med checks and UAs to insure compliance. And compassionate by giving patients another chance if they slip up, take a drug they're not prescribed. They should recognize the nature of addiction and understand that there will be relapses and slips. Those patients need therapeutic help and I do believe that suboxone patients should be required to go to individual or group therapy for at least a year.

It is awesome that you've found an NA group that accepts MAT patients as full members. There is nothing wrong with 12 step programs unless they don't allow MAT patients to speak at meetings, etc. However, I think that it would be helpful if someone created materials available nation and world wide for a start up of suboxone specific meetings. It could include something similar to step work, or smart recovery. People are starting sub support groups, but there is no consensus on what the groups should include.

Amy

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 Post subject: Re: Please help me
PostPosted: Sun Oct 04, 2015 5:10 pm 
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Amy, this NA group is very accepting. They have no policy other than saying that the only requirement for membership is a desire to stop using drugs. The guy who chairs the Speaker meetings is very laid back and he had me at his house for stepwork ten years ago so when I shared that in the past year I had completely lost all desire to get high on drugs, all drugs, and this was a radical new me ... it was then he asked me to be a Speaker. But the term he used to describe what had got me to the loss of that desire was "antithetical." By the Prayer of Hope, an addict, any addict, can stop using drugs and lose the desire to use drugs. They say that abstinence and NA involvement can somehow lead to this. And they leave a person's decision's about medical treatment to the addict and their higher power. If I were to be a speaker and tell my whole story, which would of course include my experiences with both Suboxone and MMT, I'd have to do it in a way that showed respect for both the principles of the NA church as well as to its members. I don't know if I'm capable of doing that. I'm fine sharing my experience with individual members one-on-one there, but I'm nowhere near being able to address the entire group and speak for 40 minutes on my story.

As posted elsewhere the main reason I dropped in there recently was reaching my 1-yr anniversary on MMT and the major milestone of once-weekly clinic visits ... talk about clean time! Plus ... mid-September I only go to clinic once a week, down from three a week, which is a "bump" of two days instead of the 1-day bumps earlier.

Methadone clinic six days a week is a huge amount of time around the clinic and for many addicts, it's practically their entire social life. When I enrolled in September 2014, that structure was a welcome change. But it would have seemed dishonest for me to be going to that NA meeting right after clinic. Things are different now in that I can tell people I've had clean UAs throughout and earned my takehomes in the minimum time. So that was on my mind when I went back to that NA group.

Culturally, there's a huge divide between me and most of the members of that NA chapter. Even though it's just a block away from a large university it's much more of a demographic of ex-cons full of tattoos who can't read than is at my methadone clinic, and thAT clinic is not in a fancy neighborhood by any stretch. So I look at all those tattoos and wonder what makes people do that. But there is a sincerity there in approaching the stepwork that is completely genuine. There was only one of them there who was complaining about people being on methadone and coming to NA, and he no longer does those rants. My situation of how I came to lose the desire to use drugs is no secret there, but unlike most of them it's not like NA is my life or even my chosen spiritual path. But in many ways I see the people at NA as being much less hypocritical than, say, among Christian churches here.

In 1895 Gustave Le Bon wrote "In every social sphere, from the highest to the lowest, as soon as people cease to be isolated they speedily fall under the influence of a leader. The majority of people, especially among the masses, do not possess clear and reasoned ideas on any subject whatever outside their own specialty. The leader serves them as guide. It is just possible that the leader may be replaced, though very inefficiently, by the periodical publications which manufacture opinions for their readers and supply them with ready-made phrases which free them from the trouble of reasoning."

So true. And year ago my isolation came to an end and I was ripe for falling under the influence of a leader of sorts. But some people don't follow leaders. And that's where I'm at now. A hermit philosopher ex-witch doctor/shaman with no disciples.

The Suboxone prescribers here are still telling clients to go to NA. And they show up and can't share. And I'm at the point where it would be good for me to be a sponsor within the NA framework.

