Guinevere Gets Sober

Recovery news, reviews and stories, by Jennifer Matesa.

Tag: Suboxone (page 1 of 4)

I’m Not A Unicorn.

It’s been a long time, dudes!! The New York Post is running a story today about middle-aged women and addiction to prescription painkillers. The reporter was looking for a middle-aged middle-class white chick to talk about this, and guess who she found.

The online headline says I was a “perfect mom and wife,” but I was not a perfect mom and wife inside my addiction. I was a lot less than that.

And as always with newspaper stories, some things didn’t make it in:

  • That my son (who is now 18) knows about my addiction, is my biggest supporter in recovery, and has always had my back (read here, and here, and here, where I told him about my addiction)
  • That both my parents were addicted to legal substances and died because of their abuses of those substances.
  • That I do not hold my doctor responsible for my addiction, but I do hold her responsible for failing to screen me for risk of addiction before giving me drugs like pure hydrocodone and morphine and fentanyl, and for failing to recognize my addiction and respond with compassion and treatment, not judgment and punishment.

The biggest thing that didn’t make it in is my main reason for talking to the Post. (I mean, the Post is famous for Page Six, right? but if it had been the New York Times or Pro Publica or the Kalamazoo Gazette, my motive would have been the same.)

I talked to this reporter because there are other reporters out there (here is one example; there are many others) saying that once you’re addicted to opioids, you may as well resign yourself to taking drugs for the rest of your life.

black-unicorn-tattoo-design

(It’s hard to find an edgy unicorn image. They’re usually pink and lavender and sparkly. This black tattoo-design is cool. I’ve been thinking about getting a tattoo—maybe I’ll ask Cara to put this somewhere on my skin)

I am, however, not a unicorn. I know so many people, including many many women, who no longer cop heroin or snort Oxy. And they don’t take methadone or Suboxone, either.

But in some public health circles, it is said that there is no “proof” that we can actually do this. Nobody (except the tens of thousands of people who live opiate-free today) has “proven” that abstinence from opioids is possible—that human beings can choose to live drug-free and actually for-real carry out that choice.

There does exist, however, some evidence that people who are addicted to painkillers or heroin stay off street drugs and stop injecting if they take other opioids. (A lot of the research is driven by the desire to find a way to control the spread of HIV infection through needles.) So indefinite maintenance with these drugs—possibly for a lifetime—is now touted as the “evidence-based standard of treatment” for illnesses like the one I have, no matter what your circumstances.

I’m very cool with anyone who chooses to take drugs for life. If you WANT to drink methadone or suck on bupe films forever to keep from shooting or copping, it doesn’t matter to me. I considered it myself at one point. I have no problem with it, and I will not bristle at you in comments sections.

It’s unfortunate that a lot of people who choose maintenance say the way I do recovery—and the way so many other people I know who have long-term abstinence from opiates do recovery—is not “evidence-based” and therefore is sentimental, stupid, unscientific, or dangerous.

I will bristle at that. (I will still not judge you, but I will bristle, because you are judging me.)

It’s the people who DON’T WANT to drink methadone or eat bupe that I hear from.

I write and speak to places like the New York Post because I have heard from so many people who want to quit their maintenance meds and can’t find anyone to help them. Including, probably, many people who stand in grocery store lines reading the New York Post.

Let me restate in words of one syllable: they want help and can’t find help. Think about that. They are paying, per month, maybe $400 cash to the “Sub doc” plus whatever it costs them to buy bupe, or they are buying bupe on the street, and they want to quit, and they can’t find help.

I want to demonstrate that help is available. In order to demonstrate this, I’m willing to do hard stuff.

It’s kind of a little bit hard to talk to a total stranger from a newspaper with a circulation of half a million and admit that you took oxy just so you could, like, make breakfast for your family. And that you changed dates on scripts, and that you let people down, including the people you loved and who loved you most, and made super-problematic moral decisions inside your addiction.

