Hello! I am a physician, board-certified in Internal Medicine and Addiction Medicine. This blog was created to help people better understand the medication-assisted treatment of opioid addiction using either buprenorphine (Suboxone) or methadone. I will be writing about different aspects of this topic, as well as the treatment of addiction in general. Hopefully, I will get a few questions, too.
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Janaburson's Blog 
Posted by Works Aside on June 17, 2010 at 6:35 pm
Dear Jana,
I have just found your blog through onepillawayfromchaos. I have been looking for something like this for 3 years! I have not yet had the chance to read through all your posts but once I have, I will be sure to come back with many questions.
My sister is a heroin addict. In and out of recovery. I have never understood her relationship with methadone. She has a history of buying it illegally, something I could never understand as she is legitimately entitled to it. I guess she was taking it to compliment her addiction to heroin. She lives in London and I live in Switzerland where they actually have a nationally approved heroin programme…
I have been blogging about my sister since February when she relapsed under our roof. It has helped alot because I have gained insight from families and addicts alike. I look forward to reading your blog and gaining more knowledge on a subject I need to know more about.
Many thanks
Nora
Posted by Roy on January 6, 2012 at 6:35 pm
HI Nora, I’m from the united states and was addicted to oxycontin for several years. And I’m goint to be honest up front. Suboxone saved my life period, I don’t even crave an opiate, I can hold them in my hand and hand them back, IT WORKS without it I’d be dead by now or in prison. I applaud your actions to get her help. SO many people where I live don’t understand the addiction, they think you can just stop if you put your mind to it, and we know that isn’t the case. I’ve been on suboxone for a year and I have never felt better. If there is any way you can get her on the suboxone instead of methadone you WILL see a big difference. If you need to talk to someone outside your family please feel free to email me. (roylane48@hotmail.com) I’ll be glad to talk to you or her. Good luck to all of you and don’t give up. I’M WALKING PROOF IT WORKS.
Roy Lane
Posted by Sixela on February 6, 2012 at 7:03 pm
Hello Nora. I’m a young woman.. almost twenty years old. I have had doctors prescribing to me for over a year for chronic pain disorders..ranging from my back (and surgeries) to my knee (multiple surgeries) and foot.. Those are my main problems with pain. I’ve gotten so much better and grew from what I once was.. when I was strongly addicted at one point. I straightened myself out. I am straightening myself out completely again. I hope to get some encouragement and inspiration from others who have felt the pain, desperation, embarrassment,.. It’s nice to know that I’m not alone. I just feel so upset that so many health problems have impacted my life so greatly in a variety of ways. From being misdiagnosed for a year and losing 75 pounds- coming so close to death..to now..getting healthy and my life back on track. I hope to find a friend that I can confide in that knows how it all feels….
The last thing I want is sympathy. I just search for understanding- no more negativity. Only positiveness and getting better/healthier! 🙂
Take care all.
Posted by Eric VT on September 1, 2012 at 9:17 pm
Roy as a addict you should know It does not matter what kind of sub she goes on on. The bottom line is if she or any addict does not want to stop using they won’t. Methadone was actually the only opiate substitue that worked for me in the end and saved my life. I have been on the clinic now for almost 11 years. But it did not start working for me in being able to live a normal productive life until I actually wanted to get clean and stop using not just opiates but all drugs. The bottom line I just was not ready to stop and still wanted to be a weekend warrior. It was not until I wanted to get clean that it worked.
Posted by steven on July 24, 2016 at 12:59 am
Amen…started methodone this week here in Denver. Thanks for your blog.
Posted by Cristal Thursby on August 6, 2016 at 1:32 pm
I also do the Suboxone and it has saved my life! I also had tried the methadone but i was still getting high so that wasn’t helping me get sober i even kept telling them it wasn’t helping just so they would raise my dose! I was nodding out everywhere i went ! But the Subs that i am currently taking has taken away all cravings i had and no matter how many i try to take you can’t get high off it! It makes me feel normal like i was before my addiction was woken! I also suffer with a bad back and a few years back i broke a leg and still hurts when it gets cold or stormy weather but the subs helps my pain so much! Good Luck
Posted by medhba on September 10, 2021 at 1:18 pm
Hi Roy, suboxone also dramatically improved my life! *high five*
Posted by ruthann on March 11, 2011 at 7:31 pm
Hello Dr. Burson,
I have found your blog doing some research for articles to post on a methadone forum I run. I wanted to tell you how much I appreciate your blog and your open mindedness where addiction and opiate replacement therapy are concerned. I have been a methadone pt for over 11 yrs now. I tried traditional rehab 3 times and would fail each time. I suffered from depression for as long as I can remember, even as a child of 8 or 9 yrs old. I won’t go into the long story, but sexual abuse, mental abuse and physical abuse were frequent in my life as well which I think exacerbated the depression. As a young teenager I was put on hydrocodone for severe endometriosis. I also had several surgeries for the female issues, which called for pain mgt. It wasn’t long though before I realized these pain killers not only killed my physical pain, but my emotional pain as well. Again, I won’t go into the long story but that began my addiction cycle with pain killers. It went on from the time I was 17 untilI was 29 yrs old. Again, I tried traditional treatment 3 or 4 times and would fail. I couldn’t even stop when I was finally able to get pregnant and stay pregnant with the miracle baby we thought we would never have and that I carried past the point of miscarrying. NOTHING could help me! I was hopeless and to the point where I wanted to die. I was on the verge of losing everything important to me! The only thing that had kept me out of jail all these years of stealing other ppl’s meds and forging scripts and such was teh fact that my husband was a well respected minister’s son and police officer in the town we lived in. I just wanted to die rather than keep hurting him and our son. That was until a doctor prescribed me methadone to treat my addiction. I knew from the first day or so that this treatment was going to give me some hope and a real chance at recovery. Of course, this doctor wasn’t certified to prescribe methadone for addiction so he was trying to wean me. I was fine all through the treatment but when I got to the last 10mg, I started to struggle again. I ended up at a methadone clinic instead and I have been on methadone ever since. I have tried several times to detox, but I would get down to about 35mg and would struggle again. I almost lost everything with my addiction before and I don’t want to EVER take that chance again. SO, if that means staying on methadone for the rest of my life, I am willing to do that rather than risk losing everything that is important to me because of addiction. Again, I am trying to make this short but all these years on ORT (opiate replacement therapy) I have had to deal with doctors and medical professionals who DO NOT agree with any form of ORT and certainly don’t support it. I have been denied pain medication coming out of an appendectomy, denied pain medication during LABOR and treated horribly by people who have preconceived ideas about a person on MMT. The majority of medical professionals that I have had experience with, DO NOT agree with ORT…..no matter if it’s with suboxone OR methadone.
