Suboxone Talk Zone and SuboxForum

Suboxone Talk Zone

Subox Forum

Anyone who follows the news knows of the epidemic of overdose deaths, particularly across the heartland of the United States.  First, oxycodone and Oxycontin were used more and more regularly for treating chronic pain, to a large extent fueled by warnings from Federal health agencies, in the 1990’s, that pain was ‘undertreated.’  After a steep rise in diversion of oxycodone and other pain medications, the Feds instituted ‘REMS’; the requirement that all medications, including opioids, must have a ‘mitigation strategy’ to reduce the dangers associated with use or misuse of the medication.

In response to the requirement for REMS, Purdue changed the formulation of Oxycontin to a non-crushable product.  Addicts who were snorting crushed Oxycontin (oxycodone) turned to heroin… which just happened to be flooding the country from Afghanistan, since the Taliban was no longer preventing growth of poppies there.  Unforeseen was the tendency of heroin users to inject, rather than snort the medication.  Oxycodone was absorbed rapidly across the nasal membranes, decreasing the ‘value’ of intravenous use.  But heroin is absorbed more slowly, and oxycodone-users seeking the same effect with heroin found that only intravenous use provided the same rapid onset.

Heroin is not held to the same standard of consistency as pharmaceutical medications.  There is no equivalent of the FDA, making sure that a milligram of heroin is a milligram of heroin, and not a half-milligram of baking soda or another adulterant.  Use of any opioid causes significant respiratory depression, and use of an unknown quantity of an opioid is a recipe for disaster!

Residential treatment has been the standard of care for addiction for decades.  Unfortunately, the relapse rate after residential treatment is over 90%, particulary among younger patients.  The sad fact, for those willing to see it, is that we had not had an effective treatment for opioid dependence… until about ten years ago, when a drug called Suboxone was approved by the FDA for treating opioid dependence.

Suboxone will sustain remission when taken appropriately, and studies show that about half of patients who take the medication stay away from other opioids for at least a year.  Suboxone consists, essentially, of a chemical called buprenorphine, which acts as a ‘partial agonist’ at the opioid receptor.  Patients taking Suboxone become tolerant to those effects, and feel no euphoria or sedation once used to the medication.

Some people argue that those taking Suboxone are not completely ‘sober’, since they are taking a substance with actions at the opioid receptor.  I get their point… but I recognize that many young people are dying, and Suboxone will save about half of those who otherwise would die– which amounts to tens of thousands of people.  I also know that people on Suboxone look and ‘feel’ as normal as anyone else– and making arguments against the use of Suboxone make little sense, given that we treat many other, less fatal chronic illnesses, using medications with many more risks and side effects.

By law, physicians who wish to treat opioid-addicted patients using buprenorphine or Suboxone require special certification from the DEA, after taking a short course.  After certification, a physican can treat up to 30 patients at one time.  After one year a physician can ask the DEA to increase that limit to 100 patients.

I became Suboxone ‘certified’ through a process that takes a day or two, but that for whatever reason, most physicians do not complete. As of late 2012, there are only about 5000 doctors in the US who can each have up to 100 patients on Suboxone. That number has decreased in the past couple years.

I write about the shortage of physicians, the occasionally-crappy behavior of the pharmaceutical company that patented and manufactures Suboxone, the side effects and risks of buprenorphine, and various issues related to addiction on my blog, Suboxone Talk Zone. I invite you to meet me there. I also started a forum called SuboxForum, where almost 10,000 people have registered, anonymously and without charge, so that they can discuss the same issues.

These web sites are intended to provide information, but not to diagnose, cure, or treat a specific patient. Anyone with health issues related to addiction or Suboxone should consult with his/her own physician, as I cannot fill that role. Please remember that opioid depenence is a chronic, highly-lethal illness that has killed many thousands of people over the past ten years– none of whom expected to be the next to die. I hope you will join us!

10 thoughts on “Suboxone Talk Zone and SuboxForum

  1. I live i tenn. Im having a hard time finding a doctor that wont rip me off. There so expesive. Plus the prescriptions are expesive. Do you have any advice?

    • The ultimate solution would come from increased competition among doctors… but unfortunately, more doctors are leaving the addiction business than entering it. I realize a couple hundred dollars sounds like a lot for a visit, but the doctors who go into orthopedics or ENT charge over 5 grand for an surgery that takes the same amount of the doc’s time— and regardless of specialty, both docs have a couple hundred thousand dollars in loans to pay back. My advice is that if you are able to find a doc who is willing to provide long-term treatment with buprenorphine, do what you can to keep the relationship going– as the trend in numbers of docs prescribing buprenorphine is downward, not upward.