But anyone who has been inside addiction and who hopes to get out will know what I’m talking about when they hear these stories. And hopefully they’ll see a light at the end of the long dark tunnel.

This site is free. If this post helps you, please use the buttons to “like” and pass it on!

Suboxone Detox Redux.

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.

 

A Suboxone film, cut for tapering.

A Suboxone film, cut for tapering.

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:

  • Get good food. Eat no sugar, no caffeine, and as much organic protein (meat, fish) and vegetables and fruits as you can. Fuel your body well.
  • Get good sleep. Don’t take sleep aids, except for maybe benadryl or melatonin, which Dr. Scanlan prescribes during Suboxone detox (see above). A low dose of gabapentin helped settle my legs and get sleep. Hot baths also did the same thing—fill your tub with scalding water and enjoy feeling your muscles relax. Scanlan also prescribes Librium (chlorodiazepoxide)—if you can get a provider to help you for a month or so by prescribing a low dose of this, it may help you sleep.
  • Keep exercising. This will ease your restless legs and arms, reset your opioid receptors, and increase your energy levels and your appetite for good food. Yoga is also effective to stretch and relax the muscles that feel cramped and jumpy.
  • Meditate. Research shows that for recovering addicts, meditation restores the connection between the limbic brain (the part where cravings live) and the prefrontal cortex (the part that lets us make good decisions). In detox and post-acute withdrawal, meditation calmed my mind and helped me understand that every goddam moment of detox passes and that I could make good choices to foster my health.
  • Read Dr. Scanlan’s paper about Suboxone detox. Pay special attention to the section called “The Jump,” in which he says he tapers people down to very low amounts and advises his patients to stop the drug when they have a week or two to take it easy on themselves.
  • Find a supportive community. Anyone who has been taking Suboxone is struggling with an addiction. And nobody gets sober alone. We all have to learn to ask for help. When I was detoxing, I needed to be in touch with people every day. I did this partly on the public forum Opiate Detox Recovery (which has a special Suboxone forum), and partly in a 12-step program, where I got a sponsor who I called almost every day, and where I went to meetings where I met people who had done what I was trying to do and were holding down jobs, raising kids, and most of all being happy.

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.

Recovering Body_small

Trapped on Suboxone: A Woman Who Can’t Say No.

My comrade-in-arms Jason Schwartz, who blogs at Addiction & Recovery News, has a good post today on harm reduction. I filed a comment on his post and was compelled to cross-post it here, in greater detail, just because I have to start sharing this information I’ve been collecting or I’m gonna burst.

A Suboxone film.

A Suboxone film.

I’ve been interviewing people who are part of the new state of American harm reduction: Oxy and Vike addicts who are “stabilized” on enormous doses of Suboxone. (If you’re part of this trend and want to share your story, please email me.)

Over the weekend I spoke to a woman who, for a 50-75mg/day Percocet habit, was prescribed 16mg Suboxone per day. She had emailed me in desperation for advice about how to quit. She’s been at this level for 7 years. She has gained 75 lbs. and has gone into menopause. She feels emotionally dead.

I can’t tell you how crazy it makes me when I hear 1) that doctors are “treating” a 75mg Percocet habit with 16mg buprenorphine (you don’t need to atom-bomb a small Oxy habit; this is how to quit); and 2) that harm reduction advocates think these prescribing practices improve people’s lives.

An ad for a Florida Suboxone doctor. Suboxone ads promising to "free" people from addiction crowd the back pages of city alternative weekly newspapers and are posted on signs across the hillsides of poor urban neighborhoods.

An ad for a Florida Suboxone doctor. Suboxone ads promising to “free” people from addiction crowd the back pages of city alternative weekly newspapers and are posted on signs across the hillsides of poor urban neighborhoods.

Here are her Suboxone doctor’s prescribing practices: she has a five-minute visit with him every two months—via Skype. (This is one of the “good” doctors—one of the ones who doesn’t charge exorbitant cash fees for twice-monthly visits.) And when she told her doctor she wanted to quit taking Suboxone, this physician told her that, if she wanted to quit , she would one day just “forget” to take it and then she would be done.