I say all that to say this, it is so refreshing to hear from a doctor who was actually able to recognize that the idea they had previously about methadone pts may not have been accurate or fair.
I follow your blog religiously! I haven’t had the chance to read your book yet, but I have it on my wish list. Thank you so much for the blog, for sharing your information and ideas and for treating your addiction patients like human beings worthy of care just like anyone else.
Posted by janaburson on March 11, 2011 at 11:29 pm
Thank you, thank you so much for your kind comments. It comes at the end of a particularly trying day, and means so much to me!
Posted by K on November 15, 2012 at 3:16 am
Hi my name is Kate, and I am a recovering addict. I was in active addiction for seven years and finally got clean and have been for a year. Your right your sister will stop when she wants to stop and usually it takes rock bottom if not there are only institution prison or death. I do not take anything today to keep me sober but na meetings and a great support group. We drug addicts and alcoholics think and do things a lot differently and use to fill the void in our life that is missing. That is why when one gets clean it’s like we are babies, we have to learn to crawl then walk. We have to learn to sit through and feel every emotion no matter how uncomfortable instead of covering it with a high. I hope this helps and wish the best of luck to u and ur sister
Posted by Ashley on June 30, 2015 at 6:22 pm
**Question: I am prescribed Suboxone and I am in a very well structured program for my addiction. I am almost 8 months clean and my whole life has turned around (for the better). My life is finally coming together and it motivates me every single day! I am getting married in a couple months and I have gained some extra weight (almost over my BMI) and I was wondering if it would be safe or not to take Hydroxycut while on my Suboxone? I have used Hydroxycut before to lose weight and know it works well and it never affected other opiates I was using but I have been scared to take it with Suboxone. Can anyone tell me whether it is safe or not please? Thank you soo much!! xx
Posted by janaburson on July 1, 2015 at 12:49 am
I don’t recommend taking that. No one even monitors what goes into that kind of stuff.
Stick with reducing portion sizes and increasing exercise.
Posted by Greg on February 5, 2015 at 3:35 am
I have had depression for years and the statement about oxy curing emotional pain is exactly the same for me.l’ve been on suboxone for 7 years and it saved me for sure.I went to a methadone clinic first but switched to the private doctor situation. This website is excellent, thanks Dr.Burson.
Posted by janaburson on February 5, 2015 at 9:50 pm
thank you!!
Posted by Jessalyn on March 31, 2011 at 4:16 am
Is it true that if you go into treatment and accept suboxone as treatment that you can never again be prescribed pain medication even if needed. (for example, if you were in a car wreck or had a major surgery) Is this true even if you pay for treatment without using insurance?
Posted by janaburson on March 31, 2011 at 10:55 am
No, that’s not true. Things happen to all of us: broken bones, surgery, etc., that must be treated with pain medication. For a recovering addict, that’s a high risk situation, but precautions can be taken to get through such a time without relapse. Suboxone is usually not enough for acute, severe pain. There are options, but generally my patients stop the Suboxone to go on short-acting opioid medication until the situation is resolved. I try to get them to find a dependeable non-addict to hold their pill bottle, I see them more often, and of course if they’re able, go to extra 12-step meetings. Narcotics Anonymous even has a booklet, “In Times of Illness” which speaks more on this question.
Chronic pain is a different matter. I prefer to try to find a non-opioid way to manage chronic pain, and perhaps the Suboxone helps enough to make the pain managable.
NO ONE should be denied pain control because they have a history of addiction. It has to be dones more carefully, but it’s inhumane to withhold opioids for acute severe pain. Sometimes I have to call my patient’s surgeons, for example, to reassure them it’s OK to give opioids like they would for anyone else, and explain the precautions we can take with these high-risk patients. Usually I see them more frequently in the office, if that’s possible, and I encourage the other doctor to see them more frequently, and prescribe fewer pills at a time.
