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PostPosted: Wed Apr 13, 2011 2:02 am 
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I have been seeing Dr. Steven Scanlan's name pop up around the forum lately. He is a psychiatrist in S. Florida who treats addiction. According to his Psychology Today profile, he does not offer ongoing care - he only does detox. He is the co-owner of Palm Beach Outpatient Detox. He is very vocal about his opinion that Suboxone should only be used as a detox tool for no more than 21 days. He is also vocal about what he considers to be the drawbacks and/or dangers of Suboxone. He has videos and articles all around the internet.

I have seen some of his work quoted here, and I can't say that I'm impressed. He seems to make up statistics based on his impressions and anecdotal evidence. I get worried when I see stuff like that presented unquestioningly because I want this forum to be a place where people can get good, solid information about Suboxone as well as community and support.

I found the following article today and I think it is a good one. This article addresses points that Dr. Scanlan raised in an article he wrote. This article was written by two MD's and is full of citations of articles and studies that were publised in peer-reviewed journals. There are footnotes and a list of works cited, so if you are so inclined you could look at the source material.

I would highly recommend reading this article if you are thinking about Suboxone treatment or considering detox vs. maintenance or if you would just like to hear the other side of the story. Anyway, here it is, I highlighted a couple of quotes for quick reference:

Data demonstrate buprenorphine's effectiveness
Link to article: http://www.addictionpro.com/ME2/dirm...AC4DB2039F815D

by Erik W. Gunderson, MD and Adam J. Gordon, MD, MPH, FACP, FASAM

We read with great interest Steven R. Scanlan, MD's article “Suboxone: concerns behind the miracle” (November/December 2010 issue), and we are writing to elaborate on several points and to review detoxification and maintenance treatment evidence to expand upon his anecdotal experience.
Opioid dependence remains largely untreated nationally; the expansion of office-based opioid treatment (OBOT) with buprenorphine is needed to address the treatment gap and to minimize associated morbidity and mortality when the disease is left untreated. In the office model, clinicians have opportunities to present patients with various treatment options that include use of non-pharmacotherapy, pharmacotherapy using buprenorphine and buprenorphine/naloxone (hereafter collectively termed “buprenorphine”), and referral to specialty professionals and services, including methadone maintenance therapy.

Mutual treatment planning often involves a decision whether to initiate buprenorphine maintenance treatment or to use the medication as a means of detoxification from the misused opioid. In his article, Dr. Scanlan advocates the use of detoxification primarily over a three-to-four week period to avoid numerous complications of maintenance in which “one addiction may be traded for another.”

We are concerned that the view equating buprenorphine maintenance with buprenorphine addiction reflects a common misconception about diagnostic criteria, and is unsupported by scientific evidence. Physical dependence on a substance is neither necessary nor sufficient for a DSM-IV substance dependence diagnosis, which is used interchangeably with addiction. Although buprenorphine-maintained patients on a stable long-term dose have physical dependence, including withdrawal with abrupt cessation, a lack of compulsive and uncontrolled problematic use precludes a buprenorphine-specific addiction diagnosis in these individuals.

Voluminous data

An extensive and growing body of research supports that positive long-term patient- and system-level outcomes can be achieved in primary care and other outpatient settings with buprenorphine maintenance treatment-even for traditionally vulnerable patient populations such as those who have HIV or who are homeless.1,2,3,4

OBOT with buprenorphine improves treatment engagement (roughly 50 to 60 percent retention at six months) and reduces cravings, illicit opioid use and mortality.4,5,6,7,8,9 Furthermore, long-term methadone maintenance therapy has a long history of evidence for successful patient outcomes; long-term OBOT with buprenorphine is an analogous treatment paradigm.

Although detoxification with buprenorphine may be more effective than non-opioid based detoxification approaches,10 the clinical effectiveness of buprenorphine detoxification appears less than that of buprenorphine maintenance. In a recent National Institutes of Health (NIH)-sponsored multi-site trial comparing buprenorphine-tapering schedules that overlap with Dr. Scanlan's approach, patients were tapered over seven or 28 days after a four-week period of stabilization.11 Approximately 85 percent in each group were actively using illicit opioids after the taper completed, in follow-up at one and three months. In contrast, an evaluation of long-term, primary care buprenorphine maintenance found a 9 percent opioid-positive urine toxicology during years two to five of follow-up (101 out of 1,106 samples).4 Patients received monthly brief physician counseling to promote abstinence, self-help involvement and functional improvement.

Prescriptive detoxification (four-week taper) in OBOT with buprenorphine will minimize provider-patient individualization of treatment and be contrary to the intention of federal legislation allowing OBOT.

Addressing bias

Despite the demonstrated benefits of buprenorphine maintenance treatment, many in the substance abuse treatment community may continue to view agonist maintenance as not being in “recovery.” Although recovery is variably defined,12 maintenance treatment when coupled with standard-of-care psychosocial treatment is capable of producing long-term sustained remission to alleviate the lifelong struggle for many individuals.

