Opioid Addiction: Why Don’t More Rehabs Use Suboxone?

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People frequently seek my help in finding an addiction treatment facility for themselves or a loved one. And just recently, a family sought my assistance in locating residential treatment for their opioid-addicted young adult son. One facility after another told me they don’t use or recommend “maintenance” use of buprenorphine – which most people know as Suboxone – aside from using it during detox, to make withdrawal a more comfortable experience.

Yet many research studies show that maintenance or long-term use of Suboxone (prescribed by specially certified physicians) or methadone (dispensed by special clinics that must be visited daily) not only helps individuals remain free from addiction to such opioids as prescription painkillers and heroin, it lowers death rates and prevents complications of addiction such as infections. The National Institute on Drug Abuse provides background information on these medications and how they work, as does the Substance Abuse and Mental Health Administration (SAMHSA).

Here are some of the responses I received from representatives of the rehabs I recently queried about whether they use or recommend Suboxone past the detox phase of treatment:

  • “Short answer, no. Suboxone is a temporary solution for a permanent problem.”
  • “You can get strung out on Suboxone as badly as on heroin.”
  • “Oh no, absolutely not. We do not discharge them on Suboxone.” When I mentioned that the scientific literature reports that people do better on maintenance Suboxone than not, I was told, “The scientific literature is false. I’ve been doing this for 20 years.”
  • “We’re abstinence-based. Our success is getting to the underlying issues and we can’t get to those when they’re under the influence of a narcotic or other medications.”

Technically, Suboxone and methadone are opioid medications, and opioids are sometimes called narcotics. (Suboxone is a combination of buprenorphine and the medication, naloxone, which is added to decrease its potential for misuse.) Both block cravings and drug seeking – they do not produce a high or impair functioning when properly prescribed.

The notion that these are ‘narcotics’ that prevent people from doing intensive therapy when used properly is ridiculous; the converse is true.-Dr. Mark Willenbring

If someone treated with them uses an opioid such as heroin, the euphoric effects are usually dampened or suppressed. “The notion that these are ‘narcotics’ that prevent people from doing intensive therapy when used properly is ridiculous; the converse is true.” says Mark Willenbring, M.D., founder and CEO of Alltyr treatment clinic and former Director of the Division of Treatment and Recovery Research of the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health (NIH). To achieve stable recovery, some people need to stay on these medications for long periods of time, sometimes indefinitely.

Another less commonly used medication for maintenance treatment is naltrexone, available in pill-form or as an extended-release monthly injection marketed as Vivitrol. Naltrexone blocks the opioid receptors and prevents any effect of opioid drugs such as heroin or prescription opioids.

Why the Resistance to Suboxone?

Andrew J. SaxonAddiction psychiatrist Andrex Saxon, M.D.’s credentials in the area of opioid use disorder treatment include dozens of peer-reviewed studies and book chapters. He sits on the editorial boards of the journals, Drug and Alcohol Dependence and General Hospital Psychiatry. His current research work is supported by the VA, the Department of Defense, and the National Institute on Drug Abuse and involves pharmacotherapies and psychotherapies for alcohol, opioid, cocaine, and tobacco use disorders as well work in co-occurrence of substance use disorders and PTSD.

I posed this question and many more to the University of Washington’s Andrew J. Saxon, M.D., an addiction psychiatrist with decades of clinical, research, and training experience in the area of opioid use disorders. When I told him about my difficulties with trying to find a rehab that supported Suboxone maintenance treatment, he said, “I get so frustrated with these inpatient programs that are wasting people’s time and money and exposing them to risk of overdose.”

He was referring to the fact that patients who get discharged without being placed on Suboxone or referred to Suboxone prescribers or methadone clinics are highly likely to experience drug cravings, then use again. They risk overdose because if they return to their pre-treatment levels of drug use after being abstinent in rehab, their bodies won’t be able to handle drug levels that high.

Following are Dr. Saxon’s responses to my questions about the resistance to maintenance use of Suboxone:

  • Why do you think so many treatment providers continue to be so resistant to Suboxone (and methadone) maintenance treatment of opioid use disorders?

Dr. Saxon: Of course it is only speculation, but one obvious answer is that residential/inpatient programs have a financial incentive to detox people and tell them that recovery without medication-assisted treatment is better. If a patient is choosing to go on methadone or Suboxone, inpatient treatment is unnecessary in the vast majority of cases. Also, many of the staff in these programs are recovering from alcohol use disorders (AUDs). They simply do not understand that opioid use disorders (OUDs) are substantially different, though of course there are some commonalities.

Another reason for resistance is fear of Suboxone “diversion” – when it’s abused or not used as prescribed or given or sold to other people. Studies suggest that most diversion occurs when people addicted to opioids are trying to get off them and don’t have medical access to Suboxone. It is very rare in the U.S. for people to use Subxone in an attempt to get high.

  • How are OUDs substantially different than AUDs?

Dr. Saxon: Opioids affect the brain (and the body—because we have opioid receptors on our smooth muscle and our gut) differently than alcohol. So the substance effects, the intoxication, the withdrawal and the ultimate changes that occur long term in brain and body after years of exposure are bound to be different. Fully explicating the differences on a cellular or molecular level is probably a Nobel Prize-winning endeavor! But it all means that treatment needs are not just the same as for AUDs.

  • Is there any evidence that residential treatment is valuable for OUDs?

Dr. Saxon: There is no evidence that I know of for the standard 28-day programs, and we do know that risk of overdose is high after leaving one of those programs if patients are not continued on Suboxone or methadone. There is evidence for therapeutic communities – residential facilities where patients stay six months or longer. Of course, such programs are few and far between.

  • The CEO (also an addiction psychiatrist) of a company that owns a group of prominent rehabs directed me to a large Australian study, pointing out that one-year outcomes showed that medication maintenance treatment and residential treatment were equally effective. Why do we seldom hear about this study?

Dr. Saxon: One cannot generalize from Australia to the U.S. – they have a very different health care system than we do. Also, there were multiple problems with the study design – for instance, it was not randomized, and the researchers don’t even report if there were baseline differences between the groups. And all outcome data were based totally on self-report so we have no objective findings.

  • It’s often stressed that whenever maintenance medications are prescribed for OUDs, counseling is also important. But haven’t a number of recent studies shown that counseling confers no added benefit to the medication alone?

Dr. Saxon: Such studies relate specifically to office-based treatment with Suboxone and not to methadone maintenance. The findings are consistent in showing that outcomes were not improved when either drug counseling or cognitive-behavioral therapy were added to use of Suboxone and medical management alone. So in early treatment, it is the medication (Suboxone) that is causing the majority of change. Keep in mind that these studies only look at patients in the first several months of treatment, so we really don’t know the effects of behavioral interventions later on.

Moreover, it’s important to realize that the physicians prescribing the medication in these studies received training on how to do gold standard medical management which includes important behavioral components. So the real message is that if you have a caring and competent physician prescribing buprenorphine who asks the right questions and makes the needed suggestions, adding on more behavioral interventions may not make a huge difference. All physicians out in practice may not have these skills, though they are not difficult to learn. In methadone treatment it is pretty clear that the medication plus standard drug counseling is better than simply giving medication alone.

  • What if people with OUDs have co-occurring psychiatric problems? I would think this is a big exception to the “no counseling benefit” finding, one that impacts many individuals.

Dr. Saxon: Very good point, and we don’t fully know the answer because individuals with severe psychiatric disorders are mostly screened out of such studies (many in the studies might have mild to moderate psych disorders.) However, patients with psychiatric disorders need psychotherapy and/or pharmacotherapy directed at their psychiatric disorders, not more behavioral interventions that address their addiction per se.

  • Some rehabs prefer Vivitrol to Suboxone, arguing that “head-to-head,” they are equally effective. Is this true?

Dr. Saxon: Actually, there is far more evidence supporting the efficacy of Suboxone (and methadone) than injectable naltrexone or (Vivitrol). Only one clinical trial done in Russia (which does not permit Suboxone or methadone) supports injectable naltrexone, and that’s the one on which the Food and Drug made its decision to approve Vivitrol for OUDs. Right now, an ongoing study funded by the National Drug Abuse Treatment Clinical Trials Network is comparing the effectiveness of Suboxone versus Vivitrol for OUDs. Using naltrexone does require withdrawal off opioids for about a week before starting it, so it is more complicated in that way than using the other maintenance medications. However, if someone can make it through the withdrawal and wants to try Vivitrol, I wouldn’t have any qualms about it but would monitor the person carefully and be quick to switch to Suboxone if the person isn’t doing well. (The risk of overdose may be higher with naltrexone than with Suboxone or methadone if clients drop out or stop medications, but it’s a risk with any of the medications, and all patients should be warned.)

