Four years after posting this interview with Dr. Steven Scanlan of Palm Beach Outpatient Detox, I’m still getting mail about how to tolerate Suboxone withdrawal. This piece and a couple others I’ve written rank in the top 10 in Google searches, and over the years I’ve been so deluged with comments and private emails about people’s struggles to get free of this drug that I keep a huge separate file for them all. I’ve talked or exchanged emails with some of these folks, and eventually I plan to put out a booklet that collects people’s experiences with this drug that is—depending on where you live—variously doled out like candy by doctors who don’t understand its strength, or available only if you drive two hours or three hours through the wilderness and pay cash to doctors who run their Suboxone clinics like whorehouses.
A reader named Bob wrote this morning:
I was using 16mg a day for 2 1/2 years, I was in excellent physical shape, ran 4 times a week, multiple half marathons, but felt enslaved to this drug. I went to an out-patient 6 week detox program, just in one week I went from 16 to 8 a day, next week went down to 4 a day, then the following week I went down to 2mg a day for a week before I “jumped”, I stayed off of it for 2 days, had ungodly withdrawals, so they gave me 2mg for one more day, I then went 9 straight days with nothing before I did 4mg on a relapse, now I am at day 6 with nothing. I am a business owner and cannot afford to be ” on my game”…any ideas as to when it gets to be ” manageable?”
I think Bob meant he couldn’t afford to be OFF his game. It seems like, in his detox center, they wouldn’t let him taper down to the minuscule doses that are most helpful in Suboxone detox. Many, many practitioners prescribing this drug do not understand its pharmacokinetics—how it behaves in the body, and how the body processes and neutralizes it. They think 2mg is a small amount.
Look at this picture. This is how some people taper off Suboxone. They cut the dissolvable films into little bitty pieces. The company that makes Suboxone does not advise doing this, because they say they can’t guarantee the drug is evenly distributed throughout the film, but guess what?—I think it’s because they don’t want people to taper off it. I’ve talked to Tim Baxter, M.D., global medical director of Reckitt Benckiser, manufacturer of Suboxone. In two separate interviews he told me, “We don’t promote detox.” They want you to stay on this drug. But you don’t have to.
Disclaimer: I’m not a physician, I’m just sharing experience and making space for many others to share theirs. If you want medical advice, you need to see a doctor. ... That said, Bob, 2mg is a significant amount of bupe to jump from. Like jumping from about 60 or 70mg of morphine (the gold standard drug to which all other opioids are compared in their analgesic and receptor-binding strength). I was tapering off the equivalent of 400-500mg morphine per day, and I used Suboxone for two months. I jumped off about 1/8 of a milligram—the tiniest bit in the photo above. Dr. Scanlan and other doctors who understand buprenorphine, the opioid drug in Suboxone, taper people down to fractions of a milligram before they jump.
So you’ve been six days clean after taking 4mg, and you continue to be physically active? Awesome job. Keep it up.
Some tips—take what you need and leave the rest:
Even more information about how to take care of yourself while detoxing and dealing with post-acute withdrawal is included in my book, The Recovering Body, which you can get on Amazon and in your local independent bookstore.
Edit: Here is an email from a guy called Larry that came in several days after Bob’s:
I’m a 60 yr old male engaged in hiking, climbing and biking. I’ve had a 15 year long opiate addiction. I’ve used suboxone for 2 years. I started at 4mg. I requested the low dose as I felt 8mg/16mg was more than I needed. I reduced my dosage from 4mg to 1 mg over 4 months, from 1mg to .25mg over another 4 months. I jumped off from .25mg ( 1/8 of a 2mg strip). I had moderate WDs for a week, 3 weeks of significant lethargy and continuing mild lethargy. I’ve been clean for 2 months. I can feel it getting better and I’m staying the course. I really don’t have any choice. The alternatives are all non starters for me.