We agree that buprenorphine alone is not a “miracle cure” but rather a means of providing enough stabilization so that the patient may participate in the rehabilitative process. Non-pharmacotherapy and pharmacotherapy should be offered to all patients with opioid dependence.

We too are concerned about so-called “script docs” collecting monthly out-of-pocket cash fees for 5- to 10-minute refill visits without patient engagement in ancillary care. Such practice is largely outside the norm, with most prescribers either offering psychosocial treatment on-site or utilizing outside referral,13 consistent with national guidelines.14 We are equally concerned about a “revolving door” of detoxification in which patients cycle in and out of acute care for repeated detoxifications. In addition to likely limited cost-effectiveness, the approach puts patients at risk for overdose during relapse due to the decreased physical dependence occurring at the end of a taper.

Ultimately, given the heterogeneity of the disease of opioid dependence, patients will be best served by having an array of service options that are not mutually exclusive. We hope that through continued questioning of clinical dogma and paradigms, such as that raised by Dr. Scanlan, as well as through further scientific study, patients will gain greater access to effective treatment-and the tremendous individual and societal consequences of untreated opioid dependence will be mitigated.


Erik W. Gunderson, MD, is an Assistant Professor of Psychiatry and Neurobehavioral Sciences at the University of Virginia School of Medicine. His e-mail address is EWG2N@hscmail.mcc.virginia.edu. Adam J. Gordon, MD, MPH, FACP, FASAM, is an Associate Professor of Medicine at the University of Pittsburgh School of Medicine.


References

1. Alford DP, LaBelle CT, Richardson JM, et al. Treating homeless opioid dependent patients with buprenorphine in an office-based setting. J Gen Intern Med 2007 Feb; 22:171-6.

2. Parran TV, Adelman CA, Merkin B, et al. Long-term outcomes of office-based buprenorphine/naloxone maintenance therapy. Drug Alcohol Depend 2010 Jan 1; 106:56-60.

3. Sullivan LE, Moore BA, Chawarski MC, et al. Buprenorphine/naloxone treatment in primary care is associated with decreased human immunodeficiency virus risk behaviors. J Subst Abuse Treat 2008 Jul; 35:87-92.

4. Fiellin DA, Moore BA, Sullivan LE, et al. Long-term treatment with buprenorphine/naloxone in primary care: results at 2-5 years. Am J Addict 2008 Mar-Apr; 17:116-20.

5. Fudala PJ, Bridge TP, Herbert S, et al. Office-based treatment of opiate addiction with a sublingual-tablet formulation of buprenorphine and naloxone. N Engl J Med 2003; 349:949-58.

6. Fiellin DA, Pantalon MV, Chawarski MC, et al. Counseling plus buprenorphine-naloxone maintenance therapy for opioid dependence. N Engl J Med 2006 Jul 27; 355:365-74.

7. Mattick RP, Kimber J, Breen C, et al. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev 2008;CD002207.

8. Gunderson EW Fiellin DA. Office-based maintenance treatment of opioid dependence: How does it compare with traditional approaches ? CNS Drugs 2008; 22:99-111.

9. Gibson A, Degenhardt L, Mattick RP, et al. Exposure to opioid maintenance treatment reduces long-term mortality. Addiction 2008 Mar; 103:462-8.

10. Veilleux JC, Colvin PJ, Anderson J, et al. A review of opioid dependence treatment: pharmacological and psychosocial interventions to treat opioid addiction. Clin Psychol Rev 2010 Mar; 30:155-66.

11. Ling W, Hillhouse M, Domier C, et al. Buprenorphine tapering schedule and illicit opioid use. Addiction 2009 Feb; 104:256-65.

12. McLellan T. What is recovery? Revisiting the Betty Ford Institute Consensus Panel Definition: The Betty Ford Consensus Panel and Consultants. J Subst Abuse Treat 2010 Mar; 38:200-1.

13. Walley AY, Alperen JK, Cheng DM, et al. Office-based management of opioid dependence with buprenorphine: clinical practices and barriers. J Gen Intern Med 2008 Sep; 23:1393-8.

14. Center for Substance Abuse Treatment. Clinical guidelines for the use of buprenorphine in the treatment of opioid addiction. Treatment Improvement Protocol (TIP) Series 40. DHHS Publication No. (SMA) 04-3939. Rockville, Md.:Substance Abuse and Mental Health Services Administration;

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Last edited by Diary of a Quitter on Wed Apr 20, 2011 10:51 pm, edited 1 time in total.

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PostPosted: Wed Apr 13, 2011 6:29 am 
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I, too, noticed Dr. Scanlan's name used frequently and as a source for genuine empirical evidence without any additional sources provided, so I'm glad you found this and posted it. Thanks, Diary, for taking the time to find this and share it with us.

I had some trouble with the link, so here's what I found:

http://www.email-hci-research.com/ME2/d ... B2039F815D

I hope everyone here takes the few minutes to read this.