Amy-Work In Progress wrote:
... It is awesome that you've found an NA group that accepts MAT patients as full members. There is nothing wrong with 12 step programs unless they don't allow MAT patients to speak at meetings, etc. However, I think that it would be helpful if someone created materials available nation and world wide for a start up of suboxone specific meetings. It could include something similar to step work, or smart recovery. People are starting sub support groups, but there is no consensus on what the groups should include.
Amy


Last edited by wishdoctor on Mon Oct 05, 2015 11:25 am, edited 1 time in total.

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 Post subject: Re: Please help me
PostPosted: Sun Oct 04, 2015 10:22 pm 
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Hermit philosophers are the best sort of philosophers (and the best sort of hermits, come to that). It's a grand and ancient tradition.

wishdoctor wrote:
Back last year there were some of them who would instead of sharing about themselves they broke the rules by speaking to the group in complaint about people "coming there loaded after getting their dose of methadone" from my clinic which closes at 11 AM. Well, actually it was just ONE GUY, an old-timer who can hardly breathe for what cigarettes have done to him and he still smokes.

But they shut him up! And I was invited to be their Speaker on a Monday when they let people with at least a year "in recovery" to speak the entire meeting. So after I was invited to be Speaker I started emailing my former sponsor and it was by email that I told him why I was reluctant to be Speaker. He's fine with it. So it'll be up to me if I want to go through with it. But I don't know because the group is almost all composed of very obvious ex-cons with everybody tattoo'd up the wazoo and some of them have great difficulty in reading and pronunciation, like one who leads the Saturday mediation meeting and he can't pronounce the word "anonymous." It's just not me.

It's great that they shut that fellow up (that kind of bile is NOT helpful, to anyone) and that they don't have a problem with ORT! I haven't had such luck, unfortunately, but as you may have guessed, I'm a hermit myself, so I don't mind going it alone most of the time. Even without the misplaced disdain for anything except the One True Sobriety, the meetings still don't quite feel like "me", as you say... but there's no judgment in that -- the fact that we're all in the same boat helps me connect, and I'm no better (or worse) than someone who didn't have the chance or the inclination to take up a literary lifestyle -- it's just that it's even more helpful to have other things in common, too.

Still, I guess it can sometimes do one some good to be around different sorts of people. I went to a private school for high school, full of the idle and newly rich, and there I was a miserable outcast. Later, I found that junkies and criminals always accepted me immediately. Hell, I'd be worried if it was the other way around.

Speaking of different: why ex-shaman and witch-doctor? I very much enjoy occult and esoteric works and philosophy, though I seem to have confused myself at some point (I'm a monist and materialist, even as I carefully carve a yantra...).


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 Post subject: Re: Please help me
PostPosted: Mon Oct 05, 2015 3:40 pm 
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crossfinger wrote:
... Still, I guess it can sometimes do one some good to be around different sorts of people. I went to a private school for high school, full of the idle and newly rich, and there I was a miserable outcast. Later, I found that junkies and criminals always accepted me immediately. Hell, I'd be worried if it was the other way around.

Speaking of different: why ex-shaman and witch-doctor? I very much enjoy occult and esoteric works and philosophy, though I seem to have confused myself at some point (I'm a monist and materialist, even as I carefully carve a yantra...).


Why ex? Because until just now I've had nobody interested in anything I had to say. That NA honcho wanted to know what my story was and invited me to be a speaker, but it didn't turn into an ongoing conversation between two friends, as was my hope. I satisfied his curiosity and there was no more to talk about. I walk among the inhabitants here as if I'm a visitor from another planet.

That cultural divide to the tattoo'd illiterate ex-cons at the noon NA has nothing to do with criminality. (The only thing that bothers me about criminals is if they talk about killing and maiming people without remorse.) It's mostly about ethnicity (Spanish) and also very importantly about class (people born into poverty and criminality). I'm a Jew born in New York to a science or engineering career (who went to work at a national lab). Even though my accent (North Jersey coast) is hard to place and is nothing like Woody Allen New York Jewish, no non-drunk native would ever mistake me for a native-born New Mexican "Anglo" as the pale-faces are called here.