  • The CEO of the rehabs defended not using Suboxone at their “abstinence-based facilities,” by saying that their patients will be going to AA and NA in the community and that 12-step programs don’t see Suboxone and methadone users as abstinent, even though the medical world does. He said, “We don’t control how the recovery community sees the world. So our big focus has been on Vivitrol.”

Dr. Saxon: So their reasoning is that the AA groups are not following the actual precepts and stated policy of AA, which is to accept people who are on medications prescribed by physicians? And the rehab program is not doing the medically correct thing so as to make their patients fit into AA groups that are running AA incorrectly and judging people? They should be out there trying to get AA groups to practice AA the right way. However, if they can get Vivitrol to work, wonderful, I’m all for it.

  • How do costs compare between the various forms of maintenance treatment, and how likely is insurance to cover them?

Dr. Saxon: Methadone costs between $300-400 per month, which includes medication, medication dispensing, medical evaluation, counseling, and urine testing. Suboxone medication cost would be about $300-400 per month retail. Physician and counseling fees would be additional. Vivitrol is about $1000 per dose with one dose per month. Physician and counseling fees would be additional. Medicaid covers all these treatments in many states but exact coverage varies from state to state. Private insurance often covers them (variations from policy to policy, obviously), but what I hear from physicians in private practice is that it is a huge hassle to get prior authorization at times.*

*Costs for primary care treatment [initial phase] at the adult residential facilities I visited for Inside Rehab five years ago ranged from $27,000 to about $55,000 for a 28- to 30-day stay.

 

  • Finally, the rehab CEO expressed concern that with Suboxone, about 60 percent of people drop out of treatment by the end of six months, and we need to be concerned. What do you think about this?

Dr. Saxon: I agree. I will have a commentary coming out in the journal Addiction this year, which makes the very same point. We need to improve our retention rates dramatically. However, saying that one treatment is suboptimal does not mean the other treatment (rehab) is necessarily better.

Let me also just say that I am not against rehab. I have just had too many calls from families whose loved ones have gone through rehab many times and continue to use opioids. Rehab alone probably works for some, but when it doesn’t, we need to be quick to try medication.

Related Reading: The Buprenorphine Diversion Problem
Image Credits: Suboxone photo courtesy of naabt.org

The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of Rehabs.com. We do believe in healthy dialogue on all topics and we welcome the opinions of our professional contributors.

What Are Your Thoughts on this Topic?

  • http://www.memoirsofanaddictedbrain.com/ Marc Lewis

    This is an important article: it gets to some fundamental
    questions that don’t have easy answers.

    The problem with Suboxone (buprenorphine) is that you’re
    damned if you do and damned if you don’t. Yes, treatment centers ought to facilitate
    extended Suboxone treatment, for all the reasons given by Anne in this article
    and by Mark Willenbring and Andrew Saxon, whom she interviews here. But yes
    again, it’s often going to fail eventually; so there are good reasons (other
    than financial ones) for treatment centers to steer away.

    Trying to understand the difference between opioid use
    disorders (OUDs) and alcohol use disorders (AUDs) is a good place to start
    solving the Suboxone problem. Indeed, most opioid addicts (recovering or not)
    don’t use Suboxone to get high. Tolerance develops quickly, if it’s not already
    there, so there’s little “high” to be had. There are bound to be days
    when you badly want to feel that high. Those would be the days when you
    exchange your Suboxone for heroin or something similar, or else you just decide
    that Suboxone is no longer for you.

    Alcohol is exciting and fun, because it suppresses
    inhibitory brain responses that keep you on the straight and narrow. And then
    it becomes a problem: no fun anymore. Opioids are warm and fulfilling. This is
    an entirely different feeling. As a one-time opioid addict, I know about that
    feeling, but as a neuroscientist who now studies addiction, I can also suggest
    why opioid substitution therapy is often ineffective.

    The “high” provided by opiates is similar to the
    feeling of being loved. We get oodles of opioids pumped up from the middle of
    our brains when we are intimate, in love, hugging or being hugged, and these
    feeling endure when we develop strong attachment bonds (as most of us do with
    parents and/or children and/or life partners). It’s not fun, as with alcohol —
    it’s the core of feeling like a connected human being — it is like a
    protective coating that both reduces threat and promises ongoing connectedness.
    And, as mentioned by Anne, opioid receptors are everywhere from your stomach to
    your prefrontal cortex. So that feeling of safety covers many gradations
    between the physical and the mental.

    So when addicts are on opioid substitutes (or Vivitrol!) and
    they don’t get high, and they’re back in their lonely apartments, aching for
    connection and peace, the diminishment of physical craving isn’t enough. They
    want to feel that rush of warm attachment, and that’s why they trade in their Suboxone,
    or complement it with other drugs, or triple their dose…or whatever.

    Opioid addicts need to feel connected — to
    themselves and to others. That’s the real solution to opioid addiction, and
    it’s not easy to come by when you’re back in your apartment. As Anne and Dr. Saxon
    point out in this article, office-based counseling doesn’t add much to Suboxone
    therapy. You still have to go home afterward.

    • Christopher Acquaviva

      Marc,

      Excellent response and right on point in my book. I am a firm believer that while medicines may be helpful in the recovery process, I tend to feel they become a crutch for many. I would like to discuss this matter with you in more detail if you have any interest in helping me. I have a non profit Foundation here in New Jersey that I am trying to get off the ground, and could use more input from others in the field. It is my position that we need some form of treatment between rehab and recovery and I also think it has to do with the love and attachment issue you mention. It has been my experience that those in recovery who have a stable family support system tend to do much better than those without, and maybe that is what we need as the in between treatment. If you are interested in discussing this further, please feel free to review our website http://www.scarfnj.org or e-mail me at scarfnj@gmail .com. Hope to hear from you.

      • Alex Penrod

        There is a treatment center in Texas called Benchmark Recovery. They offer a year long aftercare program where a recovery coach acts as a liaison between the family and the client and monitors the clients activity in recovery for the entire year. I in no way represent this recovery center, I’m just an alumni who stayed clean and I think you would be interested in what they are doing down here. Texas is being flooded with east coast addicts right now. I see this epidemic in full force here in Austin.

        • Christopher Acquaviva

          Alex, thanks for the information, I will take a look at it.

          • http://www.memoirsofanaddictedbrain.com/ Marc Lewis

            Hi
            Christopher. I’ve somehow lost your email address, or it’s hidden or something,
            so I might as well reply to you here, publicly.

            I appreciate your invitation to join you in forming a foundation based on
            compassionate support and related ideas. In fact, I like the way you talk about
            recovery. I like that you urge people to speak up and address the enormity of
            the problem and point to the efforts being made to fight it. I like the fact
            that your organization is non-profit, and I especially value your emphasis on
            diversity in the pathways that lead to recovery for different people.

            But you refer to addiction as “a disease” quite often. This is a
            strong defintional platform — a very explicit conceptual framework — and you
            seem to take it as self-evident. In fact, you say: “When we make others
            understand this disease is like any other medical disease, we will be on the
            way to helping everyone. We just need to make everyone understand what we
            already know and feel.” But “we” don’t all know and feel that
            addiction is a disease.

            I don’t want to get into the definitional debate here. We could go on for
            pages, volumes, about whether it’s a disease, or a learning process, or a
            choice, or a this or a that. (And I do go on at length elsewhere.) But by just
            assuming that it’s an “x”, you plunk it in a cohesive, clear-cut
            category — and you make it sound like that’s the category we all have to
            endorse to join the fight.

            I hope you know that many addicts (ex, recovering, and not-so-recovering) as
            well as professionals don’t see addiction as a disease at all…and in fact
            there is a raging debate going on about just that. (See posts and articles by
            Maia Szalavitz, Stanton Peele, Sally Satel, Bruce Alexander, and the recent
            publicity about the Hari book.) In my view, there’s nothing self-evident about
            how to conceptualize addiction — hence the debate. So your eloquent appeal to
            recognize diverse approaches to recovery may fall on deaf ears — ears that
            don’t have to be deaf — at least for some of us — based on a single
            definitional brush stroke.