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PostPosted: Thu Apr 14, 2011 10:49 am 
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I disagree with some of Dr. Scanlan's views, but agree with others.

For one, I can't understand why he is seemingly opposed to suboxone maintenance, yet is more tolerant of methadone maintenance. I've been on both, and firmly believe suboxone is the lesser evil.

Maintenance IMO has its place as a last resort treatment for opioid addiction. After someone's tried detox and relapsed, tried detox -> long term rehab (4 months min) and relapsed, done the NA thing without success, tried depot / implant naltrexone without success, then long term maintenance should be on the cards. Then if someone's tried tapering and relapsed more than once, life long maintenance should be seriously looked at.

It's just unfortunate that it's often used as the first line treatment. Why is that? Fact is our brain's endogenous opioid system still work the same as someone in active addiction while we remain on maintenance. Sure the other parts of our head fix up - impulse control, consequential thinking, empathy, responsibility - but the moment we stop maintenance (if ever) it still takes approx 18 months for our opioid system to resemble that of a non-addict. This is the same amount of time, and even more because of it's long half life, of someone coming straight off their DOC.

Quote:
Although buprenorphine-maintained patients on a stable long-term dose have physical dependence, including withdrawal with abrupt cessation, a lack of compulsive and uncontrolled problematic use precludes a buprenorphine-specific addiction diagnosis in these individuals.


So they're telling me that if there were no other opiates in the world - no heroins, vicodins, oxys, fentanyls etc etc - that people wouldn't be chasing after buprenorphine like fiends? It still has potential for abuse and addiction imo.

Dr. Scanlan is right in that nothing comes close to the feeling of being free of any dependency. It's the most liberating feeling, especially if I've been in addiction a long time. But maintenance definitely does have its place. I just wish doctors were more forthcoming with the reality of what it means to be dependent on suboxone, so the patient / client can make an informed decision.

PS>> Did anyone else notice Dr Scanlan's use of 12-step language throughout that article? Perhaps his own attendance at those meetings has influenced his medical views a bit. NA and maintenance will never co-exist peacefully imo, no matter how much the committees try to change the culture. You can just tell by the "addict's" look of shame every time they ID as being on "drug-replacement", and the crazy tapering schedules they inflict on themselves to try to be a "part of" their truly "clean" peers... :shock:


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PostPosted: Thu Apr 14, 2011 11:45 am 
Nice post Tearjerker. You brought out some good points, in my opinion. To me, it almost always comes down to the fact that there is no "one size fits all" when it comes to addiction. I have said before that in a perfect world, all of us 'addicts' would be well educated regarding our treatment options. But in reality, we are not. For the most part, we are just so desperate to stop the madness of our addiction, that we will buy into almost anything that anyone in seeming 'authority' or 'wisdom' seems to offer us......a way out! In my opinion, almost all the true experts in the field of addiction have something of value to offer as a solution. Most all of these professionals also have at least some degree of bias in their opinions. That's when it becomes so critical for the addict to be able to sort through all of these opinions and come to our own best solutions for us as individuals.
I agree with you, Tearjerker, that in most cases, long-term or life-long maintenence should be saved for a last-resort option, when all other attempts at sobriety have failed. One of the problems with that, again in my opinion, is that we live in a generation of people who are so averse to suffering, so accustomed to being 'comfortable' that we simply won't tolerate the pain of withdrawal. Further, we live in a generation in which most of us simply cannot afford to be out of commission for several months or even more than one year of PAWS symtoms. We have to be 'on our game' and fully functioning at all times. In many cases, the people around us will not allow us to be 'sick' or less than optimal in our functioning like that. Not to mention the economic repercussions that would go along with it. So many of us are left without any real good chance at getting and staying 'clean.' There is just too much pressure to perform.
I know that that is what happened to me.....I got 'clean.' I just couldn't continue on with PAWS anymore. It was just taking too long for my poor abused brain to adapt back to normal again. The depression and lethargy of PAWS can be suffocating, therefore leading most to relapse just in an attempt to feel 'normal' and function better. So for me, starting maintenence with bupe pretty much was a last resort. I truly felt that I had to try something different. Did I really grasp what I was getting into? Probably not, not completely anyway. But you're right.....being on maintenence is not so much different as far as our brains are concerned, than being on our former drug/s of choice. Our tolerance is still sky high. We're still set up for withdrawal when the maintenence is discontinued. And we still are subject to a potentially lengthy period of time for our brain functioning to return to a balanced state again. And it's important that we understand that.
However, when it all boils down, there are many of us who are far better off on bupe than not. The benefits, for a lot of us, far outweigh the risks. I'm grateful for bupe. It's given me a chance to work on everything else so that in the end, I may have a fighting chance at coming out okay.
The arguments for and against will rage on. But it's an individual choice we all have to make. I'm grateful, too, for this forum. Here we can all share what we have learned and sort through it to come to our own conclusions based on the best information we have out there.
Thanks for sharing everyone!


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PostPosted: Sat Apr 23, 2011 4:33 pm 
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I dont know how I missed this thread... interesting for sure.