Burquenos use the term "South Valley" for geographic location of all the auto shops with large rows of shiny "rims" to be bought by brown-skinned poor people whose first language is Spanglish and who used to revere the Low Rider cars but that seems to be no more. It's amazing that entire subcultures like that scene are gone just from passage of time. I never imagined I'd live to see so many things that I've outlived.

So I'm a stranger in a strange land. The only people like me are loners, who don't socialize much. So I'm very glad to meet you!

My hero and mentor, Harry Elmer Barnes, wrote that when the Nineteen Eight-Four system takes complete control of what people regard as knowledge and they've spent their entire lives with their thoughts being controlled via the control of history and language, that they will then be unable to comprehend they are living in a totalitarian world. I came of age in the 1970s when there was a revolution going on. Radical groups were planting bombs. People were hijacking airplanes. The Libertarian Party of USA was founded in 1974 I think. 1974 was the year that Mad Magazine had it largest ever circulation. A million people marched against the Viet Nam War in Washington, DC. It was maybe the only time in history that popular protest forced the end of a major war. And when my eighteenth birthday came I didn't register with Selective Service, which was and is a felony punishable by up to five years in prison. 1974 was a year of great turmoil and many people actually doing things in opposition to the status quo. It was in to be out. But compare that to now when it seems the young people today are the most apathetic and conformist ever. Is there even a counterculture today? Pagans? Gimme break.

I only spent three years in high school and rarely think about it except to remember that I was in seventh grade when was one of a few tens of students there who didn't stand for the Pledge of Allegiance. I wonder if a young person in today's America could ever be able to see through all the lies and delusions of the world we live in after all the conditionings of that upbringing and the don't-bite-the-hand-that-feeds-you syndrome on top of all the societal conditioning going on as a result of technology-driven network effects that far exceed anything imaginable to George Orwell, who died in 1949 and who intended to give his best-known book the title Nineteen Forty-Eight, the year of its hoped-for publication date.

It's only two years since I found a book by Harry Barnes, but since then a whole world of social theory and critical history has opened up for me. And this stuff explains so many things that made no sense before. For starters it explains why people believe what they see on television. And it also gives an explanation for how NA can work. Yes. I think that the success of NA in helping people be abstinent from drug use is because of the power of belief and human willingness to follow a leader, as the Le Bon quote above.

People have a need to belong, and NA can be a new family for people who have been made total outcasts. And there's also the power of repetition in the way they recite their principles and dogmas at the beginning of every meeting. Suffice to say, I see nothing surprising in the stories of people who stop using drug and stay abstinent because of their joining in the NA fellowship, and then being welcomed and made to feel like they have discovered a new way of living much better than anything they thought possible. And if they become involved in NA it can be their new way of life. It's all obvious in light of the crowd psychology principles I've been reading about.

NA can work because of the exact same reasons that over 99% of the American people could are unable to even consider all the evidence that the events of 9/11/2001 were probably the largest hoax in history ... and that we've been living under the exact same totalitarian system described in the book that Orwell struggled so hard to get published as Nineteen Forty-Eight. Humans as social creatures are extremely gregarious, meaning that we get along to go along, that we try to be like others in order that others will like us, etc., etc.

Once a person buys in to a mass delusion and accepts it as truth, they have motivation to perpetuate and even to expand it in scope by becoming missionaries of a sort who try to spread the gospel of whatever ideas might have been questionable to them initially. But after they see that pretty much everyone believes in something, they don't want it to be a mistake, so they do their best to convince any non-believers to join with them in this herd unified by belief.

I can look at this dynamic from the outside as I've looked at the world since childhood. In what might be the last conversation I had with my mother I told her the when I watched the crowds of people going to work in Manhattan they were not the heroic figures aka mobile meal tickets she saw as hopefully-non-adulterous breadwinners for suburban households for all the stay-at-home moms who've never worked such as herself. Heroes or drones? When I watched those men waiting in line to board a bus or train to take the one-hour commute to the city they were mindless drones lacking free will every bit as much as the honey bees or ants who live in colonies and where every bit of energy they expend is always entirely focused on what will benefit the herd to which they belong.

