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TagsBY IRA LEVY
COMMENTARY
You won't find this advertised on the state tourism board's website, but it is a well-known fact that New Jersey has some of the purest street heroin in the nation. It is a popular choice among local drug users.
The federal Drug Enforcement Administration reported in 2008 that heroin use among New Jersey's 18-25 population is more than twice the national average. Many doctors and addicts are relying on Suboxone — a narcotic that can be taken at home to treat the addictions caused by heroin and other opiates — as a long-term solution for the addictions these drugs cause. I disagree.
I believe Suboxone encourages patients to continue thinking and acting like an addict long after they are out of recovery.
With more than 500 Suboxone prescribing doctors in the Garden State, we have to make sure we don't turn one addiction epidemic into another.
I do not mean to criticize Suboxone as a detoxification medication. In fact, we use it regularly at Sunrise Detox, in Stirling, to control opiate addiction. The "cold turkey" approach to treating withdrawal is too dangerous and the pain of the symptoms can make it psychologically challenging for a patient to stay in the facility and complete the process. However, it is not an ideal solution for long-term treatment.
Picture a 35-year-old heroin addict who is missing his commuter train to Manhattan, stealing from his children and running around on his wife. He goes to one of these clinics and the doctor puts him on a Suboxone maintenance program.
Six months down the road, he isn't stealing from his kids' piggy bank, he's showing up to work and he's a reliable husband, but he is still dependant on Suboxone. Is he in recovery?
I say no. This man is still dependant on a narcotic. As a friend of mine said about people on Suboxone maintenance programs — they may be functioning in society, but they're not living in it.
Here in New Jersey, I see more and more evidence that Suboxone is headed down the road of Methadone. And as a former drug addict who was on the Methadone program for two years, I can truly say it did not help my recovery at all. In fact, it enhanced my addiction. It gave me a legal way to get high.
Suboxone is a tremendous tool we have in our arsenal to make the detoxification process as tolerable as possible. It allows our patients to leave Sunrise with virtually no withdrawal symptoms.
But don't view Suboxone as a long-term treatment. We do not write prescriptions for Suboxone for our patients when they leave Sunrise Detox. Patients who medicate with large doses of synthetic opiates are no better off than when they first checked in for treatment.
The withdrawal symptoms are minimal for short-term Suboxone use, but they can grow to be quite painful after long-term use.
The two questions I'd like to ask those health professions in favor of Suboxone maintenance is: What happens when a patient needs detox for his Suboxone addiction? Aren't we just switching seats on the Titanic?
Ira Levy is a detoxification expert at Sunrise Detox, a private luxury detoxification center with a location in Stirling, New Jersey. He can be reached at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or 561-533-0074.
You’re basically saying all signs and symptoms of the disease are gone but then asking “so is the medication effective?”. It sounds like you think the real goal is to be off all medications while the purpose of addiction treatment is to end the damaging compulsive behavior that has taken over the patient’s life. Taking a pill each day isn’t the problem, consequences of addictive behavior is what matters and is what needs to stop. If this was any other disease it would be proof that the treatment was effective since the disease is now in complete remission. The stigma associated with addictive disorders is so strong, that it distorts our logic. Testing your logic with another chronic disease usually helps clear things up. Let’s say it was a seizure medication and all signs and symptoms of the disease were in remission, would you still be asking if the treatment was effective after all the patient is still taking the medication?
Attempting to apply and make sense of non-medical terms coined before modern complicated medications existed doesn’t work. The definitions of “In- recovery” and “clean” (as they apply to addiction) were created before buprenorphine and before recent advancements in the understanding of addiction medicine. These terms no longer accurately describe the disease of addiction. For example signs and symptoms of addiction can be in total remission yet the patient may require a medication, these terms don’t allow for that and would consider successful treatment a failure as a result. When using medical terms like “remission” sensible evaluation becomes much clearer and its easier to recognize that stopping the damaging compulsive behaviors is what matters not taking a daily medication.