            I want us to give more thought to the diversity of approaches to understanding
            addiction…as well as acknowledge the diversity of ways to overcome it.

            • Christopher Acquaviva

              Marc,

              Please understand and let me be quite clear. It does not matter to me how one classifies addiction to me. From my simple understanding, people refer to it as a disease because of the way it has mental and biological effects on a person. Honestly, I am not sure how one classifies it has anything to do with how we treat it and frankly as I mentioned I don’t care. As you stated we could discuss it forever, but regardless of that discussion, it will not make those who suffer from addiction any better.

              With that said, and again to be honest, if anyone would have a ” deaf ear ” because of a definitional broad stroke, I would honestly be concerned about their true passion to help those who suffer from addiction. I would think that anyone who has taken the time to actually do enough research to have the ability to make an arguement as to the definition of addiction should also understand clearly that how we help someone who has an addiction issue is more important than how we define the term.

              I can understand from the scientific perspective how those people could get caught up in that discussion, but people like myself who only want to help those who suffer with addiction don’t care. We only want to find the best way to help. So as far as I am concerned, my gut tells me that someone who would not want to help because of a definitional term does not have enough passion to help fight for those who can’t fight for themselves with regards to getting past their addiction.

              I do this for only one reason, I want to find a way to help others. Although I am not a licensed practitioner with regards to addiction, I have been fortunate enough to take on 3 or 4 people personally and get them back on the right path. Each one has had different issues and had to be dealt with differently as far as how to keep moving forward, but in the end what was common throughout was they all needed someone to keep them on the path. My feelings are as long as their is someone willing to help keep you moving forward in the early period of recovery, chances are much better you will succeed in the long term. I just hope I am right.

              In any event, regardless of your definition of addiction ( a conversation for another day ), I would still be interested in exploring what you think about my idea’s as far as recovery. It has taken me a year to get to this point where I have finally created a clear path I think I want to follow with my foundation with regards to helping those who suffer from addiction. Now I need to follow through and get moving. Any help or feed back you can offer is appreciated.

              Regards,

              Christopher Acquaviva, Founder
              Second Chance Addiction and Recovery Foundation of NJ

              http://www.scarfnj.org
              scarfnj@gmail.com

              • http://www.memoirsofanaddictedbrain.com/ Marc Lewis

                You say “Honestly, I am not sure how one classifies it has anything to do with how we treat it…” I couldn’t agree less.

                And when you say, “my gut tells me that someone who would not want to help because of a
                definitional term does not have enough passion to help fight…” etc, it’s just plain demeaning. There’s lots of passion going around. Remember, different strokes for different folks.

              • Christopher Acquaviva

                Marc,

                I am sorry you feel that way, but again, I am not sure, regardless of the term used to classify addiction, why it would make a difference of how it can be treated. Since I am unaware of any official protocol with regards to addiction treatment, if I say it is a disease and you say it is a lack of willpower that caused someone to become addicted to a drug, why would that matter with regards to try varied approached to treatment. It makes ” no difference ” how define addiction since at that point, the person who suffers from the addiction is only looking to get help and get back on track with their lives. Do you honestly think that at that stage they are in, they are concerned with anyones definition of addiction. All they would want is help, I am sure semantics would not come into play. As and to your second comment with regards to ” passion ” again I am sorry if you feel that is demeaning, but in my book, the passion I am concerned about is that of helping the person who is suffering from addiction. Thats what you have to be passionate about. If you can be easily derailed or offended by the definition used to describe addiction, it would seem to me that your missing the point completely. In my mind, these are two totally distinct issues and one has nothing to do with the other. As I said in my previous posts, the definition of addiction is a battle of science and medicine and people who are trying to make a point that has nothing to do with how to fix the problem. I would not change my thoughts on how I would try to help someone suffering from addiction no matter how you defined it. It is really apples and oranges. All that really matters is what and how we can try to make those who have addiction issues better. It really is just that simple to someone like me that really is only concerned about getting those affected better.

      • http://www.memoirsofanaddictedbrain.com/ Marc Lewis

        Hi Christopher. This sounds really interesting. I particularly like the phrase “non-profit” and I like the ideas you are highlighting. I’ve visited your site and I’ll send you an email shortly.

        • Christopher Acquaviva

          I look forward to hearing from you Marc

  • Alex Penrod

    I think this is total drug company propaganda. There are a lot of claims that are completely false. Suboxone gets you high, period, my friends and I abused it all the time when we were out of heroin. Its main chemical, buprenorphine, is a semi synthetic opiode derivative made from thebaine, the same part of the poppy plant that makes oxycodone or OxyContin. It is categorized in the U.S. as a schedule 3 NARCOTIC. These are just facts, no opinion yet. My opinion as a recovered heroin addict who lives happily abstinent from all mind altering chemicals is that I would rather suffer the fast intense withdrawal from heroin which last about 5 days than suffer the AGONY and mental ANQUISH of suboxone withdrawal which goes on and on for weeks if you let them put you on maintenance. When you stay high and dependent on prescription dope, you’re brain is not making the neurological changes required to overcome addiction, you are still addicted, being in treatment is a waste of time if you don’t stop taking the narcotic you’re addicted to. You might as well stay home and enjoy your prescription handcuffs there. That’s why treatment centers don’t want maintenance going on in treatment. It defeats the purpose, you won’t respond, you’ll just become a spiritually healed opiode addict who depends on suboxone and probably still has the urge to drink and do other drugs. The brain will not recover if you keep feeding its drug. People just don’t have any faith in heroin addicts, they don’t believe in us and out chances so they want to just dope us up and keep us out of trouble, it doesn’t work like that, I’m living proof, heroin addicts do recover and their brains can be healed.

    • Christopher Acquaviva

      Alex, first let me congratulate you on your recovery. We seldom today hear of anyone who wants to brag about being a recovering heroin addict unless of course they are using it to make a profit. As to your main statement, to some extent you are right. Factually with regards to the drugs make up and affect, you are on point. I have also heard that many heroin users abuse Suboxone to try and get the same high as heroin. Obviously, you know that does not work in the long term and most will use it as a stop gap until they can score more heroin. With that in mind though, and my position is that treatment without medication is best, yet I also think that some medical intervention maybe helpful. Everyone is different. No treatment program should be the same for everyone, they all need to be customized to some extent. I know people who have been able to go to rehab and walk out like nothing was ever wrong, and I know those who have walked out and never survived the recovery process. This is a very slippery slope but that does not mean medicine can’t be beneficial for some. You choose the harder road and I applaud you for that, but that does not mean it is for everyone. You need to be open minded to some extent when it comes to treatment alternatives. We never know what works for the next guy. Continued success in your recovery, and if your interested in helping others, feel free to join my organization at SCARFNJ.org or our Facebook group Second Chance Addiction and Recovery Foundation of NJ

      • Alex Penrod

        I’m open with my recovery status because its my only credibility to make any judgments on a topic like this. I’m in college studying counseling theory and pharmacology but I don’t have credentials yet. In my opinion the people who have been addicted to heroin, tried suboxone, and eventually got completely clean are more qualified to talk about it than a PHD. As with anything theory and practice differs considerably. The theory of suboxone and methadone is wonderful, its harm reduction. In practice, its much uglier and rarely yeilds success. Its just another stumbling block in the way of someone completely stopping. The best thing for a heroin addict is to get separated from their substance by facing extreme consequences and going to jail or loosing everything they own or seeing all their friends die. Then its real, then its a problem. As long as people have this idea they can stay dependent on opioids and function its detrimental. Its a disservice and prevents them from having the soul shaking experience it takes to get clean. I watch it over and over in recovery and I wish I could give people my experience. A brutal awakening to new life and self empowerment.

        • Christopher Acquaviva

          Alex, again I commend your efforts. Just be sure to keep an open mind. As I said previously, what works for one does not work for all. It is important to be able to not always rely just on your experience because it worked for you. If that theory were true, we would only have one type of treatment for everything. Just be willing to accept the fact that you have been blessed and fortunate to be able to overcome your addiction. You are one of the lucky one’s, not everyone can say that. Good luck and continued success in your future endeavors.