“I think he just doesn’t get it,” she said.

He’s never taken it, so he’s in this la-la land that people can come in with an addiction and take Suboxone, and boom—they’re cured.

She’s desperate to get off Suboxone, but she knows she can’t do it by herself. She looks back at her previous Percocet habit with longing and regret—withdrawal from that level would have been comparatively easy.

She recently had surgery, and the anesthesiologist and nurse told her that they’re seeing more and more OR patients on bup—it’s the new wave. … After her surgery she took 2 Percocet every 4-6 hours as directed, and within five days a devastating withdrawal descended upon her. She described it as a band of fire belted around her abdomen, along with all the other symptoms of withdrawal, magnified. She managed to abstain from Suboxone for almost two weeks, hoping she could stick it out—and it only got worse, despite taking 3-4 Percocet every 3 hours.

In the end she couldn’t hack it. Within half an hour of taking one strip, the belt of fire disappeared.

I told this woman that there are public health experts and media mouths who think she’s better off because she’s no longer doctor-shopping or significantly threatened with overdose. I asked, How would you respond to them?

“I’ve lost my freedom to choose,” she said.

I’ve lost my personality. I’m more quiet and withdrawn. I feel like part of me is dead. And I’m a slave to it. I have to have it. I’ve lost the ability to say no.

A woman caught in a system that doesn’t let her say no. Don’t we call that “rape,” or “coercion”?

Suboxone revenues, 2005-2011. A curve generally thought of as "exponential."

Suboxone revenues, 2005-2011. A curve generally thought of as “exponential.”

And, please, Jason, let’s talk about the money. Reckitt Benckiser pulled in $1.4 billion from Suboxone products in 2012. A Harvard researcher who is looking at American Suboxone prescribing and reimbursement tells me much of it is paid by Medicaid.

So, though my middle-class, employed, insured source gets her Suboxone through Cigna, and though her doctor does not accept Medicaid or other public assistance, taxpayers—you—are indeed underwriting a great deal of this system.

It’s mostly poor people who are trapped on this drug.

Reckitt and Titan (who is developing the implants—the ones recently rejected by the FDA for not delivering enough drug to to the patient) see Oxy and Vike junkies, along with heroin addicts, as a deep mine of insurance and taxpayer revenue, just as Purdue saw pain patients—potential OxyContin buyers—10 years ago.

And, finally, let’s talk about how “people can’t abuse Suboxone.”

melted_suboxone

A melted Suboxone film, ready for injection.

 

People can and do abuse Suboxone.

To Use Suboxone, Or Not To Use Suboxone?

A reader writes:

Hi G,

I know there is no magic bullet or simple answer, but I thought you may have a suggestion for me. I’ve been taking perc or ox for five years, for the first 3 it was only 30-50mg/day but now it’s between 150 and 180.

Suboxone scares the shit out of me, but at the same time, every time I try to taper, I fail and I’m starting to go broke. I lost my health insurance.

I go to meetings 4 or 5 times a week, all helpful, but the physical part keeps me hooked.

I heard suboxone may be ok if used very briefly (like a month or less), as when taken for longer, the withdrawal is way worse than the oxy itself. I wish I could go to a 7-day detox or something, but I just don’t have the money and I don’t have insurance. I also freelance so I need to be able to work and I can’t lose more than a few days. 

Anyway, I started trying to find low-income or sliding scale suboxone programs in NYC, but it’s slow going and I don’t want to just get hooked on something else. I have read long term effects of suboxone are bad too.

I guess my Qs are:

if I were to do suboxone briefly, a few weeks, would I just then have the same withdrawal as I would going cold-turkey from the oxy anyway?

is there something else in my area (or anywhere) where someone could go for opiate detox that costs nothing or very little?

I want to be clean so bad, but every time I try to taper I just fail.