Posted by Roy Lane on February 3, 2012 at 10:00 pm
If you are injured you can still be prscribed pain medicine. Just let the Dr. know that you are taking suboxone. The pain medication will kill the pain you just don’t get “high” from it. At least thats what my suboxone Dr. tells me.
Posted by zenith15 on September 17, 2012 at 2:50 am
Hi Doctor
Were you aware that NA also has a written policy that states that patients on methadone or suboxone are “in active addiction” and are not to speak/share at meetings, hold office, etc but rather are to sit in silent shame as having “used that day” and then told to “get with someone after the meeting” so they can be encouraged STRONGLY to get off medication assisted treatment? Many professionals in the field recommend NA for their Medication assisted treatment patients without being aware of their official policy on this, or that their patients will be strongly urged to reject the very treatment they are prescribing if they attend these groups and admit their MMT/Sub status.
Posted by janaburson on September 17, 2012 at 10:01 pm
NA also says “the only requirement for membership is a desire to stop using.” My patients have earned their seats. I tell them be careful who they tell they are on medication. The most important part is listening, anyway. Many addicts will welcome people on methadone and Suboxone with open arms, and some will not.
And there’s always AA; some addicts feel more comfortable there, and use what they hear about alcohol to apply to drugs.
Posted by zenith15 on September 17, 2012 at 10:42 pm
Many AA groups feel that having addicts as members dilutes their message of recovery (though I disagree strongly) and so members are discouraged from discussing anything but alcohol abuse.
As for NA, yes it’s true that is the only requirement for membership–however–if you search for NA bulletin #29 you will be able to read their stance on methadone, and recently they updated with a newer bulletin, which basically says the same thing–that they strongly discourage members from using medication assisted treatment, that their official policy is still that this is active addiction and such patients should not speak or share, but that ultimately they recognize that individual groups can choose whether to allow this or not. They then go on to suggest that such members, rather than being given the right to share their recovery story or hold office, instead be encouraged to “sweep up and clean ashtrays” so they can feel part of the group that way instead.
Many people have the argument that they will just refrain from saying anything about their medication. That’s all well and good if it suits you, but my feeling is, it is misleading. If I go in there and stand up and take keytags for my years of recovery and when they want to hear my speech, I just talk about meetings and steps and higher powers and whatnot and say that that is how I recovered, I am misleading people. There may be someone brand new in attendance–someone on methadone or suboxone–and when they hear me say my piece, they may think “Wow, she abused opiates for years and she got better with just the 12 steps, so I should be able to do that too!”, when in fact, my methadone treatment was and is vital to my recovery. By being forced to hide that fact in order to gain acceptance at the group, I am betraying my own self, I am keeping shamefully hidden the treatment that saved my life, and I am not being respectful of the written, official policies of the group I am attending, which asks that MMT patients not speak and “get with someone after the meeting”.
Please don’t misunderstand–I think what you are doing is a wonderful thing. But so many practitioners are not really aware of these policies and how it may harm their patients. These are two different modalities and they are not necessarily complimentary. I teach classes for MMT patients and run a longstanding forum/board for them and I can tell you that this comes up over and over again, where people are either forced to go to 12 step groups or strongly compelled to go, by their MMT providers, and as a result, end up completely confused, feeling great guilt over their treatment, etc. It’s almost like a doctor prescribing medication for a physical illness and then insisting that the patient attend meetings of the Christian Scientists, who as I understand it, forbid the use of medication.
I have been to many hundreds of both NA and AA meetings in my time, and while some are more accepting of medication than others, at each group, there was a strong undercurrent of feeling that taking medication to support one’s recovery is wrong, and is no different than giving a bottle of whiskey to an alcoholic, etc.
Posted by janaburson on September 17, 2012 at 11:02 pm
There are some AA groups who tell members not to talk about drugs. but as you probably know, at most meetings, no drug is mentioned anyway. It’s more about sharing experiences & feelings and how to get through problems without the need to get high.
I have around 100 Suboxone patients in my office, and around 23 are avid 12-step recovery group members. Most of them have gravitated towards AA for some reason. I also have 2 in Alanon, and several in Celebrate Recovery, a Christian 12-step based program. For the patients who go and feel a connection there, it’s been a tremendous help.
I don’t force my patients to go, if they don’t feel welcome. Groups in this area vary quite a bit about their outspokenness against methadone and Suboxone. I do insiste they get some form of counseling or therapy, and 12-step meetings are only one option. If a patient has limited ability to pay for private counseling, 12-step meetings are a great option. I’d also be OK with secular recovery meetings, but this area just doesn’t have any.
I would love to have a Methadone Anonymous to refer folks to, or medication-assisted anonymous or whatever.
Posted by janaburson on September 17, 2012 at 11:20 pm
I also looked at your website – nice! Great participation. You are doing important work there. Patients in medication-assisted recovery, I don’t have to tell you, face so much ignorance, prejudice & bias…it’s great to have a site that’s supportive!
Posted by zenith15 on September 18, 2012 at 2:02 am
Thanks! There are actually several secular support groups out there, such as Secular Organizations for Sobriety (SOS), Lifering, S.M.A.R.T., Women for Sobriety, etc but they are in no way as prevalent as the twelve step groups. Methadone Anonymous groups often meet at clinics–they are patient-run and materials and readings are available online. Perhaps you might talk to some patients about starting one up. If you need help finding materials, let me know. Also, there is a website called methadonesupport.org that used to have and may still have online nightly methadone anonymous meetings.