There are people at NA for whom it's been a tremendous good and it's like they're born anew and everything has become wonderful and they have purpose and their new-found family and tribe can be their entire life. What a tremendous reward they have found for being drug-free or "clean." Of course those people can stop using drugs and lose the desire to use drugs.


Last edited by wishdoctor on Tue Oct 06, 2015 3:56 pm, edited 5 times in total.

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 Post subject: Re: Please help me
PostPosted: Mon Oct 05, 2015 9:53 pm 
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I've gotta say something here from experience. I was one of those you talk about buying off the street as an opiate naive person. This was during a really rough spot in my life and I would've turned to any drug, suboxone was what was available. Of course it got my high for a week or so but after that it just kept my depression away and kinda made me feel ok. I was on it that way for 4 years and during that time I got a job, bought a house, had kids, got promotions, had a really good life. Imagine if what I had found was heroin that day instead, or oxy, I wouldn't have achieved all those things. It wasn't until I decided I wanted to get off that I turned to heroin and it nearly destroyed me in a few months. Looking back I like to think I put my pending addiction in remission before it physically started, although it had mentally started. I got lucky I feel. So I think people getting subs off the street to get high are way better off if they get hooked on that than heroin. From my experience anyways, I was going to get addicted to something, I got subs and was able to live a great life on them and I wasn't even getting high. Of course I would never recommend that to anyone but that's just how my life turned out. If I would've never decided to quit the subs and just found a dr instead I wouldn't have almost lost everything to dope. I think you're trolling


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 Post subject: Re: Please help me
PostPosted: Thu Oct 08, 2015 11:04 am 
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The power of positive thinking can do amazing things. Beginning Labor Day weekend I was going to that NA group almost every day. And at every meeting they repeated the prayer of hope, that every addict can stop using drugs and lose the desire to use drugs. Mantras can work. Every shaman knows that they can and do work.

So there I was after reaching the major accomplishment of once-weekly clinic visits which meant that with six takehomes that I could dilute, and a dispensing nurse that wouldn't notice or even care if I threw away most of what was in the cup, it gave me the opportunity to lower my dose for a few weeks without having it be on the books. (Clinic rules allow dose to be dropped no quicker than 5 mg per week.)

It started when I was getting four takehomes. I'd take three of the full bottles and add water to them and then divide up the total into four bottles, and mostly added water, judging their equal content by putting each of the new bottles on an accurate scale. It was accurate because the added water lowered the sensitivity to "noise" in measurement.

After a month of this my methadone dose was reduced by roughly 25%. From 60 mg to 45 mg. And I began what most people would call nodding off. That's right. All of sudden I'd feel sleepy and I could nod off even sitting up in a chair. That happened usually in the afternoon and then always after dinner. But after each episode I'd feel sluggish for the rest of the day. And I started going too bed earlier and sleeping longer than usual. And yes it seems counterintuitive.

I've never thought of my "psychiatric condition" as a disease; rather it's a personality type. Back in ancient Greece they might say I had an excess of melancholy humors.

The sleepiness I felt recently from a lowered methadone dose was EXACTLY the same as the lethargy I felt when I was tapering Suboxone down to the point of taking tiny crumbs. And going back to my full dose it took more than a week for the lethargy to go away, but it's completely gone now.

I think that sleepiness in both MMT and Suboxone patients can be the result of having a dose too low. But I doubt that most any MD would be able to understand that because it doesn't comport with linear dose-response.

Imagine how harmful it could be if people are told by doctors and friends and themselves to do the exact opposite of what they really need. Plenty of people who experience what seems to be nodding off might decide to lower their dose even more, doing the opposite of what will make them feel better.

My dose is 66 mg and I don't take a "rinse" so there is usually 5-10 mg that gets lost. And I dropped my dose at over a few weeks to an exact 2/3, or 44 mg/day, measured out by adding water and then dividing it into exact equal parts. So I went from 60 mg to 44 mg and the sleepiness would hit me all day and make me sleep longer at night. There was absolutely no insomnia, but there was some anxiety.

I ended up learning after a year that I really do need this medicine because for the first time in my life I'm experiencing solid happiness on a daily basis and am truly in balance, mind and body.