Any thoughts/suggestions appreciated – I know you’re not a doctor or professional, you just seem to have a lot of info and I know how we like to help each other. 

Thanks in advance.

B

Dear B,

There is no magic bullet, but in my experience there are simple answers.

The first was to know that I wanted to get clean. (Which you say you do.) First problem solved: I was telling myself the truth. The truth was, I was willing to do what it takes. And It Takes What It Takes.

The second was to ask for help. (Which you have. Keep doing it.) Nobody, but nobody, does this on his own. Even the people I know who don’t go to meetings have put together communities of other people trying to stay sober.

The third was to use my willingness and my growing community to decide on a path, and walk the walk.

For some people, Suboxone is the solution. They’ll tell you they don’t mind eating an opioid for the rest of their lives—it’s “like a diabetic taking insulin.”

In my opinion the diabetes analogy is worn out. I wanted my solution to be real freedom. When I reached out for help I met people who had shot heroin and who had gone bankrupt buying drugs over the Internet and who had drunk themselves into blackouts—people who drank and used to the excess I had, or worse—who were clean and sober. I wanted to break ties with all drugs that cause physical and psychological dependence. For me taking drugs is signing on for slavery. Just my reality.

I really wanted to go to rehab but I knew I couldn’t leave my kid for that long.

Here’s how I decided on a Suboxone taper.

I knew I couldn’t detox off full-agonists like oxy. Too alluring. (More truth-telling.) I needed to change all my habits. So I asked for help—I found a detox doctor who was willing to oversee a Suboxone taper for me.

I told him at the outset that I wanted to taper. When my resolve flagged, he reminded me that the project was to get free.

I put the taper in his control. I never had more than one week’s worth of drugs in my possession. He wrote out the taper, I wrote out the check, we shook hands. I waved the white flag and gave up.

I did what he and a bunch of other people—Dani, Allgood, Sluggo, Bonita, all online friends; and my new real-life sponsor and community—told me to do. I put my faith in the people who were sober and who told me I could be, too. I burned a script for more drugs. I went to meetings and opened my mouth and let myself cry on people. I kept collecting sober people around me.

Several weeks later I was drug-free for the first time in years.

And yeah, I ain’t a doctor, but I’ll offer this anecdotal caveat: if you’re taking 180mg Oxy, they’ll try to start you out at 8-12mg Suboxone (or maybe even more). But that would be increasing your tolerance. If you really want to get clean, you’ll start at 4mg and taper to 3mg within two days. You could do a 2-week taper, cutting to 1/4mg—the equivalent of 1 Percocet—at the end and have a relatively smooth landing.

Post-acute withdrawal.

I ain’t gonna kid you: staying clean was a slog. Tapering off suboxone was not nearly as bad as detoxing cold-turkey from fentanyl or oxy, but it wasn’t painless—I shivered, I kicked in my sleep, I sneezed 20 times in a row. Keep in mind, my tolerance was more than twice yours, and I’m probably a little smaller than you. I spent each day telling myself if I made it to bed without having stolen drugs (because yes: I used to steal drugs) or used anything, including alcohol, I was a success.

The best treatment for drug-cravings was vigorous exercise. It helps the body produce its private supply of morphine and dopamine. Dr. Steve Scanlan told me research shows people who exercise cut their recovery time in half. I made playlists that helped me drag my body around the neighborhood. Walk, run, cycle. Do pushups. Lift weights. Start small and grow bigger. I exercised, and my body and mind recovered.

Healthy. (Mostly.)

Healthy. (Mostly.)

A 180mg oxy habit is totally beatable. With a stick, my friend. Dude, if I can get clean, you can. I was on more than twice that and I’m free today. And I did not use insurance to get clean. But I paid what it took—the first of several critical investments I’ve made in myself over the past few years. Paying that doctor made me realize that, for a long time, maybe all my life, I’d withdrawn a great deal without putting very much back.

 

The most important information here: Get to a meeting. Tell them you want to get clean. Ask them to help you.

