Guinevere Gets Sober

Recovery news, reviews and stories, by Jennifer Matesa.

Suboxone: Amazing Detox Tool, Monster Maintenance Drug.

An Expert Talks About Suboxone: Dr. Steven Scanlan of Palm Beach Outpatient Detox

Steven Scanlan M.D.

Steven Scanlan M.D., medical director of Palm Beach Outpatient Detox

Steven Scanlan, M.D. is board-certified in psychiatry and addiction medicine. In his practice, Palm Beach Outpatient Detox (PBOD), on the Florida coast, he has detoxed more than a thousand patients off many drugs, including alcohol, benzodiazepines (Valium, Xanax, etc.), and sleep aids. But his specialty is opiate detox.

Scanlan has been practicing as medical director of PBOD for about two years. His practice, he said, is located in an area where more than two-thirds of all oxycodone prescriptions in the nation are issued—the south Florida coast that has become notorious for its “pill mills.”

Scanlan said 70 percent of his patients come to him addicted to oxycodone at levels of about 300 to 600mg per day. About 20 percent also come in with alcohol problems. “The rest use Vicodin and Ultram,” and a few come in addicted to Fentanyl, he said.

And then there are the increasing numbers who come to him desperate to get off Suboxonea drug that combines buprenorphine, a synthetic partial-agonist opioid, with another drug to prevent abuse. Suboxone (commonly known as “Sub” by people with addiction) is used in opiate detox and maintenance, it’s known and “prison-heroin,” and it’s now commonly sold on the street.

Scanlan says he has seen Suboxone work brilliantly as a detox tool and dangerously as a maintenance drug.

I first heard Scanlan speak on a podcast that’s now defunct. Two reasons I was eager to talk to him:

1. Scanlan chose addiction medicine as a result of his own recovery from opiate addiction. He understands addiction from personal and professional experience. While training to become an anesthesiologist Scanlan became addicted to Fentanyl, a strong opioid used in surgical procedures and for severe pain. After trying many times to quit on his own, he found a physician who helped him detox over two weeks using Subutex—plain buprenorphine—and other medications to ease the detox symptoms. He joined a recovery program, then decided he was well equipped to help others suffering from the same problem. Many of his physician colleagues didn’t like working with addicted patients, but he found he did. In his practice, he doesn’t just dole out drugs; he gives patients 24/7 followup until they’re physically comfortable and involved in some kind of support program.

2. I wanted to hear his clear-cut ideas about detoxing off opiates. He only does detox. He never does maintenance. Unlike so many other scientists, who believe people addicted to opioids can never stay off them, he believes we can get free.

“Believe me—it’s much more lucrative to do maintenance, to keep patients on Suboxone,” he said, adding that it’s even more profitable than, for example, doing Botox injections. Hundreds of practitioners—some of them with no experience with addiction—prescribe Suboxone as a maintenance drug, keeping patients on it for years at high levels and charging exorbitant cash fees. But for the vast majority of addicted people, Scanlan does not believe drug-maintenance is appropriate—or even safe. Buprenorphine is such a new drug, he says, and its long-term effects have not been adequately observed and researched.

He has said that Suboxone may curb cravings for other opiates and allow people to stop stealing and get their lives in order. But the problem is that, after three months or so, patients have terrible difficulties quitting Suboxone because of its sheer strength in binding to opiate receptors, its long half-life, and the fact that it’s a partial-agonist binding to receptors built for full agonists. And despite what the media tell us, there are many people who don’t want to spend a lifetime on high doses of Suboxone.

You know what? When I was detoxing off fentanyl in 2008, I felt so good on Suboxone that I thought about staying on it. Then something happened. I no longer felt so good. My feelings dulled. I no longer wanted food or sex. I realized my body was adapting to the drug—or trying to. Fortunately my outpatient detox doctor had no more slots for Suboxone maintenance patients, so I tapered off as quickly as I could. If my doctor had been operating under the new Comprehensive Addiction and Recovery Act, he may have had a slot for me, and I might have gotten trapped on Suboxone as so many others have.

Scanlan said most people, including physicians, do not comprehend the strength and effects of buprenorphine. “Everything changes in the body when you’re on opiates long-term—the way the body regulates pain, the way it regulates hormone production, sleep, emotions—everything,” he said. And buprenorphine, he repeats, is an opiate. Its effects are not just physical: as a psychiatrist, Scanlan has noticed in his practice that at long-term doses of just 2mg, Suboxone can block almost all of a person’s emotions.