I do some some problems with the article though. The statment about bupe not being misused??? I for one see it all the time. I have seen a few post here admitting to abusing sub. Snorting it, etc. I even seen some encourge lying to MD about it. Not sure how that promotes healing from addiction at all. I also had a problem with the statement of rare misuse by the MD's who are prescribing sub. I NEVER had a md and had several see me for more then 5 mins. Three out of 5 didnt even ask me if I was on any other meds. I have a friend and this really pisses me off... her MD actually wanted to do a GYN check up knowing that this chic see her own pvt GYN md yrly. When she said she has her own he said that he still needed to do this since this is how he also checks her bowels? I been trying to get her to report this quack but out of fear of loosing she scripts for sub and benzo's she jsut keeps lying to him saying she has her period. She had a friend that use to work in the office but got fired. THis friend said that only the young cuties gets this treatment. I know he writes her large doses and she sells half to pay for appoint and make extra bucks for herself. In my zip code there are so many that offer sub its alarming. I remember first visit with sub doc he said by NO means should I take benzo's with sub... now its the norm. Not one of my MD spent more the 5 mins on visits.. none suggested 12 step meeting or any couseling. And everyone I talk to about thier MD its the same story. So I see this as the norm, not few and far between. BUt as Dr J says.... why go to meetings when your not desparate. I dont agree with him on this statment at all... for me, sub didnt teach me how to live dope free and for many dont do crap for the chronic lying etc. Again, dont get me wrong. I do know a few folks that without sub they will go back to street dope.... they have tried but failed. Again these folks do nothing to change anything either. Maybe stop hanging about with those that are fireing dope.. as he says.. they will steal from him. LOL. But he surely isnt changing anything else. Not that we have much in comon these days but I would rather see him on sub then street dope for sure. At least I can talk to him if I run into him on the street and he is alive.

I guess what my problem really is with sub is that I got no where with it. I do know that it stop working for me or that my chemistry just didnt mix well with it because according to this site and Nabbit too many others feels great while on it. I was just not that lucky. I was on meth a while back also. I did like that I only had to see MD once a month and not go daily till I worked up to take homes. So that for sure was a plus. Also that sub dosnt show in 12panel urine screens. Thats a BIG plus for me. I do know that this last statement will change shortly. My job will start testing for it. I dont know how that will go over since most have scripts for it but I do know if on Methadone it dosnt matter... cant work there while on meth. Will be intersting to see what happens after they start testing for it. Dont want to say what I do for a living here but my job is sensitive enough that one cant report to work while on any opiate scripted or not. If there is a reason to be on a opiate you just have to call out while using it.


For tearjerker.... I have a buddy in fla that went to dr scanlan. why he rather see someone on meth then sub was put like this or close to it. Meth being a full agonist is safer he feels since the brains receptors are made to accept the meth. Sub being partial, the receptor are not able to adapt, like putting a square peg in a round hole so the brain constantly struggles to maintain homeostastis but is unable. This creates other problems. I cant remember what the "other" problems are, I will ask when I talk with him again. He did try and get off the sub by using this doc but failed. He just couldnt hold up to the paws he said. And also addicted to benzo's and didnt want to stop them. I think something due to not wanting to switch up with librium or something. I just cant remember. LOL..I am finding that I have a lot of memory lost of details.

just a side note... this memory lost is not all negative. I have so many choices of movies to watch. I know I have seen them before but watching them now is like seeing them for the first time. LOL, I surely didnt see that I was missing so much while in treatment. Now that I can retain stuff I dont have the time to watch movies or its not acceptable for me to sit in front of the tv that long. Not sure how I did just sit there for movie after movie. I am doing good (past two weeks) if I sit long enough for Surivor. It happens to be my fav show and the only one now I am wiling to sit doing nothing for an hour. I find myself wanting to do something during commericals though... wife loves it. This past wensday I did the wash duing the show, folding and running down to switch over from wash to dryer during commercials. She is in heaven... me, I feel like I have so much to make up for and this is the easist thing I can do for her and not miss my show. HEHEHE.


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PostPosted: Tue Apr 26, 2011 11:55 am 
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birdie wrote:
Not one of my MD spent more the 5 mins on visits.. none suggested 12 step meeting or any couseling. And everyone I talk to about thier MD its the same story. So I see this as the norm, not few and far between. BUt as Dr J says.... why go to meetings when your not desparate.


I find it difficult to attend 12 step meetings whilst on Suboxone or Methadone simply because unofficially it's still considered using, despite the committees trying to change this attitude. Too many people in the rooms feel that a person cannot achieve any real recovery whilst on "drug replacement". Even ID'ing with "Hi I'm X and I'm on drug replacement", which we are told to do, sounds to me like "Hi I'm X and I've replaced my drugs". It only hammers in this sense of shame that for me in the past easily leads to relapse.

birdie wrote:
For tearjerker.... I have a buddy in fla that went to dr scanlan. why he rather see someone on meth then sub was put like this or close to it. Meth being a full agonist is safer he feels since the brains receptors are made to accept the meth. Sub being partial, the receptor are not able to adapt, like putting a square peg in a round hole so the brain constantly struggles to maintain homeostastis but is unable. This creates other problems. I cant remember what the "other" problems are, I will ask when I talk with him again. He did try and get off the sub by using this doc but failed. He just couldnt hold up to the paws he said. And also addicted to benzo's and didnt want to stop them. I think something due to not wanting to switch up with librium or something. I just cant remember. LOL..I am finding that I have a lot of memory lost of details.