Thanks for your reply!
Posted by K on November 15, 2012 at 3:25 am
To the comment about na telling people that are on suboxene to not talk and sit silently inshame. This is not the case. Everyone who comes is free to speak about their experiences with getting through the rough times and the great experiences of making it. It’s like this: you don’t go to the doctor cured well same as with na and aa. When u do want help u may go to a meeting physically or mentally using. Yes there is a difference, we always relapse before we even take the first drink of drug, and believe me aa and na meeting have saved many lives and I am greatful for bill he taught me to accept and to take my life one day at a time, because I am worth it
Posted by JAN SPILLMAN on February 8, 2013 at 1:14 am
It is true! Please don’t tell people otherwise because I will tell you right now from experience. I went into Suboxone treatment for opiate addiction. 6 months later (one year ago) I was in a terrible crash. I went to the emergency room. They did ex-rays and although my neck wasn’t broken,. it looked and felt really bad. They gave me toradal for pain and referred me to an orthopaedic dr. I had my chart in my hand as my boyfriend wheeled me to the check out desk, as I couldn’t walk for several weeks after the crash. I noticed my chart said, “history of narcotic use” which is info they only could have had by seeing my pharmacy profile. They used it against me and every doctor I’ve seen since has done the same. I see a Chiropractor, lol! All the discs in my neck are ruptured and half in my thorasic and lumbar spine. The tendons and muscles in my arms were ripped and had to heal on the own with no help from a physician because of my history. To this day, no doctor has helped me with my recovery and I’m still in phase one of recovery according to my Chiro. He can only help me so much, I guess,
Posted by JAN SPILLMAN on February 9, 2013 at 6:29 pm
Doctor, I just wrote you again, and have been trying to get much needed advice as I was and have consistantly been denied pain medicine after 2 major car accidents,
Posted by janaburson on February 9, 2013 at 11:52 pm
I’m sorry but I’m sure you’ll understand that I’m not able to give you advice, especially since your case is so complex. I can say that they patients I’ve seen successfully taper off methadone have done it slowly, over at least six months, even more. I would suggest you talk to the doctor at your OTP, voice your concerns, and formulate a plan with her about the best courst of action.
Best wishes.
Posted by JAN SPILLMAN on February 19, 2013 at 9:07 am
In the city I live in, once you have been to substance abuse treatment of any kind, you are black-balled, or at least I was. I tore muscles, tendons and ruptured many cervical discs, etc. I wasn’t able to walk for a few weeks after the accident. But because I was in a Suboxone treatment program, my medical record states, “history of narcotic use” so they gave me toradol and sent me home. No one has been even willing to treat me except for a Chiropractor. I’m applying for disability because I’ve been unable to work for over a year now.
Posted by janaburson on February 19, 2013 at 3:06 pm
That’s a shame. Having the disease of addiction does not mean you can never take pain medications. It does mean that you must be careful if you have to do so. Certainly long-term ( more than 3 months) would be problematic, but opioids for a few days after an acute injury is not unreasonable. Addicts, both in recovery and not in recovery, do feel pain with injuries and should be treated with opioids when appropriate. Judging There are ways to make it safer for you – find a dependable non-addict to hold your pill bottle, schedule more frequent follow up visits with your doctor, etc.
Posted by jonathanbarlow2013 on August 6, 2013 at 7:47 pm
This is excellent information and counsel. My only additional comment is the role of loved ones… Loved ones can dramatically decrease the risk of a relapse following surgery if the become a part of the process. Some families may feel hesitant but it is the most effective and efficient way if done appropriately. I am reminded of a gentleman who returned to opiates following dental work. He continued to use in secret. A year later his wife found out about his full blown relapse… Sadly he chose to take his life rather than to start recovery again. I don’t share that story to scare you. I share it to encourage families to become a part of the recovery solution.
Posted by janaburson on August 7, 2013 at 2:55 pm
I agree. Involving the family is so important.
Posted by Jason on June 28, 2011 at 8:57 pm
I have chronic pain from compressed discs and a titanium plate in my pelvis. I take suboxone 12mg per day and most of the time I still ahve pain. What medication can I take? I’ve tried naproxen but it didn’t help.
Posted by janaburson on June 29, 2011 at 10:49 am
Hi Jason,
Suboxone isn’t a very strong pain medication.
It depends on your medical history, so I’m afraid all I can tell you is to talk to your doctor.
Why are you on Suboxone? If it’s because you have addiction in addition to chronic pain, other opioids are obviously going to be very high-risk medications.
Jana
Posted by Marie on May 28, 2011 at 3:52 am
How refreshing it is to see a Dr. that truly gets it. Bless you.
This is my second time on Suboxone and I’m trying to do it differently that I did last time. I have been to rehabs several times.Like everyone else I have a long story and have struggled with pain and a chronic illness.
I only wish there were more Dr.’s like your self that treated us like any other pt. We didn’t choose to become addicted to pain meds. It’s not like we woke up one morning and make a decision to mess up our lives over damn pain pills.
It’s Dr.’s like yourself that can get the message out and i know I speak for many that I appreciate you and your time and heart that goes into helping other suffering addicts.
I have not read the entire blog yet. I just found out about it from another forum of a lovely lady that runs it.
I did ssee someone say about a book u may have wrote. I’ll try to find that.