If you don’t make it this time, taper to a lower dose, no more than .25 mg. It’s worth doing.
(Emphasis mine. ) Fifteen years on opioids, and he’s now free. Congratulations, Larry.
Good luck to Bob, Larry, and the countless people out there who are trying to get free. Let us know how it goes.
In yoga yesterday I could see evidence of my heart beating in my chest.
I had bent my back into supported Bridge Pose. Then I rotated my upper arms away from each other and watched my ribcage rise up like an arch. I could see the soft pounding of my heart. There it was, just an inch or so under the flesh covering the bones of my ribs, in the spot where it’s been beating for more than half a century.
I sometimes cry when I do yoga heart-openers. I spend a lot of time with my shoulders hunched in front of a keyboard, or else hunched against the criticisms my own mind levels against me. My massage therapist tells me my shoulders are cranked so tight because I hold my body like a boxer with her gloves up and her elbows drawn against her abdomen. She tells me to practice opening my chest. This un-swaddles my heart, which sometimes makes me cry.
I’ve had to make drastic changes in my life in the past few years. My life today looks little the way it looked three or four years ago. Change brings relief and it also hurts, and it flips me out that I might be making mistakes. And because I’m five years sober, I feel like I’m supposed to know better than to have that kind of fear—all that self-centered garbage I ask each morning to be hauled away from me. As if “God” were a garbage-man, or my personal errand-boy: Take it away!
So I not only have fear, I have shame that I’m feeling fear, and then ancillary shame that I’m asking God/HP to take the fear away. Which makes me hunch even further into myself. Shame Spiral, anyone?
I talked about this in yesterday’s Y12SR yoga meeting. It was Easter Sunday. The topic was gratitude that we’re even alive. One after another, people talked about losing parents, family, friends to addiction.
Sixteen years ago around Easter, I was 34 and driving out to my parents’ house every day to help my dad take care of my mother, who was dying of lung cancer. She had smoked three packs a day for 40 years. When she finally died on June 3 of that year, I was so mortally pissed off at God that I spent the next eight years trying to poison myself. I started by stealing a few of my dead mother’s morphine tablets and ended by committing my last felony prescription forgery in roughly July 2008. Great way to use my artistic skills.
I shouldn’t even be here typing this. I should have overdosed or gone to jail. I remember the first time I took some stolen morphine. I lay in bed feeling as if somebody had stacked a pallet of bricks on my chest. A heart-closing exercise. I would exhale, and it would be a long time before my body wanted to inhale again. It scared the shit out of me and I loved it: I wouldn’t have to feel the fear or the anger.
When I made it into recovery, one of my first feelings was guilt that I’d escaped the death sentence that killed both my parents.
People were talking in yesterday’s yoga meeting about how recovery is like the resurrection in the Easter story. It occurred to me that it was also interesting to remember some elements of the Passover story: we’d taken steps to mark ourselves as ones to be skipped over by the angel of death. Also, each of us in the room had escaped slavery—the root of the word addiction. And we get together to tell our stories, never forgetting that we don’t have to be slaves anymore.
I can see how helpful it might be for a group of people to have some kind of religious ritual to keep remembering that they’re chosen. How many times have I heard, during the course of a meeting, “I was supposed to live!—God has a plan for me”? If that’s true, then God discriminates.
I think God doesn’t have plans for my life.
The only plan is love. And it’s not even a plan, it’s a law of nature, and living with it is an exercise of bringing my little tiny (but enormously fucking perverse) will into line with that force. (Splinters are small, but they hurt like hell, right?) Love is the currency, the current of power, that God/HP/Whatever deals in. Bona fide love is pure, reliable, healing, life-giving, durable, like the sun.
If you think about it, there’s nothing we eat that doesn’t come from the sun. We actually EAT the sun every day, which is a fabulous image: Here, take a bite of this star! When we hug each other’s bodies, it creates electricity that comes, when the trail is traced back to its origin, from the sun.