His theory sounds feasible, but where's the data to back up it up? I can't see any studies anywhere that confirm this. Given there's no research to back up his claim, all I can assume is he's going by his patient's accounts, which hardly provides the foundation to declare this as fact. He has never been on any maintenance himself, yet people here, including myself, have been on both methadone & suboxone and the general consensus is the Sub beats the 'done hands down. I always felt that my life was more stable and productive whilst on Suboxone. While I was on methadone I still looked like a junkie. I felt stoned, saturated with opiates, sweaty and my joints ached like an old man. Nobody in their right mind would have employed me in a semi-professional environment. While I'm on Suboxone, even the recovering "addicts" in NA can't tell I'm on treatment - I work, study, maintain relationships & live pretty much like your average productive member of society.

I also wonder if he harbors an equal dislike for Naltrexone seeming as that is a full antagonist, and also doesn't occur in the brain naturally.

I hear you about some doctors out there. For months I was telling my doc that my Depakote was speeding up my metabolism of the Sub to the point where I could use within 4 hours of my dose. It was also giving me bad liver pains (I have Hep C). He kept denying that this could be the case. I was finding it really hard not to use when my sub would wear off after 6 hours leaving me turkeybumped and teary-eyed most of the day, every day. He kept saying I was just caving in cos I was relying on my suboxone to get me clean. After months of hassling I finally convinced him to let me switch off the Depakote, and now the Sub is holding me just fine. My cravings are manageable, & my liver feels fine so my energy's back. What irks me is that if I didn't hassle him and just followed his advice, I would have stayed on the Depakote possibly for life and my liver would have deteriorated rapidly to the point where I'd probably need a transplant in 20 years.

A number of years ago I suffered from Neuroleptic Malignant Syndrome (nasty stuff - often kills) after a psych put me on Thorazine. I got sent to emergency and luckily came through fine, but a bit shaken. Anyway, I go see the doc and tell her what happened and what the ER diagnosed, and she said it was impossible, it wasn't NMS, and it could only have been Opiate Withdrawal because a week ago I'd used morphine ONCE for the first time in ages. She just couldn't admit that her prescription had nearly killed me.

Why is it that so many docs, especially psychiatrists, have a "deny deny deny" attitude when it comes to side-effects of their treatments? And why is it that so many doctors simply can't admit it when they make a mistake?


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PostPosted: Mon Jun 13, 2011 5:14 pm 
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i agree, don't like long term maintence i do agree with the view methadone basically is the same thing as suboxone for LTM. I see his point. I wish i wasent slowly comming off it. ive been pushing to get off suboxone for 2 months, AA works great for me.


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PostPosted: Wed Jun 15, 2011 12:14 am 
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i'm 26 been to 8 inpatient rehabs(atleast 30 days each)... xxx detoxes..

i went to aa/na i did the 12 steps had sober time.. keep relapsing

basically ive decided to take sub for maint because its better than shooting oxy 15x a day and death...

I really dont feel guilty taking it... It saved my life..

I think it all depends on situation but for me sub saved me


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PostPosted: Wed Jul 13, 2011 10:51 am 
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I have a big problem with ignoring Scanlan's observations simply because he has not done a formal scientific study. He is not just going by the hundreds of sub patients he has detoxed. Tens of thousands of sub cases have been documented on forums over the years.

We live in a different age now. An age where scientific research remains the best way to find something out, but we also now have the internet and everyone has access to it. From the internet you get "free research material". No it's not in a controlled environment, but when tens of thousands of sub patients have said it makes them tired, depressed and fatigued, then half of them come back and report that "oh yeah I just got my testosterone checked and thyroid checked and one (or both) are really messed up", you can reasonably assume that sub has something to do with this problem. In fact, to me (4.0 honors graduate in Chemistry), the internet gives far more insight into a problem than you can get with a formal scientific study. Scientific studies cost money and often have very few participants. You get tens of thousands of free participants on the internet. This represents a fraction of people on subutex, but where there is a lot of smoke there is a fire, and you can assume that many more have the same problem but don't use the internet to report it.

I have been on sub 6 years and even back then there were 2 sub boards filled with people complaining. The long term users, even back then, were warning me not to start taking it. I did not listen and I even came back to the forums after starting sub (32mg was my first prescription). They told me not to dare take 32mg, to start at 16mg at the most. That the doctors did not know what they were doing with this drug. The sub vets were right, my doctor was wrong. It remains the same way today. When you have so many people on sub and posting about there EXPERIENCE WITH THE DRUG, this trumps scientific research that will not even take place for another 5 years and when it does, it will be with very few participants.

