This post can also be seen on Treatment Today, under expert advice.
I have been around those using and prescribing Suboxone for several years now. And currently I am very torn between the help I have seen the drug give, and the addictions that it seems to continue to drive. Mainly because the number of people I have seen actually totally come off this drug, can be counted on one hand.
Let’s start with the positive and give credit where credit is due. I have seen Suboxone help get people off hard street drugs. I have seen it help parents go back to work and to start living a somewhat normal life. I’ve seen mothers arrive to a mental and physical place where they were finally able to petition to get their children back from the court systems. And I have seen it help torn families become loving families again, as moms and dads were able to see their child’s face appear in the face of the addict that once stood before them. In helping with these achievements, it can definitely be seen an amazing drug.
And maybe to be equally fair, one must first personally define their own definition of ‘success’ for addiction treatment. As a doctor once told me, “I don’t care if they snort it, eat it, inject it, or absorb it rectally; if they are alive tomorrow … I win!” There are a multitude of others out there that are just as concerned with ‘harm reduction’ vs. true abstinence and recovery. I have heard many, many times … “at least it is the lesser of the possible evils.” And it is true that, in order to learn something new to help you recover tomorrow, you must indeed be alive to hear it.
However there is a growing elephant in the recovery rooms that no one seems to want to address nor talk about. I have personally seen a significant increase of people coming INTO recovery that are fully addicted to Suboxone itself! Now how exactly does society plan to get someone off their drug of choice, by legally continuing to give them their drug of choice?
First and foremost – IF Suboxone is indeed a true recovery drug, why does it rank so high on the list of favorite street drugs as well? Maybe it is time we reassess or even begin new research on the ‘true’ “ceiling” and diversion statistics?
Secondly, how are we going to address pugging some of the obvious holes we have in the overflow of Suboxone onto the street? Specifically, how is it that there are still so many ‘recovery programs’ that are giving patients 3-4 pills/strips a day, for months and years on end, with little to no tapering, little to no monitoring, and no consequences for deviance or diversion? This treatment model echoes the shady pain clinic’s that would write (and sadly still do) people 10x the amount of daily pain medication, that any one person could actually ingest and live to tell about it. Suboxone is not like meth, people aren’t just ‘cooking’ it on the streets; it is going out the door on overly stuffed script pads … which don’t just write themselves.
So without going off onto too many tangents, or getting overly winded on any one soap box, let’s get back to the drug itself. Suboxone for all practical purposes would appear to be just a simple tool, much like a hammer (although maybe not quite as ‘safe’ as once thought). A hammer in the hands of a skilled and caring craftsman can build an amazing house. Yet that same hammer in different hands can tear down the very house that was just built. Therefore the outcome of Suboxone would seem to rely heavily on the morals and values of the doctors prescribing it, as well as the education of the patients taking it.
Could it be that having the prescribing mentality that someone who has abused and self-medicated for a multitude of years is now going to actually “take only as directed” because they are in ‘recovery program’; is just as ludicrous as the patient believing that taking a ‘pill’ is all they need to do, in order to stop taking pills?
I don’t think it’s a coincidence that the success stories I have seen, have been at locations where the doctors had extensive monitoring, enforceable rules, just consequences; and combined those with both counseling and physical/nutritional help. This being directly compared to the non-existent success rates of those ‘recovery centers’ that had little to no tapering, little to no consequences, with patients nodding out in the ‘meeting room’, yet were allowed to drive off with their umpteenth scrip of 4 a day … after their cash payment of course.
I personally don’t think the problem is with the drug Suboxone itself … I think the problem resides in something much deeper. I believe it hides in the lack of accountability, education, morals, and values of those directly involved in the recovery process. Impacting everyone from prescribers, to judges, to the person who is actually taking the prescription. Sadly I fear that we as a society are doomed to continue to repeat this downhill spiral until we collectively stop allowing ourselves to be ‘over medicated, and under educated’ about these issues!
Who am I?
I have been called "Sirthinkalot" and "The mender of souls." I am an addiction specialist and a full-time psychology student on the way to Dr. Davis in clinical psychology. I am currently crusading for the expedited paradigm shift in addiction recovery!