If you feel you need inpatient or other professional help, try Phoenix House, a large NYC-based treatment system with detox facilities in Long Island City. Or try the “free and affordable” resources listed on this website.

Among Addicts, It’s A Small World After All.

The other day I get an email from an English guy who says he has a story about Subutex, if I’m still collecting stories about buprenorphine (I am still collecting them and will be talking to folks starting in May—if Suboxone saved your life and/or kicked your ass, please email me).

This guy spent 10 years on buprenorphine after a devastating heroin habit. He took methadone to get off heroin, and he thought that in Subutex he’d found a painless stepping-stone off methadone. But bupe has given him all kinds of problems with his intellect, emotions, creativity, ambition, passion. He writes,

I cannot feel joy.

He jumped off Subutex two weeks ago and writes that he has already had a couple slips because he’s so impaired that he can’t stand it.

I have a loving wife, two beautiful sons, supportive friends, an ok job and yet I have been wanting to die for a few years now—not actively suicidal (you can’t be actively anything on long-term sub maintenance) but quietly hoping that fate would off me.

I know what he’s talking about. So does my jump-buddy, Bonita, who kicked Suboxone days ahead of me in 2008. So do thousands of other people who have had trouble either being on or kicking buprenorphine, or both.

//

So, but here’s where it turns “most uncanny,” as Nigel said: In writing back, I mention I’ve spent tons of time in the UK, mostly in London and Yorkshire.

Nigel replies: he was raised near Kensington High Street (London), and he was educated at the Catholic boarding school, Ampleforth (York).

I know where Ampleforth is, I say, because I’ve been practically everywhere in the North from the Lakes to Robin Hood’s Bay, and all the dales and moors in between.

And I’ve lived in London. I tell him about a very unhappy, lonely winter I spent in London 15 years ago. “To combat a serious case of depression,” I tell him, “I used to push my son up Marloes Road toward Ken High Street and into Holland Park every day I could. I retain a great affection for Holland Park, and for a little tiny key-garden called Edwardes Square.”

Edwardes Square, West London. Photo courtesy of Londonholic.

Edwardes Square, West London. Photo by Londonholic.

Most Americans visit St. James’s Park, Regent’s Park, Hyde Park. Holland Park is an underrated treasure, appreciated mostly by Londoners, who, on warm summer nights, enjoy outdoor concerts and pick-up footie matches on the lawn. And friggin nobody knows Edwardes Square. I get blank stares when I mention it to anyone. It’s just a little tiny square in West London. When people get that far they make the cab fare worth their while by visiting Kensington Palace, the V&A Museum, the boutiques on the Kings Road. You can’t even get into Edwardes Square unless you live in one of the houses facing it. I myself couldn’t get in. But it was my little psychic refuge that long-ago early spring.

Nigel, however, says: his parents live off Pembroke Gardens Close, adjacent to Edwardes Square:

I know the area intimately.

Then:

He says he himself used to live on Marloes Road across from the Devonshire Arms.

Devonshire Arms pub.

Devonshire Arms pub.

(Nigel has lived in some fancy places. Not Belgravia, but still.)

I picture the Devonshire Arms: big corner pub; patio paved for pleasant outdoor boozing. (I never drank at the Devonshire Arms; I had my baby with me, always, and my codeine back at the flat.)

Nigel tells me,

My bedroom window overlooked Marloes Road, and I spent some of the darkest days of my heroin addiction in that ivory tower. I would have been there in 1998.

So. While I was struggling with killer postpartum depression the winter of 1998, walking several miles per day with my boy in a stroller, up Marloes Road and then Campden Hill Road to Notting Hill Gate, then west to the northern entrance to Holland Park—I was passing Nigel in his house every day.

G was rationing out her American codeine.

Nigel was banging his British smack.

And now here we are, on opposite sides of the sea, talking about how to live sober.

Most uncanny, 

Nigel writes.

Definitely a very small and funny old world.

Thank you, Nigel.

Older posts
Visit Us On FacebookVisit Us On Twitter