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.
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.