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 Post subject: Two tears for Suboxone
PostPosted: Wed Dec 09, 2015 9:19 pm 
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Here's a fantastic article written by an NA OCM (Older Cleaner Member) about how Suboxone treatment is viewed within the 12-step fellowships.

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Two Tears for Suboxone
By MICHAEL CLUNE


Why is the addiction-recovery world so adamantly against a pill that helps users kick heroin?

Imagine you’ve been diagnosed with a fatal disease and you have two options for treatment. In the first option the doctor directs you to an Institution where the staff speak in metaphors. You spend a month in the Institution learning that your disease is like a tree planted in your brain. That thought you just had? A leaf of the tree of your disease. The people in the Institution teach you how to use mysterious spiritual powers to destroy the root of your disease. It works like this:

RECALL those moments scattered through your life when something or someone parted the fabric of your thoughts and you saw serene waveless ocean and knew nothing bad could ever happen.

PERFORM certain activities that draw this serene waveless ocean up through your gestures and into your instincts to rain down through your thoughts and drown the root of the tree of your disease.

ATTEND meetings where you repeat the long version of these steps holding hands with a group of others.

That’s the first option for treating your fatal disease. In the second option the doctor gives you a prescription for Suboxone pills and tells you to take them as directed.

Which method would you choose? I should say, in case it isn’t obvious, that method two is much more effective than method one. I chose method one.

I recovered from my addiction to heroin using the traditional recovery program based on the 12 steps of Alcoholics Anonymous, subsequently adapted by Narcotics Anonymous. Broke, demented, and suicidal, I was arrested and charged with felony possession of heroin on New Year’s Eve 2001. The judge suspended my sentence, in part because I agreed to participate in 12-step recovery meetings.

I entered a 28-day treatment center where they explained to me that the steps are intended to induce a spiritual awakening that will dissolve my desire to get high. Because spiritual awakenings are famous for disappearing from day to day or even from one minute to the next, the steps—and attendance at 12-step meetings—are designed to make that spiritual awakening a permanent, renewable, and routine feature of everyday life.

My awakening came after about two weeks in the center. It was weird. I went out for a walk by myself and saw an old chair abandoned in the middle of a field. The moment I saw the empty chair I suddenly knew that my thoughts were hollow. Then my thoughts were gone and the sun was coming up inside the landscape. Inside the old chair. Inside each withered blade of grass.

I walked back to the center and told my therapist, and he nodded and wrote something down on a form on his clipboard.

What happened in the field? I don’t know. As far as religion goes, I’ve always been somewhere between atheist and agnostic. Before I left the center I asked my therapist what he thought was behind these spiritual awakenings. He said it didn’t really matter.

When I got out of the treatment center I made a list of things to do every day—meditate, go to an NA meeting, exercise, keep a journal, and do something good for someone else. It worked. I haven’t used heroin, or alcohol or pot, or any other intoxicating chemical for more than 12 years. I even quit smoking a decade ago. I’m healthy and emotionally stable. I have a good job. I live in a nice neighborhood with people who smile when they see me. Their smiles are real. They don’t expect me in their house at two a.m. with a rope and a mask.

Method one worked for me. Until recently I had a sense that it could work for you too.

Now my sense of things has changed.

***

I’ve worked with addicts in various volunteer capacities since I had six months clean. For one reason or another, most of the people I worked closely with when I lived in Michigan and Florida weren’t heroin addicts. Alcohol was their drug of choice. Or pot. Or Xanax or something. The AA method works the same whatever the drug, so I didn’t think about this too much. Sometimes the addicts I worked with relapsed, but sometimes they came back.

Then I moved to Ohio, and a strange thing started to happen. Nearly all the younger people I met in recovery, all the guys who asked me to sponsor them in the program, were heroin addicts. Gradually I learned that Northeast Ohio was in the midst of a “heroin epidemic,” partly due to Vicodin or Percocet addicts turning to dope for a cheaper alternative.

