MedWorm provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest medical blog items that have been tagged with 'buprenorphine'. Sat, 03 Sep 2011 02:31:57 +0100 http://www.medworm.com/index.php?rid=5182333&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FTuIBpEDapBQ%2F I would like to add a couple things to my pages about opioid dependence.  For those not familiar with the sites already included, you can find most of them through links at a home page called Addiction Remission.  I have ‘bupe tube’, a collection of educational videos;  bupe news, a site that has news releases related to opioid dependence and buprenorphine, and a page that has items for purchase– including my book, and even underwear with the ‘talk zone’ insignia!  Nobody has purchased a pair yet, for some reason…. Ideally, I would like to drop the ‘subox’ part of the name to the blog and forum, and replace it with ‘bupe’ or with ‘opioid’.  I’m worried about losing readers, of course, and losing the little b... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=5182333 Fri, 02 Sep 2011 04:17:50 +0100 5182333 http://www.medworm.com/index.php?rid=5174866&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2Fb7cMgoHVGao%2F Discussions about chewing or crushing buprenorphine provide examples of the doublespeak that only confuses people.  My own recent discussion with another Suboxone prescriber went like this: “I don’t want patients to crush or chew the tablet because that will make it get absorbed too quickly.  In fact,  I usually recommend the film, because it dissolves much more quickly than the tablet.”  Say what?  Do we want it to dissolve more quickly or not?  The truth is that it really does not matter.  The dissolving of buprenorphine— or the film– is the LONG part of the process. The veins under the tongue absorb the drug in Suboxone. Actually, buprenorphine passes through all of the surfaces in the mouth, eventually entering capillaries under the surface.  The veins under t... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=5174866 Sun, 28 Aug 2011 23:20:49 +0100 5174866 http://www.medworm.com/index.php?rid=5140310&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2Fb4mUXsOZtdk%2F When Suboxone first became an option for treating addiction to pain pills back in 2003, some people were excited about having a cure for opioid dependence. Those people were mistaken. It is true that Suboxone has been a huge benefit for treating opioid dependence, but the medication cannot cause the permanent changes in the brain that would be necessary to prevent relapse. Instead, in order for the medication to work, people must do what they do with other medications—keep taking it. Not all scams are so obvious I recently read an article on another web site that advocated a certain person’s ‘method’ for rapid opioid detox. I went to the primary web site for the developers of that method—pulled to the site in the same way that I am drawn to watch late-night commercials for g... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=5140310 Thu, 18 Aug 2011 20:04:56 +0100 5140310 http://www.medworm.com/index.php?rid=5078045&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2Fph8VNxNqhAc%2F I recently received a question about stopping Suboxone (buprenorphine)…. I deleted the message but I remember the bulk of it, and I have a copy of my response. I thought that someone else out there may find it useful, so here it is: The question: I have decided to go off Suboxone after that was recommended to me by almost everybody. My doctor told me to taper off by going down to 2 mg per day, and then take 2 mg every other day, then every third day, and stopping after I get to every 4th day. I followed those instructions and I am taking it every other day, but I am now getting sick every other day. Is this a good way to stop Suboxone, or do you recommend another way? My response: I’m not certain who is giving you advice. More and more, the standard of care is to keep people on bu... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=5078045 Sat, 30 Jul 2011 04:09:56 +0100 5078045 http://www.medworm.com/index.php?rid=5036582&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F5LpSKHRr-d8%2F Each physician who prescribes buprenorphine for opioid dependence can treat only 30 patients at a time during the first year as a certified prescriber. After a year, physicians can apply to have the limit increased to 100 patients. I have been at the 100-patient limit for some time, in part because of the shortage of providers willing to undergo training and go through the paperwork to get certified. At the same time, there are no limits at all on the number of patients who can be treated by doctors with high-potency opioids, and no limits or regulations on the types of conditions that can be treated using narcotics. It is no surprise that I receive several calls per day from people who ask for help, who I am forced to turn away. The 100-patient cap, combined with the shortage of doctors,... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=5036582 Sun, 17 Jul 2011 18:23:12 +0100 5036582 http://www.medworm.com/index.php?rid=4945208&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FVpNNB4h6x5I%2F I received the following e-mail a couple days ago: Hi I had been on Suboxone for 9 years. I was put on it the week it was approved by FDA. I found your posts in a blog. I was looking for a class action suit against this terrible drug. That man who said he was enjoying a Suboxone was right. I was on it almost 9 years and did get high and stay high all day, just like methadone. It causes depression and brain damage. I have been off it for 2 months now and am very sick with depression, panic attacks, and have not been able to even take care of myself. Please, if people want to get off drugs help them and send to treatment and AA NA. thanks nancy Those of you who have read this blog for a while may remember the posts ‘back in the old days’—a few years ago—when I would get these kinds o... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=4945208 Sat, 18 Jun 2011 23:50:00 +0100 4945208 http://www.medworm.com/index.php?rid=4893927&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F8pitPCKr9a4%2F Ah yes…. another post about my book… Over the past few years, I’ve taken posts from this blog, posts from other sources that I’ve written, some sections of a ‘memoir’ that I have not gotten around to writing… and combined them in a book about addiction. The book does not hold together as well as it should, and it is way too long– so instead of a ‘sit and read’ book it is more like a reference, similar to the blog itself. If you like this blog, you’ll like it; I’ve taken the more important posts and cleaned them up and organized them. I’ve added some new material as well, including a section about my own background. If you have a loved one on Suboxone, or have an interest in the medication yourself, you will know... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=4893927 Fri, 03 Jun 2011 14:07:39 +0100 4893927 http://www.medworm.com/index.php?rid=4883910&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2Fiz1T5XSIZzU%2F On May 27th, 2011, actor Jeff Conaway died from complications of opioid dependence. His death has been attributed to several causes—sepsis, pneumonia, and aspiration among them— but there is little debate over the ultimate cause of his death at the age of 60 years, that being addiction to opioid pain medications. Mr. Conaway reportedly struggled with chronic pain and addiction to pain medications for a number of years. His situation was particularly tragic—living with severe pain that was relieved by nothing save for a substance with the power to destroy him. Such situations are, unfortunately, not uncommon. It is easy to take the position that Mr. Conaway should have avoided pain pills; that his addiction essentially disqualified him from even considering them. I will take that atti... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=4883910 Tue, 31 May 2011 15:57:00 +0100 4883910 http://www.medworm.com/index.php?rid=4771349&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FCXOtxFUDhh8%2F I’ll often joke with others who have histories of addiction over the ingenuity of addicts when it comes to finding or using drugs.  If that amount of creativity and work ethic were ever harnessed for legitimate reasons, the opportunities would be limitless! I have similar thoughts when I read the story about several county inmates at a New Jersey jail, who smuggled Suboxone into jail disguised as watercolor paint on cartoon images! Dope Smugglers The story has a humorous side, of course– but after we stop laughing, we are all sobered by the memories of the living hell created by opioids, detox, and withdrawal.  I’ve met many, many people who went through detox in jail or prison, and I realize that being in such a state is no laughing matter.  I assume that the exp... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=4771349 Sat, 30 Apr 2011 18:02:55 +0100 4771349 http://www.medworm.com/index.php?rid=4753976&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2Fg_ZUm4xRsCc%2F Yesterday I received the following e-mail: Hi Dr. Junig, Please let me first say – Suboxone SAVED MY LIFE. I was down and out until 2 years ago, when I began using Suboxone. Now, having completed all the pre-req’s for medical school with nothing less than straight A’s, I find myself on track to apply to medical school. But here’s the problem. I’m still taking Suboxone and have no desire to stop. I will quit if absolutely necessary, but I’m wondering if you’ve heard anything new regarding the legalities of health care providers taking buprenorphine. I would love to enter a field like psychiatry or family medicine, as these are the doc’s I’ve grown fond of over the past two years. I haven’t told my doctors of my med school plans, as... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=4753976 Tue, 26 Apr 2011 02:18:42 +0100 4753976 http://www.medworm.com/index.php?rid=4696959&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FuA9yORq3fi8%2F I have written about the sleazy actions of health insurer Humana.  Today I filed a formal complaint with the Wisconsin Commisioner of Insurance regarding their practices.  I’ll copy my letter below, rather than take the time to write everything over again.  If there is an attorney willing to work the case on contingency, please contact me.  Likewise, if other patients or physicians are having similar problems with Humana, send me an e-mail through my website at www.fdlpsych.com. The complaint: My patient, XXXXXX, has been treated for opioid dependence for two years, using maintenance treatment with Suboxone.  He has maintained sobriety from opioids.  He also suffers from panic attacks and takes Effexor daily.  He uses lorazepam, a sedative, several times per month, and takes a... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=4696959 Sun, 10 Apr 2011 01:00:18 +0100 4696959 http://www.medworm.com/index.php?rid=4677120&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2Fl3Km47ZfZRo%2F Sorry about the re-run—I wrote this several years ago, and I still agree with the concept of ‘dynamic character defects.’ As I read it now, I recognize how things have changed; buprenorphine (Suboxone) has been incorporated into many of the major treatment centers, and even the smallest programs have at least become familiar with the medication. There still exist some programs where the staff remain ‘anti-Suboxone’, but those places are becoming the exception, and are essentially marginalizing themselves out of the treatment industry. You may note that I had an attitude of cooperation when I wrote this post, years ago. I suggested that those who prescribe buprenorphine work WITH those treatment centers that were ‘anti-Suboxone;’ that they recognize each others’ strengths. ... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=4677120 Tue, 05 Apr 2011 00:42:45 +0100 4677120 http://www.medworm.com/index.php?rid=4622509&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FJUCM1S6JwUs%2F I recently resumed writing for the expert forum on addiction at MedHelp.Org. One result of writing for MedHelp is that I receive a number of e-mails from people with questions about specific issues related to buprenorphine. The most common questions are from people on buprenorphine undergoing surgery, asking about the safety of anesthesia and about postoperative pain control. There are very significant problems with medical coverage for patients on buprenorphine undergoing surgery. Patients on buprenorphine will occasionally need surgery, and in such cases there are often no doctors willing and/or competent to manage postoperative pain. Psychiatrists, frankly, have little knowledge or experience in this area. Before psychiatry residency, medical school graduates generally complete a medica... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=4622509 Wed, 23 Mar 2011 01:35:08 +0100 4622509 http://www.medworm.com/index.php?rid=4528018&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FHjXRDxrC72U%2F Since I began using buprenorphine to treat opioid dependence in my psychiatry practice, I’ve learned quite a bit about what works and what doesn’t work. Buprenorphine is an amazing medication when used properly, and undoubtedly saves thousands of lives each year. Even when used improperly, buprenorphine has life-saving properties. Addicts who take buprenorphine illicitly, but above a threshold dose and frequency, will become tolerant to the effects of the drug, and will be largely protected from overdose. There is little appreciation for this part of the story, which is understandable. We cannot expect society to embrace the illicit use of a substance. Buprenorphine is, after all, an opioid, with some abuse potential. There are appropriate efforts underway to reduce the diversion of b... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=4528018 Mon, 28 Feb 2011 03:02:02 +0100 4528018 http://www.medworm.com/index.php?rid=4489989&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FMqjEhG0FKVE%2F Another chapter from my untitled book, ‘Clean Enough,’ begins with comments from a reader of my blog.  The picture has nothing to do with anything, except that the Packer win was pretty awesome.  The view is from my seat at Lambeau during a game this season. Lambeau I have been using various opiates for the past 2 years.  I’m sure it has affected my life in numerous destructive ways, but at the same time I feel that it has given me hope.  As a lifelong sufferer of anxiety and depression I have always looked for solace, and found it in books, art, music etc. But as I got older I got into drugs, in my case a path leading straight to opiates. As soon as   found them they were solution to all of my problems; I felt secure, safe, confident, sociable, and adventurous.  I fo... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=4489989 Thu, 17 Feb 2011 18:38:37 +0100 4489989 http://www.medworm.com/index.php?rid=4411730&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Fsuboxonetalkzone.com%2Fbupe.pain.pdf Humana Health Insurance recently revised their guidelines to ultimately reduce the number of scripts for Suboxone that they will cover.  I am in the process of writing the Humana Grievance Department a letter to regain coverage for a patient who was doing very well on the medication.  To provide context, last week I learned of a former patient who had stopped buprenorphine for his own reasons, who passed away a few months later from on overdose of heroin.  And then this morning a patient told me about her nephew, who at the age of 16 is in a coma after an overdose yesterday. Buprenorphine has the power to prevent these and other deaths from opioid dependence.  But patients must have access to the medication.  Many barriers exist;  doctors are reluctant to prescribe, afraid of their p... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=4411730 Thu, 27 Jan 2011 09:35:23 +0100 4411730 http://www.medworm.com/index.php?rid=4389368&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FiaTTH8R6dbU%2F NFC Division Champions 2011 The last time the Packers were in the Super Bowl, in the mid-1990′s, I didn’t go;  I was in my30′s and I figured I’d go another time.  Now I’m in my 50′s.  The way things go, the Pack may never get there again in my lifetime. On the other hand, I don’t have a couple grand laying around.  And we are talking about a 3-hour game.  I don’t drink or use drugs, so I won’t have any drug-fueled, strobe-lit parties to try to remember (or headaches to try to forget!). I suppose I could start a fund– send Junig to the SuperBowl to fight addiction!  Think it would fly? I don”t have any ideas for twisting this around to a lesson about addiction… except to encourage everyone to find something in li... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=4389368 Sun, 23 Jan 2011 23:47:28 +0100 4389368 http://www.medworm.com/index.php?rid=4361312&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F2fUYjz31s-8%2F Every now and then I receive an e-mail  or comment that is sufficiently long to warrant a post of it’s own.  Below is the comment without interruption;  a bit lower I repeat parts of the comment, interspersed with my own responses.  I hope you find it interesting. The comment: I am a strange case: vegetarian, healthy, Pilates instructor, good-looking– NEVER A DRUG ADDICT — but i had a secret-  I was badly depressed for years- treatment resistant to over 30 meds, only some helped to a point… I did extensive research into the brain and opiate systems and i wondered if it was possible my endorphin system may be the culprit ( check this primer: http://www.prohibitionkills.blogspot.com/)  I was desperate enough to try out opiates as a final solution ( and I monitored m... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=4361312 Tue, 18 Jan 2011 05:53:49 +0100 4361312 http://www.medworm.com/index.php?rid=4349704&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FdL7cjorvk4M%2F I am always impressed by how similar addiction progresses in one individual versus the next.  The next reader’s comments and my comments afterward demonstrate a pattern that I have observed in one opioid addict after another.  Throughout the book, comments that I receive from others will be italicized. I started on Suboxone in Feb 08 to get off opioids. It worked very well for me, I lost 20 pounds while on it, got very active, and above all was the happiest I had been in a long time. After 7 months of taking 32 mgs a day I had to wean off it because I had no more insurance and it was very expensive. I tried to wean the best I could and the end of Oct was it for me. I was down to taking 2 mgs a day then completely stopped because I ran out of Suboxone. About 3 days after I stopped takin... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=4349704 Fri, 14 Jan 2011 23:52:13 +0100 4349704 http://www.medworm.com/index.php?rid=4331248&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FF3ViFJlIPxg%2F I’m not sure about the make-up of readers of this blog.  I know that there are about 20,000 page views each month, but I don’t know how many are by people addicted to opioids, people taking buprenorphine, family members of addicts, or physicians who prescribe buprenorphine.  If you fall into that latter category– i.e. if you prescribe buprenorphine, or if you prescribe other medications to treat opioid dependence such as Vivitrol or methadone– consider joining the group at linkedin.com called ‘Buprenorphine and other medication-assisted treatment of opiate dependence.’  If you already belong to LinkedIn, you can simply follow this link to join: http://www.linkedin.com/groupRegistration?gid=2710529 I have always resisted separating those who prescribe ... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=4331248 Tue, 11 Jan 2011 05:18:52 +0100 4331248 http://www.medworm.com/index.php?rid=4327070&cid=t_172193_151_f&fid=39304&url=http%3A%2F%2Fwww.recoveryhelpdesk.com%2F2011%2F01%2F09%2Fpregnant-inmate-on-methadone-asks-to-be-released-early-to-get-suboxone%2F Pregnant inmate Ashley Michelle Sligh says that the methadone treatment provided by the Duval County (FL) jail will cause harm to her unborn child.  She wants to be released early so that she can switch from methadone to buprenorphine. Medical experts have long recommended methadone treatment for pregnant women who are opiate dependent.  But a new study funded by the National Institutes of Health and recently published in the New England Journal of Medicine suggests that buprenorphine (brand names Suboxone and Subutex) may be a better choice. “Methadone, which is the standard of care, works fine, but buprenorphine works better” “Methadone, which is the standard of care, works fine, but buprenorphine works better,” says study co-author Dr. Peter Martin of the Van... Recovery Helpdesk blogs http://www.medworm.com/rss/comments.php?id=4327070 Mon, 10 Jan 2011 02:53:01 +0100 4327070 http://www.medworm.com/index.php?rid=4305112&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FAKUTLpy0n0M%2F Aarghh! (he said, moaning in frustration…)  I realize that it isn’t so much anger that shortens our lives as much as the repression of that anger—so pardon my venting!  I just finished an appointment with a patient who described something that is all too common, and that really makes my blood boil. I’ve seen ‘Tom’ in my practice for about three years, since he presented with severe heroin addiction.  He once made good money working in the financial industry, but was reduced by addiction to a shadow of his former self.  He had infections in his arms from using needles, to the point of being in danger of losing one of his arms because of destruction of the limb’s blood supply.  He had tried stopping dozens of times without success, having only several ‘clean days’ in a... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=4305112 Sun, 02 Jan 2011 17:27:41 +0100 4305112 http://www.medworm.com/index.php?rid=4302290&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2Fw04RB3n_ILQ%2F I often receive e-mails asking for advice on tapering Suboxone, or asking how long Suboxone withdrawal should last.  People who read my blog know my approach to stopping Suboxone; I see it as an exercise in futility even in the rare cases where the person is successful, because of a relapse rate that verges on 100%. A couple myths to get out of the way… there is NO evidence that withdrawal becomes more difficult the longer a person is on buprenorphine.  In fact, from my experience the opposite is true.  The feelings and emotions during withdrawal are aggravated by the guilt and shame of active using, and the further from active using a person gets, the less the suffering during withdrawal—and the better able the person is to keep some perspective on what is happening, rather than dr... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=4302290 Fri, 31 Dec 2010 23:33:38 +0100 4302290 http://www.medworm.com/index.php?rid=4275595&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FRyVWAhIqjcQ%2F Why buprenorphine? The partial agonist nature of buprenorphine is behind the usefulness of the drug for treating addiction and chronic pain.  Opioid agonists always cause tolerance, and the tolerance usually causes cravings for more and more drug– no matter whether the drug is being used therapeutically or recreationally.  Tolerance is unavoidable, at least for now (there are some chemicals that may reduce the development of tolerance, but they are not yet on the market). Buprenorphine, on the other hand, initially results in some level of tolerance, but the tolerance stops at a certain level so that cravings do not occur.  The ability of buprenorphine to eliminate cravings for opioids is the basis for its ability to induce remission of opioid dependence. The Drug Enforcement Agen... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=4275595 Tue, 21 Dec 2010 04:19:19 +0100 4275595 http://www.medworm.com/index.php?rid=4251268&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F-vpKoQxWNlw%2F I recently heard from a person who had been told by her physician that she ‘must get off Suboxone before even thinking about getting pregnant.’  I’ve mentioned a number of times that I’ve had about 15 patients go through pregnancy and delivery on buprenorphine, and all have done well.  I encourage people thinking about pregnancy to search this blog for articles related to that topic, as there are a number of posts including some that have recent articles from the scientific literature about buprenorphine and pregnancy. I’m writing now because I noticed that my newsfeed that carries the most recent scientific reports about buprenorphine has a number of articles about pregnancy.  You will find the newsfeed in a couple places–  at the bottom of www.addi... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=4251268 Sat, 11 Dec 2010 22:38:33 +0100 4251268 http://www.medworm.com/index.php?rid=4245613&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FNlNRq7VNamk%2F Physical dependence vs. addiction Tolerance and withdrawal are signs of ‘physical dependence’ on a substance.  Addiction, on the other hand, is a complicated term that has different meanings in different contexts, but generally refers to an obsession or attachment to a behavior, person, or substance.  Many people mistakenly consider physical dependence and addiction to be the same.  To illustrate the difference, there are many medications that cause physical dependence that are not addictive.  Effexor and Paxil, two common antidepressants, cause physical dependence and have very uncomfortable withdrawal symptoms.  Physical dependence occurs in non-psychiatric medications as well; suddenly stopping some blood pressure medications will cause an upward spike in blood pressure... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=4245613 Fri, 10 Dec 2010 03:05:34 +0100 4245613 http://www.medworm.com/index.php?rid=4230320&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FUpAr4nYYtVU%2F What is Suboxone? Suboxone is the trade name for a medication that contains buprenorphine and naloxone. A similar medication, Subutex, contains buprenorphine without naloxone.  Both are manufactured and sold by Reckitt-Benckiser, a company based in the UK with operations world-wide. Suboxone is FDA indicated for the treatment of opioid dependence.  Both medications are also used ‘off label’ (**see footnote ), or without FDA indication, to treat chronic pain and more controversially,  refractory depression.  Because of longstanding regulations in the United States that prohibit treating opioid dependence with narcotics, a waiver from the DEA is required in order for doctors to prescribe buprenorphine for that indication.  Buprenorphine can be used to treat other conditions,... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=4230320 Sat, 04 Dec 2010 23:52:33 +0100 4230320 http://www.medworm.com/index.php?rid=4220469&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2Fe8CVx1yT8bI%2F I received notice today from the area’s Reckitt-Benckiser rep that the company has secured a mini-coup of sorts, requiring state of WI Medicaid subscribers on buprenorphine to use the Suboxone Film formulation.  Here is the notice I received: Reckitt-Benckiser stock share price since Suboxone vs. S & P 500 Wisconsin State Medicaid has as of December 1st  today added Suboxone Sublingual Film as the preferred delivery system. I have attached a file description. Because of some of you large geography and some limited stocking in certain areas. I would suggest you begin prescribing the Film to all your Medicaid patients as soon as possible to insure pharmacy coverage moving forward. All pharmacies can receive for stocking and distribution to your patients with 24 hour notice. For ... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=4220469 Wed, 01 Dec 2010 21:30:50 +0100 4220469 http://www.medworm.com/index.php?rid=4187059&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FUiscgpBTd9w%2F I have set up a page that contains a feed from most major medical journals and science news outlets, configured to show the latest scientific news or studies related to buprenorphine.  It will not necesssarily capture every newspaper story, but it will capture any stories in the scientific literature.  Please bookmark it! www.bupenews.com (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=4187059 Sat, 20 Nov 2010 14:45:21 +0100 4187059 http://www.medworm.com/index.php?rid=4179529&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F4SUSqcWgQww%2F Many of you are familiar with my e-book, ‘User’s Guide to Suboxone,’ that has been available for sale on the web.  The copy that is sold through that site is ‘print-protected’ and copy protected;  a password is required to open the document and it cannot be printed– at least not without a bit of digital trickery.  e-book about buprenorphine I was just looking through the book, and realized that it ain’t that bad– I’m no Hemingway, but I think that it contains some good ideas, and the words are spelled correctly.   The chapters are listed at the end of this post. I plan to upgrade ‘the forum’ in the near future, and part of that process includes raising money for a web designer.  My friend Jim will always be the ‘... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=4179529 Thu, 18 Nov 2010 22:08:48 +0100 4179529 http://www.medworm.com/index.php?rid=4139490&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FkHFCbvPhF9c%2F Much thanks to a reader for sharing a story out of Maine from several months ago. The story refers to a common situation that doesn’t really register unless one happens to look at things with a different frame of reference.  The story refers to a woman jailed for driving on a suspended license.  The local Sheriff has a policy at the jail that people on buprenorphine or methadone for opioid dependence are ‘S.O.L.’– I think that is the official term– so the woman sued the jail for ‘cruel and unusual punishment.’  From my reading of the article it appears that special accomodations were made to allow the suit to simply go away, allowing the Sheriff and everyone else to delay making a formal decision on their degree of hypocrisy.  But the issue wi... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=4139490 Fri, 05 Nov 2010 01:58:48 +0100 4139490 http://www.medworm.com/index.php?rid=4134274&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2Ft2Lu2Pq6Vj8%2F I’ll take a break from the book to post a question and answer with a reader: My daughter’s doctor recently started prescribing her a pill called only ‘buprenorphine,’ instead of her usual Suboxone. Should I be concerned about the change? My answer: You don’t mention the age of your daughter, but your question raises the issue of how involved should a parent be in the treatment of a child?  Perhaps a more general issue is whether anyone should be closely involved in the treatment of someone with opioid dependence?  After all, I frequently write that opioid addiction should be seen as ‘just another disease,’ and it is hard to make the case that people should share the details of their medical histories with others, at least after reaching adulthood. But opioid dependence, whi... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=4134274 Tue, 02 Nov 2010 23:16:26 +0100 4134274 http://www.medworm.com/index.php?rid=4098474&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2Fg61NOs1vm40%2F Introduction Bias of the book You will notice the several times throughout the book I take issue with people over what they say about buprenorphine treatment of opiate dependence.  On my web sites I have been told by those who favor ‘total sobriety’ that I am biased in favor of Suboxone.  I don’t know how to best respond to those characterizations.  I have reviewed the studies related to buprenorphine and Suboxone and become sufficiently educated to understand and critically evaluate those studies.  I have experienced opiate dependence for 17 years and experienced treatment failures and treatment successes.  I have experienced relapse and watched friends relapse and in some cases die from addiction.  I have worked for years with addicts in solo practice, in the Veterans Adminis... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=4098474 Thu, 21 Oct 2010 01:01:00 +0100 4098474 http://www.medworm.com/index.php?rid=4074455&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FX3zhh0WqrR8%2F Introduction:  2. Sharing my story The book begins with a description of my own descent to active opioid addiction, my climb back to sobriety, and my efforts to remain sober.  It is important that I share my own story of addiction and recovery for several reasons. First, all addicts have some amount of internalized shame from addiction-related behavior. It is difficult for an addict to read a discussion about addiction without at some point feeling that the comments blame the addict for his bad behavior. This is especially the case if the discussion includes the type of dialogue that the addict must hear if he is to recover; i.e. comments that imply some degree of responsibility and accountability on the part of the addict.  By sharing my story I want addicts to know that I am one of th... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=4074455 Sat, 16 Oct 2010 16:27:33 +0100 4074455 http://www.medworm.com/index.php?rid=4074459&cid=t_172193_154_f&fid=35946&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCanadianMedicine%2F%7E3%2FToGPD39dVYY%2Fgetting-drug-addiction-treatment-on.html Implants may trump liquid and pillsMethadone has helped countless people hooked on heroin and prescription pain relievers wean themselves off for over 40 years. A methadone alternative may soon outshine the well-known withdrawal aid in some important ways.Buprenorphine hydrochloride, a semi-synthetic opioid compound used for pain control and detoxification, has been available in pill form for two years. But its downside includes diverting the tablets for sale on the streets and crushing and liquefying them into an injectable – and therefore more potent -- form.A recent study published in the Journal of the American Medical Association (http://jama.ama-assn.org/cgi/content/short/304/14/1576) shows promise for a buprenorphine implant, called Probuphine by its California makers, Titan Pharm... Canadian Medicine blogs http://www.medworm.com/rss/comments.php?id=4074459 Thu, 14 Oct 2010 23:05:00 +0100 4074459 http://www.medworm.com/index.php?rid=4061080&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FXOtwvgvu1SE%2F I’ve been writing teasers for a book about buprenorphine for a couple years now.  I keep very busy trying to maintain a solo psychiatry practice, and for awhile there I was running constantly… keepiing the practice going by day and writing nonstop at night.  I’m not sure what possessed me at the time;  I know that I tend to focus more on what I have NOT done than the things I HAVE gotten done, and I really wanted to write a book.  I still do.  But after submitting the product to a number of publishers, I have learned that there is a wide range of publishing arrangements that people work out.  A number of publishers, for example, require ‘new writers’ to make an investment in their own book before the publishers will invest money of their own;  the start... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=4061080 Wed, 13 Oct 2010 03:47:33 +0100 4061080 http://www.medworm.com/index.php?rid=4122082&cid=t_172193_151_f&fid=39304&url=http%3A%2F%2Fwww.recoveryhelpdesk.com%2F2010%2F10%2F06%2Fprobuphine-buprenorphine-implant-on-the-way%2F I am watching the progress of Probuphine, the buprenorphine implant, as it clears each new hurdle in the drug approval process with a lot of interest.  This new medication could really upgrade our options for treating opiate dependence. Probuphine is a new form of buprenorphine currently in phase 3 clinical trials in the United States and Europe.  Probuphine is a small, solid rod that is placed under the skin by a doctor in a simple office procedure. Probuphine provides 6 months of continuous buprenorphine dosing from a single implant or set of implants.  Buprenorphine is a medication used to treat opiate dependence.  Buprenorphine limits cravings and prevents physical withdrawal from opiates. Buprenorphine (Suboxone and Subutex) are currently available in pill form or film form.  The... Recovery Helpdesk blogs http://www.medworm.com/rss/comments.php?id=4122082 Wed, 06 Oct 2010 20:02:22 +0100 4122082 http://www.medworm.com/index.php?rid=4036952&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2Fh6cgyIMyoMA%2F To those who follow this blog, I apologize for taking a bit of a breather from posting.  I’m stll here, but my energy for late-night arguments over the disease nature of addiction has dropped a bit– at least for the time being. I have talked for some time about putting together a book about opioid dependence that combines scientific principles and subjective experience… I’ve completed that project, and I’m not quite sure what to do with it.  I am thinking about selling it as an e-book, and using proceeds to rationalize time away from my practice spent here on the blog.  I have plenty of plans, but like many people I struggle to complete the things I envision.  My goal for some time has been to seek support for the blog and forum from pharma, and to work wi... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=4036952 Wed, 06 Oct 2010 04:17:56 +0100 4036952 http://www.medworm.com/index.php?rid=4013561&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FZTDcLVbCLDw%2F It i salways humorous when companies do what Reckitt-Benckiser recently did– make a small change in their product, then trash the old product in favor of the new, more expensive product.  “The OLD formulation is GARBAGE!  It poses huge risks! It is reckless and irresponsible to prescribe that tablet (the one that we’ve been marketing for years, that is…)” The orange rectangle is buprenorphine film For people who are confused, here is what happened…. Reckitt-Benckiser, the makers of Suboxone and Subutex, used to have a stranglehold on the market for buprenorphine.  Profits poured in from selling buprenorphine at ridiculous prices;  $6 per tablet in the Midwest for Suboxone, and over $11 per tablet for Subutex.  The prices were particularly obnoxiou... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=4013561 Tue, 28 Sep 2010 22:25:32 +0100 4013561 http://www.medworm.com/index.php?rid=4001811&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FZ8T0OUgmcmI%2F Much thanks to a doc in Australia for recent comments: Rats that can jump From one Doc to another (I’m in Australia). You may be interested (or possibly know) how we do things here. Basically, addicts can register at any Dr who’s completed a programme and is then authorised to prescribe what we call Schedule 100 drugs: mainly buprenorphine and methadone. Almost all these Dr’s ‘bulk bill’ ie. are free for the patient. Once prescribed, the patient turns up at a chemist (who’s set up to dispense S100 drugs) daily and receives their dose. After 2-3 months of stability ‘takeaways’ may be authorised by the Dr: up to 3-4 a week. In general terms there is almost NO prescribing of 30 day bottles here – Px need too see the pharmacist daily and th... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=4001811 Sat, 25 Sep 2010 20:57:29 +0100 4001811 http://www.medworm.com/index.php?rid=3983556&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Fsuboxonetalkzone.com%2FRelapse.pdf This study of people on buprenorphine compared a control group that had a quick med check each week during the study period, with a ‘counseling group’ that had two one-hour sessions per week throughout the period, talking about interpersonal issues, personality problems, trauma and stress in the patients’ lives, and other feel-good issues. Guess what? There was NO DIFFERENCE in relapse rates between the control group and the addicts that received intensive counseling. None. Nada. Zero. I have stated many times that opioid dependence deserves treatment as a MEDICAL ILLNESS, a chronic illness, a potentially fatal illness that finally has a chronic and effective treatment available. But now that this life-saving treatmennt is finally here, the insurers have the gall to limit... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3983556 Mon, 20 Sep 2010 03:59:46 +0100 3983556 http://www.medworm.com/index.php?rid=3943033&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FUzr165ZpdOI%2F I often receive e-mails from people that go something like this:  I was addicted to oxycodone and heroin for 5 years, and lost my marriage, several jobs, and the trust of my children.  I was completely broke, and considering suicide.  Then I heard about treatment with buprenorphine and found a doc who prescribed it.  Since then everything has been going much better; I have a job, I’m putting some savings away, and I have been starting to reconcile with my family.  But my doctor says he wants me off Suboxone and is making me taper, and I’m definitely not ready.  I am starting to panic because I know that if I have to go off buprenorphine I’ll only end up using again.  Is there a way to make him keep me on buprenorphine? Why the rush? I have described my approach ad nauseum on t... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3943033 Wed, 08 Sep 2010 00:16:26 +0100 3943033 http://www.medworm.com/index.php?rid=3934618&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FcmYI8zhgHaw%2F I haven’t gone anywhere in case you’re wondering… but I recently started writing a blog on Psych Central, called ‘an epidemic of addiction.’   Please add it to your reading list!  This is my favorite time of year and the time I am most likely going to be outdoors, so watch for posts to pick up a bit as things get colder outside. I’m probably in the wrong state of mind to be blogging, so consider this more along the line of venting.  I had an encounter with a local physician a couple days ago that left me shaing my head–  I have a solo practice so I have forgotten just how misguided medicine can sometimes be.  I was asked to speak with an orthopedist for a patient who takes buprenorphine, who was having major knee surgery.  The orthopod start... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3934618 Sat, 04 Sep 2010 17:55:25 +0100 3934618 http://www.medworm.com/index.php?rid=3903137&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FngDKLFI5ha8%2F A reader’s question: I have been on Suboxone for 2 years. My addiction was Oxycontin.  I had knee replacement surgery and was successfully able to take pain meds and then get off them and go back to Suboxone. My medical Doc and I noticed that when I restart the Suboxone, I get 2-3 plus pitting edema in my legs, severe enough to require diuretics– and they don’t even work very wel. When I have stopped Suboxone in preparation for surgery, I immediately lose 15 lbs and the edema goes away. My Suboxone Doc says that there are no side efffects. I am 53 and have heart disease, and I know that this extra fluid is not good for my heart. My kidneys are normal. Have you heard other comments of this nature? Is it dose related?  This is a serious situation for me. Reply: I have h... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3903137 Thu, 26 Aug 2010 05:26:01 +0100 3903137 http://www.medworm.com/index.php?rid=3780574&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F8VAO5gQkFwI%2F A question in response to a recent article, and my answer.  My primary point is to address what buprenorphine maintenance CAN do– which is far more than simply ’replace’ opioid agonists.  I recently received a message from an AODA counselor that totally misses the point of buprenorphine;  a message that did what the anti-sub crowd typically does– i.e. present a skewed view of buprenorphine and then tear down that skewed view.  I’m not posting his ‘straw man’ message here, as there is already enough misinformation out there without his contribution.  Instead I’ll share a different, nicer letter: Hi– my name is (Julie) and I’m a member of your site however I never post as I usually find answers to my questions. I too wo... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3780574 Fri, 23 Jul 2010 04:38:09 +0100 3780574 http://www.medworm.com/index.php?rid=3772473&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Fsuboxonetalkzone.com%2Fbuspirone.pdf I have written about this topic multiple times, but perhaps a summary is appropriate.  More and more evidence and clinical experience suggest that buprenorphine is best considered a long-term ‘remission agent’ for opioid dependence.  Such a conclusion would have been obvious years ago if not for the hesitancy to do what has been suggested by addictionologists for decades, and treat opioid dependence as a DISEASE.  While many people pay lip service to addiction being a chronic illness, the reluctance, particularly by AODA counselors, to fully accept a medication for the condition is clear evidence of the stigma that continues to force addiction into the realm of ‘character.’   AODA counselors would do well to do some serious soul-searching on this issue– ... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3772473 Wed, 21 Jul 2010 05:00:13 +0100 3772473 http://www.medworm.com/index.php?rid=3754090&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FfLSB9H_u6ks%2F Wisconsin has been very generous in regard to covering prescriptions for buprenorphine.  The State’s main Medicaid program, BadgerCare, generally covers buprenorphine indefinitely;  while that probably  rubs some people the wrong way, the simple fact is that opioid dependence is a life-long condition marked by repeated relapse, even after expensive residential treatment.  We know that stopping buprenorphine after short-term treatment– less than 6-12 months of maintenance– virtually guarantees a return to using opioids.  There are likely some people who, after staying away from addictive behavior and having their minds freed from obsession for some period fo time, can go off buprenorphine and remain clean.  But there are many who will need buprenorphine as a long-ter... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3754090 Thu, 15 Jul 2010 01:41:49 +0100 3754090 http://www.medworm.com/index.php?rid=3742413&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FZ8Ge2KYuLOk%2F I’ve shared my history many times, including mention of my ‘spiritual awakening’ in 1993 that kicked off about 5 years of active AA invovlement.  After struggling with an obsession to use opioids for months, a meeting with a psychoanalyst sparked the ‘awakening’ on my drive home.  I was suddenly very tired of what I was doing– the lying, hiding, desperately searching for something to stop the withdrawal, fighting with my wife… and running from psychiatrist to psychiatrist, trying to find one to agree with MY version of the world, who I would agree to see for treatment.  I now realize, by the way, that ‘change’ by definition appears foreign, wrong, and inappropriate;  a patient who sees a therapist who agrees with everything the pati... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3742413 Sat, 10 Jul 2010 14:41:04 +0100 3742413 http://www.medworm.com/index.php?rid=3726788&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FDsxTw29rNSE%2F Something I haven’t yet come across: Acesulfame Potassium Well, i’ve been clean with the help of Suboxone for 14 months now. Throughout my treatment I’d been getting tongue blisters and ulcers at least two at a time. I’ve probably had them six to eight different times in this 14 month period. I realized something wasn’t right, and started investigating, trying to figure out what the problem was. I watched the foods I ate and the things I drank. Nothing seemed to work; they just kept coming back. So, the only thing I could think of was the Suboxone.  I read the pamphlet that comes with the medication. The artificial sweetener in Suboxone (Acesulfame K sweetener) is what I am allergic to. I have been allergic to artificial sweeteners my entire life. I had been taking a... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3726788 Mon, 05 Jul 2010 04:58:43 +0100 3726788 http://www.medworm.com/index.php?rid=3724583&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FDsxTw29rNSE%2F Something I haven’t yet come across: Acesulfame Potassium Well, i’ve been clean with the help of Suboxone for 14 months now. Throughout my treatment I’d been getting tongue blisters and ulcers at least two at a time. I’ve probably had them six to eight different times in this 14 month period. I realized something wasn’t right, and started investigating, trying to figure out what the problem was. I watched the foods I ate and the things I drank. Nothing seemed to work; they just kept coming back. So, the only thing I could think of was the Suboxone.  I read the pamphlet that comes with the medication. The artificial sweetener in Suboxone (Acesulfame K sweetener) is what I am allergic to. I have been allergic to artificial sweeteners my entire life. I had been taking a... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3724583 Mon, 05 Jul 2010 04:58:43 +0100 3724583 http://www.medworm.com/index.php?rid=3721971&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2Fxc27AjUeZU8%2F Over a year ago I wrote about the transdermal formulation of buprenorphine available in Europe called ‘Butrans.’  One problem with the treatment of opioid dependence using buprenorphine has been the limited dose options available;  while 2 and 8 mg sublingual tablets are fine for maintenance, they are wholly inadequate when it comes to tapering off buprenorphine.  The ‘wall’ of withdrawal symptoms that people discover as they taper past 2 mg is a product of the ceiling effect of buprenorphine– so useful on the way up, but so challenging on the way down!  At 2 mg, the level part of the dose/response curve ends, and each decrease in dose causes a drop in opiate effect and a drop in tolerance… and so an increase in (albeit temporary) misery.  Smaller d... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3721971 Sat, 03 Jul 2010 01:03:03 +0100 3721971 http://www.medworm.com/index.php?rid=3714452&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FgYtzWzcKeOk%2F Look mom-- no neonatal abstinence syndrome! The article below describes a presentation at a recent meeting of ACOG, the American College of Obstetricians and Gynecologists, that compared the use of buprenorphine or  methadone for treating opioid addiction during pregnancy.  