          • Alex Penrod

            I realize I come off very aggressive on this issue. I’m in no way at odds with you as the author of the article. I’m angry at opioid addiction and I wish there was a simple solution to it. I’m tired of losing friends and not being able to give them what happened to me. I’m passionate about it to the point of obsession. Now that I’m clean its my mission to find out what would help others. Suboxone probably has its place as a tool to use medically, but its not an end game, and I want to know what would be most helpful while people are detoxing off everything. My own experience is all I have to go by. It took a tremendous change in me that couldn’t be induced with medication. Its that change, I believe, that allows people to stay clean once detoxed.

            • Christopher Acquaviva

              Alex, I understand your passion, I feel the same way. Unfortunately, we are to few in numbers like this. We need more people to understand the disease of addiction in order to make a dent in the problem. This is like breast cancer was 15 years ago. No one cared about it, but now look at the perception of it once people realized it could be dealt with. We will make headway, we just have to be patient and thoughtful with our approach. When we make others understand this disease is like any other medical disease, we will be on the way to helping everyone. We just need to make everyone understand what we already know and feel. And by the way, I did not author the article, but again, I feel your pain. :)

            • Gail

              Agree

        • Alex Penrod

          Most people just aren’t ready to stop and they’ll spend years manipulating their families, going on and off suboxone, in and out of treatment. Its the coddling behavior of the family that supports this drawn out cycle. Kick them out, don’t give them money, if they’re hardcore they’ll turn to crime and go to jail. Everyone has a different bottom. The raising the bottom approach is not very effective. The addiction will use it to continue to manipulate.

        • Gail

          Exactly!

      • Jacob

        That’s the problem. We have to RAISE our voice! link to facebook.com

        • Christopher Acquaviva

          Jacob, I assume you are in recovery, so tell me, why don’t groups like AA/NA get behind organizations like my Foundation to try and get the word out and help. I understand the stigma attached to addiction, but if no one who has been affected by the disease wants to help fix the problem, what does that say to anyone else who wants to support the issue?

          • http://www.raisaratoga.org/ Jacob Weakland

            Christopher what is your foundation?

            In my opinion, organizations such as AA/NA do not support the notion there are many pathways to recovery. As I like to say:”There’re many doors to the same room –the room being RECOVERY, not a 12 step meeting.”

            I understand the reluctance regarding the members of twelve-step meetings unwilling to share their story –It is a personal choice.

            My understanding shifts to compassion and empathy, when faced with a different point of view regarding “What works.” (There is not a cure-all treatment or meeting)

            The underlying wisdom holds true, for me, in the 12-step philosophy, although I feel many do not practice what they preach.

            We will not experience a makeshift change in this country until People become educated –truthfully– addiction and recovery. Shining a positive light on people in Recovery, showing there are people who recover. In fact, 23 million Americans are in long-term recovery–and do not attend 12-step meetings, they have recovered, but how?

            Early in my recovery I learned I had distorted thinking, although I believed my thinking to be right and rational, it was not. Because of core beliefs ingrained in my thought process I viewed my irrational thinking as rational, hence distorted thinking.

            I bring up the cognitive aspect of recovery because I believe many people — older than younger– have not accepted their thinking may be distorted.

            Bill Wilson himself sat in front of Congress and shared his story.

            He once stated he dreams of the day AA’ers lined the halls of Congress.

            There are many doors to the same room, and yes an abstinent based 12-step philosophy is one of those doors. How many people relapse or die because they were playing merry-go-round with this one and only door? What about Secular Organizations of Sobriety, Harm Reduction, Recovery 2.O, Smart recovery, Cognitive behavioral therapies along with mindfulness, yoga, meditation, third-generation cognitive therapies such as MBT and ACT. The list goes on, the point is we have to become educated, truthfully, the time to start was yesterday and we have to educate the younger generations. Honestly — for the change of tomorrow

            • Christopher Acquaviva

              Jacob,

              I could not agree with your response more, and that is my entire point. Rehab and recovery are not perfect sciences. Honestly, no one has the right answer, we all have some answer that sometimes works and sometimes does not. Regardless of that for a second, to me, what I believe to be most important now as the addiction problem continues to spiral out of control, is we need to get society to accept and understand the problem so it can be dealt with. Clearly, anyone who has been directly affected by addiction understands, but those people are limitied in what they can do for others because they have to deal with addiction issues themsleves. We need to be able to depend on everyone else to help those who suffer from addiction. The only way we can do that is to first of, educate kids on addiction, the more they know, the better chance we have of keeping them safe. Next we need to remove the stigma associated with addiction. This is no longer the poor junkie in the back alley. Today, it can control anyone, from a poor personn in the inner city to the child of the top CEO’s in the country. Addiction has no target market, it wants everyone. So what we need are more people like you who are willing to step out and let the world know your not a waste. You can be succesful and contribute to society like anyone else. We do just need to make our voices heard. If you want to know more about me or my Foundation, you can go to our website at http://www.scarfnj.org You can also go to our Facebook page at SCARFNJ or our Facebook group at Second Chance Addiction and Recovery Foundation of NJ. Feel free to friend me if you would like to contribute to our efforts. Again, I would just like to thank you and commend you for your actions. God Bless and stay steadfast to continue your journey back to a life free from addiction.

    • kennethanderson

      I am really tired of AA and NA members like Alex Penrod going around practicing medicine without a license on the internet. Methadone and buprenorphine are medications which have a proven track record of saving the lives of people with opioid dependence. This is demonstrate in article after article in the medical journals. People who graduate from12 step rehabs have a greater chance of dying of overdose than those who get no treatment at all and continue using drugs on the streets. There is zero evidence that people who go to AA or NA have recovery rates any higher than those who go it on their own. If you want your loved one who takes opiates to die, then follow Alex Penrod’s unlicensed medical advice. If you want them to live then get them to an MD who can prescribe methadone or bupe.

      • Alex Penrod

        So you’re advocating keeping opioid addicts on opioids for life? Or using it to detox? Why do you feel my experience with heroin addiction and trying suboxone for myself is not valid. Are you really naive enough to think that addiction treatment works like the theory in the textbook? My point is that if you’re going to live in prescription handcuffs and continue to stay doped up, you don’t need to be in a treatment center learning how to live a healthy life without drugs, you’re not ready for the change, you’re still dependent, go to the methadone clinic and continue to live fix to fix. If you want to change your life, then go through a medical detox, and go through some kind of transformative program, 12 step or therapy, it doesn’t matter. The point of most treatment centers is to achieve recovery, the methadone clinic is for harm reduction. And I won’t be unlicenced for long, I’m finishing my degree as we speak. Im on a mission to expose the crap that goes on in our feeble excuse for treating addictions. The addict needs a voice in this process, I’m that voice, if you’re not willing to listen, what kind of a professional are you? I could be your client.

        • kennethanderson

          Personal anecdotes are not science. How could you get into medical school if you don’t know that?

          • Alex Penrod

            I’m getting a counseling degree, not studying to be a doctor. There aren’t many medical doctors who really understand addiction. They test drugs, suboxone and methadone are effective substitutes for other opiates. They keep the patient from getting sick. That’s science. They occupy the same neurological receptors in the brain and create the same effect. That’s science. I’m not saying the drug doesn’t do what it was tested to do. I’m saying its not really recovery from addiction to continue taking an opiate drug. Its substitution. That’s a valid concept in pharmacology, substitution. So, your argument is that to be on the safe side, a person shouldn’t attempt full abstinence from opiates because they may relapse and die from a lowered tolerance. I get that. I’m saying that that is called harm reduction, keeping people on a substance indefinitely. I’m saying as an addict I can testify that I didn’t begin to experience improved mental health and a better life until I got completely clean. Suboxone got me high and kept me in an addictive state of mind. So that is why treatment centers don’t agree with having people continuing to be dependent on substances in their facilities. That is what the article is talking about. AA and NA don’t consider you clean until you are actually clean but they cannot keep you from coming and you don’t have to share that with anyone. I am clean, I would never want to go back to the depression and apathy of suboxone maintenance. So I feel it should be used to detox quickly, and then the person should find the support the need to stay clean because it is possible. People do recover and they don’t need to spend 100’s and 1000’s of dollars to buy the doctors dope.

            • Alex Penrod

              On a side note. The medical establishment expresses so much frustration with AA and NA, but can I call my doctor for support in the middle of a crisis? Can I go hang out at his house? No, that’s why we addicts have to stick together and support each other because medical professionals are not in the business of selfless altruism, they are in the business of billing insurance and dispensing narcotics to solve your problems. They should present a suitable alternative support system that is free before they go bashing people with good hearts helping each other.