Anyway, back to the forum thing. I told the people in these forums that they were idiots, that the sub would not "turn on me" and that doctors knew more about it than they did. Well sure enough, in between 2 and 3 years on the drug it "turned on me". I experienced the same horrible depression, severe fatigue, and loss of interest in life that so many people warned me about back in 2005. I went back and apologized to these guys, and I will never listen to a word my doctor says about the subject again. His knowledge is literally at least 3-5 years behind what I can learn over the internet about what this drug does to people. His hired "addiction specialist" is literally just a talking pharm company brochure. She has absolutely no clue about the drug's effect on people. And how would she? SHE HAS NEVER USED IT. She is also motivated by an easy job, easy money, and no incentive to get to the real truth.

Scanlan is right on the money. He says that of all the people he detoxes (all the different addictive drugs in the world), the people on long term sub experience BY FAR the worst detox and sometimes it lasts more than a year. Then they have PAWS to deal with that are as long as methadone or longer. Why would he lie? Say he has detoxed 200 people off sub. What are the chances this changes with the next 200? It's very slim.

Subutex destroys your body and mind. That I know for a fact. How it does it may not be known for 10 years. I was told by my doctor that it would heal my brain :) And it did a good job. I am suicidally depressed (never was depressed at all even on heavy long term oxycontin use), my thyroid is hypo, and my testosterone is shot like almost every other man on the drug. Now that is some good healing!


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PostPosted: Wed Jul 13, 2011 11:00 am 
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BupHasMe, please refrain from stating your personal opinion as fact.

Any "research" done by Scanlan will be skewed by the fact that his patient sample is self-selected. As is the sample of patients who self-report negative side-effects of bupe on the internet. That is why randomized trials are the gold standard.

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PostPosted: Tue Nov 15, 2011 4:57 pm 
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I guess you do not tolerate dissent, as removing my post attests to. Suboxone destroyed my nervous system.


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PostPosted: Wed Nov 16, 2011 10:54 am 
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Hey josephdfco,

I didn't see your original post, but I thought I'd comment on your statement that "Suboxone destroyed your nervous system."

When I quit Suboxone, I too thought my nervous system was destroyed. I used to tell people that I felt like my nervous system was shredded. My arms would shake like a leaf constantly, I actually had to use two hands to eat my cereal in the morning or I'd shake the dang cereal right out of the spoon. For months and months I didn't shit right, constant diarhea. My insides twitched and carried on all day long.

Anyway, my nervous system issues eventually subsided to the point where I don't really notice anything now. I don't think you've done any permanent damage, I believe your nervous system will eventually level out, it just takes time.

As a side note, I've always been a "high strung" person, I've always been on the nervous side and getting off of Suboxone just exasperated the whole nervous thing. It's like opiates had a calming effect on me for years and when I took the opiates away, all hell broke loose. Give it time, your nervous system should come back to normal.

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PostPosted: Wed Nov 16, 2011 2:30 pm 
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Hi Romeo. Thanks for your reply. I started having terrible reactions to suboxone about two years into maintenance. I am a former corpsman who served with SEALs and marines, and have always been in outstanding physical condition. My addiction to pills started after being shot with a heavy machinegun in 1993. Fast-forward to last year:One of the first things that happened to me on suboxone was that I went from running marathons to not being able to run at all. I literally couldn't breathe. I couldn't sleep, became psychotic, and was having seizures. My ability to concentrate and my memory all but dissapeared. At first, I thought it was the naloxone (there is a study where the effects of 2mg sublingual naloxone precipitated physiological withdrawal in methadone maintenance patients; so much for the "it doesn't work that way" claim), so they switched me to subutex. This worked for about a week. When I switched, I had been taking 5mg suboxone, but quickly found that I could only tolerate 2mg of subutex, AND I could only tolerate 0.2mg at a time without having a SEVERE headache, vomiting, and a burning smell. By day 8, I could no longer take bupe at all in any amount. I braced myself for the withdrawal (Years ago, I had jumped from 150mg of methadone to zero overnight; it was hell for the first 3 months, but I did it), but instead of just withdrawal I literally could not breathe and I was wrapped in an indescribable pain, like I was on fire! I was started on methadone, but this quickly turned into its own nightmare. I started at 30mg, but quickly became intolerant to it too. I now have to alternate between it and oxycodone sustained release; 7.5 mg of methadone (2.5 mg at a time because any more and I have intolerable symptoms) at midnight, and 10mg of Oxycontin at noon. If I try to take either of these by themselves, they seem to get toxic quickly (a doctor said that the alternating seems to "reset" my receptors), and if I don't take them at all, I cannot breathe, I get literally psychotic (which is bad because I am very, very strong), there is a smell of burning rubber, nausea, and the burning sensation. With the extremely low amounts that I am taking, if everything was normal, I would be able to jump off with minimal discomfort (I can handle a lot of discomfort; I had acute pancreatitis during hell week of BUD/s and I didn't ring out). I have seen three neurologists at the VA, Have had MRI with contrast, and two different EEGs. I also had a cardiac stress test and a pulmonary function test. As it stands, the only thing I can do at this point is continue taking the other poisons, and hopefully in a couple of months or so the suboxone poison will lose its grip.