I hear from pregnant women often, who write out of frustration that their OBs have never heard of buprenorphine or Suboxone and asking what they should do to educate their physicians.  Let’s hope that studies like this one help get the word out!  If you search this blog you’ll find a number of my posts about pregnancy, opioid dependence and buprenorphine.  Some of the posts include articles about neonatal abstinence, breast feeding while taking buprenorphine, and comparisons between buprenorphine ... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3714452 Thu, 01 Jul 2010 05:18:54 +0100 3714452 http://www.medworm.com/index.php?rid=3695819&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FK5rmdPkAWmg%2F A reader wrote with a question that I don’t think I’ve addressed on the blog. Do you have a threshold for how much narcotic a patient must be using before you will put them on buprenorphine? I am concerned about narcotic addicts that are using 6-10 Vicodin (hydrocodone) a day for example.  Many have very mild withdrawal symptoms, but are never-the-less unable to stop on their own. This is an insightful question that provokes enough discussion to fill at least one blog post.  I don’t have a simple answer, other than to go on a case-by-case basis and try to determine who, if anyone, might be able to walk away from opioids completely (i.e. a person who I would be less likely to put on buprenorphine, as doing so would drive tolerance higher) vs. those who will need maintenance t... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3695819 Fri, 25 Jun 2010 03:54:28 +0100 3695819 http://www.medworm.com/index.php?rid=3683882&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2Fd-pwJsheFrc%2F The old days I worked for several years as the medical director of a residential treatment center in Wisconsin, leaving the position several weeks ago.   On my last evening in the place I took a moment to look around and think about how addiction treatment has changed in the past decade.  I looked at the pictures of the patients in their charts, who were mostly in their late teens or early 20’s.  The most common class of ‘drugs of choice’ were opioids, including oxycodone, heroin, methadone, morphine, and hydrocodone.  I thought about the different but similar program that I attended ten years ago, filled mostly with addicts and alcoholics in their 30’s and older.  I wonder if Bill W would have come up with the same twelve steps, had his target been not 50-year-old alcoholics... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3683882 Sun, 13 Jun 2010 04:02:16 +0100 3683882 http://www.medworm.com/index.php?rid=3683883&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FdGzB5qPMGqo%2F Some of you may be up on ‘affiliate marketing’.. for those who aren’t, there are many variations on the idea out there. I now have it set up for my e-book and audio recordings and a few people are already taking advantage of it. The basic idea is that an ‘affiliate’ gets a percentage– 30% in this case– of sales of the products. Since my e-book goes for about ten bucks, the affiliate share is little over three dollars. Other products sell for $10 – $20. It costs nothing to be an affiliate, and once you are set up there is no action required on the affiliate’s part except receiving money in a PayPal account. To set it up, follow instructions at this page.  There are a number of affiliate sites out there; my particular program uses E-Junk... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3683883 Mon, 07 Jun 2010 00:14:34 +0100 3683883 http://www.medworm.com/index.php?rid=3683884&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FpTi9YcGtKZk%2F A person wrote about feeling ill after taking Suboxone, thinking that naloxone is to blame and frustrated that her physician would not prescribe Subutex: I first read your blog last week as I was going through the despair and misery of withdrawal from Percocet, and considered suicide. I didn’t want to die, or create anymore suffering for my family; I just didn’t see any options or hope. Your well written words (I thank you deeply) about the hell of withdrawal got my attention & brought me to tears. I continued to read, found out about Suboxone, which led me to message boards from others like me. For the first time I felt hopeful. I found a doctor and made an appt, and after the initial, office administered dose I found myself feeling the best I had in years– no withdrawal and ... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3683884 Mon, 31 May 2010 05:00:56 +0100 3683884 http://www.medworm.com/index.php?rid=3618098&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Fwww.youtube.com%2Fv%2FzElJGMwpwt0%26amp%3Bhl%3Den_US%26amp%3Bfs%3D1%26amp%3B For those of you who prefer watching to reading, here is a video with a few thoughts about why will power is NOT any kind of strategy for staying clean.  As I describe, believing in will power is not only unhelpful;  it even INCREASES one’s chance for relapse, and serves as a frequent justification for the using that leads to full-blown relapse.  Please share comments at Buprenorphorum.com.      (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3618098 Fri, 28 May 2010 00:09:29 +0100 3618098 http://www.medworm.com/index.php?rid=3683885&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2Fms1h_PKIXto%2F A question and answer session with someone who is considering stopping buprenorphine.  His message first, with identifying information removed: Hi, I just sent a donation through PayPal. I used Norco 10/325 since 1999, about 20-40 per day for the past five years.  A month ago I went on 2 mg Subutex but don’t like the feeling of being drugged.  The next day I went down to 1 mg/day, and have been at that dose since.   I liked the Norco because I could still function, and could “feel”, including joy.  Now I have no feelings of joy at all, just feel drugged all the time.  I meditate and exercise 30 min/day, have done that for years, so maybe that kept me grounded. Q:  What is the quickest and most comfortable way for me to taper?  Should I use Ativan to help with rest... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3683885 Tue, 18 May 2010 21:33:37 +0100 3683885 http://www.medworm.com/index.php?rid=3683886&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F6pDf8G5Xkjs%2F Great news from SuboxForum.com, a.k.a. buprenorphorum.com, where today Chris55552 posted the following: Hey everyone, Not sure who all keeps up with pharma news or the reputation/quality of generic drug companies but I recently discovered that Teva Pharmaceuticals (generics) has their version of generic subutex available. Teva USA is the most dominant generic company in the US and is highly regarded as High grade quality. Marketing Start Date:05/10/2010 Tablets will be available in the following: 2 mg: White, oval, flat-faced, unscored tablet. Debossed with 798 on one side and stylized b on the other side. Each tablet contains 2.16 mg of buprenorphine HCl, equivalent to 2 mg of buprenorphine base. Available in bottles of: 30 Tablets NDC 0093-5378-56 100 Tablets NDC 0093-5378-01 8 mg: Whit... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3683886 Mon, 17 May 2010 21:04:10 +0100 3683886 http://www.medworm.com/index.php?rid=3683887&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FQc7c4dFGvCs%2F As I’ve mentioned, I was at a ‘summit’ about buprenorphine in Washington DC earlier this week.  I didn’t hear anything earth-shaking at the meeting, but will share a couple things that I learned there over the next few posts.  One night I was reviewing messages in my hotel room and I received an e-mail from a person saying that Social Services took her baby away from her at the hospital because she had delivered on buprenorphine.  The baby was essentially being held hostage by the hospital under Social Services orders, and was being treated, against her wishes, with opiates to avoid opiate withdrawal.  I had a patient a year or two ago who had a similar experience, where her baby was placed on a morphine drip against her wishes, after she delivered while on bup... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3683887 Fri, 14 May 2010 23:09:18 +0100 3683887 http://www.medworm.com/index.php?rid=4122091&cid=t_172193_151_f&fid=39304&url=http%3A%2F%2Fwww.recoveryhelpdesk.com%2F2010%2F05%2F14%2Fseries-10-things-you-should-know-about-methadone-number-10%2F Conclusion Much maligned and often misunderstood, methadone remains a wonderful gift.  A gift that has saved thousands of lives, held together families, and brought hope and success to many who felt hopeless and defeated by their addiction. Methadone is not a magic bullet, and it is not an appropriate treatment for everyone.  But if you care about people with opiate dependence, I urge you to speak up and help others understand the value of this important path to recovery. (Source: Recovery Helpdesk) Recovery Helpdesk blogs http://www.medworm.com/rss/comments.php?id=4122091 Fri, 14 May 2010 07:29:36 +0100 4122091 http://www.medworm.com/index.php?rid=3683888&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FwD2SqjnHJJo%2F I am often told by opiate addicts that they would kill themselves rather than go through withdrawal again.  I assume  that the comments are  exaggerations to make a point.   But a recent nightmare helped me realize that the comments are not hyperbole– but rather are serious attempts by addicts to describe just how horrible their experiences were.  I remember my own detox only when I force myself to remember it (0r after the occasional bad dream);  I have a tendency to repress the memory, perhaps as people do with traumatic memories.  But when I really think about my experience during those 5-7 days at the end of that horrible hall in that horrible ward, I cannot imagine going through the experience again, for any reason.  I hate to say it as a psychiatrist who knows... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3683888 Wed, 12 May 2010 04:17:56 +0100 3683888 http://www.medworm.com/index.php?rid=3683889&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2Fp1gjS1K-cpc%2F Below is one chapter of my long, long book– the one that I will probably never finish.  I wrote this chapter about two years ago, and have not published it anywhere else, at least not that I can remember.  It is LONG, but if you are addicted to opiates and considering your options, I hope you will check it out.  I invite other addicts and friends of addicts to read it as well, even though it is LONG (did I say that already?).  It essentially describes my ‘vision’ for addiction treatment going forward.  I am posting it now because I will be attending a summit in DC over the next few days, discussing the use of buprenorphine going forward with other experts in the field.  I will  bring back word of any new developments and share them here. Addiction to heroin and pai... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3683889 Sat, 08 May 2010 21:09:41 +0100 3683889 http://www.medworm.com/index.php?rid=3683890&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F-SPFG7m65Vs%2F I might as well keep this run of posts going with an e-mail exchange from earlier today.  As usual, minor aspects of the message were changed to protect anonymity. The message: I am interested in setting up a tele-psychiatry appointment with you. My boyfriend is a heroin addict who has been on Suboxone for approximately four years.  He started at 12 mg and tapered down to 2 mg over a six month period.  He recently went through a detox program and has completely stopped Suboxone — except that he relapsed recently with a small amount of Suboxone. I feel like I need to get smarter about supporting his fight to stop opiates.  I purchased one of your tapes where you say that willpower has nothing to do with quitting opiates.  I know that this is a recurring theme in combating drug ab... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3683890 Mon, 26 Apr 2010 01:21:54 +0100 3683890 http://www.medworm.com/index.php?rid=3502994&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Fwww.youtube.com%2Fv%2FlrqjJGoSQgc%26amp%3Bhl%3Den_US%26amp%3Bfs%3D1%26amp%3B In this video I explain why the ceiling effect is so important to the effects of buprenorphine for treating opiate dependence.      (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3502994 Sat, 24 Apr 2010 23:15:29 +0100 3502994 http://www.medworm.com/index.php?rid=3501713&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FZtxdm2NHMkg%2F I have produced a few educational items, and I sell themt priced at a small fraction of the street cost of one tablet of oxycodone.  All proceeds go toward the support of this web site, the forum, and other educational efforts.  The most popular item is the e-book called ‘User’s Guide to Buprenorphine.’  You can get a sneak peak at the inside of the book at Amazon.  I receive good feedback about the e-book but the most ’successful’ recording has been the one entitled ‘How long are you going to take that stuff.’  The recording is designed for parents, spouses, or children of opiate addicts who take buprenorphine;  especialy for those family members who don’t quite ‘get it,’ who ask the title question every week or so. I have... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3501713 Sat, 24 Apr 2010 03:59:50 +0100 3501713 http://www.medworm.com/index.php?rid=3499318&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FSadlVD8RGs0%2F A ‘quick one’…  I have written before about getting the most buprenorphine from a God-awfully expensive tablet of Suboxone, and will repeat myself for newcomers.  Note that my description is based on an understanding of pharmacology, organic chemistry, and physiology– NOT on the recommendations of Reckitt-Benckiser or the FDA.  My suggestions also come from knowledge of other, similar medications that are absorbed through mucous membranes– for example fentanyl, which is dispensed with a trans-mucosal delivery system for cancer pain. A bit of background…  the reason you can’t just swallow a tablet of buprenorphine and expect it to work is because of something called ‘first pass metabolism.’  The liver is very good at breaking dow... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3499318 Thu, 22 Apr 2010 20:42:03 +0100 3499318 http://www.medworm.com/index.php?rid=3483131&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FRw-QkOLg8FM%2F Several weeks ago an article with a provocative title was posted at Suboxone Forum.  I don’t remember the exact title, but it was something like ‘Toxicity from High Dose Buprenorphine (HDB).  Before everyone gets too excited, there was nothing all that new in the article, which consisted of three case reports about deaths of people taking buprenorphine.  One case consisted of a suicide from very large doses of buprenorphine, one was a death from combining buprenorphine with other respiratory depressants, and the third death was in a person with liver failure who took buprenorphine with other psychotropic medications.  There are a couple issues brought up in the article that are worth mentioning. First, I appreciate their use of the term ‘high dose buprenorphine,&#8217... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3483131 Sun, 18 Apr 2010 20:56:42 +0100 3483131 http://www.medworm.com/index.php?rid=3480943&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FJ_3mUNbT218%2F Remember back when I used to write those ANGRY posts, where I would take people to task for their silly comments about buprenorphine?  I remember them.  THOSE were the days!  I was always ready to go nuclear on anyone who tried to debate whether buprenorphine treatment was ‘good’ or ‘bad.’    C’mon punk– MAKE MY DAY.  I’ve become more circumspect since then (OK, so I had to look the word up–  at least I had HEARD of the word before!)  I got tired of going to bed with heartburn every night.  I also realized that people will do what people want to do.  I have no power over them, and don’t WANT power over them.  Addicts must find their own truth, and all I can do is provide information when people are ready to ask for it.  Liv... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3480943 Sun, 18 Apr 2010 04:48:14 +0100 3480943 http://www.medworm.com/index.php?rid=3460400&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FwlOJtFGT2c0%2F I have been involved in Q and A with a person in another part of the country, and will share some of our exchange after removing the identifying info. BTW, I receive many e-mails from people and I just don’t have time to answer most of them; I DO provide ‘educational consultation’ (not a ‘medical’ relationship) at a rate of $100 per 30 minutes, and anyone is welcome to set that up by writing to appointments@fdlpsychiatry.com. The person below consulted me over her daughter, who is addicted to opiates and on buprenorphine but not doing well. The grown daughter receives some level of support from her parents, who are in that horrible position of trying to pull back to avoid enabling while at the same time fearing that pulling back will cause relapse or worse. The mother has had the... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3460400 Sun, 11 Apr 2010 17:09:37 +0100 3460400 http://www.medworm.com/index.php?rid=3416338&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FlWJ8jGUmjFQ%2F What follows is a lightly-edited version of one of my posts from a couple years ago.  I still think that this is a good model for understanding the actions of buprenorphine. Buprenorphine and the Dynamic Nature of Character Defects ‘Suboxone’ and ‘Subutex’ are the trade names for medications that contain buprenorphine, a substance used to treat addiction to pain medications and/or heroin.  Buprenorphine treatment for opiate dependence has been an option in the US since 2003.  Other treatment approaches for opiate dependence have been used for decades but have had limited success.  With a little imagination, treatment approaches can be placed on a continuum depending on the degree to which the treatment demands changes in the personality and behavior of the addict.  Methad... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3416338 Mon, 29 Mar 2010 00:53:31 +0100 3416338 http://www.medworm.com/index.php?rid=3399183&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F31o-gt8r7jQ%2F I’m often asked “hey, what is YOUR story?”  That opens the door to a long, drawn out presentation… or I’ll just say “I have a book about the subject ready to go– do you know any publishers?”  I DO have a book ready to go, by the way…  and I welcome any e-mails from people with ‘industry connections.’  The book is about my story, of course, but is also an attempt to examine ‘addiction’ in a way that provides greater understanding of the condition.  A family member of an opiate addict will understand addiction better after reading the book, for example.  I also talk about Suboxone quite a bit.  In fact, readers of this blog will know how the book goes, as the book is a reflection of this blog.  In some c... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3399183 Wed, 24 Mar 2010 01:04:58 +0100 3399183 http://www.medworm.com/index.php?rid=3366441&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FkjCHziS7Fpo%2F I sometimes get the sense that there is a parallel universe besides this one, and I am not sure which one is real.  In one, the kids grow up safely, and every premature death is cause for alarm that generates immediate effective action by the community.  In the other universe, kids in their teens are dying in ever-increasing numbers, and only their family members and a few close friends react with alarm.  After a few weeks each death is forgotten and life goes on–  for some.  The parents and siblings of the children who lose their lives somehow stumble forward, living the rest of their with the horrible realization of this second universe–  the one that they didn’t know about until it was forced upon them. My heart goes out to any parent who has found the way to thi... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3366441 Sun, 14 Mar 2010 01:06:20 +0100 3366441 http://www.medworm.com/index.php?rid=3363827&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FkjCHziS7Fpo%2F I sometimes get the sense that there is a parallel universe besides this one, and I am not sure which one is real.  In one, the kids grow up safely, and every premature death is cause for alarm that generates immediate effective action by the community.  In the other universe, kids in their teens are dying in ever-increasing numbers, and only their family members and a few close friends react with alarm.  After a few weeks each death is forgotten and life goes on–  for some.  The parents and siblings of the children who lose their lives somehow stumble forward, living the rest of their with the horrible realization of this second universe–  the one that they didn’t know about until it was forced upon them. My heart goes out to any parent who has found the way to thi... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3363827 Sun, 14 Mar 2010 01:06:20 +0100 3363827 http://www.medworm.com/index.php?rid=3354587&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2Fh5n8npz-1F0%2F A new one-stop site for opiate dependence information and resources I have organized my web efforts around a central ‘hub’, at a web page called ‘Addiction Remission’.   Thank you for checking it out, and for sharing it with other people who struggle with addiction in themselves, in their family members, or in their patients.    If you have a moment, please give the site a ‘plug’ on your favorite social network, twitter, blog, or search engine.   I rely on you– and appreciate your help. JJ      (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3354587 Thu, 11 Mar 2010 00:25:43 +0100 3354587 http://www.medworm.com/index.php?rid=3339819&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2Fcgk4cY3o0p0%2F Regular readers of this blog know that I am a big fan of buprenorphine treatment of opiate dependence. I used to spend hours arguing with people over whether or not buprenorphine represents “a drug for a drug”, before eventually deciding that those who must be talked into buprenorphine treatment are poor candidates for buprenorphine treatment. I am now less motivated to engage in such discussions, but for those who are interested, my arguments are scattered throughout the archives of the medhelp.org addiction board, the commentary section of my YouTube videos, and in earlier posts to this blog. The motivation for this current post stems from two recent incidents. The first was the reaction of a group of physicians at a dinner several nights ago, when I was speaking about a diff... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3339819 Sun, 07 Mar 2010 05:40:50 +0100 3339819 http://www.medworm.com/index.php?rid=3231811&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FHpCUpOKhqP0%2F I will share some thoughts that I left at a discussion at a ‘linked in’ group about addiction.  I was responding to someone who was equating addiction and physical dependence in a baby born to an opiate-addicted mother.  My feeling is that such women are given way too much of an attitude by the nurses and others who care for them, and that was the motivation behind my response.  Read on: There are many differences between physiological dependence and addiction to substances. For example, people who take effexor are dependent– and will have significant discontinuation-emergent side effects– but they are not ‘addicted’, which consists of a mental obsession for a substance. The same is true of beta-blockes, in that discontinuation results in rebound hypertension... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3231811 Tue, 02 Feb 2010 01:42:36 +0100 3231811 http://www.medworm.com/index.php?rid=3228020&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F3HUH4XKx0j8%2F A member at the buprenorphine forum wrote about his own health issues including hormonal imbalances, prompting me to do a literature search on buprenorphine and testosterone.    I found a couple interesting studies and invite people to visit the forum and read about them, and comment if you wish.  To find the comment thread, just go to the bottom of the first page and the ‘index’ will list the new topics. Oh– and please consider signing up while you are there.  Feel free to use an alias to maintain confidentiality.  Our numbers are growing, and the forum is open for anyone– including friends and family members of opiate addicts, or even people who only have an interest in the topic of opiate dependence.  We ask only one thing– that those who are lookin... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3228020 Sun, 31 Jan 2010 19:33:30 +0100 3228020 http://www.medworm.com/index.php?rid=3223496&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FzUfWRsZRVWg%2F I will introduce this topic by typing my response to a reader who asked whether buprenorphine, the active ingredient in Suboxone, shows up in urine drug tests.  More specifically he asked whether companies have the ability to test for buprenorphine.  I will end the post with a question… so please stick around to the end! Typical 10-panel urine dipstick test There are tests out there—multi-panel dipstick tests– that react ‘positive’ to Suboxone in the opiate panel.  Or at least there used to be;  I used to see that reaction with a brand  of tests I no longer remember, that I used several years ago.  For the past couple years, every dipstick brand that I have purchased has responded ‘negative’ to buprenorphine (or naloxone for that matter) as an... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3223496 Sat, 30 Jan 2010 01:58:56 +0100 3223496 http://www.medworm.com/index.php?rid=3124704&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FJKLe95JhAjw%2F I’ve been posting more lately, but I’m hoping to slow down by the end of the holidays to let everyone catch up.   I’ve also mentioned ‘my book’ several times in the past year, promising to myself and to others deadline that comes and go.  I wish I could take a month and work on it full-time, but I don’t see much chance of that happening… so I’ll have to just keep chipping away at it.  I can be a perfectionist and everything can be worded just a little better…  I’m the same way some mornings with my electric razor, until  my wife gets sick of watching me ‘make it perfect’ and takes the razor from me.  I came across an article the other day that described a form of OCD that involves exactly that behavior&#821... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3124704 Mon, 28 Dec 2009 04:17:06 +0100 3124704 http://www.medworm.com/index.php?rid=3122201&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2Fb0Wiv1AfTyw%2F I frequently point out the lack of outrage over the epidemic of opiate dependence and the consequence of that epidemic.  I live in ‘middle America,’ and sometimes it seems that everyone I know has some connection to opiate dependence– a relative who is an addict, a friend who died, a parent who is in prison.  My perceptions are admittedly distorted by the work that I do, but I don’t know who has the more accurate perceptions; me or the people who seem surprised to hear that most high school kids know where they could get heroin.  Addicts who I treat who come down from the U.P. of Michigan tell me that heroin is very easy to get up there now, even cheaper than oxycodone.  I guess that’s to be expected, given the horrible economic situation up there.  One... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3122201 Sat, 26 Dec 2009 04:56:51 +0100 3122201 http://www.medworm.com/index.php?rid=3119074&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2Fs4w_ba7x0Uw%2F Had to mention that I heard that Steve Tyler went in for rehab for ‘pain pill addiction’ related to falling off a stage or some other injury…  Wish I had that ‘falling off the stage’ line when Men’s Health did their story about me! Two wrongs made a 'right'? I keep thinking that wil all the young people dying from overdoses of opiates (Heroin or oxycodone) and all of the ‘fancy people’ who have died or been destroyed by opiate dependence, why hasn’t the issue become a national crisis?  I bet that 10 times more young people died of opiate dependence in the past year than died from H1N1 virus, but which one gets all the press?  Is it the shame of the victims that keeps it so quiet?  I meet often with parents of children who ha... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3119074 Thu, 24 Dec 2009 06:27:49 +0100 3119074 http://www.medworm.com/index.php?rid=3119075&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Fsuboxonetalkzone.com%2Fmedinteractions.pdf A note of follow up:  According to TMZ, a variety of medications were found in Brittany Murphy’s apartment under her name and under the name of her husband and mother.  Of course it is possible that the medications actually belonged to her husband and to her mother– but as you read in my last post, I am not surprised that opiates were included on the list.  THe medication list:   Was her death related to dangerous medication combinations? 1.  Topamax.  Topamax is an anticonvulsant that is also used to treat migraine headaches, and sometimes prescribed as a mild ‘mood stabilizer’–  say for someone who has symptoms of bipolar disorder but who instead has borderline personality or just ‘mood swings’ that don’t quite qualify as full blow... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3119075 Thu, 24 Dec 2009 01:30:05 +0100 3119075 http://www.medworm.com/index.php?rid=3101069&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2Fk1550MxtWPI%2F A quickie question from a youtube viewer: hiya–  Wondering if you could tell me if this is a good idea.  I’m almost at the end of my taper from methadone from having addiction to oxycontin. been on methadone coming up on 2 years and I’m taking 8 mg a day.  and was thinking of asking my doctor to switch me over to Suboxone when i get down to 2 mg, use suboxone 2 or 3 months to help with the methadone withdrawal, and then taper off the Suboxone. My doctor brought up Suboxone to me whe n i was at 30mg, but I didnt know anything about it, so I dismiised it.  Now i hear its a better treatment.  Any advice would be helpful.  I want off methadone very bad, I’m just nervous about what comes at the end.  I have to continue working– cant take much time off ... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3101069 Fri, 18 Dec 2009 04:54:04 +0100 3101069 http://www.medworm.com/index.php?rid=3097078&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F-P_FDPVM1r4%2F Reckitt-Benckiser, the first (but surely not last) manufacturer of orally dissolvable buprenorphine sold under the brand names Suboxone and Subutex, has been aggressively pushing doctors to refer addicts taking buprenorphine into a program called ‘Here to Help’ that they promote as something that will keep patients compliant with buprenorphine maintenance.  Regular readers of STZ know that I have not been impressed by Reckitt-Benckiser over the years, and so I’m not going to just jump on the ‘here to help’ bandwagon unless I see value in the program for my patients.  I have referred SOME patients to the program, but the feedback I have received has not been positive.   Patients have told me that they receive confusing or conflicting information, or that ... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3097078 Thu, 17 Dec 2009 04:58:28 +0100 3097078 http://www.medworm.com/index.php?rid=3084984&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FgVxWqsjlozo%2F One of the primary insights that I want addicts to gain from reading this blog is the similarity between their own thoughts, feelings, and pattern of use and the thoughts and patterns of use of other opiate addicts.  We are all dealing with the same beast, we have all felt the same desperation, and we have all experienced the same distorted thinking.  I hope that reading the desperate stories of others will help the reader understand that he or she is not alone, and will help readers identify their own distorted thinking.  But tonight I finished the final performance of a Holiday play with Community Theater (I played the psychiatrist who interviews Santa in a take-off on Miracle on 34th Street) and so I want to tell a happy story related to something that I heard from a patient last wee... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3084984 Mon, 14 Dec 2009 05:58:30 +0100 3084984 http://www.medworm.com/index.php?rid=3084985&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FrYNsBqhjgzo%2F I haven’t done this for awhile…. but it is time for a shameless request for you, the readers, to promote my site– or more accurately my sites.  This site is easy enough to promote;  if you read a post that you find interesting, PLEASE use the social networking buttons to spread the word.  If you are a big stumbler, the button is hard to miss at the bottom of the post.  If you use other social networking like Facebook or one of the dozens of less-active sites, use the ‘pass it on’ button and they will all pop open for you to choose from. Have a popular blog? If you really want to make my day, add me to your blog roll.  Even better, tell your readers about my blog and add a link to my blog.  If your site is about opiate dependence or other addictions (or a... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3084985 Mon, 14 Dec 2009 03:32:16 +0100 3084985 http://www.medworm.com/index.php?rid=3040035&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FDjbNHVoi4MI%2F There are so many people who feel like the person who wrote to me today. I remember that feeling so clearly– that there was no solution– but now I see that there is another life, and that some people will find it. And tragically, some won’t. There are many different levels of ‘insight’– it isn’t the case that I now ‘have it’ and before I didn’t have it. I will always have blind spots– some large, some small; some short-term, and others that will last a lifetime and that I hope won’t trip me up again. I will do my best to share the insight that I have gained with the person who wrote to me– today, and going forward. I don’t know if I will be able to help or not. Dr Junig; It is XX am on Sunday, November 29th... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3040035 Mon, 30 Nov 2009 03:46:50 +0100 3040035 http://www.medworm.com/index.php?rid=2992862&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FBrBugBAJ014%2F I am in need of some help from the people listed in the title– so if you have connections, help me out.  I am adding this sentence to the front of this post after rambling too long, as I’m afraid that the person I need won’t get to the important part!  If you work in the areas I mentioned or have connections to someone in those areas, please read on. I’ve talked about some of the goals I have had for this site over the past couple years…  one of my ‘personal issues’ is that like most addicts, I like to take things on by myself and solve problems by myself.  I remember, in fact, my first time in treatment in 1993– an outpatient, 21-session group therapy program– when one of my assignments was to ask another person for help at least o... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2992862 Fri, 13 Nov 2009 19:03:45 +0100 2992862 http://www.medworm.com/index.php?rid=2981370&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FMMhPs4d1OfU%2F Medpedia has been expanding on a number of fronts, with a ‘wiki’ approach to all things medical– including addiction.  This blog– Suboxone Talk Zone– will be included in the News and Analysis section of the site;  I also hope to submit content and contribute to our knowledge base about opiate dependence going forward. I invite readers to visit Medpedia and review my thoughts about the relationship between buprenorphine maintenance and traditional recovery.  The topic will be important as we sort out whether buprenorphine should be used as a bridge to step-based treatment, as a long-term treatment that stands on it’s own as a treatment for a chronic condition, or a combination of both paradigms. When it comes to medical information there are many optio... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2981370 Wed, 11 Nov 2009 02:39:38 +0100 2981370 http://www.medworm.com/index.php?rid=2948486&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FB-o7JGMb9cY%2F Hey Doc, I went to Walgreens early this morning and they had the drug on hand. So, if there is anyone who still has doubts as to the drug being available at local pharmacies- this shows the 2nd largest drugstore chain has it available in its pharmacies. Note: the writer is referring to a Walgreens in Wisconsin. The tablets themselves are round and white with the imprint of 54 411 on one side and a blank opposite side. Really the best way to describe them, is that they are identical in every feature (minus the imprint code) as the “512 Generic Percocet” tablets. As for taste and texture I found them to be much easier to tolerate than the fake orange Pez flavor laced with formaldehyde that Suboxone leaves in your mouth for hours. To me it was as if chewing a large aspirin and ... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2948486 Sun, 01 Nov 2009 01:57:22 +0100 2948486 http://www.medworm.com/index.php?rid=2948487&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Fwww.youtube.com%2Fv%2Fw7_4MRoNm5Y%26amp%3Bcolor1%3D0xb1b1b1%26amp%3Bcolor2%3D0xcfcfcf%26amp%3Bhl%3Den%26amp%3Bfeature%3Dplayer_embedded%26amp%3Bfs%3D1 Not to open up a controversy or anything… but there is considerable disagreement between physicians in principle and in practice over the importance of ‘counseling’.  To define our discussion, ‘counseling’ is used to refer to everything from one-on-one psychotherapy to group therapy to twelve step programs.  I am going to try to be more pointed and brief than my usual blah blah blah style;   I would be happy to argue the point ad nauseum at someone else’s expense, but I simply have too much work to do today.  I attached my youtube video in case anyone wants to hear me blather on and on about the subject. My feelings about counseling: - A century of Recovery experience has taught us that psychiatrists and therapists have a horrible record of ‘t... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2948487 Sat, 31 Oct 2009 17:31:11 +0100 2948487 http://www.medworm.com/index.php?rid=2947145&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Fsuboxonetalkzone.com%2Fbt.pdf Good Morning Dr. J- I just got off the phone with Roxane Labs, the only approved manufacturer of generic Subutex and the product IS available in all 50 states. It is available to pharmacies and dr offices direct from the manufacturer as well as from all major distributors. There is an ample supply available and is not on back order. Opiate addicts taking Suboxone are hoping for a drop in price with the announcement of new generic medication from Roxane Pharmaceuticals I called around to the major pharmacy chains and all three can order the drug (CVS, Walgreens, and Wal-Mart). None, at least in the Milwaukee area, keep it in stock because of its “orphan drug” status; however most can have it within 24 hours. (Only one of the pharmacists I spoke with actually offered to “pr... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2947145 Fri, 30 Oct 2009 18:50:03 +0100 2947145 http://www.medworm.com/index.php?rid=2927571&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FTE0Y1mdYkn0%2F I may be fanning the flames of rumor, but it was posted on Subox Forum today that generic Subutex (essentially a sublingual buprenorphine tablet) will be available tomorrow at a price of around $2.40 per tablet.    Not the cheapest drug, but a drop in price of over 50%– which would come as great relief to many people.      (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2927571 Mon, 26 Oct 2009 00:02:49 +0100 2927571 http://www.medworm.com/index.php?rid=2901837&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FTXmFoGNZjyM%2F I received a couple responses to my youtube videos tonight that are worth responding to.  For people who haven’t stumbled across the videos, you will find them if you go to youtube and search under ‘suboxone’ or ‘suboxdoc’.  They are pretty much the same thing as what you read here—a combination of my experiences in treating opiate dependence using Suboxone, education on the actions of buprenorphine, some of my personal ‘theories’ (maybe ‘opinions’ is a better word) on the relationship between sober recovery and buprenorphine maintenance (what I like to call ‘remission treatment’, to distinguish it from methadone maintenance, which works through a different mechanism), and my thoughts on the different treatment options for opiate dependence. Blogging in ge... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2901837 Sat, 17 Oct 2009 03:39:52 +0100 2901837 http://www.medworm.com/index.php?rid=2886747&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FU_-KYhNcoac%2F A year or so ago I wrote an article about the relationship between Suboxone maintenance and traditional recovery.  The article has been reprinted in several forms with minor changes from one  copy to the next, but the general points are repeated here.  I have received occasional comments from people who agree with me and from people who disagree, and from people who hate Suboxone and people who say that Suboxone saved their lives. I received a thoughtful e-mail the other day that deserves re-posting to a broader audience.  For those who are interested in the relationships between addiction and character defects, and the impact of buprenorphine or the twelve steps on these character defects, I suggest that you first read the original article, and then read the e-mail response printed be... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2886747 Mon, 12 Oct 2009 19:25:26 +0100 2886747 http://www.medworm.com/index.php?rid=2881338&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2Fa8qER_s7zkk%2F Thank you to some astute folks at the Suboxone Forum who recently provided information about a possible generic competitor to Suboxone.  One contributor provided this interesting story about the  profit potential from Suboxone for Reckitt-Benckiser and the considerations for the development of a generic product.    Another person mentioned the news from the FDA site on October 9 that announced the approval of generic buprenorphine tablets by Roxane Pharmaceuticals.  The Bloomberg article mentions a new thin film delivery vehicle for buprenorphine under development by RB, claiming that the strip will deliver the medication more rapidly than the dissolving tablet.  Again, those of you who have read this blog or who are part of the forum already know the way that I recommend people tak... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2881338 Sat, 10 Oct 2009 20:28:42 +0100 2881338 http://www.medworm.com/index.php?rid=2836336&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2Fz6GC-4leY3s%2F I recently receive e-mails or read posts at Suboxone Forum that go something like this: I used all kinds of pain pills over the past ten years—Vicodin, then oxycodone, methadone, and even fentanyl patches. Then I got into heroin for a year and finally hit my rock bottom. I went to a Suboxone doctor and he put me on 16 mg per day. At first everything was great, but I don’t like the side effects. I get so tired every day. I’m not happy like I used to be. I wake up in the morning and don’t have any energy or excitement for life. I really don’t like what the Suboxone is doing to me and want to stop. Sometimes it is a little different—the first part is the same, but then the person writes: I really wanted to stop taking it so that my body is free of chemicals so I stopped. I was rea... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2836336 Sun, 27 Sep 2009 03:37:12 +0100 2836336 http://www.medworm.com/index.php?rid=2820594&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2Fcrqmz9BWymc%2F I have talked about the book I am working on– I decided at some point to come out with two things. I receive so many questions about Suboxone– apparently many doctors don’t come up with suggestions for dealing with surgery, pain, etc. So I have produced an e-book that describes my approach to dealing with all of the little things that can become big things without proper guidance. The e-book is called ‘A User’s Guide to Suboxone’, and can be downloaded for $17.95 using the links below. This book is all very practical– not theory.  It discusses how I handle planned vs emergency surgery, pregnancy, inductions from high tolerances, tapering…  I don’t want people to use this as the final say, but rather to use the information to spark co... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2820594 Mon, 21 Sep 2009 05:37:45 +0100 2820594 http://www.medworm.com/index.php?rid=2814720&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2Fcrqmz9BWymc%2F I have talked about the book I am working on– I decided at some point to come out with two things. I receive so many questions about Suboxone– apparently many doctors don’t come up with suggestions for dealing with surgery, pain, etc. So I have produced an e-book that describes my approach to dealing with all of the little things that can become big things without proper guidance. The e-book is called ‘A User’s Guide to Suboxone’, and can be downloaded for $17.95 using the links below. This book is 25 pages long, but it is all practical– not theory.  It discusses how I handle planned vs emergency surgery, pregnancy, inductions from high tolerances, tapering…  I don’t want people to use this as the final say, but rather to use the inf... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2814720 Mon, 21 Sep 2009 05:37:45 +0100 2814720 http://www.medworm.com/index.php?rid=2782321&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FCsTZ-9cLSH0%2F For the past 6 years, Reckitt-Benckiser has sold buprenorphine under the brand names ‘Suboxone’ and ‘Subutex’. Buprenorphine has been sold under other names in the past, notably ‘Temgesic’, which was buprenorphine intended for intravenous use by medical professionals treating pain. Many people, myself included, have been anxiously awaiting a less expensive formulation of buprenorphine– for example a generic product. We could also use a number of new formulations of the drug called ‘Suboxone’; it is very difficult to taper in it’s present form, for example, and a large pill with lower concentrations would be a tremendous help. Even better would be a ‘taper pack’; many medications make taper packs for use in STARTING the... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2782321 Thu, 10 Sep 2009 15:55:34 +0100 2782321 http://www.medworm.com/index.php?rid=2774920&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Fsuboxonetalkzone.com%2Fcoolworld.pdf Every chronic pain patient and opiate addict looks forward to the day someone finds the Holy Grail for opiates:  an agent that blocks or reduces tolerance and that eliminates withdrawal.  The two phenomena are linked and so the same agent may help with both problems,  or perhaps instead there will be a better understanding of the myriad interactions involved in opiate tolerance and not a single cure, but rather a number of medications beside the current, insufficient gold standard, clonidine.  A few weeks ago I decided to do some reading on opiate tolerance to see what we have learned lately,  and I started out with Google, searching the phrase “opiate dependence mechanism of tolerance”.  To my surprise, the first ‘hit’ was a NIDA monograph– try it for y... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2774920 Tue, 08 Sep 2009 00:49:13 +0100 2774920 http://www.medworm.com/index.php?rid=2772726&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FQ2uUjfRgRq4%2F I ended the ‘85% off’ sale of the recordings listed to the right of the blog;  they are also listed at the web page ‘Sober After Suboxone,’ along with some other useful recordings about opiate dependence.  I have received good feedback about the recordings, and I think that the ‘how long’ one is the most useful for the people reading this blog;  people at other stages of opiate dependence may find other recordings more useful, such as the one that discusses opiate dependence treatment options.  The treatment options are NOT just a list of the different options available;  they are a list of the options from the perspective of someone (i.e. me) who has dealt with my own opiate addiction for 16 years.  They take into consideration the fact that few p... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2772726 Mon, 07 Sep 2009 01:11:29 +0100 2772726 http://www.medworm.com/index.php?rid=2674499&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FMUqkdXfkywc%2F Dear Dr. Junig, our websites and commentary are inspiring. I have never before seen such a clear articulation of what addiction is like and what it is like for an addict as a member of society.  I too am an addict, but I have not admitted it before now. This will be my first step. I have been using various opiates–ranging from hydromorphone to tramadol and hydrocodone for the past 2 years.  My current dose is moderate, around 40-60mg of hydrocodone per day.  I’m sure it has affected my life in numerous destructive ways, but at the same time I feel that it has given me hope.  As a lifelong sufferer of anxiety and depression I have always looked for solace, and found it in books, art, music etc. But as I got older I got into drugs, in my case a path leading straight to opiate... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2674499 Thu, 06 Aug 2009 04:17:05 +0100 2674499 http://www.medworm.com/index.php?rid=2657913&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FIps0651c_Tc%2F I have written about the recording listed in the right column of this blog– ‘How long are you going to take that stuff– education for those who love someone taking Suboxone’.  The point of the recording is to educate angry mothers, fathers, children, siblings, or spouses about WHY you are taking Suboxone, and WHY you are not ready to stop taking it.  The recording consists of me talking about Suboxone for one hour– about how it works, about the fatal and chronic nature of opiate dependence, and about how you are NOT getting ‘high’ from Suboxone. The recording has been listed for about 20 bucks, but I hear the same thing from so many people– ‘my mom thinks I should stop Suboxone’– that more people should be getting it than ... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2657913 Thu, 30 Jul 2009 21:33:50 +0100 2657913 http://www.medworm.com/index.php?rid=2622053&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F2j6pgt7eu8k%2F I receive about a dozen e-mails each day asking for advice; some are quite long, and while I would love to be more helpful there are days when I don’t have time to even read them, let alone answer– so please understand if I have not gotten back to you. One thing that has also ’soured’ me a bit on personal communication is that I forget just how messed up addicts ARE– how distorted their world becomes, and how frustrating it is to become involved in trying to help someone who is not yet ready to be helped. I am going to post an exchange I had yesterday and today with one such person… I was way up north this weekend and not connected to the internet, but I received an e-mail on my i-phone and at the time had nothing to keep me from reading it. Having read ... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2622053 Mon, 20 Jul 2009 23:48:07 +0100 2622053 http://www.medworm.com/index.php?rid=2571233&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2Fk0ntW69LwHg%2F Many people who take Suboxone have heard this question at some point, from parents, friends, siblings, a spouse… well-meaning all. Unfortunately, the words are not so much a question as they are a statement: You should get off that stuff– that Suboxone. Many patients tell me that the statement often leads to an argument that they cannot win, as the person is not interested in hearing a new perspective– particularly from the person who got into the whole addiction mess. The situation becomes a ‘Catch-22′ in that the more the addict argues over why he should stay on Suboxone, the more the other person says ’see– you can’t live without it!!’ I have prepared an hour-long recording in which I discuss the reasons for staying on Suboxone; at l... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2571233 Sun, 05 Jul 2009 03:55:34 +0100 2571233 http://www.medworm.com/index.php?rid=2528172&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FqMa0hQ26IYo%2F You’ll notice a link to a company that makes medical ID jewelry in the sidebar and below–  not a bad idea to wear one if you are taking Suboxone.  I think that a year ago it was less important, only because many EMT’s didn’t know what the heck Suboxone was!  But realize that if you have been in an accident and are in pain, it will take significantly higher doses of narcotic (usually morphine in an ambulance or ER) to get any pain reduction– sometimes as much as 10-fold higher doses!  Even if you are able to speak, a bracelet or necklace with the name of the drug will likely be taken more seriously than whatever words you are able to put together in the confusion of an accident scene.  I think an imprint of either ‘Suboxone’ or ‘buprenorp... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2528172 Sat, 27 Jun 2009 01:41:01 +0100 2528172 http://www.medworm.com/index.php?rid=2513211&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Fsuboxonetalkzone.com%2Fdepression.pdf I can’t remember– did I ever point out this article about the use of buprenorphine for depression? I stumbled across it today while looking for something else.  The paper is from 1995, about a study done even earlier– well before Suboxone was around. Here is the abstract: Opiates were used to treat major depression until the mid-1950s. The advent of opioids with mixed agonist-antagonist or partial agonist activity, with reduced dependence and abuse liabilities, has made possible the reevaluation of opioids for this indication. This is of potential importance for the population of depressed patients who are unresponsive to or intolerant of conventional antidepressant agents. Ten subjects with treatment-refractory, unipolar, nonpsychotic, major depression were treated with... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2513211 Wed, 24 Jun 2009 18:55:34 +0100 2513211 http://www.medworm.com/index.php?rid=2513213&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Fsuboxonetalkzone.com%2F%3Ffeed%3Drss I have been wrapping up the book I have referred to– I have decided to self-publish under the name ‘Terminally Unique Publishing’, so watch for it in the future.  The name will be ‘Dying to be Cleaner: a Psychiatrist tells the truth about addiction, recovery, and the controversial medication that COULD save lives’.  I might change the last part of the name… I will have to see what the focus groups say (focus groups?  WHAT focus groups?!). The other thing I have been doing is practicing psychiatry, including treating addiction with and without Suboxone.  I have had a frustrating stretch of time, the last month or so;  I have about 5 openings right now for Suboxone patients, and have had a heck of  a time with the appointments.  I have no shortage o... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2513213 Fri, 19 Jun 2009 05:07:31 +0100 2513213 http://www.medworm.com/index.php?rid=2442793&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Fsuboxonetalkzone.com%2F%3Ffeed%3Drss A new feature on SuboxForum.com is the ‘Q and A,’ where I select a question to answer in detail.  I will post my answer here as well.  I won’t post the original question, but it is embedded in my response so I think everyone will figure it out! There are really a number of questions in your post, so I will do my usual thing and answer them as we go through the message. As always, these are my opinions; consult your own doctor before changing anything about your dosing or medication. The message/my responses: Thanks. I feel obligated to pay, and will–but I’d rather pay when the time is right for me to go thru w/d off subs. My problems are more than just getting off this suboxone. I now know I need to be in better stable frame of mind to go through this—... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2442793 Mon, 25 May 2009 05:02:15 +0100 2442793 http://www.medworm.com/index.php?rid=2442794&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Fsuboxonetalkzone.com%2F%3Ffeed%3Drss ‘Seven years’ refers to a scrape over on SuboxForum.com with a moderately disturbed woman from Roselle, Illinois…  Those of you who haven’t visited are really missing some good action!  We also have a new ‘Q and A’ section that I think will be a hit.  Please visit and register, but more than that, WRITE!  People on Suboxone need to talk to each other so that they don’t feel like isolated members of an ’underclass’.  I tell you– there are more people on Suboxone than you would ever imagine.  I can’t remember the exact number, but somewhere around 500,000 people have been treated in the past few years (7 years if you believe our crazy lady from Roselle!).  So let’s talk… as you will read below, the stakes a... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2442794 Fri, 22 May 2009 04:30:12 +0100 2442794 http://www.medworm.com/index.php?rid=2424506&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Fsuboxonetalkzone.com%2F%3Ffeed%3Drss A couple people have written to me saying that while I sound a bit ‘defensive’ and as if I am taking things personal, they like it when I let my true feelings out– including my anger.   If you are one of those people…. read on.  I will say, though, that I realize that there are times to maintain one’s composure.  I’m not the type of person who will excel in that environment.  When I worked in the prisons there were the inmates– people who had great difficulty holding back their anger– and the administrators– the shy, quiet people who would smile and shake your hand and then write you up for acting too ‘aggressively’ and hurting their feelings… or, if they read the manual would say that the work environment was &#8... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2424506 Wed, 20 May 2009 04:30:27 +0100 2424506 http://www.medworm.com/index.php?rid=2406195&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Fsuboxonetalkzone.com%2F%3Ffeed%3Drss I spend some time on this post at the forum so I will share it here as well.  First, a post from a person who uses the name ‘Suboxone7yrs’: I was addicted to vicodin for 10 years popping 50 pills a day of Vicodin ES or NORCO, I then decided enough is enough, went to the ER and they gave me a list of doctors who deal with addiction. I went to see this female doctor who gave me the 3 hour consultation thing, then put me on 32mg of SUBOXONE, she sold me the suboxone out of her office for $5 per pill, rather then paying $8 a pill at a Walgreens I thought ok why not?…Well 5 years later this doctor STILL had me on 32mg of SUBOXONE! She then must have gotten caught because she was no longer in practice, so I found another doctor who was commited to getting me off, it took 2 yea... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2406195 Wed, 13 May 2009 04:40:32 +0100 2406195 http://www.medworm.com/index.php?rid=2399223&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Fsuboxonetalkzone.com%2F%3Ffeed%3Drss I just got back from Chicago, where I spent the day learning about ‘best practices with Suboxone’ with the people from Reckitt-Benckiser. I feel an obligation to share my experiences with those of you who are so strongly connected to the efforts of R-B —and I am not referring to owning stock in the company. I’m not in the mood to go on forever; meetings with pharmaceutical company people always tire me out and even bring me down a bit—I’m not sure exactly why. I would almost think it would be the opposite, because things look so easy from the perspective of a PowerPoint presentation. Although as I put my psychodynamic background to use, I realize that an opposite reaction makes sense. Tune into my radio show podcast sometime and listen as I talk about psychodynamics; dysphoric ... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2399223 Sun, 10 May 2009 04:39:38 +0100 2399223 http://www.medworm.com/index.php?rid=2399224&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Fsuboxonetalkzone.com%2F%3Ffeed%3Drss I’m sorry, those of you who have been reading this site for the past couple years, to go through this once more…   but I have another of THOSE messages, and it has been, what, a few weeks since I discussed the short-term/long-term issue?   Rest assured that I spare you, the reader, more times than not.  I suppose I could tell the writer of the message (the one I am about to share) that he could search the blog for ‘foolish pharmacist’ or any one of a dozen other posts about the topic and spare me from writing and all of you from reading… but he probably wouldn’t do that.   So in my typical fashion I’ll post his message interspersed with my comments. The message: I want to add my perspective on Suboxone. I think it is a great medication but O... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2399224 Sat, 09 May 2009 03:34:52 +0100 2399224 http://www.medworm.com/index.php?rid=2341897&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FS8LLaaUXuxM%2F Thanks for the the feedback everyone! I should explain the logo… when I was doing the logo contest at logotournament.com (which is an excellent resource by the way) I asked for help in picking a winner. The logo at the top of the page was not an entry at that point, and a different logo was chosen– one that to be honest I wasn’t all that thrilled about. By the time I returned to logotournament.com there were a few more entries, including the one above– which I liked more than the one that everyone chose… so… I overruled the democratic process and picked it. Sorry! I just thought the other one looked too much like a pharmaceutical logo. But back to more serious topics…  I received a question from a person about using Suboxone to treat depression. ... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2341897 Wed, 15 Apr 2009 02:24:50 +0100 2341897 http://www.medworm.com/index.php?rid=2341900&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F3vHWFoXQFnE%2F Thanks, all of you who wrote comments to my last post.  I remind everyone once again to consider taking your comments here and after writing them, also taking them to SuboxForum.com.  I am going to put up a new category to discuss topics that were initiated here;  it would be great to get a spirited, respectful ‘give and take’ on some of these topics.  As I have mentioned before, the only thing that I will block on that site would be debating whether people on Suboxone are ‘in Recovery’– just because there are plenty of other sites for that, and I want the forum to be for people who have made their decision– and don’t want to be harassed over it.  I will be upgrading that site shortly and changing the hosting account;  hopefully I will pull i... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2341900 Mon, 13 Apr 2009 04:27:30 +0100 2341900 http://www.medworm.com/index.php?rid=2341901&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Fsuboxonetalkzone.com%2F%3Ffeed%3Drss Here is a ‘what would you do’ question: Today I saw a new patient who came in asking to start Suboxone.  She has a significant addiction to heroin– I don’t know heroin doses very well, but she said she uses ‘four bags per day’.  Incidentally, if anyone knows the conversion of that dose to the daily amount of oxycodone, please post in the comments and let me know.  She was in moderate withdrawal, and had not used for over 24 hours– which usually would suggest appropriateness for induction of Suboxone at least from a ‘precipitated withdrawal’ standpoint.  On the other hand, if four bags of heroin is a ridiculously high dose, her tolerance may have been so high that even after 24 hours, withdrawal would be precipitated. When I have peo... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2341901 Sat, 11 Apr 2009 04:52:24 +0100 2341901 http://www.medworm.com/index.php?rid=2341902&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Fsuboxonetalkzone.com%2F%3Ffeed%3Drss A friend sent me a link to an article that suggests an anti-smoking effect from naltrexone.   Naltrexone is an opiate antagonist similar to naloxone (the second ingredient in Suboxone);  naloxone is active intravenously, and naltrexone is active orally.  Naltrexone is indicated for treatment of cravings in alcoholism;  it is also used (but not ‘indicated’) for early treatment of opiate addicts in traditional recovery, as a ‘back-up plan’–  an addict knows that even if he DID use, the effect would be blocked.  Naltrexone is NOT that helpful for opiate cravings, which is why there is a niche for buprenorphine to fill. A couple weeks ago I read a study that found increased release of endorphins in the brain of rats after they were given alcohol;  the endo... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2341902 Mon, 06 Apr 2009 22:21:45 +0100 2341902 http://www.medworm.com/index.php?rid=2341903&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2Fodal-VfIUrg%2F A person added a comment asking a question related to pregnancy. I have moved her comment/question up here: Please help. I am confused by the information I am finding on the internet. I am on Suboxone, it will be 2 years in April ‘09. I was planning on getting off Suboxone this summer — as I teach & summer would be the best time to try to get off this med. The reason I am pushing to get off Suboxone right now is because I want to have a baby. And of course it would be in the best interest of the baby to be off. Here is the problem —- FIRST, I may be pregnant right now. This terrifies me because I was pregnant last November & I had a miscarriage. I have one child, so I know I can be pregnant. The OBGYN said I could have miscarried for a number of reasons, i... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2341903 Mon, 06 Apr 2009 04:51:29 +0100 2341903 http://www.medworm.com/index.php?rid=2302364&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2Fn7n-ZXtxzIo%2F I am the ‘expert’ on a couple forums at MedHelp.org, including the forum for chronic pain;  tonight I was answering a couple posts and came across the name of a medication I was not familiar with: Butrans, by Napp Pharmaceuticals.  After looking up the medication I learned that BuTrans is a 7-day buprenorphine patch manufactured in the U.K. that comes in doses ranging from 5 to 20 micrograms per hour.  I have mentioned in other posts that what is really needed to taper off Suboxone is a lower-strength form of the medication;  buprenorphine is just so potent that when people taper down to a quarter of a tablet they are still taking 2000 micrograms of buprenorphine– which is a significant dose.  The potency of buprenorphine is clear when one realizes that BuTrans is co... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2302364 Sun, 05 Apr 2009 03:00:28 +0100 2302364 http://www.medworm.com/index.php?rid=2302365&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FDZgepB_37ws%2F For the sake of a good night’s sleep I will share the post I just left with my good friend over at ‘arm-me’ blog– see the blogroll for the link.  