Thank you for all you do.
Marie
Posted by janaburson on May 28, 2011 at 1:29 pm
Thank you very much. For some reason, I’m passionate about educating people about the benefits of medication-assisted therapies. This is odd, because years ago I learned that abstinence- based, 12-step recovery was the only real recovery. But when I dug into the research, I was amazed by the number of studies showing benefits from methadone, and now buprenorphine. We’re talking 45 years of studies, and the treatment community seems to ignore all of it. That’s not right, and it’s not good medicine.
And just like 12-step recovery isn’t for everyone, medication-assisted treatment isn’t right for every opioid addict. If an addict can do well without meds, great. That’s the ideal. But no treatment works for everyone, and these two medications can be life-saving. Yes, they also have disadvantages. but what medications don’t?
I do this blog because I’m struck by the judgment and unfairness that people, in excellent recovery on medications, have to face from family, law enforcement, medical professionals, and even treatment center personnel. It’s not about right or wrong. It’s about what works.
Posted by frieda on January 4, 2013 at 6:06 am
If the government regulated the use of cars the way they do pain management drugs, in many states no one would be able to set foot behind the wheel of an automobile and drive. As a nation, our Puritan roots still compel lawmakers to focus on the people who are misusing drugs instead of those who are managing them well because they are very ill or are suffering from post-surgical pain or damaged nerve pain that will be chronic for the rest of their lives. It is ridiculous in this day and age, when there are so many other more important ills in the world for people to focus on, that pain meds used regularly by physically ill people should even be a topic of conversation. Every human being in physical pain deserves relief–animals too, the mentally ill and needless to say children and people who have not yet obtained citizen ship. There will always be a sector the population who abuse pain killers–that is a fact of life. It should not be given so much importance that people who use them for physical pain who handle pain meds without overreacting to them and do not throw their lives down the drain when in possession of pain meds are lumped in with people who simply go crazy when they get near pain meds. Anyone who cannot handle pain meds WHEN IN PHYSICAL PAIN obviously needs help taking them in a supervised way or controlled environment. But they qre the EXCEPTION to the rule and their needs or misdeeds should not impinge on the rights of ill people whose reputations can be severely damaged when people learn they need pain meds because of a physical condition. Someone should write Alan Dershowitz about the rights of successful pain medication users and the damage to their self-esteem and reputation that can result because every doctor is being forced to work in tandem with the lawmakers–are they police or health practioners?
Posted by Marie on June 12, 2011 at 6:11 pm
Dr.Jana,
I’m hoping you can give me a answer I desperately need.
I’ve been on Suboxone for 2 1/2 months and this is my 3rd. Dr. I will be going to this week. The first one took my Ins. but there were MANY issues and I’m pretty sure he will be on the news before long.
The next one I went to I had to pay for only for him to tell me I had to go every week at 200.00 for 6 weeks.
So,I found a Dr. that actually called me and spoke with me. I have to pay her cash and she is not close by but if she is good i’ll deal with it. My problem is,she told me she does not have a Medicare number. I’m on Humana/Medicare. I assume that means I will not be able to submit a claim form to get my money back.
My problem is,I’m concerned this is going to be a problem for me when I go to fill my Suboxone. I didn’t think anything of it until she told me she didn’t know i I would have a problem or not when I went to fill it since she has no Medicare number. I have been approved for the Suboxone after I went thru a Appeal after being denied.
There is no way I can pay for the Suboxone. I did that for 3 weeks waiting for my Appeal to go thru and that has hurt me badly financially
Do you know if that is going to be a problem? If so,I have to know beore I go. I’ll have to go back to calling Dr. after Dr. again.
All I want is to get stabulized so I can start counseling and try to move on with my recovery. I’ve been so stressed over all this I’m not even eating.
I didn’t have any problem with any Dr. taking my Ins. when I was on the opiates and now I keep running into one wall ater the other.
Any help would be greatly appreciated.
Marie
Posted by janaburson on June 12, 2011 at 6:32 pm
Hello Marie,
thanks for writing, but I don’t know if Medicare will pay for your prescription or not. I’m betting your pharmacy may know the answer to this. If they don’t, I’d call Humana/medicare. I’ve had patients who encountered similar difficulties. One patient had Medicaid in another state, and they will pay for the medication, but only if prescribed by a doctor who is licensed in that state.
One of the biggest obstacles to treatment remains the costs. Between the doctors’ visits, counselors, and medication, it adds up quickly.
But don’t get discouraged. You can still go to 12-step recovery in Alcoholics Anonymous or Narcotics Anonymous, since they are both free. You may not want to mention you are on medication. These meetings can help you stabilize.
If you can’t find any affordable Suboxone treatment, please consider going to a methadone clinic. Methadone’s been around for 45 years, and it works when done correctly. The priciple behind methadone is the same as with Suboxone: both are long-acting opioids that can be dosed once daily to prevent withdrawal and block other opioids.
For information about area Suboxone doctors, you can go to http://buprenorphine.samhsa.gov
Posted by Jason on June 28, 2011 at 9:28 pm
Dr. Jana,
Can Suboxone Doctors also prescribe methadone? I’m looking for a way to afford treatment, and after 2 years of payng cash for Suboxone, I just can’t afford it any longer. Also I am unable to go to a clinic every morning for methadone.
Thank you!