Area NA meetings filled up with heroin addicts. They couldn’t stay clean. It was as if each meeting was divided into two sections. The smaller group was made up of us old-timers, people who had been coming to meetings for years. The larger group contained newcomers, a shifting mass of new faces every week.

And even though the meetings were teeming, they felt tiny, since there were only a handful of people you’d see more than a few times. After a while a newcomer’s face began to seem insubstantial. It lacked permanence. Sometimes, we old-timers would find ourselves speaking THE FAMILIAR PLATITUDES to each other through a newcomer.

The newcomers were disappearing. They died by the score. We handed out phone numbers, books, hugs. They vanished. Just a few of the hundreds of guys I gave my phone number to came back. When I asked myself what makes them different, the answer, though it appears obvious in retrospect, surprised me. Most of them were taking suboxone.

Suboxone is the successor to methadone in what’s known in the world of addiction medicine as Medication Assisted Therapy. It’s a hybrid, made up of buprenorphine, an opiate that effectively eliminates cravings and withdrawal symptoms, and naloxone, which blocks the effects of any other opiate, to discourage addicts from slipping.

As a treatment for opiate addiction, methadone has some major drawbacks. One of them is that methadone is generally distributed through government approved clinics, often requiring addicts to come to the clinic on a daily basis to get their supply. Since there aren’t many clinics, addicts typically must travel significant distances each day, interfering with their efforts to operate as normal members of society.

Suboxone, on the other hand, is usually prescribed by doctors on a monthly basis. It’s dispensed at doses that don’t produce a high and that don’t impair physical or mental functioning — in that it seems similar to the antidepressants often prescribed in traditional, abstinence-based recovery.

Jason Jerry, a doctor who practices addiction medicine at the Cleveland Clinic, told me that the evidence for the superiority of medication-assisted therapy, using drugs like suboxone, over abstinence-based recovery is overwhelming. According to a recent study, opiate addicts who use the method I used have an 86% chance of relapsing within two months. Studies of addicts treated with Suboxone, on the other hand, show three month retention rates of 52% to 79%. In an especially striking statistic, 38% of addicts receiving suboxone remain in recovery after five years. Heroin addicts on suboxone cut their risk of death by overdose even more dramatically when compared with traditional recovery methods.

You’d think that anything that can help save a heroin addict’s life would be seen as a good thing, especially among recovering addicts themselves. So why, then, when I touted suboxone at an NA meeting with a bunch of regulars did they look at me as if I’d gone insane?

The problem is that many of the regulars at NA meetings don’t believe that you can be clean if you’re taking suboxone. NA even has a policy stating that people on medication-assisted therapy can’t speak at meetings and can’t describe themselves at meetings as clean.

When I talk to a newcomer who’s trying to kick dope, I recommend that they speak to their doctor about suboxone, but my new approach has earned me only scorn at meetings.

“That’s like telling someone that smoking crack will get their mind off booze,” one said.

“And it will,” said another.

“But that’s not recovery,” said the first guy. “Recovery is total abstinence from all mood-altering drugs. Just like it says in our literature.”

“But,” I protested. “Lots of us take antidepressants. That’s a mood-altering drug. And yet we say we’re clean.”

“Zoloft isn’t crack,” he replied.

“Mike,” one asked quietly. “How did you get clean?”

“That’s not the point,” I said. “We’re not talking about me.”

“Your recovery is based on a spiritual awakening,” he said. “And you are trying to deny that awakening to these addicts. You are trying to prevent them from getting what you have!”

The attitude expressed by my NA friends that night drives the medical community nuts. The doctors stand around in shock and ask themselves: Don’t these people get it? The abstinence-based method just doesn’t work that well. We have decades of data. It’s not so different from a Christian Scientist refusing to let a child with an infection take penicillin.