This is health! I never expected that I'd live as long as I've lived because it was so miserable most of the time. It's a miracle that my former health problems caused by i.v. drug use are completely gone.

Methadone allows me to live in health. Nothing else of recent decades ever came close.

(The closest to this in recent years was a time early on in my Suboxone treatment when I was taking a yoga class five days a week and I was working as a consultant and getting all the positive reinforcement from doing work that I enjoyed and was for the common good, and unlike now, back then I had several friends who were alive and had a relationship with my parents, all of which is no longer. It seems a bit odd that the loneliness from a lost career and lost friends and family are not getting me down. The biggest loss is not having a close friend to talk to, because they all died, but it's no realistic for me to hope to find replacements for them.)


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 Post subject: Re: Please help me
PostPosted: Fri Oct 09, 2015 1:32 am 
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I hope you find one here.

You are spot on about the reasons that lowering your dose can cause sleepiness or lethargy. As Dr. Junig always says, at lower doses bupe starts acting like an agonist.

Amy

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 Post subject: Re: Please help me
PostPosted: Fri Oct 09, 2015 11:48 am 
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Amy-Work In Progress wrote:
I hope you find one here.

You are spot on about the reasons that lowering your dose can cause sleepiness or lethargy. As Dr. Junig always says, at lower doses bupe starts acting like an agonist.

Amy


Thanks! I like posting here. Way back when I used to spend a great deal of time and energy in posting about drugs. And those deceased friends of mine were all people who met me as a result of our posting in the same places. After a while of communicating with each other by replying to each other's posts we took it to email and then telephone. But that was then and this is now. It makes no sense to think that history will repeat itself. The internet posting began in 1998 on alt.drugs and it came to an end when I was Trampy at drugbuyers.com who instead of being Pooh-Bah was their only Oracle. All that is over and the world I live in is a world full of fools who don't like being told that everything they believe in is false and it's been that way forever and so forever has been the scorning of people who can see through the lies. Which is why I'm reading H.L. Mencken now.

...

Low dose? It's so simple it should have been obvious. Why was there marked lethargy during a few weeks of temporary methadone dose reduction going from 60 to 45 mg? I think it was simply opiate abstinence syndrome.

My body had adapted itself to feeling normal with a daily intake of 60 mg of methadone. I don't feel high or impaired in any way, which many people would find impossible to understand.

The experiment caused me no harm. And it has convinced me that I made a very good choice in going on MMT a year ago in September. I could have found a doctor to prescribe me Subutex, for $250/month for the scrips, and they do no paperwork for insurance meaning that only Medicaid would pay for the pills and I'm not poor enough for Medicaid.

Which reminds me of the class differences of ORT clients as between methadone and Suboxone. People who are not poor are generally averse to methadone due to preconceptions and "herd thinking" where they seem to vastly prefer Suboxone because of a crowd perception that people on MMT are dirty and poor and criminal.

I guess the common preconception of a typical person on methadone might be something like the illiterate poor tattoo'd up the wazoo ex-con who is on parole --- the people who seem to dominate that NA group I was visiting recently where I was asked to be a Speaker before anyone there knew I was on MMT.


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 Post subject: Re: Please help me
PostPosted: Fri Oct 09, 2015 3:13 pm 
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At my sub doctor's office, which is a family practice, there are all sorts of people I see in the lobby. I can tell, for example, that the grateful looking, shaky, and maybe scruffy-looking person is seeing my doctor for the first time for suboxone treatment. My doctor takes insurance, so that is probably the common denominator of his sub patients. They have some kind of insurance.

The biggest reason I never considered going on methadone for my addiction was that after becoming stable on suboxone I can go to my doctor's office once a month for my medication. Also there was no lag time between being inducted on suboxone and feeling like a completely normal person. Going to a daily, regimented program was not for me. I arranged my own addiction therapy and sought out a couple of SMART Recovery meetings.

I don't think everyone walks into the sub doctor's office for induction and leaves feeling a complete lack of withdrawals and cravings, but that was my experience.

