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Buprenorphine/Suboxone: Boon or Not?

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Buprenorphine/Suboxone: Boon or Not?

Here’s a drug you may not have heard mentioned in a long time: Buprenorphine (and in a compound, Suboxone). When I read a front page story in The New York Times last month titled Addiction Treatment with a Dark Side, I had no idea it would be about this medication. Or that the paper would devote so much space to it instead of featuring such a long article in the magazine. Or that it would be so controversial. So I chose, as part of the title, the same question I posed about the new medication Zohydro — Boon or Not?

The article begins with the story of a carpenter and sometime rock musician who started taking pain pills after falling off a roof. He became addicted to the pills, tried to commit suicide, and enrolled in a rehab. Now he takes buprenorphine, in a compound form as Suboxone, and says it has saved his life.

Others have not been as lucky. A 20-year-old overdosed on it one night when he and his friends were getting high, and the friend who gave it to him went to prison. The Times article said,“Suboxone is the blockbuster drug most people have never heard of…. its success fueled by an exploding opioid abuse epidemic.” It’s billed as “a safer, less stigmatized alternative to methadone.”

But as the two personal stories indicate, here’s the rub:

“Buprenorphine has become both medication and dope: a treatment with considerable successes and also failures, as well as a street and prison drug bedeviling local authorities. It has attracted unscrupulous doctors and caused more health complications and deaths than its advocates acknowledge.”

suboxone-film-with-box.jpgI talked to someone whose family member keeps relapsing on heroin about this article, and that person said this:

“I felt they had too much negative to say about Suboxone/Subutex and didn’t say enough to break the stigma of using a medication to control opiate addiction and to help relieve the physical pain that is caused by opiate addiction. My family member who is on Suboxone, has a problem because AA is not accepting of medication.”

My contact also wondered why top experts weren’t interviewed for the article. I didn’t make a list of pros and one of cons while I read the article, although it would have proved interesting. Our leaders should definitely consider weighing them because the Affordable Care Act will allow many more abusers to get treatment. One of the benefits of being on Suboxone is that patients don’t have to go to a clinic to obtain it. Also, although it produces euphoria, the effects are milder and they plateau, “making overdoses less likely and less deadly.” Still, inmates may have an easier time of getting it because one preparation is a thin strip that is easier to hide, and many doctors prescribing this drug have troubled records.

There is another article on Buprenorphine, from 2005, in Wired magazine. It begins with a heroin addict who sounds elated with the results and then, much like The New York Times article, delves deeply into the issues, which, I’m afraid, are over my head.

The New York Times article had 379 comments on the day I looked. Here are two comments that are favorable toward Suboxone:

1st Bellingham, WA

“The success rate for opiate addicts in conventional treatment is so low as to be closely akin to no success at all (if somebody quotes a number higher than 5%, they’re lying). Suboxone provides a harm reduction strategy that works–of our initial clients over 50% are still not using other opiates. Often the search for perfection-absolute abstinence-is the enemy of the good. The good is an improved life-relationships, jobs, health, recreation, etc. Only people without a first-hand experience with the ravages of opiate addiction, or recovering holier than thou addicts, could fail to recognize the benefits of suboxone. In over 23 years associated with recovery, without suboxone in the mix I have only known a few opiate addicts succeeding in recovery. In the past two years I have known dozens.

Incidentally, I’ve never favored methadone as a treatment tool for reasons too involved to go into here.”

2nd  Madrid, Spain

“Buprenorphine saved my life. Without it, I would still be addicted to Heroin.

As a bonus, Bupe is the most affective [sic] antidepressant I’ve ever taken, with no need to change dosing even after several years.

It is a miracle drug. It’s just that the health system has executed it poorly, and they dose their patients far too high. I find no reason to ever stop taking it, as it is the most affective deter ant to using agonist opiates.

I’d rather be on Bupe for the rest of my life than ruining my life with Heroin and Oxy and all the rest of the junk I used to steal and lie to procure.”

For another opinion, Joan recommends watching this interview with MBRC alumna Krissie Bergo whose journey off suboxone was recently the subject of a clinical study by Dr. Kenneth Blum, PhD that was published in the Journal of Addiction Research & Therapy.  Dr. Blum is Malibu Beach Recovery Center’s advisor on neuroscience.



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