But I also have to admit that I know how the folks who yelled at me feel. The old-timers at meetings, they know the old method doesn’t work so well. They’re not stupid. It fails, time after time. They’ve seen it fail for years, for decades. Of course it fails! It’s a completely bizarre contraption with an enigma for an engine and pure mystery for gas. The fact that it fails isn’t amazing at all. What’s amazing is that it sometimes works.margin-ad-left

People sometimes compare going to NA meetings to a diabetic taking her insulin. But NA isn’t like insulin. Diabetics who benefit from insulin are grateful, but they’re not amazed. The addicts who’ve recovered through the abstinence method are amazed.

Still, I’m committed to supporting addicts who choose to take suboxone. I’ll keep fighting for their right to participate as equals in the recovery community.

But imagine that an old man gives you an empty bottle, and tells you that when you rub it a genie will appear to grant your deepest wish. And imagine you discover that in fact the genie appears only once every ten times you rub it. Would you return the bottle? I doubt it.

Of course, if your friend got hit by a car and lay bleeding on the pavement, you’d probably call 911 before trying the spirit. That’d be right thing to do. You don’t want him bleeding out while you’re patiently rubbing a bottle. Call the doctors. That’s what I would do. And when the ambulance comes and fixes your friend up, you wouldn’t feel sorry for him because he wasn’t healed by a mysterious spirit. Would you?

Okay, maybe you’d feel a little sorry for him. You wouldn’t cry though. Or if you did, you wouldn’t cry much. Two tears, maybe.


http://thenewinquiry.com/essays/two-tears-for-suboxone/


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PostPosted: Wed Dec 09, 2015 11:12 pm 
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Well I know what Ill be reading to the next Bupe Group of Recovery meeting sat night.

Thanks for posting this TJ.. Where ever did you find this? ..ha.

Maybe the tide will turn someday? May take some rewording of the Basic Text, and who will stand for that?. Idk..

Some here who know me a tad know of my plight with my old na buds, but this guys letter really spells it out clearly, at least to me. Ivd had this talk with others. Sometimes it was like talking tova brick wall,but not always..

Good people there, but for subbers. ...?

Razor


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PostPosted: Thu Dec 10, 2015 2:46 pm 
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Razor- first wanted to say thanks to you as well. I posted the other day (hadn't in a long while, so forgot who all the mods were and I thanked them for their contributions to this site). You all make an effort to reply to every post, and when other members (including myself) do not comment, all the mods (as far as I can tell), always welcome people, and try to share uplifting info/replies.

This was a great read, back in 2009, when I went to a 30 day rehab for the first time, I embraced the 12 steps, b/c there was nothing else, and I was in such bad shape, I'd do anything to get clean. I had some short term success, but continued to relapse constantly, until I went on Suboxone, and then I got my life back together. I do miss the meetings (the good ones), and I even went to a couple after being on subs. I never revealed that I was taking anything, because I don't think it's anyone's business; I mean not everyone shares that they're taking mood stabilizers or anti-depressants, so why tell anyone what my medical issues are. I saw how a lot of "old-timers" looked down on the "subbers", and some even had contempt for those alcoholics on antibuse (sp?).

I stopped going, b/c I was like WTF, you all say we have this common disease, but you only want to help, if you do it the 12-step only way. Some will say, think of your disease like cancer, or diabetes, and the 12 steps are like insulin or chemo...only they're NOT the same. If someone gave a cancer patient, or a diabetic a pill to put their disease in remission everyday, he/she would be an idiot not to take the medication. I think the Big Book is great, and I like the concept of the 12 steps, b/c we all need to work on the issues that contribute to wanting to use, but I hope down the line, that MAT will become more accepted, and people will get over their egos, and realize that lives are being saved by bupe products.


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PostPosted: Thu Dec 10, 2015 3:21 pm 
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I loved reading that!! Thank u TJ for posting this, I especially loved the part he referenced the penicillin curing the infection but ppl didn't believe in medicine....that's perfect! Like u razor, I'm definitely going to be reading this in my next sub meeting because it's perfect.

Like u Todd, I also went to an inpatient rehab that was 12 step based and I tried so very hard to latch onto that. I lasted almost six months of pure misery with cravings and depression and I relapsed. It does work for some, absolutely, but it didn't me and I really tried.