Posted by janaburson on June 29, 2011 at 10:52 am
Any doctor with an appropriate DEA license can prescribe methadone to treat pain, but it’s illegal to prescribe methadone from a doctor’s office if it’s meant to treat addiction. That’s because of the risk of medication misuse in people who also have addiction, and the dangers methadone presents due to its very long half-life. Methadone can only be prescribed for the treatment of addiction through properly licensed and registered Opioid Treatment Programs – that is, the traditional methadone clinic.
Posted by J on July 8, 2011 at 5:51 am
A friend recommended your blog. Thanks
Posted by Jackie on August 21, 2011 at 11:28 pm
I became addicted to opiates after I started taking them for my endometrios. I went through detox and have been clean for 32 days now with the help of NA. I am just getting my first period since getting clean and am terrified of the pain since I cannot rely on opiates for pain relief. What are my options?
Posted by Steve on October 12, 2011 at 3:40 am
I haves been on suboxon for a year. I have a terrible toothache. I have tryed everything nothing helps. Can’t get it pulledright away. Can I take a pain pill until then?
Posted by janaburson on October 12, 2011 at 7:09 pm
There are several ways of managing your dental pain. But you need to call your doctor and follow her advice.
Posted by Roy Lane on February 3, 2012 at 10:07 pm
I had a toothache myself and had to have it pulled my suboxone Dr. agreed to let me have them and the pain meds work. You just don’t get ” high ” on them. And don’t take them both at the same time.
Posted by todywife on November 21, 2011 at 9:27 pm
I’m sorry I didn’t clarify. I was at the clinic for a year the first time and at 140 mg. I left and came back. That’s the second time around (now) that I’m at 95mg and they are telling me I’m too high.
Posted by janaburson on November 21, 2011 at 10:37 pm
Thanks for clarifying. There are so many variables that I don’t know what to make of your case. I think you should meet with your doctor and outline all of this information, especially that you’ve been on a higher dose and apparently did well. Methadone leves help decide that appropriateness of a dose, but it’s not the only thing to consider. If I were your doc, I’d want to see you just before you’re due for a dose, and three hours after you dose. That way, your doc can see for him/herself if you’re sedated at this dose.
Posted by Rebecca Ibarra on November 23, 2011 at 7:12 pm
i am 28 years old. i have been going thru pain pill addiction for two years and i have hit rock bottom and i still cant stop. i had my husband take all money from me but i still find ways to get money. i have family support and i want to quit but i cant stop the urge i am so afraid that i will lose everything in my life if i cant get thru this. please give me some advice.pleae
Posted by janaburson on November 24, 2011 at 12:40 am
You need to go to a drug addiction treatment center. Please go to this web site and click on your state to locate addiction treatment:
http://findtreatment.samhsa.gov/
Posted by Jason on November 24, 2011 at 1:24 am
Rebecca, I was where you are and I can tell you that Suboxone gives you your life back almost immediately. I didn’t/don’t crave the pills anymore and I remember being SO relieved that the ‘pill chasing’ was over..for me right away. Suboxone (especially the first two weeks or so) makes you feel so good and you will have energy that pills never gave you and you will finally sleep like you used to..it’s amazing. We’re in the same boat, only now I’m taking Suboxone. I do feel dependent on it, but nothing like the pill chase and the fear you have when you start running out. Please go to a Sub doctor or the treatment center Dr. Jana metions. Good luck and keep posting your progress so we know you’re ok. Jason
Posted by todywife on December 19, 2011 at 1:17 am
So they put me put me up to 110 milligrams and said I couldn’t go up any higher til I saw the physicians assistant. he tested my mental health my physical health and ask me if I was burning the candle at both ends. None of that is making me withdrawal so he grabbed a piece of paper and did a test of withdrawaling.you could score 0-3 of every question and out of 30 I scored 14 so he will put me up 5 milligrams of a week until I get to 125 n then I have to do a nother peak and trough. does this seem logical? I don’t understand what he is trying to get at. I was so sick that morning I vomited at the clinic. I just hadn’t dosed for 26 hours. what is going on with me? is this normal? Please help!!
Posted by todywife on December 20, 2011 at 1:04 am
I will continue to talking to them.I haven’t exaggerated any of my symptoms because I truly want to get help. I’m not looking at a number to make me feel better, but I honestly feel withdrawal at this point. I just hope that we can all agree on this. I don’t wanna be perceived as drug seeking at all. That’s not my reasoning for wanting to go up.it wouldn’t matter the number whether it was 10mg or 200mg as long as I’m comfortable to handle on my daily stresses I will be satisfied. I will keep you posted and thank you for all your help. Bless you have a happy holiday season
Posted by Sam on January 11, 2012 at 6:20 am
Just finished up a year of hell with my pill addict son. His addiction came as a complete suprise to us – he was a college student, athlete, a good kid who we never had problems with. So the sadness over this is unbearable. I feel like the son I knew is gone. We got him started on Suboxone and counseling, which seemed to help for about 3 months. Since then he’s been on and off Suboxone, using, stealing, lying etc … a familiar story to many I’m sure. His life has spiraled downward. I don’t understand why Suboxone doesn’t work for him. I guess I was looking for a magic potion or something. It has been exhausting and the joy has surely gone out of our lives.
