spini4
Bluelighter
- Joined
- Nov 18, 2003
- Messages
- 795
In the field of addiction treatment, most professionals have embraced one clear absolute that has become the foundation of our collective belief system. It is an absolute that recovery hinges on, complete abstinence, from all psychoactive substances.
The 70s reinforced this commitment when Quaaludes and Valium became problematic for those predisposed to addiction, despite the pharmaceutical industry’s assurance that they were "non-addictive." However, the 80s and 90s challenged our beliefs with a new medication, which promised to treat depression, by impacting the brain’s serotonin reuptake systems.
A long, painful debate ensued as we slowly acknowledged the inherent wisdom of treating depression, when present, with medications that had proven their value and safety. We finally decided that antidepressants like Prozac and Paxil could be safely used by those in recovery.
Now, we again find ourselves enmeshed in debate regarding, buprenorphine (Suboxone) a new medication, designed to treat opiate addiction. There are those who contend that it is "just like Methadone" and should never be used. Others believe that it can only be used, as an adjunct, to a detox regimen. There are also those who hold that, for most opioid addicts, continuing on Suboxone is the most practical, prudent, safe, and effective strategy. Recent studies have tended to concur.
This new medication for opiate addiction is, in truth, simply the unique combination of two very old, well known medications: Naloxone (also called Narcane or Naltrexone) in combination with buprenorphine, a semi-synthetic narcotic, which also serves as a partial agonist for the mu and kappa receptor sites.
Buprenorphine has a lengthy history as a marginally effective analgesic. As a partial agonist, buprenorphine also displaces opiates from the receptor sites due to its greater affinity for the site. It also eliminates withdrawal symptoms and craving in opiate addicted patients. While, in the narcotic family, its properties and effects are very different from full agonists like Hydrocodone, Oxycodone, Morphine, Heroin, etc.
Buprenorphine is unique in that it does not have the capacity to make the user feel "high" with either therapeutic or increased doses. It also offers very little risk of overdose, taken by itself or with Naloxone. Most importantly, buprenorphine does not create tolerance, thus, the opiate dependent person who has started buprenorphine is very likely to reduce their dosage by choice, as they discover lower doses serve to close their receptor sites. There is nothing to be gained, by the patient closing the site more, as their withdrawal symptoms have totally dissipated.
In my discussions with addiction professionals, I have often encountered very strong opinions regarding the use of Suboxone. When asked to explain why Suboxone should not be used, as an adjunct to long-term recovery, I have encountered interesting and sometimes disturbing responses.
One professional, from a very well known facility, defended their use of Suboxone for detox only, by professing that patients on Suboxone are "unable to access their spirituality." I chose to refrain from asking how this was measured. Others have expressed a variety of reasons that I will list and attempt to address.
"It is just like Methadone."
In fact, Subutex (buprenorphine only) or Suboxone is very different chemically in its structure and effect, from Methadone. Having worked in a Methadone clinic, I saw the line of patients each morning waiting for their daily dose. The vast majority gradually developed a tolerance to the Methadone and their dosage increased until the staff would place them on a 21-day detox. Afterwards, the same tolerance buildup would begin again. There is no tolerance buildup with Suboxone, so dosages remain the same or come down on their own.
Often clinic patients would "chip" heroin on top of their methadone so the Methadone served as a base opiate dose and, thus, required less heroin to achieve a "high." Suboxone blocks the effects of any opiate use so using any opiate would be a waste of time and money.
More at: http://www.myvalleynews.com/story/66296/
The 70s reinforced this commitment when Quaaludes and Valium became problematic for those predisposed to addiction, despite the pharmaceutical industry’s assurance that they were "non-addictive." However, the 80s and 90s challenged our beliefs with a new medication, which promised to treat depression, by impacting the brain’s serotonin reuptake systems.
A long, painful debate ensued as we slowly acknowledged the inherent wisdom of treating depression, when present, with medications that had proven their value and safety. We finally decided that antidepressants like Prozac and Paxil could be safely used by those in recovery.
Now, we again find ourselves enmeshed in debate regarding, buprenorphine (Suboxone) a new medication, designed to treat opiate addiction. There are those who contend that it is "just like Methadone" and should never be used. Others believe that it can only be used, as an adjunct, to a detox regimen. There are also those who hold that, for most opioid addicts, continuing on Suboxone is the most practical, prudent, safe, and effective strategy. Recent studies have tended to concur.
This new medication for opiate addiction is, in truth, simply the unique combination of two very old, well known medications: Naloxone (also called Narcane or Naltrexone) in combination with buprenorphine, a semi-synthetic narcotic, which also serves as a partial agonist for the mu and kappa receptor sites.
Buprenorphine has a lengthy history as a marginally effective analgesic. As a partial agonist, buprenorphine also displaces opiates from the receptor sites due to its greater affinity for the site. It also eliminates withdrawal symptoms and craving in opiate addicted patients. While, in the narcotic family, its properties and effects are very different from full agonists like Hydrocodone, Oxycodone, Morphine, Heroin, etc.
Buprenorphine is unique in that it does not have the capacity to make the user feel "high" with either therapeutic or increased doses. It also offers very little risk of overdose, taken by itself or with Naloxone. Most importantly, buprenorphine does not create tolerance, thus, the opiate dependent person who has started buprenorphine is very likely to reduce their dosage by choice, as they discover lower doses serve to close their receptor sites. There is nothing to be gained, by the patient closing the site more, as their withdrawal symptoms have totally dissipated.
In my discussions with addiction professionals, I have often encountered very strong opinions regarding the use of Suboxone. When asked to explain why Suboxone should not be used, as an adjunct to long-term recovery, I have encountered interesting and sometimes disturbing responses.
One professional, from a very well known facility, defended their use of Suboxone for detox only, by professing that patients on Suboxone are "unable to access their spirituality." I chose to refrain from asking how this was measured. Others have expressed a variety of reasons that I will list and attempt to address.
"It is just like Methadone."
In fact, Subutex (buprenorphine only) or Suboxone is very different chemically in its structure and effect, from Methadone. Having worked in a Methadone clinic, I saw the line of patients each morning waiting for their daily dose. The vast majority gradually developed a tolerance to the Methadone and their dosage increased until the staff would place them on a 21-day detox. Afterwards, the same tolerance buildup would begin again. There is no tolerance buildup with Suboxone, so dosages remain the same or come down on their own.
Often clinic patients would "chip" heroin on top of their methadone so the Methadone served as a base opiate dose and, thus, required less heroin to achieve a "high." Suboxone blocks the effects of any opiate use so using any opiate would be a waste of time and money.
More at: http://www.myvalleynews.com/story/66296/