Can the sun be improved upon? I wondered that the other morning. The sun hangs in delicate balance with the life on this planet, and if we tried to make the Star Experience better (say, get rid of clouds, so we can see the star more often), we’d only be screwing up on a grand scale. Sometimes I have to understand that life is fine as it is.
(It’s tempting to think that “God” puts signs in my way to remind me, but she doesn’t.)
Lately I’ve been having some experiences in human love that have given me a glimpse of the vast purity and beauty of this superhuman power source. My son is one big part of these experiences. So are some close friends of mine, and the people in my recovery community. All these people provide me with perfect opportunities to give away love, and like the Bridge Pose, this cracks my heart open. And what I give comes back, multiplied.
Of course, I don’t think I “deserve” even the human part of the experience, much less the “divine” one. So, in case it’s not real, or in case I lose it (because guess what? nothing lasts, goddammit!!), I run around with my shoulders hunched. Or I force them back and paint on a tough mask that makes me look bitchy, arrogant, aloof: Throw anything at me, man! Take away whatever you want, I’ll survive, I don’t fucking need ANYBODY!
Fake power. Meanwhile inside the mask, G is hunched: small, scared, in need of arms around her, even temporarily.
Before I got sober I had little idea how to take care of myself when feelings like these struck. I’d try to make them go away by numbing them with drugs. Now, instead, I run with the dog, throw a dinner party for my old friend Nancy whose husband just had cancer surgery (successful!), start the painting another friend asked me ages ago to make, do mental push-ups by studying another language, engage the help of a smart no-bullshit therapist, give my students and their work my attention, compile playlists of beautiful music, ride my bike on this city’s long river trails, make lists of people and things I’m grateful for, practice yoga, take photographs and post them to share the world’s beauty, etc.
I also go to meetings, for the same reason people celebrate Easter or Passover or any holiday, and for the same reason they go to coffee houses and dog parks and book clubs and yoga studios: because I’m part of the tribe of Homo sapiens, and the desire for community is practically encoded in my cells. Because my heart needs to be around other beating hearts. Because cracking my chest open helps me exchange a little more love, which plugs my life into a great big socket of power.
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Last summer I came across a New York Times opinion piece by a Canadian biologist about the widespread collapse of North American beehives. There are multiple causes, but the author focused on the fact that both fields and hives are treated with pesticides.
The author noted that a typical honeybee colony contains residue from more than 120 pesticides. “The only human equivalent is research into pharmaceutical interactions, with many prescription drugs showing harmful or fatal side effects when used together, particularly in patients who are already disease-compromised,” he wrote. “Pesticides have medical impacts as potent as pharmaceuticals do.”
We might turn this around and say that pharma drugs have toxic impacts as potent as those of pesticides. Through this five-year-old blog, I’ve received dozens of emails from people all over the country suffering intolerable side effects from long-term courses of medication, asking for help in quitting. Usually they’re on opioid replacement drugs—particularly Suboxone—but also benzodiazepines (such as Valium and Xanax) and, less commonly, antidepressants. Often these readers have gone to their doctors with relatively modest painkiller habits—say, 60 milligrams per day or less—and were told to call a Suboxone clinic, where they were put on enormous doses of replacement drugs.
“Frequently what you find is patients who go to the provider and say, ‘I’ve been on this for three years and I’d like to come off,’ and the provider doesn’t have the tools or doesn’t want to deal with it,” says Ravi Chandiramani, N.D., medical director of the Sundance Center treatment center in Scottsdale, Ariz. He adds,
The provider actually serves as a nemesis to that individual’s wanting to come off the medication.
The “N.D.” behind Chandiramani’s name indicates he is a doctor of naturopathy, a medical discipline that focuses on disease prevention and treatment by encouraging the body’s native healing abilities and educating patients about their own health. Seventeen states currently license and regulate naturopathic medicine. Chandiramani is the only naturopath in the U.S. directing medical care at a Joint Commission accredited residential rehab. He says his job has become “getting people off the stuff that everyone else puts them on, and replacing it with healthy lifestyle choices, education, and empowerment.”