In addition, buprenorphine’s half-life is 37 hours, which means it takes the body more than a day to excrete half the dose. When dosed once a day, the body doesn’t have time to catch up, so the drug builds up in the system—a phenomenon called “bioaccumulation” that Rachel Carson documented in the buildup of toxins among wildlife in her book Silent Spring. A patient dosing with buprenorphine at 8mg is not only getting 8mg—he’s getting the 8mg, plus the amount not yet metabolized from the day before (4mg). And 8mg is a low-end maintenance dose. In the U.S., patients are commonly dosed at 16mg or 24mg per day.

“There’s definitely a risk to going on Suboxone long-term—anything over three months,” he said. “It would be easier to detox patients if they were coming in at a year’s time at one milligram, or a half-milligram, which is where they should be. But they’re always coming in at 16 milligrams. Or 4 milligrams for four years but really they’ve been at 8 milligrams and they’ve lowered it just before they’ve come to see me. I have to get them to tell me what they’ve REALLY been taking.”

Scanlan is the only professional I’ve ever heard who can explain why the body reacts so differently to Suboxone than to full-agonist drugs like heroin, Vicodin and methadone. Read on…

Suboxone tablets

Suboxone 8mg tablets

G: Educate me about buprenorphine.

Scanlan: It’s the most amazing detox medication I’ve ever seen. But for maintenance—it’s harder to get off than methadone. Suboxone is 25-45 times as potent as morphine. It’s the king of the hill in terms of opiates—it displaces every other opiate off the receptors, except for Fentanyl. [Maintenance physicians] use way too much of it. When you build up to a serum level, it’s SO POTENT.

Americans should look at European countries’ use of buprenorphine. They’ve had it much longer than we have. They use lower doses; they have as much maintenance as we do. In Scandinavia, what do you think the number-one most-abused drug is?—buprenorphine. Simple facts: they’ve had it longer, and it’s the most abused drug. That’s what I’d like people to know about.

Buprenorphine is now the 41st most prescribed drug in the U.S. Five years ago, it was the 196th most prescribed. [Update, April 2016: Suboxone is now the 16th most prescribed drug in the U.S.] So you can see what a money machine it’s becoming. … The research to get Suboxone approved [by the FDA] was funded in conjunction with the NIH. Until the NIH is run by someone in recovery from addiction, this propaganda will continue. [National Institute on Drug Abuse Director] Nora Volkow is great, she’s smart, I’ve met her, but she doesn’t have a clue.

G: Why don’t you prescribe Suboxone as a maintenance drug?

S: I wasn’t against maintenance when I detoxed. But I’ve seen a lot since then. And I had a detox physician who told me, “Do NOT stay on this drug for more than three weeks, or else you’ll be dealing with a whole different problem.”

Buprenorphine is a partial-agonist opiate. It binds to the receptor and only activates it partway. Opiates are meant to bind to the receptors and activate them fully. But if you put something completely foreign in the body like a partial agonist, the body says, “What is this?” and it tries to reach homeostasis. It struggles to understand it as a full agonist, and it can’t. There is nothing in nature that is a partial agonist, and our opiate receptors are not designed to operate with partial-agonists. Buprenorphine definitely does something unnatural to the body.

I’m not against maintenance for a certain percentage of the population. I have a friend who runs a methadone clinic, and I think there’s a percentage of patients who need to be on maintenance for the rest of their lives. Perhaps five percent of the [addicted] population. If you want to do maintenance, though, you want to do methadone. Methadone at least has been used for a lot longer, and we understand it better.

G: How do you conduct detox?

S: To detox patients off long-term Suboxone, I use clonidine [a blood-pressure medication] and Librium [a benzodiazepine] because it’s more water-soluble. And I use Darvon, a weak opiate. Its half-life is short. … The Librium is the last to go. And they complain of disturbed sleep. I don’t use Seroquel because it can be abused. I use what acts on the antihistamine and melatonin receptors—the only two receptors they haven’t messed up yet. … It can take five months to get someone off long-term Suboxone.

For a Fentanyl detox, I give them Subutex. Fentanyl detox is the most brutal detox but it has the quickest recovery of the receptors because Fentanyl has such a short half-life.

I tell them to exercise. Studies show that 12 minutes of exercise per day with a heart rate of greater than 120 beats per minute restores the natural endorphin system in half the time. The people who do that, their sleep architecture returns to normal in half the time of people who don’t exercise. Twelve minutes. And of course you can do more.