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PostPosted: Wed Nov 16, 2011 3:16 pm 
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Hi and welcome, I did not delete your post but did read it. There is nothing wrong with dissent or posting your experience as you did above. I do not wish to quote your 1st post so I will just say that what you wrote the 1st time is not acceptable for this forum. If you have any questions about what was wrong with it specifically please feel free to pm me or any of the other moderators.

I am sorry you are having a difficult time and hope your drs can figure out what's going on so you can get some relief. I would also like to take this opportunity to thank you for your service to our country. Putting your life on the line to protect your fellow American's is truly admirable.


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PostPosted: Wed Nov 16, 2011 3:50 pm 
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Hey joseph,

I would like to extend my thanks to you for your service to our country as well. Thank you Sir.

After reading your last post, the only thing that popped into my head was that you may have some kind of allergy to opiates. Allergies to opiates are quite uncommon, but not unheard of. You might question my belief that you have allergies because you took Suboxone sucessfully for 2 years, but I know allergies sometimes come and go. My wife became allergic to peanuts after the birth of our daughter, prior to that, she was a peanut butter eating fool.

I just did a quick google search for "opiate allergy" and it turns out the allergy response can sometimes be controlled with an anti-histamine.....these few were listed....Phenergan, Vistaril, or Benadryl. You may ask your doctor about trying some Benadryl with your dose and see if that helps at all??

I'm really grasping at straws here with the allergy thing, but after reading your last post, I wanted to at least try and help in some way.

Oh Yeah, if you're taking other medications they might be interacting with the opiates?? A quick google search may help you to figure out if there are any interactions going on.

I know this sucks, but sometimes we have to do our own homework when all the doctors can come up with is a great big DUH?? Search the internet, dig deep and don't give up.

Good luck, man.

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PostPosted: Fri May 18, 2012 4:25 pm 
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After reading everything available by and about Dr. Scanlan, I find nothing to indicate that he thinks his method is the only "correct" one. He seems to be offering one version of how sub therapy might be used. Clearly, it would be better if all patients were aware of all options at the critical Induction time.

Starting any treatment without an excellent diagnosis and prognosis, would be like starting a course of cancer treatment after doing one's own research on the topic or talking to a few people. A good diagnosis in any field tends to mean more options for treatment. One size fits all is by far the worst way to go.

Not Dr. Scanlan, or any one or few physicians should be allowed to determine how inductions will go. And leaving it to the individual "art" of medicine of the individual in private practice is a disaster. What is evolving and much needed is best practice standards that empower patients and make sure treatment is appropriate.

Best practice standards at induction -- with these in place Doctors like Dr. Scanlan would be referring patients who would not be best served by his methods. This is how it should be for all ---patients and doctors would benefit.

S


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 Post subject: Right on
PostPosted: Mon Jun 04, 2012 10:51 pm 
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birdie wrote:
For tearjerker.... I have a buddy in fla that went to dr scanlan. why he rather see someone on meth then sub was put like this or close to it. Meth being a full agonist is safer he feels since the brains receptors are made to accept the meth. Sub being partial, the receptor are not able to adapt, like putting a square peg in a round hole so the brain constantly struggles to maintain homeostasis but is unable.


I totally agree with this. Short back story: I have been using dilaudid to try and get off suboxone. So far so good. I have tapered quite nicely and with no ill effects. Luck being on my side, I also had a tooth pulled the other day which came with a nice script for 30 vikes. Might come in handy when the dilaudid is gone.

My urge to get off suboxone was mainly because now in our state there is a prescription database, and I would prefer my pcp not to know about my sub scripts. My last sub script was last August, being one of those who was prescribed way more than needed so I built up a nice supply.

To throw a wrench in things, I got a letter a couple weeks ago telling me my pain clinic is closing. The only other suboxone choices in my town seem to be the meth clinics.

ANYWAY since starting my dilaudid taper I have been happier, able to work better and longer, and overall a better person to be around. I fully agree that suboxone as a "partial agonist" is completely foreign to our brains and far more damaging than a full agonist. If for whatever reason this taper does not work, I will use methadone. I know suboxone helps many many people stay off street drugs, and I am not arguing that there is not a place for it in treatment. But in my opinion, my brain seems to like things that closely mimic endogenous opioids much better than a foreign substance that just gets stuck in the receptors.

And I have no doubt in the future these days will be looked upon as we now look upon blood letting and other medieval medical practices. Some people are born with defective opioid systems, that's all there is to it. To not let us legally have substances that closely mimic these opioids will be seen as evil and cruel in the future, I have no doubt about it.