I think you are correct though that there is a misperception of people undergoing MMT. I have a close friend on methadone and he does happen to be an ex-con from a drug charge, but he has turned his life around like I wouldn't have believed. I firmly believe that I am no better than any other addict and I express that often. It would be better if both methadone and suboxone users banded together to tackle stigma, but there are MMT advocates that believe that sub users should have to jump through every hoop required of MMT patients, despite the medications being very different. That is not helpful or realistic. At the same time, sub users need to recognize that if they are only taking suboxone and not working on their recovery, that they are staying sick.

Amy

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 Post subject: Re: Please help me
PostPosted: Tue Oct 20, 2015 4:30 pm 
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You're very lucky Amy to have felt good so quickly on entering treatment. Placebo is a wonderful drug, don't get me wrong. What matters most is feeling good about the treatment you're in. Nobody but you can know if it's giving you a good quality of life.

Today at the clinic with 45 people who got there before me and we have a number on a piece of paper so we know who is next in line, with the problem being a new dispensing nurse after the old one quit, again! -- I see the same people who just have no concept of having clean UAs from stopping their use of drugs. Maybe only 5 out of 100 people there are staying clean and earning takehomes, but I can't imagine me doing anything else but staying clean of drug usage while on MMT. It just seems like most of them are like living dead people, or zombies, and they take the 100 mg a day of methadone on top of whatever else they can get, whether it be opiates or benzos, which is what most of the dirty UAs show.

Yeah. Health insurance coverage could be an important factor for choosing between Suboxone and methadone. And I know all about that because my former PCP was running a primary care health clinic at a university hospital where he also taught at the medical school so the idea was that he'd be teaching new PCPs how to be good doctors where it's university policy that all their PCPs have X numbers while also be providing primary care for people on Suboxone with all the administrative staff needed for all the paperwork that came to be needed for all the various insurers and their own requirements of jumping through hoops to get the prior authorizations needed, e.g. UAs, behavioral health, etc. Patients in his clinic were there by invitation only, with the name of the clinic giving no indication of its true purpose which was to provide state-of-the-art integrated health care for opiate dependents desiring Suboxone. When I started treatment there it was all fully covered by a Medicare Advantage plan and I saw the doctor every month or two. The only thing expensive was the $66 or $75 copays for brandname Suboxone prior to the generic tablets, when it dropped down to just $5 per month.

My treatment there came to an end in January 2014 when I discovered that I'd been living with what can only have been, because it was cured so rapidly by Cipro taken for extensive cat-scratch wounds, a chronic infection of some bones in my feet for the entire six-year period I was his patient at that clinic. When it eventually became clear to that doctor that he had unwittingly been treating my associated foot pain with Suboxone he announced his retirement from the practice of primary care and the 100 patients cared for there were all reassigned to other providers within the university health care system, which is the largest overall health care provider in town.

I was of course left to my own devices because I had made a state medical board complaint against a doctor who was regarded as god. He just had too much on his plate. But he will keep his job teaching as a full professor of medicine and also other stuff like being on the state medical marijuana board.

Modern medicine sees no good in chronic infections, but in my case I think that there was some benefit to me from the demands in placed on my immune system. (Note the "malaria cure" for syphilis in the case of the notorious gangster Al Capone whose treatment at Johns Hopkins was mentioned in the Diary of H.L. Mencken.) I think that Suboxone sucks because of the shitload of Narcan in it, and so my choice was Subutex which I'd almost certainly have to pay for myself, or methadone which I have to pay for because I'm not poor enough for Medicaid.

I'm lucky to live close by to what many here would tell you is the best methadone clinic in town. It was the very last one of them in town to accept Medicaid which was forced on the clinic owner by the fascist dictates of Obamacare. There were plenty of people who have Medicaid who were paying $260/month for care at my clinic because they prefer it to the others.

And I of course have to pay for it. Takehome privileges are generally not transferable to other clinics. What I've earned is not transferable. I go now just once a week. And in just two more months I can put in for every other week, getting 13 takehomes from visiting the clinic very two weeks. The very highest level, 27 takehomes every four weeks, is for having two years of treatment.