              • kennethanderson

                We should also note that the official position of Alcoholics Anonymous is “No A.A. member should “play doctor”; all medical advice and treatment should come from a qualified physician.” Not only are you practicing medicine without a license on the internet when you tell people to get off their prescribed medications–you are also in violation of official AA policy.
                link to aa.org

              • Alex Penrod

                Never told anyone to stop taking anything. This is not an AA meeting, I claim no affiliation with AA. I expressed a point of view, one that is under represented. If you can’t handle it, it makes me think there is something very personal about these medications to you. Something made you very jaded about treatment centers, and recovery, and its your personal experience, not science that you are really reacting to. Its ok, I’m not saying anyone should feel bad about taking the harm reduction way, it is better than active addiction, but its not what treatment centers are trying to achieve. They’re trying to get people completely free of their dependency. And look at the hate sent their direction for their efforts, if you don’t want what they offer, don’t go, go talk to your doctor, simple as that.

            • kennethanderson

              If you do not have an MD you are not qualified to tell people to get off of medications. The trouble with 12 step programs is that they inflate the egos of people like you and give you delusions of grandeur to the point that you believe that you are God and know better than doctors and scientific researchers what medications to prescribe. The scientific research demonstrates that people who graduate from abstinence only rehabs are far more likely to die of overdose than those who continue to use heroin on the street. See Strang 2003. What is proven effective ib keeping people alive is methadone and bupe.

              Frankly if you get an addiction counseling credential all it proves is that you have memorized a lot of mythology which has been debunked by science. It does not qualify you to tell people to stop taking the medications which are keeping them alive. link to substance.com

              • Alex Penrod

                I never told anyone to get off their medication, I simply explained why treatment centers don’t agree with maintenance. I shared my personal experience with the medication. How am I practicing medicine? I’m an American with a point of view and you have no right to shut me up. You’re probably on suboxone yourself and that why you have such a defensive stance. Remember when the answer for mental illness was a labotomy? That was some good medicine wasn’t it? These doctors are obviously God. I don’t represent any 12 step program, I’m not claiming to be a doctor, I’m not telling anyone to stop taking their medication. I’m explaining the difference between recovery and harm reduction. My experience with maintenance backs up the treatment centers position on it. Simply sharing my thoughts here, which I have a right to do. No malpractice here.

              • Clarabelle12

                Wow…. You don’t say those same things to Counselorshick when she posts here, and her quals are no better.

                How about you rmore completely bring up the AA position on meds, which is that they support medically supervised protocols? You seem quick to try to chill another’s right to speak simply because you disagree with it.

            • Geoff_Clapp

              Please stop lying to yourself.

              “The addict needs a voice in this process, I’m that voice,”

              You are not “The Voice of the Addict” in any more sense than a priest is “The Voice of God.” Your ego is talking out of your ass.

              A counselor’s license is nothing like a doctorate of medicine. Every day you live as a recovered addict without medical treatment options, you have one less option keeping you from relapse.

              • Alex Penrod

                Okay, so after three and a half years completely clean, you’re saying suboxone is somehow useful to me to keep me from relapsing? That’s ridiculous, if I took a suboxone right now it would get me high and probably make me throw up and that would be the relapse, its a narcotic scheduled by the DEA. I do not see your point, why would I need medical treatment after ive detoxed, its not physical after that, its a mental compulsion that you have to just work through, then it goes away. Giving someone dope to make them stop craving dope is pretty dumb. Once detox is over, its time to learn to live clean in recovery. If you continue to use your crutch that you are dependent on, that defeats the purpose. I have a friend that’s on methadone, just never could get clean, he used to go to jail all the time. Now he’s fat, sits around mumbling to himself, same old junkie, hasn’t changed a damn thing about himself or his lifestyle, but he’s not shoplifting anymore and it taught him to get up early to go to the clinic, what a success. That’s what I’m talking about. Methadone and suboxone are used for harm reduction, a less of two evils, it is not recovery to continue taking narcotics you get sick without, I’m done arguing with people about this. Why do you non addicts care anyway? Unless you’re making money off it somehow.

              • Geoff_Clapp

                Sigh. How clueless are you? How old are you? Do you really think there is One True Way, and you have got it figured out? You sound hopelessley naive, like a young kid who just read Ayn Rand or Nietzsche and thinks he has the answers to other peoples problems because…why exactly? Because you are sober? Bravo Alex. Oh and please stop lying to yourself. Your ego is not good drugs, it is a poison far worse than those you crave.

              • Alex Penrod

                What exactly is your point and your argument? All you’ve done so far is attack me as a person, and make assumptions about me. You haven’t made any argument for what you support or what you think should be done with suboxone. I have presented my argument for why I feel the way I do in a thorough and articulate manner. You’ve trolled through and took shots at me, but don’t have any ammunition against my point of view. Desperate people reach for personal insults when their intelligence or knowledge of the subject runs dry. I don’t believe there is only one way to stay clean, but I believe that being on narcotics is not being in recovery from your addiction, its a substitute. Ayn Rand? Her brand of capitalism is what is destroying the middle class in this country, but that an entirely separate issue. Make a point this time please, don’t just take shots at me, any young punk can do that, ive been around the block a few times, I dont get riled up about petty crap.

              • Sarah Brown

                I agree with everything you’ve said. Just thought you should know someone els agrees with you. All these people and their “science”. There is so much more to it than that. And only an ex addict or a current one like myself get that. This is just another medicalization of sin. Like all those parents thinking their ill behaved children have “oppositional defiance disorder”. No behavior is ever the individual’s responsibility any more. That’s our society now. Every bad behavior is excusable. Good for you!

              • Bassguy422

                Alex, I have been in and out of treatment a few times. Most recently I did a 30 day inpatient program including a 5 day detox with Suboxone. When I finished the program I felt great and on top of the world, knowing that i stayed clean for 30 days. I went to AA and NA meetings every day. I still had a ridiculous amount of cravings though. I managed to stay clean for about 3 weeks before another guy from treatment called me and asked to hang out. He pulled out a pipe for ice, which I don’t do, but that’s all it took. I started calling everyone I knew to find some dope. Btw, I moved half way across the country after treatment to a place where I knew none but a cousin, aunt and uncle. I managed to find something the next day and feel right back off the wagon. The best time of my life after my addiction began was the 2 years of sobriety I maintained after a prior treatment program. That program wasn’t inpatient. I went every day from 9 to 5 for 2 weeks and they put me on Suboxone. I did an IOP program with them after that, where they kept me on Suboxone. Almost finished, but ended up going to jail for a month due to sentencing from a prior drug charge. Because I was prescribed it by a doctor, they kept me on it during my jail stay, and I continued on it for another couple months after the stay, always using it as prescribed. I only stopped taking it when I did because the doctor who prescribed it said I needed to begin school full time if I wanted to continue the program with her, even though I worked 50 hours a week already. So I decided that it was the end of that. I weaned myself off of it by taking a few less mgs every day until my final prescription ran out. I never once felt any sort of high from the Suboxone, but I also didn’t go through the debilitating withdrawal that one gets from quitting opiates. After I stopped taking the medicine I didn’t have any cravings whatsoever. I told all the people I knew that still used, over the phone off course, that it’s a miracle drug if it’s used correctly. I stayed clean off drugs for 2 years following that, never having a craving or desire to use. I did end up relapsing when I had begun running a company for my uncle when he became deathly ill and had 6 major surgeries in a 7 month period, and was either hospitalized or on bed rest for an entire year. Before I took over for him I had started back at college full time and was doing very well, until I had to work 70-80 hours a week running the company while trying to study and do homework and actually wake up for classes the next day. I ended up going to see a friend whom I thought was clean, but it turned out he wasn’t, and he had stuff at his house and did it in front of me. Had I not been going through the overwhelming amount of stress that comes with running a business alone, but while trying to maintain good grades in school at the same time, I would have most likely walked away. Instead I felt like it would be good to actually be able to relax for a little bit, since I hadn’t really had that chance in 5 months. And just like that I was back on it. By the way I had quit receiving counseling which probably had a big part to do with it. I thought I could make it on my own. But addicts know that isn’t possible! This time around, I fell back into within weeks of getting out of treatment, and I was seeing a counselor weekly, as well as going to meetings daily. If the treatment center would have allowed me to stay on Suboxone when I got it, that wouldn’t have been an issue. I also learned my lesson about thinking I could make it on my own, so when the time came to get off the Suboxone, and my brain and body had no longer had any cravings to use I would just be in counseling and have never sought to use drugs again. I know this for a fact! It worked before until I thought I could manage without outside help, which I know not to do now. The problem is they wouldn’t allow the Suboxone use, which would have kept me from even thinking about use for the 4 to 6 months following treatment, which is the time they say it takes to stop actually craving the drug. If it is used as prescribed there is 0 euphoria, which actually does allow your brain to stop craving before you get off it. Even though it is a synthetic opioid, your body and mind doesn’t crave them after proper tapering since there is no euphoric feeling from it. Methadone is different, it does give euphoric feelings, because it attaches itself to all opiate receptors, whereas buprenorphine doesn’t attatch itself to the mu receptors which are the ones that give the most euphoric feeling. Long term Suboxone maintenance has been very successful for me in the past. I am currently looking for a long term program in the area I just moved to, as I have no doubts that since I will keep up with counseling, and receiving outside help when needed; I will be successful in maintaining sobriety for the rest of my life. It’s wrong to judge other people and their path in life. In the end whatever higher power you choose to believe in will be the one to judge, it is not our place to do so. If someone stays on methadone for life because they don’t trust themselves to get off it and not return to use, then that’s their prerogative, and they will be judged for that one day too. However, I would like to believe that someone who is bettering themself, and doing the best they think they can to stay off illegal drugs shouldn’t be judged harshly, as we both know it is a difficult and painstaking process. Give people a break! We’re all human, and the goal is to try to do the best we can to live a good honest life in honor of our higher power!!