G: And you urge them to join a recovery program?

S: They need some kind of support system. Let me tell you—everyone who’s stayed off Suboxone, they’ve been in AA or NA. Thirty-day inpatient programs have an average rate of 5 percent sober after one year. But from what I’ve seen in my practice, anyone who does an honest fifth step in AA or NA stays sober—the numbers are greater than 50 percent. And anyone who can do an honest ninth step and make amends, the number shoots up to over 90 percent.

Everyone who comes to me, I get them off opiates. One-quarter of the people I treat are sober at six months, and ninety percent of those are actively involved in some program. They’re not just going to meetings or involved in community service—they’re actively seeking some kind of spiritual growth. It all comes down to whether people want to do the work.

G: What about people who are afraid of becoming depressed after detoxing from long-term use?

I ask them, Was there ever a time you were sober? Did you have a bout of depression before then? If not, then it’s probably substance-induced. You have to take a thorough history. The statistics say: of all people who get clean, 15 percent have mental illness. Maybe a bit higher than the general population.

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Related posts:

How To Detox From OxyContin and Other Opiates

Reader Questions: Addiction, Chronic Pain, and Drug Maintenance

Have questions, or want to see someone interviewed here? Email me at guinevere (at) guineveregetssober (dot) com.

9 Comments

  1. Guinevere, Freebird and Jennings. I have enjoyed the exchanges between you and can tell immediately you all have more intellectual knowledge than I. I see right in both sides. One thing I surely want to know more about is the other drug spoke about. Imbogain? You can tell I didn’t go back to get its spelling. Rehab is so different for many people, their needs, drugs used and their ability to recognize what is working or not. Different for all I am sure. From the place of how I am doing today as opposed to detox 30 years ago after which I had 10 years clean. I think in this recent rehab I met people that probably need subs the rest of their lives. If for no other reason than keeping them becoming broke buying on the streets and especially drugs not controlled. ( Heroin ) This detox I believe was not handled properly by explanation in any way. After detox 30 years ago – catapress, librium both for the 1st week of a four week detox. I was sleeping well, drug free, eating well and felt well. Emphasis on felt well. I am still on subs that docs say should be on a year @16 mg. That is a joke from all I have read. If he had his way I’d be taking a host of other things too ie. Traz – cymb – seriq – and he doesn’t really know me well enough to care. But he can have patients on it for a year. 30 pr. year. With that said and things I’ve stated tonight in other blogs let me get to the difference for me. Am I doing better YES. Am I keeping my life organized and in order YES. Am I craving drugs no – not even the subs. I get my monthly scripts and have some in medicine cabinet and still a script to pick up before he writes monthly script again tomorrow. I am cutting down slowly to jump then at the lowest possible rate.
    His first question wasn’t what took me off the wagon after 10 years it was so you made ten years before you went back to it. The last 10 major surgeries through me back on and my irresponsible thoughts that oh this ain’t gonna get me again. It did. The difference with the subs is that I just don’t ever fucking feel well or me. I don’t have the wonderful rem sleep I had from other detox. I hardly sleep EVER – I rest a lot though. I am eating well and gaining back weight but I use the bathroom once every three days and I try not to push but have to to begin. Always some blood. My nose I think is just going to run the rest of my life and I am not focused. Probably from lack of good sleep and though I do all I am suppose to do I don’t feel right. I stopped for 3 days and the feeling was like an overwhelming feeling of ill like I was just going to lay down and die. They said this is a miracle drug that detox symptoms will be minimal and then will ween you off and then send you to Disney Land. Then I start reading all the stories of nightmares of this drug. How many people can’t hardly get off. Sick so much longer. then throw in PAWS for good measure. I was not told anything like about how hard it is to get off. And I am opiate free since November 9th. Before at other detox over three months clean past detox treatment – going to bed felt wonderful. And waking up so refreshed felt wonderful. Dreaming holding someone you love. I don’t want anyone touching me. My doc now knows of all prior medical and gives it for pain. Opens up him another slot eh. only 30 pr. yr. but hey mines for pain. Web-site for suboxone maker says NOT TO BE USED AS PAIN MEDICATION. I wouldn’t mind going to a meeting but it won’t help or hurt. I just feel like I’ll miss my pee break where I sit on the toilet zoned for 45 minutes staring at nothing or same thing for 45 minutes. I sit because of leg and hip surgeries then zone until i feel my ass is so sore and I can hardly stand. Or out of no when I have a cup of coffee and smoke I zone and find my cig on the floor with yet another burn hole. I don’t feel like me – and I don’t feel good like I should and I can’t focus. So I take it to avoid the feeling of the detox that starts with the feeling like I’m dying I take it to become the walking dead. Now had the doctors told me these things I would have opted for being a little sicker early and well now or at the very least feel like I’m me. I think you all have good points but read these blogs people write. They break my heart – wait I break my heart. So if I can’t jump and begin to feel like me again I am going to American Addiction Center where they have said they will get me off subs. At least they stand behind their program cause if you don’t succeed first time next time is free-Jack!!! Anybody with sense knows 16 mg is a lot of this shit. They keep telling me it is maintenance dose. I have lost more faith in doctors regarding this crap than in anything else EVER. So we now everyone is different to a point yet we know most people I talk to about its use hate it and struggle greatly trying to get off of it. The arguments should of informing the patients more regarding the use and trying to walk away. And yes if some soul has had a heroin habit for 20 years this would be a hell of an improvement. They will have a better quality of life but not the best quality that they might have had if their use had been less in time duration. So now I;m just as clouded as I was when I started this blog but I’m getting off this stuff. And we should all appreciate each others experiences and knowledge so to help one another succeed. I have never felt as I read that Guinevere has been condescending and Jennings you certainly can tell by what you write you have experience and knowledge. Until its resolved how about if one of you come here and hold me for three weeks assuring me the man I knew is coming back – I loved that man and suboxone has him fucked up. So my experience if you are my friend if they say subs run the other way as fast as your legs can carry. Yesterday I accomplished everything I wanted though it feels like going through the motions without an attachment to anything in real time. I had a yogart watched my favorite show Duck Dynasty staring at the TV. next thing I knew yogart cup on the floor. I was happy I hadn’t zoned too long just felt weird. Yeah same show was on ’cause they repeated every two hours. That two hours of my life- it gone. Thanks maybe thats was my therapy. Getting a yogart – uh oh!

