Misuse of Suboxone

After I made some posts on this relatively new blog about Suboxone film, including pictures of the film, the number of hits to my blog increased dramatically. But I saw a pattern. I was getting hits from search engines, after people entered phrases that indicated they were looking to either snort or inject Suboxone.

 Over the past thirty days, the number of hits to my website from people entering phrases related to injecting Suboxone is: 138

 Phrases about snorting Suboxone: 114

 Phrases indicating attempt to get high from Suboxone tablets or film: 26

 Maybe not everyone who entered such phrases actually was looking to learn how to misuse the drug. Maybe some of the entries were people merely gathering information. But I suspect most people were addicts trying to get information about the misuse of Suboxone.

 Then I also receive a few posts that I don’t approve for this blog site. Recently I got an interesting post from an IV addict who describes how he separates the buprenorphine from the naloxone before injecting the tablets, but I’m certainly not going to publish that information. True, you may be able to find this information elsewhere on the internet, but not here.

 All of  this is challenging me to re-consider what I believe about Suboxone.

 I prescribe it from my private office, and I’m having misgivings about this. Are my patients injecting or snorting? I don’t think so, but now I wonder if I’m fooling myself.

 Maybe the only safe way to use Suboxone is through opioid treatment programs, where patients have to come each day to get their dose and take it in front of a nurse,  just like we do with methadone. 

Comments?

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21 responses to this post.

  1. I am sure there are people that will do anything to get high, but there are good people out there trying to do the right thing… and the reason they switched to Suboxone was so that we didn’t have to go to a clinic everyday and dose in front of a nurse. Some of us have jobs, kids places to be and we dont live in the city and with the clinic only dosing to 9am everyday you never feel you a day off, even on the weekends… Everyone should not be punished because there are some who are not trying to stay clean, this drug is a great drug no matter what.. We are still going to have addicts for the rest of time abusing or trying to abusing something… It seems that “treatment” in this county is based on what everyone does wrong, instead of the ones who are really doing right.. The people who really change their lives are always looked at in a bad light, just like this post, what about the majority of people who take their medication like their supposed to? Instead maybe we should change everything because of the ones who cant do what their supposed to do.. How about us as providers just come to realize theres always going to be people like that, we have to do our best of weed them out and read our patients… But I’m SO sick of hearing, “There going to take Suboxone away” “There going to make you come in everyday a dose” Etc, Etc… Just because there are some WHO will ALWAYS, ALWAYS do this no matter what.. And theres ALWAYS the people who really need the help and do what their supposed to every month to obtain there medication the right way, they always get punished for doing the right thing.. ALWAYS just because there addicts…

    Reply

  2. in Ref to AB’s post: There are good ppl out there trying to do methadone treatment right, who also have jobs, families etc and have to spend 3 hours round trip out of their day to get to the clinic everyday because they are also being punished for the bad ones behaviors.

    While suboxone has helped a lot of ppl, I think they touted suboxone as the cure all that it is not and gave ppl the misconception that it was “better” than methadone because of the naloxone in it. Well, as we can see, ppl are going to find ways to abuse it just like anything else.

    I also don’t think that a lot of the docs who have taken an ONLINE course should even be treating addicts anyway. Most of them have no idea what addiction is all about and a stupid ONLINE course isn’t going to change that! They look down their noses at the addicts and a big portion of them don’t even AGREE with MAT but prescribe it because of the profit increase.

    I realize that suboxone has it’s use, just like methadone and has helped so many ppl, but I totally think they should regulate suboxone just like they do methadone. Either that or be fair and loosen up the rules on the methadone pts to make it easier for AT LEAST those of us who are doing the program correctly.

    Studies have shown that most diverted methadone comes from the pain pts getting it from the pain mgt docs and not from methadone clinics anyway so I think there is room for change here. Stop allowing the pain mgt docs to prescribe methadone so easily, or make those pts accountable just like those who attend methadone clinics. Same with suboxone, either tighten up the rules for suboxone pts and docs or make it fair for all MMT pts who receive treatment no matter what type of medication they are on.

    Reply

    • Actually, I think most patients on methadone are doing well. It’s just that the ones that are NOT doing well get all the attention, and cause consternation in the community. People who are working, taking care of their kids, living normal lives on methadone never come to anyone’s attention.

      I agree with you about the online course. It’s not sufficient. I took the online course, but then also took the day-long face to face, eight-hour course. The latter was much better. I think many docs who took the online course also took another, better course.

      Reply

  3. PS: I really like your blog by the way

    Reply

  4. Posted by Abbie on January 17, 2011 at 7:42 pm

    If your doing the right thing at the methadone clinc, you should be earning take home doses. As set by federal law.

    Reply

    • yes, you are right Abbie, but even though Fed Regs say a clinic can allow a pt up to a months worth of take outs if they follow the guidelines set up for that, each state and each clinic has their own rules as well. I know of clinics who will never allow you more than 2 weeks of take out ever, no matter how long you have been there and/or how long you’ve been a stable pt. I also know of clinics who go even further and will never let you have more than ONE WEEK’S worth of take outs, ever.