The conversation there arose over the recent Suboxone-related deaths in Milwaukee, Wisconsin, and I was responding to a writer who made the bold claim that ’spiritual based’ treatments were superior to non-spiritual treatments, and that Suboxone is OK but only if used ’short-term’– a statement oft-read on the internet that is based on… well, based on nothing at all. My Comments: I would be interested in the reference for the comment about the ‘higher rate of success for Faith-based addictions programs’. I work and lecture in the field of addiction– and have been dealin... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2302365 Fri, 03 Apr 2009 04:07:09 +0100 2302365 http://www.medworm.com/index.php?rid=2302367&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F1DxhB2xC9gs%2F When I went through treatment in 2001 I had a number of rough days–  I liked the treatment center very much (eventually), but the detox facility was horrible. I wouldn’t treat my dog the way I was treated during that horrible week that I spent there.  I was very sick;  I have talked about it before, so feel free to skip ahead if you have already heard me wallow in self-pity…  but I was using intravenous opiates, including fentanyl, sufentanil, demerol, morphine, dilaudid…  you name it.  I had gone through a couple horrible experiences, once by accidentally injecting naloxone in a desperate effort to treat withdrawal (I was at that dangerous stage of addiction where I was so sick that even an unlabeled syringe seemed worth the risk…. for some reason it di... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2302367 Mon, 23 Mar 2009 00:43:12 +0100 2302367 http://www.medworm.com/index.php?rid=2284543&cid=t_172193_88_f&fid=38129&url=http%3A%2F%2Fsandnsurf.medbrains.net%2F2009%2F03%2Ftoxicology-conundrum-006%2F The phone rings as you sit down for lunch. You are asked for advice concerning a drowsy 2 year-old boy who was brought in to a Children’s Emergency Department by his worried parents. The child’s father has an ongoing struggle with opiate addiction and is on suboxone maintenance therapy. According to the father he “turned [...] (Source: Life in the Fast Lane) Life in the Fast Lane blogs http://www.medworm.com/rss/comments.php?id=2284543 Sat, 21 Mar 2009 21:00:53 +0100 2284543 http://www.medworm.com/index.php?rid=2280050&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Fsuboxonetalkzone.com%2F%3Ffeed%3Drss The latest in YouTube video… in this short flick I talk about the ‘disease concept’ of addiction and how it applies perfectly to the use of Suboxone. Grab a bucket of popcorn, sit back, and enjoy the show… By the way, I just watched a movie entitled ‘Teeth’.  Has anybody seen it?  Netflix allows me to watch movies that I would never pay to carry from a video store!  Now they have an ‘instant download’ service that allows members to watch movies without charge… and so my standards drop a bit, as it is easy enough to simply stop a movie that turns out to be a ‘turkey’.  The movie ‘Teeth’ was very strange…  If you like dark comedy/horror flicks that have a strong feminist message, that may be the one ... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2280050 Sat, 21 Mar 2009 03:54:52 +0100 2280050 http://www.medworm.com/index.php?rid=2269129&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F391vxZ_L734%2F The voting is done… and what I would have considered an ‘unlikely choice’ came out on top!   How I tallied the scores:  I gave a logo 5 points for a first choice selection, 4 points for a second choice, and 3 points for a third choice.  The points came out as follows. Logo number, followed by total points: #9, 48 points The Winning Logo #2, 30 points #1, 19 points #6, 18 points #7, 17 points #5, 13 points #12, 13 points #11, 12 points #10, 11 points #3, 8 points #4, 5 points #8, 0 points. I myself was rooting for #2– as one person put it, it was the one that doesn’t look like it came from a pharmaceutical companies brochure.  I also liked all of the little ‘heads’ with the cut-out balloon inside.  But I knew going into this that I am not good... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2269129 Mon, 16 Mar 2009 01:27:47 +0100 2269129 http://www.medworm.com/index.php?rid=2269130&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F_Aa53zs0W9s%2F On a message board called ‘opiophile’, a person wrote about being a long-term opiate addict, then taking methadone for a couple years, then going on Suboxone for a couple years.  He eventually stopped Suboxone, and had a miserable period of withdrawal… which never, by his recollection, ever totally went away.  He works for the Democratic Party (not secret info– it was in his post) and eventually used opiate agonists again (hydrocodone and oxycodone)… during his time in DC for the Obama inaugauration.  He described how wonderful he felt, experiencing the opiate sensations while at the same time ‘being part of history’. He returned to normal, boring, miserable life… until discovering a source for ‘Kratom’.  Kratom is a plant imp... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2269130 Sun, 15 Mar 2009 16:22:42 +0100 2269130 http://www.medworm.com/index.php?rid=2261021&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F-cXj303Fb3U%2F I’ve always known that there are some things that I am good at, and some things that I am not-so-good at.  That is why I asked for help with the logos;  I have never been very good when it comes to ’style’, and this exercise was no exception! I am not going to announce a winner yet, but I have tallied the votes so far and I admit to a bit of surprise at the results.  One logo has no votes, and one logo is far out in front;  and there are a couple tied for second place.  As for my top three choices– they are all among the bottom vote-getters. The response has been positive with the exception of one person who wrote back saying that all of this was ‘flippant’ and that I should be spending my time doing something that REALLY helps addicts, like lobbyin... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2261021 Wed, 11 Mar 2009 23:00:48 +0100 2261021 http://www.medworm.com/index.php?rid=2261022&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F0IERGd7dTXk%2F I need a logo– something to identify my ‘brand’ other than the junkie shooting up with the ‘X’ over it. And I found a great place to shop for a logo, called ‘logotournament.com’–  you provide information about your product, or company, or whatever it is you want a logo for, including the mission of the company, your favorite colors, the type of design you want… and then you set a price that will serve as the prize for the winning design.  I had a great response, from designers from around the world!  I initially had about 60-70 designs, but I narrowed the list down considerably to 12 finalists.  At this point I am asking for YOUR help. The logos can be found by clicking on ‘vote for logo’ in the header, or by clickin... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2261022 Tue, 10 Mar 2009 16:46:43 +0100 2261022 http://www.medworm.com/index.php?rid=2249564&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2Fak_vQT8kUiQ%2F I wish I had more time to devote to this topic right now, but I am on my way to a short vacation… so I will not be available by e-mail for at least a few days.  Everyone is pacing around the house right now, waiting for me to finish with ‘that stupid computer’. I had to to write, though, because of a horrible incident in Milwaukee a couple days ago that took the life of a 15-year-old girl named Maddie Kiefer.  According to news stories, she snuck out from her house in Whitefish Bay, one of Milwaukee’s’nicer’ suburbs– by nicer meaning a place where the houses are kept up, many children grow up with two parents, and the public schools send a high proportion of students to colleges.  The suburb lies just north of Milwaukee, and along with other nor... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2249564 Sat, 07 Mar 2009 22:09:36 +0100 2249564 http://www.medworm.com/index.php?rid=2227722&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Fsuboxonetalkzone.com%2F%3Ffeed%3Drss I forgot to mention… I am trying a new widget, halfway down the right side– you can chat to others who are reading the blog.  I think you can also steer away to other chat rooms, but what would be the point of that?! While I am at it, a question: I have talked with my local patients about getting a group together for people who would like to make the next step and taper off Suboxone. I am thinking of having a group that meets fairly often, by webcam. We could use one of the free programs out there like oovoo that allows a number of people to talk and see each other, or if anyone knows of a great program, let me know. I have been a part of recovery groups for years– 6 years in aftercare alone, not counting my time since becoming a psychiatrist. There would be organization... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2227722 Mon, 02 Mar 2009 05:44:52 +0100 2227722 http://www.medworm.com/index.php?rid=2227723&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Fsuboxonetalkzone.com%2F%3Ffeed%3Drss One thing I enjoy so much about the blog is that I receive comments from people around the world… hello to my new friend in Holland, and California, and New York… I have also mentioned before how the miserable disease of opiate dependence affects people from all jobs and socioeconomic groups. I receive messages from members of the underground world of opiate dependence, and so often I think about how surprised people would be to know what a huge problem this is!  Writers, stockbrokers, artists, businessmen, doctors, lawyers, factory workers, photographers, teachers, students, IT professionals, waitresses, realtors, landlords, welders, professors, home-makers, mothers and dads… I have talked to opiate addicts from all of these occupations, and more.  And in all of them,... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2227723 Mon, 02 Mar 2009 04:38:42 +0100 2227723 http://www.medworm.com/index.php?rid=2211577&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FPXPCZvTz9ts%2F I received some feedback after writing about tapering Suboxone here and on my site Sober after Suboxone (soberaftersub.com), and I would like to share the information and suggest a new way to think about buprenorphine during the tapering process. First… it has already become clear to me that Zofran, or odantreson, is not the big answer for opiate withdrawal that everyone is hoping for.  Oh well…  maybe some day.  As I have said a number of times, some day there will be a medication that prevents tolerance, and I would expect such a medication to affect withdrawal as well, as the two processes are closely related.  On the other hand it is possible that such a medication would actually prolong withdrawal, by preventing the plasticity required for the receptors to return to no... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2211577 Mon, 23 Feb 2009 05:18:52 +0100 2211577 http://www.medworm.com/index.php?rid=2201243&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2Fzatup15xYBw%2F Thank you to Heather Hajek for the following report. I found the report on several health pages with RSS feeds, but unfortunately there is no byline to the article that says where ‘Heather Hajek’ writes– I did a Google search for her name and came up with a few more health articles, so I assume she is a health reporter for some newspaper. But if you find this, Heather, thanks– and I suggest you add a line to your articles stating where you are writing, as your articles are placed in newsfeeds without any identifying information.  The article: Nausea Drug Can Help Reduce Symptoms in Opiate Withdrawal Opioid addiction, whether illegal heroin or legally prescribed medications, is a growing problem in the United States. There are companies that are working on opioid su... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2201243 Fri, 20 Feb 2009 05:02:07 +0100 2201243 http://www.medworm.com/index.php?rid=2195327&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FMb95kiR9M8M%2F Yes, you heard it here fir…. fourth…  it is hard to stop Suboxone.  As anyone pausing at this web site knows, it is hard to stop ANY opiate.  There are many forces at work against you when you are tapering off opiates; physical withdrawal, mental withdrawal, cravings for opiates, and the unconscious mental effects of addiction– the conditioning of your mind to see opiates as the solution to all of those uncomfortable feelings.  With all of that going on, it is no wonder that most ‘opiate tapers’ end unsuccessfully, leaving the addict more discouraged than he was before. Suboxone is clearly different than other opiates, and the differences profoundly influence the tapering process.  I will mention my good friend Brian over at suboxonetaper.com, where he wa... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2195327 Wed, 18 Feb 2009 04:32:24 +0100 2195327 http://www.medworm.com/index.php?rid=2195329&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FKQVixe099Ug%2F A question from a reader: I have been taking oxycontin 40mg 4 years and want to quit so went to dr and gave me 12 suboxone 8mg took one 8mg yesterday at 3pm which would be 20 hrs after last oxy i was having serious withdrawals 10minutes after taking the suboxone i felt so nice freezing cold went away and so pleased, it is 10am and still no chills, is it possible the suboxone is out of my system now? should i still follow the dr’s calender? My Response: There are at least two points I want to make.  The first is a direct answer to your question:  no, the Suboxone is not out of your system.  You still have considerable withdrawal in front of you, and you are being kept from withdrawal by the long duration of action of the buprenorphine in Suboxone. You are used to taking 40 mg of Oxycod... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2195329 Thu, 12 Feb 2009 03:04:14 +0100 2195329 http://www.medworm.com/index.php?rid=2195330&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FY4bf4Qn4LME%2F I am branching out in a couple directions. First, I am going to start posting on Blogger, essentially duplicating the content that I am posting here. I think Blogger, being part of Google, has a wider circulation; I particularly like the feature where one can keep clicking on ‘next’ and leaf through blogs from different countries. The address of that blog is http://bupetalk.blogspot.com. I am also adding some recordings for sale at Sober After Suboxone, or http://soberaftersub.com.  The recordings discuss the treatment options for opiate dependence, how to know when you are ready to stop  Suboxone, and how to stop Suboxone without withdrawal.  I discuss all of these topics here and there on the blog, but if you are looking for a concise explanation (for an hour) of one of th... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2195330 Sat, 07 Feb 2009 02:27:57 +0100 2195330 http://www.medworm.com/index.php?rid=2195331&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F6LJSeNd1V7g%2F I often answer questions about Suboxone that require the qualification ‘if it is being absorbed properly’. If a person asks how long it take for Suboxone to wear off, or at what dose does the ceiling effect occur, I need to be sure that the person is taking it in a way that maximizes absorption; otherwise all bets are off. If a person simply swallows the tablet, for example, the level of buprenorphine in the bloodstream will be much lower than if it is taken correctly. The usual instructions  for taking Suboxone are to place a tablet under the tongue and let it dissolve.  It is important that Suboxone be taken once per day, in the morning;  this instruction is included in the course for physicians but is too often ignored.  I will talk another time about the philosophy for ... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2195331 Thu, 05 Feb 2009 04:38:19 +0100 2195331 http://www.medworm.com/index.php?rid=2195332&cid=t_172193_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2Fc1oOarRT5y8%2F When a person asks for help with some issue in his/her life, a safe and relatively common answer is to suggest ‘counseling’. Trouble with your marriage? Get counseling. Depressed? Take an SSRI, sure, but get some counseling too. Kids acting up? Send them for counseling. Wondering about the meaning of life? Lose your job? Have a flight get cancelled? Try some counseling! What about all of this counseling? Does it do any good? There seems to be this assumption that any counseling is good counseling—but why would that be? The standards for providing ‘counseling’ vary by state, and in some states pretty much anyone can hang a shingle to be a ‘counselor’… What are we talking about when we say ‘get counseling’? What if we take the word ‘counseling’ and change it to a diff... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2195332 Sun, 01 Feb 2009 23:09:01 +0100 2195332