  2. This doctor doesn’t understand that it takes longer than three months for a suboxone patient to change, and develop a program of recovery. Using Suboxone for 3 months then stopping would have a super high risk for relapse. Suboxone is more of a long term drug and if used properly and after a year or 2 of solid recovery should one even think about coming down slowly.

  3. Here’s a little story about my experience with the little orange strips….

    I took Suboxone films on & off for roughly 2 1/2 years with varying success. In
    the beginning, I advocated STRONGLY for the lowest dose possible because
    I had heard it could be difficult to get off of (drug replacement
    therapy? whats that? haha) and also realized I could still GET HIGH on
    full agonists over this low dose. Suboxone was a double edged sword for
    me….the yin and the yang….

    On the one hand, it became the PERFECT EXCUSE to continue to relapse on full agonists until I was actually ready to get clean. Some addicts buy into the propaganda in the
    drug information pamphlets…many don’t. Don’t get me wrong, it was a
    FANTASTIC crutch while attempting to live a “normal” life.
    Unfortunately, I quickly figured out the “game” of how to trick the
    clinics (despite having to submit urine and blood tests), and would plan
    relapses once I had “proven” to the doc I could stay clean. After 2-6
    months of *faithfully* taking my Suboxone, I would “go out of town for a
    few weeks” save up the Suboxone I wasn’t taking (I was usually
    prescribed at least double, sometimes triple, of what I actually took)
    and then just switch to a new clinic when I ran out of money for drugs
    and wanted to go back on Suboxone. Insanity. I know. Clearly I was on
    the war path! But how stupid and easily manipulated were these
    “providers of healthcare”!?!?! The 8 hour class clearly isn’t enough. It
    must teach them how to use that ridiculous 3 strike system…OH and to
    close on holidays, 3 day weekends and any other random reason that
    prevents you from having your dose for over 24 hours…and they expect
    their patients (addicts, mind you) to come back without seeking out some
    kind of relief from the psycho-somatic anxiety that produces? HA! Good
    luck with that.

