Suboxone– nobody's business.

There are plenty of people out there who ‘take issue’ with Suboxone.  Isn’t it odd, when you really think about it?  I mean, we don’t have people arguing about whether someone else should take medicine for their diabetes;  we don’t have people get in the face of cancer patients, and tell them that ‘the chemo is really going to suck!’ So what is it with Suboxone?
Today I came across a web site called ‘’, or something along that line.  I posted something in response to a person who wrote something like ‘I’m addicted… help!’ —  I wrote that I had info about Suboxone at my blog and on my recordings– the ones I have shamelessly plugged on this site (another shameless plug– go to  I really though I was giving useful information, but within a few minutes someone reported me for spamming, causing me to be ‘banned’, then to add insult to injury I got a note from some person saying ‘while some people have had help from Suboxone, it has really screwed some people up, so I hope you’re not one of THOSE doctors… ‘   It is in cases like that when I realize that the internet is missing something–  and that someone (maybe Al Gore when he invented it!) should have added a way to just send the ‘f’ word through cyberspace so that it flies out of the other person’s computer and whacks the person on the forehead… WHACK!!– like that.  Do I sound resentful? (sorry).
‘I HOPE you’re not one of THOSE…’   Wow.
I am a bit ornery tonight, as you can tell.  I’m not sure why–  I have been storing up a couple resentments, and I really should do something about that, as resentments are really bad for sobriety.
Anyway… I don’t know whose fault it is– bad doctors, nosy busybodies, self-righteous types– but some people are really screwing up the whole Suboxone thing.  This is an amazing medication, folks– take it from a person who got clean in the days before it was available.  The ‘old way’ of getting clean required first losing everything– house, career, savings… maybe freedom, and maybe even one’s life.    Some people found a ‘rock bottom’ and got into treatment; some fraction of those people stayed long enough to ‘get it’;  some fraction of those people stayed clean for a month; some fraction of those people stayed clean for a year.   Recovery happened for only a few people, and only after great losses.
A patient of mine died last spring;  he was 25 years old, had just found a great job… he wasn’t on Suboxone, mainly because he had only been using for a couple months.  I had him lined up for treatment but then he got the great job, and insisted that ‘I have too much to lose– I would never use now!’.  I tried to explain that it doesn’t work that way– that people relapse when they are doing well, when they get that great job– that is when they get cocky and forget about the misery, and the mind starts spinning…
He was a nice kid.  I have his autopsy report on my desk.  I have another set of photos on the floor near my desk from a different case– another 20-something year old guy who died from opiates.  I have the police photos in that pile, showing him in his parents’ house, in the bedroom where he grew up, but now with a swollen face from the attempts by EMTs to ventilate him, unsuccessfully because he died a few hours earlier while his parents slept in the room next door, or maybe his mom was awake and worried about him from the friends he had been hanging with…

it is terrible, talking to the families afterward– the parents second-guess every decision they ever made, torturing themselves for months, years–    I know death from my anesthesia days in Philadelphia where every night a couple kids were brought in with holes in their chests, bellies, or heads.  I got sick of it there, and I get real sick of it now.  Nothing glamorous about death from opiates– James Morrison fat and blue in the bathtub… Elvis on the floor three feet from the toilet, pants around his ankles… Cobain with his head blown off from a shotgun.  Not cool.
Suboxone has save thousands of lives.  No doubt about it.  No, it is not perfect.  Few medications are perfect.  Want to know a secret about antidepressants?  They barely work.  Just barely.  In almost all clinical trials of antidepressants, about 50% of the placebo group gets better on sugar pills, and about 70% of the treatment group gets better on the medication.  That is it– all of the excitement over Prozac, and we are talking 70% vs 50% recovery.  Compared to that, Suboxone is a true miracle.
Tomorrow I will try to find the time to write about something that I talk about extensively.  Yes, it is on my tapes (that is meant as sort of a joke, and sort of another shameless plug!).  The topic will be about how Suboxone can do much more than many people get out of it.  Many people just use if for the effect on cravings– which is admittedly very dramatic and important.  But there is so much more to addiction.  As an aside, don’t confuse ‘addiction’ with ‘physical dependence’– they are two different things.  People become ‘physically dependent’ on many medications– for example the withdrawal from effexor is horrible!  That is not addiction– addiction is the mental obsession that crowds out everything other part of life, that prevents intimacy with other human beings, that makes life shallow, dry, and miserable.  When people say you have ‘substituted one drug for another’, they are missing the point entirely–  it isn’t about what you are taking.  It is about whether you are still actively obsessing over a substance or not.  Suboxone stops that obsession– THAT is the point.
So tomorrow, or maybe over the weekend, I will talk about how Suboxone does that– and how you can make sure it happens.  Yes, just taking Suboxone will get you halfway there.  But if you recognize the ‘conditioning’ of your brain that has occurred from using, and take Suboxone properly, you can ‘extinguish’ that conditioned pattern of thinking.  THAT is the wonder of Suboxone– and the people that buy it on the street and take little pieces every four hours are missing that point completely.
And the nosy folks who get in your face about Suboxone are clueless about it as well.

Telling employers, parole officers, and hospital boards about Suboxone and addiction

I received a comment in reply to a post about a person who’s parole officer was demanding that he stop taking Suboxone.
The comment/question: What about the hippa act?…how did your employer find out about your past addiction,current use of suboxone?
In this case the parole officer was well aware of the history of addiction, as the criminal charges were related to the patient’s use of opiates.  HIPPA does not play a role in that case– after a conviction a person has to provide whatever information the court demands, and anything related to addiction is fair game.  From the court’s perspective a person does not have a right to privacy in regard to illegal activity, which would include the illegal use of legal medications.
Regarding employers, at least in the US employers are allowed to perform drug testing, and in some cases to ask about history of addictive disorders.  I am most familiar with the medical field where questions about prior addiction are the norm.  Addiction is a ‘protected disability’ according the the ADA, but the protection is narrow–  an employer can fire or refuse to hire a person for the behavior related to the addiction– not for ‘having’ addiction, but for breaking the law, working while intoxicated, etc.  The common question on applications for medical positions is ‘do you have an addictive disorder that has the potential to affect your ability to care for patients?’  President Bill Clinton would struggle with that question– if he didn’t know what ‘is’ is, he would never figure this one out!  What I mean is that a person who is actively addicted is going to be in denial and think that he/she is fine.  On the other hand, a person in good recovery is going to know that any addictive disorder will ALWAYS have the ‘potential’ to affect performance.

An employer can ‘discriminate’ against a person with a history of addiction IF having addiction is relevant to the nature of the job.  Someone hiring anesthesiologists can object to hiring an opiate addict, because the job requires the handling of potent narcotics.  A bar owner can refuse to hire an alcoholic for the same reason.
A word about drug testing–  some drug tests will show buprenorphine as positive for opiates, and some will come up negative.  It depends on the brand of the test.