Posted by K on November 15, 2012 at 3:36 am
I am a recovering drug addict and have been clean one year I was using for seven. Suboxene is really only supposed to be used to help with the withdrawals and to keep the strong cravings at the beginning, but slowly taper off. In my opinion as a person In recovery he doesn’t need meds because it takes more than that you have to find the root of the void he is trying to feel by using. Na was a huge help to me because it showed me I was not alone or judged of my struggles and successes. Drug addicts and alcoholics are wired differently then someone who doesn’t abuse. And it’s ok to go to a meeting high in the beginning because you don’t go to the doctor cured right? Get him in a meeting and create a huge support group and remember to take it one day at a time.
Posted by K on November 15, 2012 at 3:39 am
Also two it really does not matter if he was a good kid or bad kid addiction is hereditary and sadly it was in his genes before he knew how to crawl, if you have any questions I would love to help, I will gladly give this gift of hope as it was so freely given to me
Posted by janaburson on November 15, 2012 at 8:41 am
Thanks for writing, and I’m glad you haven’t had to take any medication. But Suboxone works best when it’s used as a maintenance medication. We saw this as early as 2003, when a study of 40 patients showed that when Suboxone was used as maintenance, the majority of that group was still intreatment and doing well at the end of the first year. But the group that was on Suboxone for a six-day taper had no patients stil in treatment (recovery) at one year…and twenty percent of them were dead of a drug overdose.
People are so different. Some addicts do fine without meds. And some need Suboxone to replace the endorphins their bodies should be making. I do think medication-free recovery is the ideal, but that doesn’t work for every addict.
Posted by nancy solt on March 30, 2012 at 3:50 pm
I have been on a Suboxone treatment plan for a year now after being on very heavy pain medications from Knee replacement and eventually amputation surgery. I have done urine tests occassionally at the docs office, however this last time it was a totally different test cup, there was no lid on it and on the boton it had a urine line and then had this strip, when the urine was in there the strip said “look for the green” there was a hint of green, I had no idea what it was. I went back to the room, waited for the doc, he came in and asked me to be honest with him, if there was anything I had done that would cause Methamphedomines show up in my urine, I was blown away, I had never done that in the past first off, and have not had any pain medication for about 6-7 months, since my last admittance to the hospital for 4 days, they made me feel like total crap. They said they were going to send my UA to a lab back east, they would not have results for about a week and from there, if it shows I have done that they will remove me from the suboxone treatment plan. This is such BS!! I came home and tried to figure out what the hell could it be. I have taken excedrin for headaches, excedrin cold and sinus, I think maybe once or twice, however I have been trying to lose weight as I am quite large, me and my daughter bought the over the counter HCG diet at walmart, that did not work so I bough Hydroxycut, I have not taken much of that either. Could any of these make my test as a false positive? I need some peace of mind with this, I feel like I am having to fight to prove myself right and this is just awful! Someone please help me. Oh- I also took Aleve.
Posted by janaburson on April 1, 2012 at 2:44 pm
I’d wait for the second test, and try not to worry.
However, I have seen patients with true positives from stuff they get at the vitamin stores. There’s not much regulation of those products, so it’s a bit of a crapshoot when you take them.
Posted by Holly on August 20, 2012 at 10:31 pm
I tested positive too for methamphetamines twice when I hadn’t done any. The first time, my suboxone Dr. sent it to a lab–it came back a false positive, but he didn’t tell me what caused it. The second time, he asked me if I had taken anything for acid reflux or gas or any other drugs, over the counter or otherwise. I said yes—I sometimes take my mother’s ranitidine when I have acid reflux. He said that is it…Ranitidine will cause a false positive, as well as other drugs. He didn’t tell me what the other drugs are that could cause a false positive. Maybe you can find out what they are and see if maybe you took one of them.
I freaked out when mine came up positive for meth, since that was my drug of choice and my doctor knew it. Knowing I hadn’t done any, I knew it would come back from the lab as a false positive.
Good Luck.
Posted by janaburson on August 21, 2012 at 12:25 am
It depends on which lab or test kit your doctor uses, too. the inital test is an immunoassay, but they vary depending on the manufacturer. In any case, unexpected results should be sent for confirmatory testing, like your doctor did.
Posted by ismelltherain on April 26, 2012 at 10:31 am
What kind of clinic do you own or work at? Colonial Mgmnt Grroup owns the one I go to, and their practices are nothing, and I mean nothing like what you are describing here. We, the 2000+ patients that go to this particular clinc, don’t come near a doctor. That is unless it’s our yearly physical. What’s more is that I have never seen the same doctor from year to year. I like to call him/her, “the doctor without a face”. It’s a shame, because I might have come out of this with a different opinion.
Posted by janaburson on April 26, 2012 at 1:42 pm
Please see my reply to your last post for some solid information. Yes, clinics do try to retain people in treatment based on the data that shows bad outcomes for patients who leave. However, if you look at the NIDA web guide on methadone treatment you’ll see that the best clinics also evaluate each person as an individual. for example, if you have a 5-year history of opioid addiction but managed to stay clean from all opioids for a year during that time, meaning your history of dependence was interrupted, you probably will be able to successfully taper off and stay clean because you did it before. But your clinic must work on relapse prevention before you’re off methadone.
And you are right – many methadone clinics are owned by large, for-profit companies. Does that make them bad clinics? Not necessarily – it depends on how they are run. If clinic owners pressure the people working on the front lines to “keep the numbers up,” meaning keep making us profits, that’s bad. Ideally, non-physicians shouldn’t control the practice of medicine. Is that the way it is in real life? Sadly, no, at least not in this field, as I’ve learned from unpleasant experience.