      This isn’t against Fed Regs as the Fed Regs are only a minimum “guideline”. Each clinic and also each state can set up their own guidelines as long as they don’t violate Fed Regs. An example of this would be if the clinic allowed pts to have more than a months take outs or not to have to wait as long as Fed Regs say they should before allowing once a month visits.

      So yes, what you say is true but it still doesn’t help when you have to come in once a week and you make a 2 hr drive one way to get there. And don’t even get me started on the cost of going to a methadone clinic vs going to an OBOT (office based opiate treatment)office which are few and far between. lol!

      Reply

  5. Posted by joey on March 11, 2011 at 10:25 pm

    i have been ON 150 MGS. OF METHADONE FOR FOUR YRS, MISSED ONE DAY AND WENT ON SUBOXON THAT DAY.I WENT IN BAD WITHDRAWALS AND NOW BEEN TWWO DAYS AND STILL DONT FEEL TO GOOD.JUST ALOT OF BODYACHHES

    Reply

    • No wonder you don’t feel good. We usually like for patients to taper down to around 40mg, then stop methadone for about 3 days before they start Suboxone. That’s because the active ingredient, buprenorphine, is only a partial opioid, but it kicks off all other opioids from the receptors, causing immediate withdrawal if you’ve been taking a full opioid.

      I’m assuming this wasn’t done under a doctor’s care?

      Reply

  6. Posted by Janet on March 17, 2011 at 5:23 pm

    I am confused about the use of Suboxone. I am getting weaned off the use of pain meds and it was suggested that once I take my last dose of oxycodone to have a plan for the use of suboxone to replace my pain medicine. I have ddd, have had one back surgery so far for disc replacement, I have real pain, but ended up using more than what I was prescribed. Is Suboxene available for general md’s to write a prescription? Is this a good idea? The advice came from a family memember who works in a treatment center for substance abuse. Appreciate any help with understanding this drug.

    Reply

    • Hmmm….that’s a relatively complicated question. First of all, I’d wonder if you have any of the symptoms of addiction. You certainly have chronic pain, and physical dependency to opioids because you’ve had to take them for so long, but do you have the psychological symptoms seen with addiction? Please see the column I posted 3/17/11 for some questions you can ask yourself to help answer this. If you have chronic pain plus addiction, Suboxone may be the best choice for you. It helps maybe a little with pain, and it certainly helps with addiction. However, you should understand that your body will be physically dependent on the Suboxone.

      If you have only chronic pain and physical dependency to opioids, but don’t have the disease of addiction, I’d discourage your doctor from prescribing Suboxone. It’s not FDA approved for pain, and it’s possible the DEA will have questions for her if she prescribes it. Ideally, it’s up to the doctor to decide the best treatment choice for patients. The doctor can prescribe medication “off label,” which means for a purpose that’s not approved by the FDA, but the doctor should document in the patient chart exactly why she is prescribing this medication. And for chronic pain without addiction, there are plenty of other opioid medications that can be used in such a situation. Doses can be tapered slowly until you are opioid-free. People without the disease of addiction are usually able to taper off pain medication, though it’s still not easy.

      So please talk to your doctor and ask her your questions, and be honest when you answer her questions.

      Reply

  7. Posted by nonya_biz on June 19, 2011 at 7:30 am

    i just wanted to say that anyone that thinks they can separate the buprenorphine from the naloxone in suboxone is sadly mistaken. the solubility properties of these 2 opiod compounds makes separation via a selective solvent virtually (99.999%) impossible. even with expensive equipment like a chromatography column or other laboratory methods like TLC, the separation is not likely.

    to me, it seems that IV users have 2 issues to deal with.. first, the addiction to the drug and second, the addiction to the needle. when an IV user is responsible for the administration of their medication, the thought of shooting it up is the first thing to enter their mind. the most effective means of dealing with people like this is to supervise their dosing and not to allow them to be in control of their meds until they have had some time to sober up. imo, they need to be babied until the track marks go away. the visual reminder of tracks are a very powerful trigger that many dont even think to avoid…

    i say this as an IV addict with 12+ years of experience dealing with opiate dependence. i know how hard it is to put the needle down as well as how hard it is to put the opiates down. once i realized that the needle was a separate issue and i had to deal with it aside from the drug, treatment became much easier.

    your mileage may vary…

    Reply

  8. Posted by Pharmaco on October 14, 2011 at 11:14 am

    Ah.. trust. This really does sum it up.

    If you have good rapport with your patients it would be evident if this is occurring. From what I have been told IV use of Buprenorphine/Naloxone tablets is not particularly euphoric and as nonya_biz pointed out it’s likely the dependance is toward the act of injecting rather than resulting effects of the drug.

    I yearn for a situation in which I could be provided with a prescription that could be filled for consumption at home. In the country I live I must visit the pharmacy every day to get my dose, getting only 1 or 2 take away doses per week. Even in the scenario I have described above, if are people determined to misuse the medication do so. Don’t think for a second that it is made possible simply by the fact that the treatment is provided in an office environment.