  • Faith1186

    I’m a recovering addict and a substance abuse counselor. I’ve work in abstinence based programs as well as harm reduction programs. The bottom line is there is no one way to manage opioid addiction. I know people who have been able to remain abstinent from all substances for over 20 years. I know others that are on methadone and suboxone who have productive, good lives. I can think of one methadone client who teaches high school and another who owns an IT company. What we need to do is stop judging each other! The stigma of addiction is difficult enough without people in recovery or in the field adding to the problem. Recovery is about living a happy, productive life and being a blessing to your family, friends and community. I really don’t care how you get there, as long as you do.

    • Shannon McHenry

      Amen!! There is no one way! Why is addiction the only disorder the patient does not get to choose what treatment is best for them?? Instead, everyone has a story about “uncle joe’s first wife”-and what worked for her!!!

    • Piotrek Ruc

      I totally agree there is no one way just get there! I been in and out of recovery for the last 12 years. I been detox ed with suboxone every time I went to detox than I usually went to 28 day treatment than halfway house iop therapy and NA. This time I just went right on suboxone and I’m rylly surprised how well its been working. I don’t get high off of it at all, I mean nothing I feel normal. My cravings are almost gone, and it’s only been 5 days on suboxone. I use it as directed, I don’t mix it with alcohol or Xanax either tho. I started to go to meetings. And like the article points out you are looked at and judged as not clean or your substituting. One one hand I don’t want to tell people I’m on it on the other hand I want to be honest with my recovery friends. And I have been with the ones that matter. I need help not be alienated and looked at as a leopard. Doctor says 6 plus months on subs. I would rylly like to ween myself off within a month. But I done it before stayed clean for about 18 months and used again. I’m also bipolar, I take my medications for that and I can not stop because I go thru a cycle again. depression/mania. I would like to stay on suboxone , it’s not cheap. I been reading everything I find on suboxone long term use studies etc. Very mixed messages I’m seeing. I’m so tiered of relapsing. A lot of my friends died this past year. There just isn’t a cure for addiction. I gotta live with it somehow. There just isn’t enough styling done on long term benefits of being on suboxone done, but I tell you what it’s working, my brain is healing. Why stop it after 7 days or a month. It’s life or death does it rylly matter that I take a pill, I do 2 fo bipolar? Shouldn’t I do everything I can to be clean? I don’t want to die. There is this saying my type of recovery can kill you. I’m gonna do all I can to stay alive, live with this diseases

  • Bryan

    I believe suboxone is best for short term use to lean yourself off. I was on suboxone for 3years and misused them, sold them to get the drugs I wanted etc. Which many people end up doing. Also why get help but be on suboxone. Your basically trading one drug for another to still “feel good”. I went to treatment they leaned me off in a week and i was good after that. I got back to my old self. I was able to wake up and make it thru the day without any pills and that was the best feeling in the world

    • Gail

      Total abstinence is the only way, agree totally!

  • brian

    Great article, lots of questions answered to help some people understand that just going through rehab doesnt always work for a lot of people in a lot of ways. Ultimately it is up to the person that is getting/looking for treatment. People have to know what treatment works best for them. Everyone is different in this aspect. Some things dont work for others as they do for some. I have been taking suboxone as prescribed and my life has never been better. I have absolutely no desire to use anymore. Its not a crutch it is what it takes to keep me living a better life away feom drugs. Aome people do abuse it and i am pretty sure that no matter what, there will always be bad apples on every tree that grows , just saying

  • Kym

    Users, in my experience, of people i have seen go through treatment, they use Suboxone just use it in replacement to Methadone, Oxy and Heroin. They stay on it because they use Xanax and Suboxone together to get a heroin high. So in a sense they are still using it to get high, but legally. Suboxone is just a subsitution to their addiction.

  • Robert

    This article is a joke. Most ppl working in rehab are recovering drug addicts. I, myself, am a recovering opiate abuser. I also abused suboxone. I also had a dr who allowed me to abuse subpxone. Its substitution. You take away and give another. Its also not needed. I pit down the opiates and suboxone, got into a 12 step fellowship, found God, and never turned back. From homeless to owning a business. You dont use drugs to get off drugs. Methadone gets you high as hell. I used it daily to get high as well. These dr should take methadone for 30 days and then be thrown in a room by themselves without it. See what happens. Same with Suboxone. Body goes through withdrawal from both. Goodnight to the fool who wrote this.

    • Gail

      You go Robert! Totally agree!

  • Rocky Hill

    Actually, Alex, when you start a sentence with “I think”…you are not stating a fact. The rest of your “facts” are partial facts. I doubt if you and your friends went very long into the withdrawal process before starting the bupe since we dope addicts don’t like pain. Thus, you really ran into the ceiling effect that keeps opiate dependent folks from getting any kind of high, unless you were just holding your breath. That’s not a fact Alex. The rest of your facts are irrelevant dribble. There are lots of drugs that are mis-categorized by our government….like marijuana and LSD. In 28 yrs. of treating addicts, I have yet to run across an acid addict and I really liked it but it just doesn’t make it as a drug of abuse.
    A double blind study was just released with participants who used buprenorphine for four months, than had a two week and four week titration. In fact, the four week titration experienced no withdrawals whatsoever, as did the placebo control group. It isn’t the suboxone that creates the “fast intense withdrawal from heroin” that you describe, it is the opiate, whether it is heroin or synthetic. However, since you are a stickler for the facts, very few people have that kind of experience coming off of any kind of opiate. In “fact”, withdrawal from opiates is what results in the 5% recovery rate for 28 day programs. The withdrawal is, typically, in an acute phase of over ten days followed by post acute withdrawal syndrome which can create a debilitating anhedonia that can last for a year or more. Unfortunately, that is when most opiate addicts give in to the cravings, exhaustion, insomnia and general confusion that is created with the Mu and Kappa receptor sites. Read up a little more on opiates. You don’t need to tell me that you know because you did drugs. So did I, for fourteen years and have thirty four years of recovery that is beyond my wildest expectations. Dr. Saxon is right. It is not the pharmaceutical companies, it is the inpatient programs that see so many lost patients if buprenorphine is embraced as it will be. Why will it be? Because it works and it saves lives.
    I am happy that you have found recovery, but make sure your facts are correct before you tell other people how to live their lives. You might just, unwillingly, participate in their death.

  • Scott Arnold

    My son is a heroin addict. He has been in four different rehab residential programs now, most recently on day 10 of a 28-day program. The time before this he was released from residential, placed on Suboxone, completed IOP, and saw the psychiatrist very regularly for his Suboxone maintenance. Not too long after starting with his Suboxone, he read something that told him it was more effective if he made a solution out of it and ingested it in 7-drop doses. Then, he started shooting up with it, telling us in each case of how this was better for him and would help keep him from wanting heroin, and that, as an addict, he knew better and we didn’t understand.