You’re not differentiating between physical dependence and addiction, which makes it impossible to understand why anyone would be in favor of buprenorphine treatment. Physical dependence just means that the patient has developed tolerance to the point that they would have withdrawal symptoms if they stopped the medication abruptly. This is normal and expected of almost all CNS medications and not a disorder nor reason for treatment. It does not negatively affect a person’s life and at most can be considered an inconvenience just as daily injections of insulin are. A slow taper off of the opioid resolves physical dependence. Addiction is a whole different set of brain adaptations and is much longer lasting and much more difficult to resolve and it’s thought that some of the adaptations, particularly the ones associated with the part of the brain responsible for memory, may be permanent. With addiction, after detox the brain adaptations remain causing symptoms of depression, craving, hyper-sensitivity to pain, anxiety, which can last for months and usually causing a relapse. Patients are puzzled and think it’s a willpower problem, because they can remember, while being only physically dependent, when they could simply stop have withdrawal for a few days and emerge relatively symptom free. But since that time an additional more complex set of brain adaptations has occurred and it will require a longer and different treatment to undo what can be and learn to cope with what can’t be undone. Buprenorphine gives the patient freedom from cravings and withdrawal so they have the time to implement the long-term solutions that will translate into sustained addiction remission.
It’s also important to understand that buprenorphine isn’t for people who can quit without it. It is only for those who are unable to stop and would relapse without medical intervention. The choice for these people isn’t bupe or just quitting, the choice is bupe or relapse and with each relapse there is the risk of death. So the people who are opponents of buprenorphine are unwittingly in effect pro-relapse or pro active addiction. If someone was able to end the addiction without bupe then of course they don’t need it and nobody is suggesting they should be on it. It should only be considered by people who cannot achieve sustained addiction remission with cold turkey or with a short detox (which is thought to be about 95%)
Publication on how buprenorphine works:
http://www.naabt.org/documents/naabt_brochure%20Version%202.pdf
Timothy Lepak
www.NAABT.org
With buprenorphine treatment first you have to be clear on what it’s for. It’s not for treating “drugs” it’s for treating “addiction”. Addiction is the uncontrollable compulsive behavior that ruins lives by interfering with job duties, finances, relationships, and just about everything important to the person and their loved ones. Addiction is the manifestation of brain adaptations; actual changes in the brain that influence behavior and judgment. Because addiction alters the brain from its normal healthy state, we call it a disease. Detox treatments don’t help reverse these brain adaptations, only time and changes in behavior and thinking can do this, and some changes may be permanent.
Buprenorphine treatment stops the cravings and withdrawal which allows the patient to establish new healthy patterns of behavior. In therapy they can learn tools to prevent relapse and learn how to they can help facilitate the reversal of the brain damage caused by years of addiction. This takes time, 6 months to a year is not an unreasonable time frame for these changes to begin to occur.
Patients stable on buprenorphine don’t show the uncontrollable compulsive behaviors of addiction instead they can return to work, begin to rebuild relationships and trust, fix stressful financial situations and eliminate other things that might have drove them back to drugs. Most people cannot make those important changes in their lives while fighting cravings and withdrawal. Once the changes in life are made and the medication is no longer needed a slow taper off of the medication makes for a comfortable transition. It is a myth that withdrawal symptoms are substantially greater after long term use, in fact most people find they need less buprenorphine as time goes on indicating a decrease of physical dependence (the cause of withdrawal).
You can read more about why it is not switching one addiction for another here:
http://www.naabt.org/faq_answers.cfm?ID=1
Timothy Lepak
www.NAABT.org
Also, you are defining treatment and recovery according to your personal views. Recovery is what best suits the patient not what someone else determines for them. Some addicts can detox while others might require a month or two in rehab. Many, many addicts don't succeed at these treatments and methadone is the best solution for them. Longer term addicts might need to given heroin itself until they can take the next step. Abstinence is a noble goal but getting there might take much longer for some or even impossible. Abstinence should always be the first option and the final goal but the cold hard fact is that you can't push an addict into a treatment unless they are willing and ready.
BTW, the supposed high from methadone is a poor substitute for heroin and other opiates. It's debatable if all methadone patients take it because it's a legal high as you explained.
I have severe arthritis in my shoulder's and ankles and hand's with out the methadone I would never be able to do my job and pay my bills but if I was given a regular opiate for my pain it could very easily effect my abilty to use the power tool's I need for my job " carpenter" not every one at these clinics is looking for a way to continue to get high while claiming to be clean.there are many people in methadone programs that do not follow the rules and continue to use while in treatment. but they need real help for their problems many have other issues that have caused them to use drugs to mask emotional or physical pain and until those under lying issues are addressed no amount of counseling or methadone will help them
May be if we didnt spend so much money sending people who got busted with a bag of cannabis to rehab's to avoid loosing their license or get thrown out of school or fired then we would have money for people with real drug problems to get the help they need.