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How long to wait after heroin? How to treat precipitated withdrawal? What dose of Suboxone is best? Do I have to be in withdrawal?
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Posted as in introduction, but also contains some questions

Mon Sep 02, 2013 6:16 pm

[I posted this same thing in the introduction forum, but I wanted to move it out because it contained some questions at the end]

It's been several years since I first began Suboxone treatment and back then there weren't places like this so readily available. I think I had an 800 number to call if I had questions, but beyond that Suboxone was still brand new and, if I remember correctly, the 8 mg pills were all that was available.

It's nice to see a real, non-corporate sponsored resource for people new (or old) to Sub treatment. I have been off and on Sub for about eight years total now, and clean for nearly six years. I've found it very difficult to completely stop, but I've been in the twilight of my Sub career for the last two of these six clean years. I pick up 15 of the 8 mg. strips every 62 days, which totals about 1/5th of a strip per day. It's an insignificant amount and at this point isn't doing much physically, but the emotional hurdle of stopping completely and staying clean for life has been hard to get over.

The research and opinion of this drug has changed so drastically since it's inception that I'm totally lost as to what the mainstream doctors believe now, and I haven't had contact with another Sub user in years now, so I don't even know what doctors are telling new patients. This is the question portion of my post. What is the consensus on Sub for short and long-term use? Do people still take Subutex? Are the orange pills still available, or is it all strips now? And how far off is a real generic alternative to the brand Suboxone (not Subutex)?

Re: Posted as in introduction, but also contains some questi

Tue Sep 03, 2013 11:36 pm

The research hasn’t really changed over the years. Residential treatment of opioid dependence has a high relapse rate. Detox has a high relapse rate. Short-term use of buprenorphine has a high relapse rate. And long-term buprenorphine…. has a high relapse rate (i.e. when buprenorphine is discontinued).

When buprenorphine/naloxone was first approved in the US, some people thought that it could be used to ‘fix’ addiction--- that if people took it for a month, they would somehow be able to ‘recover’ from opioid dependence. Fewer people who prescribe buprenorphine buy into that idea anymore.

A number of studies have made clear what should have been obvious: that addiction to opioids is a chronic, multi-faceted illness, and using ANY opioid short-term has little effect on the course of addiction. On the other hand, the people who stay on buprenorphine/naloxone have about a 50% rate of abstinence from other opioids. The value of buprenorphine over taking pure agonists (like oxycodone, hydrocodone, or methadone) is the way the opioid effect reaches a plateau as dosage is increased. That effect allows for an unchanging opioid effect, even as blood levels vary from dosing and drug metabolism. That effect is tuned out by tolerance, and the result is that when taken correctly, mu receptor effects of buprenorphine are lost.

My bias in favor of long-term use of buprenorphine is well-known on the forum. I understand the desire that people have to be cured of addiction, and to escape their addiction for good—with no need for a long-term medication. But from all I know and see, the only way for that to happen is for personality to change--- for example if a person becomes a 12-step zealot, and attends meetings regularly. Another choice is to continuously treat addiction with an agent that puts it into remission—as buprenorphine does.

I worry that the things that will have the biggest impact on buprenorphine treatment will be the things that are a bit misguided. There is a diversion problem, which has the possibility of causing politicians to take away buprenorphine—as happened in Eastern Europe. People seem to forget just how bad things were before they went on buprenorphine. Also, the urge to ‘get off Suboxone’ fuels the profit of short-term detox and rapid detox programs. That is where the money is, in buprenorphine treatment—in taking in new patients, and finding reasons to kick them off it to make room for new intakes—or in taking large fees and promising to get patients ‘clean’, even knowing that 95% of the people will be using again within one year.

I believe that people have the right to follow their own interests, but I worry that misinformation affects those interests. I want this forum to be the first place where people complain about buprenorphine, or discover a problem from treatment… but I also encourage people to recognize the power of a ‘herd mentality’, and question the things they hear—rather than engage in conspiracy theories or faulty reasoning.

About the medication—the only brand form of Suboxone is the film. There are generic tabs, and generic buprenorphine tabs. Other forms are in the pipeline for various pharmaceutical companies, including new combinations of buprenorphine with other opioids, for treating depression. These agents have not been approved, though—and I don’t know I they ever will be.

Re: Posted as in introduction, but also contains some questi

Thu Sep 05, 2013 9:06 pm

Epic response, thank you. It's pretty cool you are active on the forums and are so opinionated, I wish more doctors were so involved. I got really lucky with mine, he's on top of the research and has a large patient pool and most importantly, he genuinely cares about addicts and addiction.

As for everything said, I agree across the board. Lifestyle changes have been incredibly hard to (honestly) make, but this low maintenance dose I'm on is a crutch I still need for now. It took me many years to destroy my life, and sometimes I wonder if it's possible to ever fix it completely, but I am finally working on that thanks to this medication and treatment.
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