    On the other hand, I’m fairly sure Suboxone saved me from overdosing on a few occasions. There’s something Suboxone did to my brain…physically and mentally (duh)…but it absolutely saved me from dying while I was busy tempting fate. I’d like to think that Bupe or Nalox bind to your receptors in a way that prevents
    overdose…but I have seen NO scientific evidence to prove this. I only
    know the feeling of taking a ridiculously giant dose of full agonist
    opiates to try to push out the Bupe from my receptors. It was a
    ~strange~ feeling to say the least (it made my boyfriend puke a few
    times)…An eery feeling/reaction that I probably would have died from,
    had it not been for the high binding affinity of Bupe. ALSO, I feel that
    it is SUPER important to point out that this state of LIMBO that I
    attempted CANNOT be maintained with Bupe and full agonist opiates. After
    switching back and forth between the two enough times, it becomes
    increasingly difficult to get BACK on Suboxone after a relapse without
    precipitating withdrawal. Most recently, I waited 18 hours after my last
    dose of short-acting opiates and I went into full blown precipitated
    withdrawals (PW) that took 3 freakin days to stabilize from.

    In the very beginning of experimenting with said limbo, it only took 8
    hours, or one night of sleep before I could take my Suboxone…without
    risking PW, again after a relapse. Long story short. Don’t PLAY around
    with Suboxone like I did. Bupe is no joke. The consequences from abusing
    it FAR outweigh any pleasure you’ll get from a relapse. The full
    effects of your agonist take time. And the clinics, well the good ones,
    almost ALWAYS catch you when you’re in limbo. Hence, my boyfriend
    eventually upping his dose from 6mg to 12mg over the course of a year,
    and my increase from 1mg to 6mg. YOU ONLY MAKE IT HARDER FOR YOUR BODY
    AND BRAIN TO HEAL when its time to taper and eventually jump. This drug
    stays in your body longer than you even realize. The lower the dose
    & shorter duration, the better.

    The Answer: Short Term Suboxone Use With a Quick 6-8 week Taper + Aftercare/Support (mental and physical)

    Anyway,
    the point is, you CAN successfully taper off Suboxone. I frantically
    searched for answers on how I was going to do this…and drove myself
    crazy with fear when I found about 9,000,000 different approaches and
    opinions (and yes I do believe Suboxone increases ones anxiety,
    emotional disconnect, hypochondria, and feelings of hopelessness.) The
    best one I found was call the Robert Taper Plan; very similar to Dr.
    Scanlan’s plan. It essentially maps out how to do a 6-8 week taper; the
    lower the dose you start on, the easier it is. So, after my most recent
    5 month Heroin binge (in hindsight, probably a good way to get any
    residual Suboxone OUT of my sysetem from months of previous attempts
    with this medication), I started at 6mg and worked my way down to .25
    mg. My boyfriend started at 12 mg and worked his way down to .5 mg. Over
    the course of the 8 weeks, I spent the longest period of time on
    2mg and then 1 mg. It was easy peasy to drop from 6 to 1. Coming down
    from 1 mg and not being able to split my dose (morning and night), was
    particularly difficult on my addict psyche. We started cutting 12mg and
    8mg strips (its all we had) into pieces smaller than half a
    pinky nail (there is no scientific way to know exactly how much we were
    actually taking, but we tried to cut as evenly as possible.) I would
    obsess about which sliver was biggest. I was FULL of fear of what was to
    come. After we jumped, we then did a 3-day hydrocodone “buffer,” taking
    5mg on day 1, 10mg day 2, and 5 mg on day 3, to “ease” us into the
    long, drawn-out, annoying, sometimes excruciating, but BEARABLE and
    TOTALLY DOABLE, Suboxone detox. Not really sure if the Hydrocodone
    helped, but I wanted to give the whole picture.

    Its been 6 weeks
    since I jumped, and I look back on my overall experience with Suboxone
    over the last 30 months or so. I absolutely still feel the effects of
    detox. The stuff is coming out of my pores (rash on forehead, itchy
    armpits, inflamed psoriasis), not even joking. I had a very difficult
    time sleeping during my last week of taper and then 2 weeks following
    the jump (roughly 24 days of only naps.) My boyfriend experienced more
    intense feelings of withdrawal, but he’s almost 100lbs larger and many
    inches taller. Plus he was on double the dose to begin with. All other
    symptoms seemed long and drawn out but we quickly began to realize the
    catch 22 that IS Suboxone.