Best to all
J


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 Post subject: Diary of a Quitter
PostPosted: Sat Jun 09, 2012 9:26 pm 
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Very good article. It brings up multiple examples of why agonist therapy is beneficial and is probably paramount to detoxification alone. I like that it is scholarly, was peer-reviewed and presents the information in an objective, open-minded non-biased manner.

I haven't heard of this Doctor, however, I do not personally agree with his ideals and think that the positive impact of buprenorphine therapy outweighs that of simply offering it for detoxification alone and believe the benefits from Suboxone are greater than the cons. It improves society by taking users off of the streets and, generally speaking, most Doctors who offer Suboxone offer some sort of psychosocial support and also require monthly/biweekly urine screens to ensure compliance. These are two examples of how OBOT is beneficial to the individual and to society as a whole.

For myself, it improves the quality of my life tremendously, and I do not know if I would be alive (suicide) if it weren't for the therapy I receive from Suboxone. My life is drastically improved and made worthwhile in the loving and forgiving hands of buprenorphine. This is my personal opinion, however, and I don't expect others to necessarily agree with me. Just a personal example of how Suboxone has changed my life for the better. Personally, if Suboxone weren't available, I may still be out there using OC's & Heroin to this day. Buprenorphine has saved my life, quite simply.

Excellent article, especially since it was reliable and referenced. An easy read, too.



Keith


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 Post subject: I must object...
PostPosted: Sat Jun 09, 2012 9:37 pm 
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Te3r jerker. I must disagree with your notion that addicts are shameful of their treatment with either Methadone or Suboxone or agonist therapy. I have no shame whatsoever. I consider my being on Suboxone as a gift and not a consequence. I'm extremely forthcoming of my past and also my therapy with buprenorphine. Not everyone is giving offense with their treatment. It is not a crutch. I'm proud of being on Suboxone in that I'm no longer an illicit substance user and the Suboxone I take today is reminiscent of my active addiction and the fact that I am no longer in that place.

I do agree with your stance in that agonist therapy shouldn't necessarily be the first option to those suffering from addiction. However, I think that it is an option and generally is considered to be a favorable one compared to nasty dysphoric medications live naltrexone or ReVia. I would have gone back to using if Suboxone or Methadone if it weren't immediately made available to me after detox. for certain. To each his own and the more options the better.



Keith


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 Post subject: Medical Technology
PostPosted: Thu Nov 01, 2012 10:33 pm 
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Jimmy wrote:
birdie wrote:
For tearjerker.... I have a buddy in fla that went to dr scanlan. why he rather see someone on meth then sub was put like this or close to it. Meth being a full agonist is safer he feels since the brains receptors are made to accept the meth. Sub being partial, the receptor are not able to adapt, like putting a square peg in a round hole so the brain constantly struggles to maintain homeostasis but is unable.


I totally agree with this. Short back story: I have been using dilaudid to try and get off suboxone. So far so good. I have tapered quite nicely and with no ill effects. Luck being on my side, I also had a tooth pulled the other day which came with a nice script for 30 vikes. Might come in handy when the dilaudid is gone.

My urge to get off suboxone was mainly because now in our state there is a prescription database, and I would prefer my pcp not to know about my sub scripts. My last sub script was last August, being one of those who was prescribed way more than needed so I built up a nice supply.

To throw a wrench in things, I got a letter a couple weeks ago telling me my pain clinic is closing. The only other suboxone choices in my town seem to be the meth clinics.

ANYWAY since starting my dilaudid taper I have been happier, able to work better and longer, and overall a better person to be around. I fully agree that suboxone as a "partial agonist" is completely foreign to our brains and far more damaging than a full agonist. If for whatever reason this taper does not work, I will use methadone. I know suboxone helps many many people stay off street drugs, and I am not arguing that there is not a place for it in treatment. But in my opinion, my brain seems to like things that closely mimic endogenous opioids much better than a foreign substance that just gets stuck in the receptors.

And I have no doubt in the future these days will be looked upon as we now look upon blood letting and other medieval medical practices. Some people are born with defective opioid systems, that's all there is to it. To not let us legally have substances that closely mimic these opioids will be seen as evil and cruel in the future, I have no doubt about it.

Best to all
J


I agree with you that many of the drugs and practices will be looked upon as "crude" in the future.

That is progress IMO.

I feel certain that there will be new drugs that have fewer side effects and will be less harmful and will be more effective than many of the drugs/treatments currently being used.

Either new drugs, compounds of drugs, metabolites of known drugs and so on will always be seen as time progresses.

There are many drugs that have been around for a long time that the FDA has not approved for certain uses, even though many know that these drugs are much better than the drug(s) currently being used. A lot of this boils down to the fact that the huge pharmaceutical companies try to stop the approval of new drugs because it will hit them in the pocet book. Just to file for an approval of a new drug, the company must submit a $1,000,000.00 few for the drug to even get to the review process by the FDA.

For now, people have to accept the fact that what is available (approved) now to us for certain ailments is better than what we had only a very few years ago.


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