Dr. Ash Bhatt, M.D., medical director at The Recovery Place in Fort Lauderdale, Fla., negotiates a similar situation. Bhatt, who is board-certified in addiction medicine and in adult, adolescent, and child psychiatry, expresses particular concern about the number of young people being treated with opioid replacement drugs who may not need them. He says:
For the right client, Suboxone can show a tremendous amount of improvement, If we can save them from contracting Hepatitis C or HIV, we would consider that.
The best Suboxone patients, he says, have family members, a sponsor, and/or a community that can support their recovery.
But he says he does not put adolescent patients on “maintenance therapy” because of the risk of damaging brain development. “Their brains are developing from [ages] 13 to 24,” he says.
When you introduce any sort of drugs that could potentially change the physiology and neurobiological development, the fact that they’re doing it themselves is one thing, but the fact that doctors are doing it—it can have devastating consequences.
As devastating as they are in the bee population. This image of the beehives dying of the toxic chemical load has stayed with me, and I decided to ask a beekeeper I know about it.
Randall Hall, 33, owner of BeeBoy Honey, maintains beehives in five locations in and around the city of Pittsburgh, where I live. He is also recovering from addiction.
Hall had a couple hives before he got sober four years ago. Just two years ago, he expanded from four hives to 30 today.
Hall taught me that the chemicals found in beehives come from pesticides sprayed not only recently but years, even decades, in the past. The chemicals, it turns out, build up in the beeswax, just as fat-soluble pharma drugs like buprenorphine and Xanax can accumulate in human fatty tissue.
Beekeepers, Hall says, reuse beeswax from year to year.
The wax is especially absorbent. Even if you stop using the chemical, your bees will still pass that on.
Hall decided to expand his honey production after getting sober partly because, after a three-month stint in rehab, he was looking for something productive to do, and partly because a well-known restaurateur in the city, also sober, offered to buy Hall’s excellent honey for his restaurants—an example of one recovering person helping another, of one teaching another self-care.
“My attitude toward the bees is totally related to taking care of myself and learning how to take care of the bees more,” Hall says.
Certainly at a spiritual level, I’m thinking of myself in the natural order of things. I’m a caretaker of the beehive—I’m not a Bee Master telling them what to do. I don’t want to abuse them in some unnatural way where I could potentially get more money out of it.
Hall uses fewer chemicals than other beekeepers he knows, despite the fact that he could lose money doing so.
I’m trying not to put chemicals in my hives. It’s so important to me that I’m willing to take that risk.
[An earlier version of this piece first appeared in Addiction Treatment Magazine.]
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I came across this video posted to Facebook by a woman whose journalism and thinking I respect.
In the comments under the post, another woman had written of Amal Clooney, “She’s a great role model.”
So I clicked on the link. I’d seen a lot of pictures of The Movie-Star’s Wife but I had never heard her speak. And I found out a few things about Amal Clooney, and (again) about the problems of growing up as a girl in this society.
I found out that I respect the work Amal Clooney does. Realistically, though, would TIME have run a video clip of her in high-court action if George had decided to marry someone less spectacular to look at?
Within the first minute of this clip, two things crossed my mind:
1) She’s smart!—listen to her marshal the evidence.
2) She’s fucking gorgeous!—it’s easy to continue to watch her.
Subheads under No. 2:
And in those two sets of conflicting examples lies the tension upon which the publishers rely to get us to watch, as if she were un grand spectacle. An entertainment.
Even the headline is telling: “WATCH Amal Clooney.” Not, “LISTEN to Amal Clooney.” Watch.