The stereotypes of the typical methadone clinic and their patients are based on fact, not fancy. Yes, it's usually no pretty picture and nothing like the clean well-lighted place you'd expect at a Suboxone doctor's office that takes insurance and does all the necessary paperwork which is more and more of a hassle as insurers are catching on to the fact that many if not most of the patients who take Suboxone continue to abuse drugs, just as before they entered treatment.

I've done both Suboxone and methadone. When I was on Suboxone there were very few periods when I was not getting high on something or other. Maybe someone will do a study hoping to show that Suboxone in a typical OTP is almost as good as MMT for treating drug abusers. But I doubt there'd be much truth in that claim. Almost-daily clinic attendance with rigorous random UAs with takehomes earned for continued abstinence is and will remain the gold standard.

Having a full year of MMT with a year of clean UAs and no cheating is HUGE! Very few do it. So I have the idea of writing a sort of travel guide to help people who might be considering methadone and they don't know anyone who has ever done it or maybe they only heard about it from people who were not benefiting from methadone doing what it's supposed to do, which is to help people stop using drugs to get high.

The hardest part of being on MMT is in the beginning when you have no earned takehomes, which meant six days a week, and Saturdays are always a drag because they have much shorter hours so it's no unusual to have a wait of at least an hour. I was reminded of that today when I could see the parking lot was full and people were hanging around outside. They have a new dispensing nurse and unlike her predecessor she follows all the rules, like refusing to give out takehomes unless the person has a box, which she said she sent someone home to get and come back with to get their takehomes.

So maybe not write a book, but I was thinking something like a magazine article describing some of the ins and outs of going on methadone and then earning takehome privileges. MMT for Dummies, so to speak.


Last edited by wishdoctor on Wed Oct 21, 2015 4:41 pm, edited 1 time in total.

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 Post subject: Re: Please help me
PostPosted: Wed Oct 21, 2015 2:21 pm 
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I had a lot of things going for me when I entered treatment, WD. And I'm sure that helped. Your implication that I might feel better because of some placebo effect is pretty laughable. I don't think that any opiate addict out there would rely on a placebo effect to take away their withdrawals and cravings.

What did work in my favor is that my doctor had me go through significant withdrawal time before I was inducted. He wanted his patients to go through three days of withdrawal before coming in to be inducted. I had comfort meds, but it was pretty yucky. The long withdrawal meant that I was really quite ready for induction. I went from misery to feeling like a normal person by the time I left the office. I was on short acting oxycodone leading up to the withdrawal. That and the length of withdrawal just made my induction very smooth and very effective.

It's much easier to take you completely seriously if you would stop making comments that imply that suboxone doesn't work for people. It wasn't the right tool for you, but it can be the right tool for others.

Anyway, I think it's a wonderful idea for you to write about methadone maintenance based on your experience. Helping others get acclimated to the system would be very valuable.

Amy

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 Post subject: Re: Please help me
PostPosted: Wed Oct 21, 2015 5:34 pm 
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Amy-Work In Progress wrote:
I had a lot of things going for me when I entered treatment, WD. And I'm sure that helped. Your implication that I might feel better because of some placebo effect is pretty laughable. I don't think that any opiate addict out there would rely on a placebo effect to take away their withdrawals and cravings.

What did work in my favor is that my doctor had me go through significant withdrawal time before I was inducted. He wanted his patients to go through three days of withdrawal before coming in to be inducted. I had comfort meds, but it was pretty yucky. The long withdrawal meant that I was really quite ready for induction. I went from misery to feeling like a normal person by the time I left the office. I was on short acting oxycodone leading up to the withdrawal. That and the length of withdrawal just made my induction very smooth and very effective.

It's much easier to take you completely seriously if you would stop making comments that imply that suboxone doesn't work for people. It wasn't the right tool for you, but it can be the right tool for others.

Anyway, I think it's a wonderful idea for you to write about methadone maintenance based on your experience. Helping others get acclimated to the system would be very valuable.