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    • I have been using OxyContin and narcos for about 2 years, I’m totally addicted and want to get clean, Is it possible to get a prescription for Suboxone, without having to go to a Detox facility ?

      • You’ve probably heard this by now, but legally no. The only drugs that are even ALLOWED to be used to prevent withdrawal, and “maintain” narcotics addicts are Methadone and Suboxone. Methadone is dispensed in “clinics”, where you have to go DAILY for months. The line is a great place for making contacts to “score”. I hated it, but is seemed the lesser of other evils.

        Suboxone can be prescribed by a doctor who goes through some special, “training”. Methadone is used “sparingly” in 3 week detox programs, to ease withdrawal. I don’t know whether Suboxone is, it is intended more for maintanance, than for detox.

        After a length of time on Suboxone, you’ll find that quitting is probably harder than quitting your Oxycodone. And it doesn’t even get you high. If you REALLY want to get clean, and most people fail multiple times — some succeed so stay positive, is to taper your OxyContin dose, and if done gradually, and without cheating you’ll get off. WAY easier said than done. There is just so much temptation. If you go the legal Suboxone route, I’d resist getting to the initial dose they want you on. I think it tends to be overkill. All you want is your withdrawal to be gone. Then use it to buy yourself some time to “legally taper”. My Methadone clinic offered it — at $175/week! Vs $99/week for Methadone — which costs almost nothing. This is a very profitable business. AND at the Methadone clinic, you still have to go everyday, and take the medication under observation. You CAN’T taper. Federal and usually stricter state regulations. It’s a crock. But individual doctors have much more latitude and would probably go for a quick taper. They’d probably warn you against, it because it usually results in being right back I’m thebOxycontin where you started. AND, while I hope this isn’t generally the case, their is a financial incentive for you to keep asking it.

        In the Methadone clinic I NEVER heard the subject of tapering off EVER brought up by the staff. Maybe for a good reason (meaning not koney for the clinic. If it’s not a very motivated patient’s idea, he’ll probably end up being a “repeat customer” (LOL but it’s not funny), or worse.

        Good luck.

      • It is difficult to separate placebo effects from real effects… but studies have shown, quite clearly, that the withdrawal after stopping a partial agonist like buprenorphine is much less severe than after stopping an agonist like oxycodone. No doubt on that issue.

        One reason there are so few doctors prescribing buprenorphine is because treating opioid addicts with Suboxone is NOT a road to riches– particularly compared to other areas of medicine. Doctors usually come out of med school owing over $200,000 for med school tuition– plus whatever they borrowed for college. Dermatologists charge $800 to spend 10 minutes removing a mole; orthopedists charge $20,000 for the 40 minutes it takes to replace a torn ACL. Buprenorphine docs typically charge $200 or less for an appointment, and see 2-4 people per hour… which is a lot of money, until you subtract the loans, the malpractice costs, and the cost of maintaining a practice. Doctors make a good salary, no doubt– but they invest a lot of money and time to get in that position… and treating addiction is not the best way to get out of debt.

        If you think your doc is keeping you on Suboxone to make money, you are simply misguided. The way to make money off Suboxone, if that is a doc’s goal, would be to ‘churn’ as many patients as possible– offering short-term buprenorphine for detox, and encouraging people to stop the medication as soon as possible. You really should count yourself lucky if your doc allows you to take it for the long term.

  3. I am a mother of a 20 yo son who has suffered with addiction for many years… He would like me to pay for a Suboxone program.. He is supposedly clean at the moment, but states that he won’t be for long and we will be dead or in jail if I do not do this for him. Financially I can’t see me being able to do this. Our insurance will only cover a program that is an hour away. I feel like he is manipulating me… I have no trust. I wake up every morning to the same thing. He has been in rehab 3 or 4 times. Jail twice. I need to know what is a loving mother to do???

  4. Im looking for info/ help on the effects of sub during pregnancy. I’m 15 weeks in.have not yet seen a doctor. Have been on opioids for 5 or 6 years now. I have been tapering off the sub and was almost off of it completely. Just want to know how to approach my doctor about it or if they can call cps so early on. Whats the potential for w/d on a new born does does my dose make a difference can I breast feed

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