Suboxone, Buprenorhpine, and limits on treatments

With approximately 150 people dying every day currently in the USA from an opioid overdose (CDC stats) – 60,000 a year – I want to share some basic information about Harm Reduction treatment options that my husband and I regret not choosing 6 months before our son died of a heroin overdose.

Buprenorphine (Subutex) is a narcotic that is an opiate agonist. Like heroin and other drugs derived from morphine, buprenorphine contains chemicals that link with opioid receptors in the brain to reduce pain and produce feelings of well-being. Buprenorphine was prescribed for many years as a pain reliever before it was approved for opioid addiction in 2000. It replicates the actions of opioid drugs — only to a much lower degree due to long-acting effects that can relieve cravings for opiates without giving the high and has a more mild withdrawal. But it can still be abused and overdoses do happen, especially when used with other drugs or alcohol.

Suboxone is a combination 4:1 of buprenorphine and naloxone, an opioid antagonist. Naloxone (Narcan) is used to quickly bring someone out of an opioid overdose. Suboxone was developed in response to a need to discourage users from abusing buprenorphine by injecting or snorting the drug to get high. Naloxone was added to the buprenorphine to keep the user from feeling the effects of the opioid. It was first released for use in 2003.

Our son’s addiction doctor prescribes Suboxone due to its proven ability to help addicts gradually and safely detox while they also participate in 12-step programs and counseling. It can take years of gradually decreasing doses to help and addict fully recover. Sadly, there is a federally imposed limit on how many patients a certified addiction doctor can treat each year with these drugs. Until 2017, the limit was 100 patients. It has now been raised to 275. This is woefully insufficient given the number of people addicted to opiates in our country.

In 2000, Congress passed the DATA-2000 Law limiting the number of patients a physician can treat annually for addiction. National Alliance of Advocates for Buprenorphine Treatment (https://www.naabt.org/reasons.cfm) has an excellent article on why we need to end the limit on care with these life-saving drugs. They give 20 reasons the law needs to be changed immediately. #20: “No other medications have such restrictions, including the prescription drugs people get addicted to and die from. Like many well-intentioned laws, the unintended consequences are significant.”

Suboxone is not a magic bullet, and we knew that when we rejected it for our son in 2014. He had been on Suboxone 5 years before and he was prescribed 32 mg a day – the starting dose now is 8 mg a day. Because of that high dose, the withdrawals were so much worse than those from heroin – and he was hesitant to go through that again at some future date. We thought he needed to ‘just try harder’ and be more committed to a recovery program. And it was expensive and not covered by our insurance. Sadly, we failed to realize that he needed both medication and a program. He went through withdrawals once again, entered a sober living home and did great for almost 6 months. But he needed oral surgery and was given Percocet and within 3 weeks he had relapsed and died of a heroin overdose. As it has been said, Harm Reduction methods may not be perfect, but you can’t recover if you are dead.

 

The Hijacked Brain

I watched an interview on the PBS Newshour the other night with a physician whose young son recently died of a heroin overdose. He has started a foundation to help raise awareness and to bring an end to this deadly epidemic. My husband and I connected with him on so many levels: having a wonderful and brilliant son – who desperately wanted to be free of his addiction – die a needless death; the remorse over not knowing what we could have done differently to help our son; the desire to do something to help others before they are forced to share our pain and grief. In the interview he reiterated the truth that few people understand about opioid addiction: once a person is addicted to opioids, they are truly not normal or themselves any more. The drug has hijacked their brain and they are not capable of thinking normally. They must have the drug at any cost.

This is the reason that there are so few opioid addicts who live long enough to enjoy recovery, as opposed to addicts who use uppers like cocaine or meth. As Tracey Helton Mitchell said in her memoir, The Big Fix: “Heroin kept me chasing my tail, but crack (cocaine) finally sent me into recovery.” Our son’s addiction doctor put it this way: “Most people will build up tolerance to opioids and that tolerance is what leads to addiction. Once addicted, it is only over a long period of time with medication and group therapy (like the 12-Steps) that a person has hope of being free. This is why I call it the cancer of brain diseases’.”

In her article in The Washington Post, December 1st, Dr. Sandra Block (a neurologist) gives further evidence as seen on EEG’s on the changes to the brain that opioids cause:

“Neurologically speaking, opioids are crafty. They turn the brain’s own electricity against it, rewiring connections in an endless feedback loop for more drugs. They trick the brain into a death trap, as users chase the chemical bliss from the drugs with more drugs. Acute opioid usage (that is, the high itself) translates into slowing on the EEG. Usually, such an effect is transient, carefully monitored by an anesthesiologist during surgery, for instance. But when the patient becomes the anesthesiologist, the cycle can become lethal…the opioids overwhelm the brain’s respiratory center, causing cardiac arrest… I’m seeing brain death in people who haven’t lived their lives yet, whose brains haven’t even fully developed, brains that are literally killing themselves for drugs.”

My goal in sharing this information is that it will bring awareness to families and friends – and addicts – about why opioids are so pernicious and that we will begin to see those trapped in the addictive spell as individuals who really do want help. Learning what actual help is, as opposed to enabling the addiction, is a topic for another time.

 

I read the news today, Oh boy…

This is the post excerpt.

 

“I read the news today, Oh boy…” I am echoing John Lennon’s sentiments as I sing this phrase after watching the national news and one more feature on the Opioid Epidemic. More statistics, more information, more deaths, more families in free fall. The anger my husband and I feel originates from the sense of helplessness against overwhelming odds: drug cartels that have been well-functioning dispensers of deadly drugs for decades; pharmaceutical companies that seem to conveniently forget that the Hippocratic Oath and swearing to non-maleficence relates to all of the medical professions; government bureaucracies that can’t seem to either figure it out or get out of the way to stem the tide of the rising death toll that is killing the future of our nation— and the world.

This is a recurring, intensely frustrating, feeling that I have carried my entire adult life: seeing all too clearly what lies beneath the surface of a problem, whether it is personal, corporal, or physical in nature, while the issues seem too big for one person to deal with. So, most of the time, I do nothing. But the opioid crisis and its effects on surviving family and friends—this did not just hit close to home, it hit the bullseye. It went straight to our hearts and shattered them forever. We had a choice to make: either walk around with a bandage over our hearts and go on with our daily lives, or bare our wounded souls in the hope that as we do so, others in the same condition will be drawn to do the same and perhaps, just perhaps, we can together begin to affect lasting changes in the demise of our children’s’ lives.