Amy


Thanks for explaining the very unusual instant effect you experienced on your induction office visit as being due to (a medically unnecessary) three days of withdrawal prior to induction. Maybe that doctor's intent was to make you suffer from unnecessary agony in a sort of reverse-Pavlovian conditioning which still apparently serves to make you cherish the drug which gave you relief.

Just because they are FDA labeled for the same indication does not mean the two drugs are equivalent and interchangeable. If you think or feel there is anything underhanded in my comments or that they have an unstated agenda or an obscured bias, you're sorely mistaken.

Methadone as used in American clinics with its once-daily dosing can provide a beneficial effect which I've never heard anyone suggest is also caused by Suboxone. I've never heard anyone say that because of Suboxone they have lost all desire to use drugs to get high. Not one, ever. And what I said about the science is that I wouldn't believe it if anyone made that claim in a study.

Among former drug abusers, if they are people in which "it works," MMT results in the complete loss of their urges to get high. It was shown in the original studies by Dole and Nyswander. It's been shown again and again. MMT works better for people older than 40 than among the younger. But if it works for a person, they stop using drugs. Period. And that just does not happen with Suboxone.

I'm talking about having 40 years of using drugs to get high and it's all gone, poof, gone. No desire to smoke pot, take stimulants, sleeping pills, benzos, nothing. All gone thanks to 66 mg per day of methadone. No thinking about how many days to when my next UA could be. No thought of cheating on the UA. And when the clinic doctor told me he didn't want me taking tramadol even though I know for sure they don't test for it, I have not taken a single tramadol pill. I've reached the pinnacle of abstinence they talk about at NA -- completely lost the desire to use drugs, all drugs.

Suboxone doesn't do that to people and anyone who says it does is a liar or a fool. But there are plenty of long-timers at methadone clinics who will tell you the same story. I've found five of them and that's without making any effort to seek them out. All the people who need more than what a small box will hold have told me the same story: they no longer have the urge to get high -- and it didn't used to be that way.


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 Post subject: Re: Please help me
PostPosted: Wed Oct 21, 2015 8:07 pm 
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Are you trying to get banned? We have welcomed you here into our forum as a sub-hating /disdaining addict for whom methadone is really working well.

And now you are preemptively accusing suboxone users as being foolish or crazy. Way to win friends and influence people!

Do not condescend to me or any other member of our forum and no more name-calling. This is your one second chance. There won't be a third.

Amy

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 Post subject: Re: Please help me
PostPosted: Thu Oct 22, 2015 12:30 pm 
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Liar or Fool, well put me in the front of the line.
Myself and many of my clinic mates have lost the desire to use anything. All of US. Yes, many are over 40. Studies do show that this age group will do very well right from the start. My experience proves this . 38 years of picking up anything and almost everything.
Changing the people I ran with, the places Id go and the things I would do also made for the transition to be a overnight success.
You have to want to stop. Period. Sub Meth,or total abstinence. Take your pick...


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 Post subject: Re: Please help me
PostPosted: Thu Oct 22, 2015 12:51 pm 
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If u want proof that suboxone has removed the desire to use then I'm sure there's tons of ppl on this forum that will tell u exactly what it did for them. I've been on suboxone for almost four years and NEVER failed one drug screen and I have zero desire to use since. Like Amy, after my induction, I walked out of my doctors office feeling completely better after 32 hrs of withdrawal hell. I've been feeling like that since. There was no placebo effect lol are u kidding me! I'm 39, I lost everything during my years of using. I've been to jail, I've been to inpatient rehab, and too many detox's to count & suboxone was the only thing that worked for me. I've abused methadone like crazy during my active addiction days, just like someone I'm sure has abused suboxone. The difference between me and u is that I respect ur choice for methadone maintenance and I know it can work. Calling us foolish for saying we have zero desire to use on suboxone is flat out wrong, ur trying to get some type of "mine works better than urs" thing started. Why? Who cares as long as what works for u works?

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 Post subject: Re: Please help me
PostPosted: Fri Oct 23, 2015 8:07 am 
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Wonder what happened to the OP? Her last post ended with "Christ save me".
Hope you're ok, SOS. If you're still on the forum, please let us know what's happening.


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