    Reply

    • I agree completely. I don’t think any of my patients are doing this. But then, I do take measures to hold them accountable like film counts and drug screens.Anyone with this disease can have a relapse, and I’d rather diagnose it early, to prevent the usual consequences.
      I’ve been amazed and disappointed at the number of people who write in to this blog who describe still trying to get high from a medication that’s meant to help them put their life back together. I don’t publish all of their comments. I’m starting to wonder if it isn’t better to start all buprneoprhine patients in an opioid treatment program, where they come to the program daily to be dosed in front of a nurse, then transition only the stable patients to office based treatment where there’s more freedom.

      Reply

  9. Posted by Pharmaco on October 16, 2011 at 4:30 am

    There is merit to your feeling regarding in patient treatment until the individual proves themselves capable of handling themselves in an out patient program. I guess it comes down to numbers, are their enough clinics in your area to handle this type of approach? Would people be unable to get treatment due to lack of places in the clinic?

    Here it varies greatly but most doctors will make each patient work hard for the ability to have a few take aways per week. This can be quickly taken away again if there is any concern about stability or trust is broken.

    Reply

  10. Posted by Robbie on August 23, 2012 at 6:58 am

    I’m an opiate addict, true story. I love the feeling more than almost anyhing. I buy suboxone off the street because quitting cold turkey sucks. I’ve been buying it for about two weeks, and I woke up a couple days ago feeling energized and ready for the day without taking any meds. But I find myself taking it to counteract the depression. The docotrs here want 300 dollars a visit for a suboxone detox program. People cant afford that. Innsurance wont pay for it. It leaves most people no choice but to figure it out by them selves.

    Reply

    • Posted by opiatesuck on February 20, 2014 at 8:38 pm

      Im a chemest at U of Ridel Dr. Co. Whats going on in this post? havent got a post in 2yrs? Lets livin up a few things

      buprenorphine is a full on diagnostic much greater than morphine and methodone and it last far longer still. Its only called a partial agnostic cause its coupled with naloxone and made into a sollution called suboxone. Trouble is it can’t be searated.

      Reply

      • I love this comment. I’m pretty sure Chemest made a typo and meant “agonist” rather than “agnostic” since it would be impossible to know Suboxone’s belief in a deity.
        LOL

  11. Posted by zach on May 11, 2014 at 5:52 am

    I have been reading through your blog over the last few days, and I agree with a lot of what you say. However, I feel that you are dead wrong in your assertion that perhaps suboxone should be only administered on a daily basis. As you know, it is far safer than methadone and has fewer drug interactions. It is even less desirable as a drug of abuse than methadone, if that’s even possible. No one I know uses either to get high-only as self-medication for withdrawal- and I know a hell of a lot of opioid addicts.

    Many addicts like me would not be able to go to a clinic every day with our current life situations to get our doses and we are perfectly capable of handling our medication in a safe and legit manner. It is not reasonable to paint us with the same brush as someone who is still so sick that they continue to try and abuse the very drug that is supposed to be helping them. You stop just short of suggesting that this massively destructive change in policy (removal of private suboxone clinics that provide monthly prescriptions from the very short list of available treatment options for addicts) be implemented but imply that there is a possibility that it is necessary. There is no doubt in my mind that many addicts including me would die if that happened. This angers me a little, I will admit.

    As far as ruthie’s point that it’s somehow “unfair” that I get a month’s supply of my medication while a methadone patient might only get a week, I laughed out loud. That is simply ridiculous. They are different substances with different risks and should be treated as such. I put up with daily dosing at a methadone clinic for almost two years before I tapered off, relapsed and stayed sick for a while, and then switched to suboxone. (I smoked grass the whole time I was on methadone so I couldn’t get take-homes, a fair trade at the time or so I thought; I was not yet committed to full recovery.) I switched to subs for the convenience and privacy and found it worked much better for me anyway. People who moan about a need for “fairness” for all MMT patients sound like children whining that they don’t have some other kid’s shiny new toy and demanding that it be taken away just because they can’t play with it too. I don’t mean to be harsh and I have a feeling this post might never be seen because of this assertion, but I just can’t bring myself to speak on this topic without saying that.

    Despite all this, I don’t mean to attack you (Jana) in any way at all, I have enjoyed reading your thoughts about addiction and especially the overwhelming atmosphere of ignorance and stigma that is so pervasive in our society. Keep on trying to educate those pitchfork wielding villagers and try not to let them piss you off too much, you seem to keep a lid on your temper much better than I would in your place from what I’ve read. Good luck to you.

    Reply

    • Actually, I agree with you. Some patients do very well with monthly visits to get their buprenorphine. Only some patients need to come daily, and I run in to the same problems you describe – patients not doing so well in treatment protest that it’s unfair. The ideal is to individualize treatment for each person and their recovery, and when we do that we get complaints from other patients.

      Reply

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