Great post!!!

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Jennifer


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PostPosted: Thu Dec 10, 2015 10:26 pm 
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absolutely yes-- thanks, TJ, for the post.

I am noticing that despite the truth, despite reality, and despite what we all know, the tide is turning against buprenorphine and Suboxone. This would not be the first time that ignorance won out. There are many examples throughout history when the same thing happened.

I see more and more articles where the writer gets the buprenorphine story wrong, and nobody takes the time to set things straight. Just today I read an article about opioid dependence that included the comment that 'addicts use Suboxone to get high'. Of course when I ask people addicted to opioids, 'have you ever gotten high from buprenorphine meds?' I always hear the same answer: 'I have no idea how people get high from it.' But the story, that a medication used to treat addiction can make people high, is too interesting for reporters to challenge. So the story lives on.... and the politicians and policy-makers believe that story.

I hope to retire within 10 years-- or at least reach a point where I can afford to let go of the things that really irritate me. I assume that my passion about buprenorphine, and about the treatment of opioid dependence, has at least some connection to the way I make my living. At least I hope that's the case-- because I don't want to waste the last third of my life fretting about the decisions made by politicians!! I keep hoping that there will be a groundswell of intelligent support for buprenorphine... the voice of the truth, that all of the beautiful, expensive rehab centers out there do little to reduce addiction to opioids or deaths from opioid overdose. The good news is that simply recognizing the chronic, relapsing nature of opioid dependence would probably lead to increased use of a medication that effectively treats the condition. The bad news is that too many people make money off programs that don't work.

Earlier today I responded to the article that included the quote about buprenorphine. I encourage EVERYONE who knows the truth to challenge the people who have it wrong, but who have a platform to spew their ignorance. Most articles on the web have a 'comments' section-- and if people would set things straight, the truth would have a chance to win out. But if everyone just assumes someone else will do it, the record will never be corrected. I encourage people to comment about your experiences, and tell the truth about the actions of buprenorphine. If you aren't ready to go public, set up an anonymous Google profile and use that for your comments. More and more states are stepping in to limit buprenorphine treatment, creating more and more regulations that only discourage doctors from getting the waiver to prescribe buprenorphine. Those regulations will be prevented if enough people share their stories.


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PostPosted: Fri Dec 11, 2015 11:34 pm 
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I wouldn't despair too much about the state of the affairs. There's always been a push-pull between the abstinence lobby and the harm reduction approaches to recovery. And it'll keep happening. Medicines like Suboxone and methadone have evidence on its side, and with this Obamacare stuff going on a lot of the old established abstinence fellowships have been brought into question. Hazelden Betty Ford have even had to put up a statement defending 12-step fellowships ( https://www.hazelden.org/web/public/vcsum0research.page ) because they're under that much fire from the medical community. From what I gather it's a pretty interesting time in the old abstinence vs harm reduction world.

If you ask me, there wouldn't need to be these battlelines drawn if the abstinence lobby and 12-step fellowships just practiced the spiritual principle of open-mindedness a little more when it comes to the benefits of Suboxone, medicine, evidence and science.

There's a book out by Dr. Lance Dodes that debunks the bad science behind abstinence fellowships and the rehab industry called The Sober Truth. I've got it on order. There's also a documentary released called The 13th Step that details the predatory behaviour of some members in the room, but also goes into the general lack of science.

I recently wrote into my local newspaper (The Age) after they published this article by one of their journalists who is also an NA member: http://www.theage.com.au/national/icecold-withdrawal-or-slow-release-20150731-gioxxd.html

This was my response:

Quote:
Chloe Booker's article, while highlighting the division between harm reduction and abstinence models for addiction recovery, failed to provide balance in those she chose to interview on the topic. She didn't interview one person on pharmacotherapy, neglecting those who are leading healthy, fulfilling lives on Suboxone or methadone, instead favoring the perspectives of those who have chosen the quasi-religious Narcotics Anonymous program of recovery.