I suppose, having chosen to marry a guy with worldwide celebrity, that Amal Clooney has bought into this whole deal. She may be negotiating her new status on something of her own terms, while also giving the press something of what they want. So as for her being held up as a “role model,” I have to think about that one.
I know a 17-year-old, the daughter of someone I care about, who is at this moment in inpatient hospital treatment for anorexia and bulimia—fatal illnesses on the addiction “spectrum.” This girl is every bit as lovely, intelligent, and articulate as Ms. Clooney. She has from earliest childhood been led, by the same culture that manufactured and published this video clip, to watch images of beautiful women being held up in some way as models—fashion models, role models—people after whom she has been led to “form” or “model” herself. She has not been allowed the cultural space to look inside herself and find her own beauty, intelligence, strength. And she’s not yet old enough to claim that space by force.
Aside from this girl I’m also thinking of an extremely intelligent 18-year-old high-school valedictorian/homecoming queen/babe currently in one of my freshman writing classes who couldn’t stop reading her teachers’ minds in order to “succeed.” I asked the class to read Cheryl Strayed’s essay “Heroin/e,” one of the cornerstones upon which Strayed built her blockbuster book Wild, which became a film last year, etc. In the essay, Strayed loses her mother to cancer and herself to heroin use. I asked the students to write about a time when they’d lost themselves. Shortly after I posted the assignment, this student emailed me saying she’d never lost herself. She was panicking: What if everyone else in the class has had a moment of traumatic loss and I haven’t?—I won’t be able to compete. “I cannot stop thinking about how I have never had a moment when I felt truly lost,” she wrote.
I am suddenly wishing that I had been lost.
I told her, Awesome: so you’ve never been lost. I said, Write about the fact that, while all around you, people are losing their way, you have managed to retain possession of yourself. … In fact, two weeks before, she had written about her compulsive perfectionism—classic addictive behavior encouraged in our society. And for the Strayed assignment she was so consumed with reading my mind and Giving Teacher What She Wants that she had abandoned her own experience.
I took a little risk and wrote her,
Perfectionism is a delusion that, in my experience, has taken me away from myself for years. You may not have lost quite so much time, or gone quite so deeply into it as I (and others) have. But even now you confess, “I am suddenly wishing that I had been lost.” That’s the wish of a perfectionistic woman.
The words “intimacy” and “vulnerability” are bandied about a lot these days, so I’ll use them advisedly. But this is the kind of “intimate” dialogue I enjoy having with writing students. I extend myself a little bit by telling the truth, and I see if they reach back. She wrote an essay that broke a little shard out of my heart. It ended,
My idea of success is currently defined by other people’s expectations. Until I can look past what others think of me, I may never find who I am, but the fear of failing while finding myself is too great of a risk. For now, I am content with being lost.
I sat there trying to stick the shard back into my heart (always an impossible task, but I’m human—I try anyway), and I reminded myself that the longest-lasting change happens in small steps. And always with radical truth-telling.
To the extent that Amal Clooney acts according to her own mind and conscience, I think I can accept her as a “role model” for young women. But I’m afraid most young women won’t see that far. After all, Amal Clooney is a high-court attorney with a thigh-gap.
Most—not all, but many—young women’s eyes have been trained to see only as deeply as the thinness between the surface of the glass on the mirror and the silver-gilt on the back.
Or even thinner.
Tommy Rosen is a brother from another mother. Last fall, in the same week, he and I published the first books extant on physical recovery from addiction. Tommy’s book is named RECOVERY 2.0, after the name of his big annual online conference. He has quarter-century in recovery, and he writes and teaches widely about using yoga and nutrition to, as he says, #MoveBeyond addiction.
I loved talking with Tommy about recovery. He has a native understanding of the body’s innate capacity to heal, which was my first higher power back in 1999.
My talk with him airs today. Please check it out! You can access it for free till February 12. After that you can pay to have all three dozen or so talks put in your own “recovery library.”
And, as always, please comment and let me know what you think.
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