    We are not broken. We do not need to
    be treated like a diabetic. In fact, the waking up from the Suboxone fog
    has been the most healing and beautiful experience I’ve had in years.
    Emotions returning ten fold! Senses heightened! Passion returned!
    Digging out of my Suboxone cocoon has opened my eyes to truth. I am
    thankful for the experience, but I know there must be changes made to
    regulate the use of this powerful drug. If I was smart enough to find
    the loopholes, surely there are others. The idea is to become
    UNATTACHED. The more attached an addict is to an idea, the more
    addicting it will be. Reckitt wants us to stay attached–its the only
    way they can turn a profit. They’ll continue to spit lies and refuse to
    introduce a lower dose strip as long as its legal…so, forever. Just
    wait until big pharma starts processing, manufacturing and distributing
    medical marijuana!

    Watch out now!

  4. You say after 30 months you are still feeling the effects of detox? What about withdrawal and PAWS? Anything? And why do you not take supplements to purge your system/liver? They work so fast….

  5. 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?”

  6. Bob: 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. Its worth doing.

  7. AMAZINGGG!! Finally, someone who knows what the hell they are doing and talking about… This is the first time I have come across another person, let alone a doctor, who has taken the time to consider all the available data and come to a logical understanding of this medication, both: its general mechanism of action, as well as its effect on the mind and body.

    I can almost understand addicts being misinformed and ignorant about Buprenorphine(Subutex, Suboxone), as there is tons of bad information being circulated, and unfortunately, much of it is coming out from prescribing physicians,”addiction specialists”, treatment facilities, and the organizations you should be able to trust and expect legitimate, honest, and accurate info from(in theory) [NAABT, DATA2000, NIH, FDA]).

    For physicians who choose to dispense this medication (and make a lottt of $$ doing so), the least you can do is learn and understand the science. Truly. If you’ve never faced a painful detox, or struggled with addiction, i suppose its hard to actually care and be emotionally invested enough to get it right….

  8. I have been on buprenorphine for 2 years now and for 2 years before that. I got off it for one year in between. On both times, I started to get gradually sicker after around 6 months of being on the drug. It gave me a terrible case of low testosterone. I started gaining weight rapidly (like 80lb in 6 months). The pain from every injury I ever had returned, except it felt worse than before. After 1 year, I developed depression that I couldn’t shake. I sweat buckets even when it’s cold. I lost all motivation and ambition. My sex drive was non-existent but I barely noticed. Nobody wants to have sex with a fat sweaty loser… By two years, my energy was so low that I couldn’t stay awake through the day. My friends and family wanted me to make an effort to get better but I lost my will to even try.

    I went to rehab after my first period on buprenorphine and got clean for a year. I thought that my body and mind would return to normal if I could just wait long enough. I did all the recommended things like aa meetings and exercise etc but after a year, I couldn’t stand it any more. The depression was unshakable and I was freezing cold and exhausted all the time. My pain went away but my mind wasn’t the same as before. Eventually, I went back on buprenorphine, except, I no longer had any will to ever stop.

    My doctor has me where he benefits the most now. I pay $375 cash every month, just to get my prescription and then another $300 to buy the buprenorphine pills. My doctor was clueless about how it causes low testosterone. He acknowledges it now but he won’t prescribe testosterone replacement so I have to waste more money on another doctors appointment for that.

    Since starting testosterone replacement therapy, I started reducing my buprenorphine dose on my own. I didn’t need as much. I have a desire to quite again, for the first time in years. I doubt I’ll ever recover fully from this poisen though. I just want to stop waisting my money on doctors who claim to be “addiction specialist”. When you get sick, there is no shortage of people to take your money but there is nothing ANY doctor can do to help.

    I don’t know what is worse, the side effects of buprenorphine or having to put up with the condescending way doctors and pharmacists now talk to me. Before all this, I was a successful businessman who earned over $700,000 per year. I was respected. I had a six-pack and was healthy.Now I get treated like a street junky who can’t be trusted by the same people who sell me this filth. I haven’t worked in the last 2 years either. Subutex robbed me of my ambition.

    My advice to anyone with this problem is to never believe anyone who says they can help you or anyone who makes a living from your suffering. There are no “experts”. Nobody knows how to make it better. There are plenty who talk a good game while they seperate you from your money though. Get help with detox and the it is all down to you I’m afraid. Relying on other people to keep me clean has always ended in relapse.

    My first “addiction specialist” doctor replaced my opiates with a bunch of anti-depressants that didn’t help one bit. They did ensure that I was forced to attend expensive monthly doctors appointments for years before I finally got off all the pills he prescribed. He spoke about how many addicts he had “helped” etc, just like this guy. US doctors don’t follow up after treatment is finished (and the last bill is paid) so none of them know if they actually helped anyone.