    Naturally, he went back to using heroin again about 6 weeks ago. This happened mostly because he started hanging out with an old friend who had started using again, so, eventually after watching his friend use several times, he decided to use again (but just this once – right). He landed in jail for felony theft and was only released from jail because he went directly into a residential treatment program.

    At first, he really liked the place and seemed to be doing very well. But, as has happened every time, now he is complaining that they don’t want him there and are opposed to him going back on his Suboxone regimen – which is how I got to this page.

    My son will turn 22 this month. Until this last incident he had been living at home. We had told him months ago that, if he got arrested again, we would not bail him out. I removed him from my health insurance and he cannot come back home to live. We feel that we have enabled him and that he needs these severe consequences in order to help keep him on the road to recovery. He will have the opportunity to apply for the Drug Court program here which, if successfully completed, will eliminate his felony charge from his record.

    He wants to leave his current rehab in favor of another that will let him go back on his Suboxone. I should also note that he has been diagnosed with Bipolar Disorder, Anxiety, Depression (which was switched to Bipolar Disorder) and, according to what he tells us, PTSD. I think the only meds he is taking right now are Lamictal and Trazadone.

    I write all this because I was not particularly impressed by the psychiatrist who was managing his Suboxone maintenance. Both my son and I got the impression that this was just a moneymaker for the psychiatrist (who spent most of the appointment time texting on his phone!). I, too, am leery of him going back on Suboxone given that I don’t believe it really helped him that much. (And, yes, I know it’s not fair to judge this in light of his clear abuses of how he was taking it.) It’s just that nearly all the rehab places and recovery homes (where we hope he will end up after residential treatment ends) won’t allow Suboxone usage among their clients.

    Anyway, I’m just looking for answers from any of you former/recovering heroin addicts. As an adult, his choices, and their consequences, are his to own, but I’d like to at least know in which direction to nudge him.

    • caroline

      Hi there, I am 25 and currently battling a fentanyl addiction…. your son will need to be on something for a while before his brain/emotions can heal. Your brain actually goes through chemical change. Try Methadone if suboxone isn’t working, but be warned you are still able to use on methadone you can’t on suboxone and suboxone is much safer…. when prescribed suboxone/methadone for the first 3 months he has to go to the pharmacy and take it in front of the pharmacist so i don’t understand how he was able to abuse it right away. But there is a very small chance he will ever be able to get clean with nothing so if he wants suboxone let him have it! Try a different doctor if you are un happy with the current one… and you can always keep a hold of the suboxone and watch him take it under his tongue everyday. Just don’t listen to anyone who says he can do fine abstinent because they’re wrong… trust me, they’re wrong.

  • Cbear

    After many years of struggling with alcoholism, I had a very quiet, profound life changing moment where I believe, I was relieved of the obsession and cravings for alcohol. However, after taking opioids for back pain, I realize I am dependent on them. Mentally as well as physically. When stopped abruptly (running out) I have physical withdrawals. I feel great afterwards for about a month, but then the mental cravings kick in and I convince myself that I NEED them for back pain. For those of you who want to jump in and make assumptions about my alcohol recovery, save your breath, lectures, and typing fingers. I am interested in giving Suboxone a short trial with strict medical and counseling and titrated gradual decrease to zero meds. I am highly motivated to do this and to be off all medications. Period! I just can’t seem to get past the mental cravings. What works for one, may not work for another. One of the main tenets of AA is DO NOT JUDGE. It takes what it takes. How do you explain away the early days of Bill W. and their use of alcohol to detoxing future members of AA. Another point is, how do you dispute the figures and percentages of addicts who manage to die sober? Not real encouraging….so keep your judgemental, egotistical, OPINIONS out of the discussion.

  • Piera

    Please I need to find a rehab that permit suboxon and suboxon tapering for my son in California , it’s very difficult to font it , please any informations is greatly appreciated

  • The Deplorable EtoculusDei

    As a recovered drug I can tell you this story is absolute horse shit. Taking an opoid addict off one drug and putting them on another is just plain stupid and it never leads to recovery. I’ve seen what happens to people who use subuxone and have yet to see any of them actually recover. Life is to short to waste on solutions that don’t work. There is no easy way to get off opiods. That’s just the frikken way it is. The 12 step programs have been helping addicts recover for over 80 years. People go to them….because they work.

    • disqus_LrUuOo7v61

      “Taking an opiod addict off one drug and putting them on another is just plain stupid and never leads to recovery”- This is not only inaccurate, but also not based on science, statistically incorrect, and inherently dangerous. 12 Step programs are at best between 5-7% effective in general. That includes their use in alcohol dependency, for which 12 step seems to work best. You have indicated that you have seen what happens to people whom use Suboxone. Your narrow view should not dictate your overall outlook on medicine. These and other statements are often made to 12-step members who are legitimately prescribed and taking FDA approved medications to treat their addictions and other co-occurring illnesses. Unfortunately,your so called “advice” , although well intended, is misinformed and not founded in scientific, or 12-step philosophy. This violates a long held 12- step policy of ” AA members should not give medical advice to each other.” AA has no opinion on outside issues, and this includes medicine.
      AA arose from the Oxford Group, a fundamentalist religious organization founded in the early twentieth century.

      AA lacks any scientific backing, research, or clinical experience to support its method. Science has turned a blind eye until now.

      AA has stuck around because members who become and remain sober speak and write about it regularly; such is the 12th step, to carry the AA religious message.

      Unfortunately this creates a sampling error: because most of us hear only from the people who succeeded in this approach. Its human to assume they represent the whole. In reality, these members speak for an exceptionally small percentage of addicts.

      The AA Big Book States:

      ‘Rarely have we seen a person fail who has thoroughly followed our path. Those who do not recover are people who cannot or will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves. There are such unfortunates. They are not at fault; they seem to have been born that way. They are naturally incapable of grasping and developing a manner of living which demands rigorous honesty. Their chances are less than average. There are those, too, who suffer from grave emotional and mental disorders, but many of them do recover if they have the capacity to be honest.’

      Bill Wilson

      So, AA does not fail- the addict does. 12 Step rehabs take your $35,000, fail in providing you any help, then you return six, seven , eight times. It still wont work? You are not praying hard enough! Call your insurance company. We need another 35K to do the same thing over and over.
      If this happened to a sick persons with bad infections, and an IV antibiotic wasn’t working, one could only imagine dismissing millions of people who did not respond to this medicine as “constitutionally incapable” of properly receiving the drug. Of course, no Doctors or other medical professionals would make such claims in the scientific arena. And, if they did, they would risk losing their standing. In professional medicine, if a treatment doesn’t work, it’s the treatment that must be scrutinized, not the patient. Not so for Alcoholics Anonymous. I believe that will change, sooner than later.

    • Econn13

      I know people that have done more than just recovered they have thrived using buprenorphine combined with 12 step programs. The key is to not be too forthcoming about it in NA or AA. Even though they supposedly have no opinion on outside issues on this they most certainly do. Buprenorphine is just another tool for the addict. They should keep their opinions to themselves. I am sure a large majority are taking some sort of antidepressant. Why do they turn a blind eye to that, but shun the buprenorphine patient? Antidepressants are mind altering and if you quit them abruptly you will get sick. I will end with this. What works for one addict may not work for another. Sobriety and life should be celebrated no matter what tools one uses to get there.

    • Jeremy Arnold

      I was on prescribed opiates for 10 years and had nerve decompression surgery. After surgery, my doctor wanted me off pain medication so I went to treatment where I was indoctrinated into AA & NA.
      Even though I had never seen an illicit drug in my life, when I finished treatment all of my friends were suddenly “ex”-addicts. Going to NA meetings I was surrounded with ex-addicts. Everyone I knew was an ex-addict and within 6 months I had seen cocaine, marijuana, meth and heroin for the first time in my life. was not on suboxone because rehab and AA/NA believes that suboxone maintenance is not abstinence it and it was a very dangerous situation. I have never used drugs just for recreation but anything that provides relief from my crippling, disabling 24/7 pain is a huge temptation. I would like to live my life and not hurt constantly!
      I stopped going to meetings and found a good counselor and psychiatrist who could prescribe suboxone and find it MUCH more helpful than rehab. I have surrounded myself with healthy people and have never touched another full-agonist opiate again despite being horrible pain 24/7. I am never attempted to abuse it because taking more does not increase its effects and I no longer have to worry about running out early like I did with full agonist opiates. Of course, it doesn’t provide the same level of pain relief either but it is a trade-off I must accept if I want to stay alive.
      AA/NA does not work for everyone and I believe it can be quite harmful to surround yourself with addicts if you are trying not to use. For someone like me Suboxone is a life saver!