I've spent a total of 4 years clean off heroin thanks to Suboxone maintenance. I am not, in the words of David Best, "living in zombie land". I'm working and studying full time, live in my own flat, in a fulfilling loving and clean relationship, have traveled the world and have ceased receiving any government benefits in this time. This is from a person who was, at his worst, a homeless thief and daily injecting heroin addict.

I tried for 6 years to get recovery in the abstinence based Narcotics Anonymous. Those years saw me experience some of the most spectacular, life threatening relapses into addiction I've experienced. Any time I had clean off heroin was largely wasted, as I was advised by my mentors not to work, study, or pursue relationships, and that I should stay on government benefits so I could attend as many NA meetings as possible. I came away from many of those meetings feeling like a fraud because I simply refused the belief in a deity or "higher power" was needed for me to achieve recovery.

Those 6 years clearly proved I wasn't one of the lucky, slim minority who can achieve total abstinence. But in that time nobody in NA pulled me aside and said "maybe this isn't working for you" or "maybe you should try something else". Many die trying to achieve total abstinence. There are people in the rooms of NA who have been trying to achieve abstinence for decades, living in and out of long-term rehab facilities and failing to get on with their lives in that time. Because 12-step fellowships work on the false premise they have a monopoly on recovery, most people under their spell aren't even aware there are viable alternatives.

I feel the voice of those for whom total-abstinence didn't work, and those of us on pharmacotherapies like Suboxone, naltrexone, Campral and methadone, aren't being heard in this debate. Many of us are clean off drugs, working, tax-paying, integrated and healthy members of society. And given our vast numbers, perhaps we should have a voice.


As you can see I'm quite passionate about this stuff.


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PostPosted: Sat Dec 12, 2015 12:21 am 
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TJ, if anyone has been though it all, it is you. I see and understand where you are coming from.
I won't get into all Ive learned and know from my experiences with NA and sub treatment but I find it impossible to do both wholeheartedly. ..Ill leave it at that tonight..great post.

And The Sober Truth?, read it last year. My guess is you ll see yourself in thoses pages. I know I did at times...



Razor


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PostPosted: Sun Dec 13, 2015 4:21 pm 
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I'm far from an apologist for AA/NA, but after reading this thread I bought and read a copy of "The Sober Truth" and was VERY disappointed. I own Dodes' other book, "The Heart of Addiction" and am open to his (or anyone's) criticisms of AA.

I agreed with the first chapters about the low success rates of both AA/NA and 12-step based treatment centers, and the inappropriateness of court ordering people to a quasi religious program. But a lot of the rest was over the top. His stories from ten people's experience of AA were the worst of the worst...people being yelled at, humiliated, preyed upon, called "Prozac babies" and worst of all, a woman making an amends at the grave of her childhood sexual molester. C'mon. I've witnessed some messed up things in the rooms, but these were just one sided horror stories.

And his condescending dismissal of othe scientists was stunning. This is what he said about neuroscientists:
"The research is inevitably conducted by biologists who have little or no training in the psychology of human addiction. This is not to say they aren’t competent scientists. We become experts in the things we do; these researchers are without question the world’s foremost experts on the study of rat brains."

After spending most of the book pointing out that studies on AA and other current treatment are statistically flawed, he posits HIS solution, psychotherapy, and offers no evidence that it's outcome is better than AA, which I doubt it is.

Oh, and he didn't even mention buprenorphine once. I know you guys weren't looking for a book review. But I had hoped to use the book as a resource for one of my final papers for school, and now I'm just pissed I spent $12.99.


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PostPosted: Sun Dec 13, 2015 4:42 pm 
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Well im surensome do better than others in those rooms. I was disappointed also that there wasn't a mention of Buprenorphine too.

That fact is you get what you put into these programs. It is the Fellowshiping that can bring an addict up, or down. Bupers have a hard time. ..

Two books I think are worth a read, Johann Hari s "Chasing the Scream", quite a history lesson there, and Sam Quinone s ""Dreamland".


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