    Withdrawal from buprenorphine is slightly easier than other opiates but 6 months later, staying clean is no easier. I met a few guys who detoxed with buprenorphine and then died a few months later when they relapsed. The doctors and rehabs probably have no idea and still think they helped those kids.

    If anyone involved in government or treatment really cared about helping us, treatment would be a lot more affordable and less arduous. Making us spent $300+ per month for doctors to sign prescriptions, is the medical community profiteering from our misery. In their vanity and arrogance, they have convinced themselves that it is about helping people… I have taken the same subutex dose for 2 years. My doctor adds zero value to my treatment. If I could buy it without needing to waste time and money with monthly appointments, I would never see another doctor again. They are just drug dealers with a license.

  9. as someone who has done suboxone for 8 months and as a detox, I have to say that there isn’t really a right answer or perfect way to do it. Each person is different and each attempt at recovery is different. Many people try to quit when they simply are not ready. Basically they are quitting for a loved one, a job, money, but not for themselves because they actually want to live sober. Most people, my self included have tried to quit just to get through withdrawal so they can take pills the “right way” this time. Sub is a double edged sword. If one can simply not stop after years and many, many attempts at sobriety, and I mean like hundreds, not just a few attempts, then if sub is what keeps you alive and off the streets shootin then its hard to argue against sub. It really takes a lifestyle change and your own personal desire to actually stand a chance at quitting. If you cannot be honest with yourself and admit you are powerless over your DOC, then you will fail every time. this is step 1 in AA. It doesn’t need to be a huge lifestyle change like many in AA preach but a suttle change in character in many aspects of your life can get you off the destructive path. Until “you” want to be clean then you have a chance. Most likely you will still relapse but its not the end of the world as long as you can learn from it. I have recently relapsed after several months clean. Its been just over a week of use and my tolerance is back to sky high. I just started a great, new job and i am really beating myself up for letting this happen. Why did I relapse? I got complacent with my program, stop going to meetings, ditched my sponsor, left Kaiser CDRP(which is a great program by the way), hung out with the wrong people. I am scared shitless as to how I am going to get through the WD and maintain myself as a good employee without people knowing. I have never been able to taper more than a few days and since its only been about 9 days of pretty heavy use my withdrawal should be enough to make me pretty miserable, especially since I cannot miss work. I have done quick detoxes before with decent success and as many of us are aware, getting clean is a lot easier than staying clean. So here is my plan of attack which I think will work well. I have got myself 1-8mg Subutex pill and 10 or so 2mg xanax,
    Since my DOC was oxycodone taken mostly as oxycontin. daily doses were 160mg-400mg. My plan is to take my last dose in the morning and go the rest of the day, preferably a thursday, with nothing. My hope is to wake up friday morning(the next day) with some pretty intense cravings. Physically i expect the symptoms to get alot worse as the goes on but if i am busy at work and can keep my mind off it, I should be just fine. Now is where the xanax i hope comes in handy. Ill take some to try and sleep friday night(night 1). Normally I would have taken sub by now but since I only want to do it with 1 8mg pill and its all i can get I need to use it just right. I plan to take my first dose, 1 mg snorted. I think you get more out of each pill this way compared to under the tongue. i will basically keep this up and make the sub last as long as I can. By waiting longer to induce into subs from my last use means i wont need as much. less is more with sub as they say. I will take xanax at night to ensure i get some sleep. other meds/vitamins will be B6, IMMODIUM for the runs, and ibuprofen for the aches. I may smoke weed but I find it but can make me anxious and scare me. the most important thing Ill be doing is going to AA/NA meetings each day no matter how much I don’t want to go. I always feel better knowing I am not alone out there. GO TO MEETINGS. Talk to people. I figure if I can make the sub last 5-6 days keep the zannies for sleep. I have never been a fan of xannax because it just makes me sleepy. So once i get back to work i will have had 3 full days off opiates but will have sub on me and should feel decent enough at work. Ill pick up a second sub if the wd is worse than expected but plan on no more than 8-10 days b/c once off the sub thats when the real work begins and you need tyhe foundation of meetings and NA and your own desire to be clean. Exercise, fluids, as much food as I can get down and a positive atitude and I expect to feel about 95% normal right arouind 2 weeks from last opiate use, Wish me luck.

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