      • The Deplorable EtoculusDei

        You’re still hooked. Your addicted life has become normal for you. That’s what happens. You don’t see the price you’re paying for your addiction. We never do. I refuse to spend my life under the power of a pill. I am free today…..and that’s what matters to me.

      • Jeremy Arnold

        What price? I have a full happy productive life and with insurance I pay $10 a month for Suboxone. I have a masters degree, career, a condo downtown, a fiancée, drive a Mercedes S550 and travel the world. I purchased my mother a house so she could retire last year at the age of 55. Right. Ow I am saving up a down payment for a place on the beach. Speak for yourself and do what works for you!

      • caroline

        theres no such thing as an “ex” addict…. you’ll always be an addict… but you’re either in recovery or in active addiction

        • Jeremy Arnold

          Life is that black in this matter, correct. And you presume to be so omniscient that you can speak for every person on Earth? I believe that for the MANY drug abusers who are not under medical supervision to treat legitimate, life threatening medical conditions you MAY be correct. HOWEVER, RECOVERY is possible. Miracles are possible. Don’t try to put everyone into your small box. Also remember that labels and be very dangerous and damaging to ones self esteem. I am glad you have found a program that works for you. Stick to it please! Let others do what works for them.

    • John Dozier

      You are so ignorant of the facts. I went to NA and see nothing but people acting like idiots reading ritualistic literature so loud it scares newcomers. Selling drugs in the parking lot. Gossiping about who has relapsed lately and who is screwing who. Men with so called multiple years of sobriety having relations with and impregnating young girls half their age who are newcomers. Yeah you got all the answers. Bunch of immoral hypocrites!!

  • Eric0101

    As a recovered addict who has been on buprenorphine maintenance for nearly 9 years now, I must say this comment section made me sad. It is thanks to Suboxone and the support of a wonderful doctor, family and friends that I have been living a healthy and normal life for so long. I have graduated from a four year university, got married, bought my first home and vehicle, had a child (and have another on the way) and work in a professional setting (and have been very successful at my job). I dont feel that my life differs from any other person trying to do the right thing every day other than I have to put something in my mouth to dissolve every morning. The way I have always viewed the Suboxone debate is: Do whatever it takes to keep living your life. It is wonderful that some folks are able to beat the addiction without the use of a medication. That wasnt the case for me. I tapered all the way off but still had to go back on Suboxone because I realized my life was going to end up going in the wrong direction again. Who is anyone else to tell me that I am not living a good, clean lifestyle? That my recovery hasnt been done the right way?

    Ive never sold my medicine on the street or given any away. That is addict behavior that I want no part of. To hear some of you speak, it sounds like youd be OK with Suboxone being taken away from everyone, including someone like me, because some other addicts have misused it or sold it. That would be the same as me saying Oxycodone should be outlawed, even though it still has legitimate uses for people with a terminal illnesses like cancer. It isnt fair. It isnt right.

    What good would it do to take my medicine from me after all the success Ive had over the years? It would only serve to destroy my life and those around me, as they watch me suffer and unable to work because of withdrawal. I would then be at risk of overdose or death, all because a few addicts obviously still in the throws of their addiction didnt use Suboxone the way it was intended.

    Yes. I know that if my medicine is taken from me I will be useless and in Hell again, but the same is true of those who take insulin for their type 2 diabetes. These are chronic illnesses that need chronic solutions. It may not be the solution for everyone, but it has certainly been the best solution for me.

    I have studied the statistics, as well. Those who utilize suboxone are less likely to die than those who are abstinent in cases of relapse. The success rate of Suboxone and Methodone are much greater than those who only utilize 12 step or other abstinence programs. These are straight facts. Why would I even want to risk the dangers associated with relapse when there is a medication that can keep me healthy, alive and functioning like an adult human being?

    On the subject of forced tapering, I believe it should be criminal. Case in point, my cousin Heather. She struggled with addiction for many years. Found a doctor who prescribed Suboxone and then forced her to taper to a point she was no longer stable. She relapsed, overdosed, got an infection from a needle and died. Such a waste of a 22 year olds precious life. All because a doctor felt that the only way for her to be in recovery was to be abstinent.

    I love my life now and hope that all of you struggling make it to a point where you can love your lives, as well. Good luck in fighting your disease, no matter which path you choose. My story is my own and I am saying what worked for me. Please understand I am not preaching that one way is better than another. Only saying what worked for me and the things I have seen and read. Love you all. – Eric

  • Eric0101

    As a recovered addict who has been on buprenorphine maintenance for nearly 9 years now, I must say this comment section made me sad. It is thanks to Suboxone and the support of a wonderful doctor, family and friends that I have been living a healthy and normal life for so long. I have graduated from a four year university, got married, bought my first home and vehicle, had a child (and have another on the way) and work in a professional setting (and have been very successful at my job). I dont feel that my life differs from any other person trying to do the right thing every day other than I have to put something in my mouth to dissolve every morning. The way I have always viewed the Suboxone debate is: Do whatever it takes to keep living your life. It is wonderful that some folks are able to beat the addiction without the use of a medication. That wasnt the case for me. I tapered all the way off but still had to go back on Suboxone because I realized my life was going to end up going in the wrong direction again. Who is anyone else to tell me that I am not living a good, clean lifestyle? That my recovery hasnt been done the right way?

    Ive never sold my medicine on the street or given any away. That is addict behavior that I want no part of. To hear some of you speak, it sounds like youd be OK with Suboxone being taken away from everyone, including someone like me, because some other addicts have misused it or sold it. That would be the same as me saying Oxycodone should be outlawed, even though it still has legitimate uses for people with a terminal illnesses like cancer. It isnt fair. It isnt right.

    What good would it do to take my medicine from me after all the success Ive had over the years? It would only serve to destroy my life and those around me, as they watch me suffer and unable to work because of withdrawal. I would then be at risk of overdose or death, all because a few addicts obviously still in the throws of their addiction didnt use Suboxone the way it was intended.

    Yes. I know that if my medicine is taken from me I will be useless and in suffering again, but the same is true of those who take insulin for their type 2 diabetes. These are chronic illnesses that need chronic solutions. It may not be the solution for everyone, but it has certainly been the best solution for me.

    I have studied the statistics, as well. Those who utilize suboxone are less likely to die than those who are abstinent in cases of relapse. The success rate of Suboxone and Methodone are much greater than those who only utilize 12 step or other abstinence programs. These are straight facts. Why would I even want to risk the dangers associated with relapse when there is a medication that can keep me healthy, alive and functioning like an adult human being?

    On the subject of forced tapering, I believe it should be criminal. Case in point, my cousin Heather. She struggled with addiction for many years. Found a doctor who prescribed Suboxone and then forced her to taper to a point she was no longer stable. She relapsed, overdosed, got an infection from a needle and died. Such a waste of a 22 year olds precious life. All because a doctor felt that the only way for her to be in recovery was to be abstinent.

    I love my life now and hope that all of you struggling make it to a point where you can love your lives, as well. Good luck in fighting your disease, no matter which path you choose. My story is my own and I am saying what worked for me. Please understand I am not preaching that one way is better than another. Only saying what worked for me and the things I have seen and read. Love you all. – Eric

    • http://mylifeas3d.blogspot.com/ DeanDD

      Eric0101… Thanks for your insightful and honest post. Suboxone saved my son’s life when he was struggling with heroin addiction. I’m all for any medically assisted treatment that helps saves lives. That said, haters are gonna hate. I wish you continued success, my friend.

    • John Dozier

      I agree Eric Methadone and Suboxone saved my life and continue to do so. I never abuse it or divert it. I make all of my appointments. People are so ignorant of the facts of how many lives this medicine saves because of some people that abuse and divert. That is why they are now making random screening mandatory. Which I have been all for anyhow. I do not want to go to groups with people that are abusing the system and this life saving drug. It is for people who want to get better not for people in active addiction.