I’ve worked at 12 clinics over the past 11 years (one place had 8 locations). I’ve worked at for-profit and non-profit, and the non-profit did not deliver the best care of all. The best clinic is one where I’m working now, Stepping Stone of Boone. I’m allowed complete authority to do what I do best – be a doctor. But this is a very unusual clinic in that its owners are all people who live in the Boone community and who have a passion for helping addicted people regain their lives. That may mean staying on methadone or buprenorphine permanently, or it may not. Obviously, the patient is the one who makes the decision. If a patient wants to taper, we talk, and we discuss the best way to do it, taking into account physical/mental health issues, other drug use, how much counseling they have they had, etc. We have an adequate number of counselors for the number of patients (very important) and we also offer buprenorphine, though it does cost more than methadone. We’ve had some buprenorphine patients do so well that I switched them to my “X” number and write Suboxone prescriptions for them, which makes life so much more convenient for them.
The bottom line – vote with your feet. if you aren’t getting good care, look for another clinic. The big problem is that there tend not to be very many clinics in many areas, leaving patients with only one choice.
Also, be honest with yourself – have you asked to see the doctor? Have you done your part to get counseling? In many clinics, if the patient seems disinterested in doing anything except getting the daily dose, the counselor may not make an extra effort to talk with you. Some patients even get angry if counselors push them to have sessions! Your counselor isn’t going to work harder than you do at your recovery.
If you don’t have an available doctor, that’s a problem. Each clinic should have a medical director. I think it would be unusual if the doctor wasn’t there nearly daily for a clinic of that size. At Stepping Stone, we have 130 patients, and I’m there in person at least 5 hours per week, and always available to staff by phone. I spend a few more hours per week looking at patient data, talking with staff, looking at how our policies/protocols are working. I’d think you’d have a doctor at a minimum of one day per week, surely.
Posted by ismelltherain on June 4, 2012 at 2:06 pm
Dr. Burson I have one more question that will I hope lead to more questions, but not here. I know that you cannot treat me without seeing me, but still I have some general information that I think you could give me. I have looked everywhere for an email address for you, but cannot find one. Is there any way you could email me @ purplerain@ismelltherain.me so I could correspond with you privately. You can delete this if you’d like, but I hope you don’t without at least emailing. I’ll make a deal (if you’ll accept)- if you do, I’ll buy your book AND read it. 🙂 See, we both help each other. Thx for all your previous help. Aashton
Posted by Tonya Redden Baldwin-Worley on June 11, 2012 at 4:05 pm
Dr, Burson, I have corresponded with you a few times and you have helped me indirectly a thousand times. Just quickly I am the one that had qtc prolongation needed high dose methadone a hard stick so many failed attempts at Peak and trough’s etc… I went to an cardio doctor and it turned out I do not have the qtc problem after three separate ECG’s. I have a 390 score so I was able to increase to 210 milligrams and split dose. My life has been wonderful since then. I only needed an additional 30 milligrams and split dose.to make all the difference. Now I have a real scare going on and I need some advice. I AM SCARED.
I have been having problems lately with a stone in my common bile duct and I have had to go to the hospital a few times when the pain got too bad for me to handle. Well since my last visit to the E.R., I have been to my general practitioner at a low cost clinic we have here in my town where I have formed a wonderful relationship with a doctor. He is the doctor that found out I did not have the QTC Prolongation (torsades des pointes) and he is very supportive regarding my being on methadone. Well he has been over seeing my stone situation and was referring me on to a gastro doctor when he found on a CT Scan taken a month or so ago, I had a mass in the right upper lobe of my lung. Apparently when the radiologist saw it he went back a few years to an old CT Scan from back in 2007 and compared the two where in 2007 it was called a “Nodule” not a “Mass” and so he commented on the dictation notes that it was a bit larger since 2007 making it a Mass now not a nodule.
I had obtained a copy of all my emergency room visit records to include labs, CT scan on CD and doctor notes for my GP doctor so I found this noted problem on the CT scan dictated report myself firsthand. I read this a few days before my appointment with my GP, and yes it worried me but one would think if it was real serious…it would have been brought to my attention in the E.R. that day and I didn’t get overly excited thinking I would have been told that I had better follow up with a pulmonary doctor too not just a gastro doctor, I mean what if I wouldn’t have stumbled upon this by being nosy about what my records, lab test and ct scans had to say????
Nonetheless, I took all these records to the GP and I did not want to make any big deal out of it to deflect away from my painful stomach issue so after the doc and I talked the stone issue out I handed him the CT Scan report and ask him what he thought about the report stating that compared to a CT scan in 2007 a noted nodule had increased in size some. I also had a CD with me that had the actual Scan images on it from 2007 and the most recent CT scan too but the report only mentions the nodule/mass issue very briefly, nothing sounding too urgent etc…..so my doc was pretty cool about everything and said we might want to look into this as soon as we get the stomach issue under control as he knows I can’t really afford the specialist referral monetary cost times two I guess. Meaning I can’t afford office visits and testing by both a gastro specialist and a pulmonary specialist. He did say emphatically we needed to get it looked into though but we will focus on the immediate need of the painful stone issue first.
So once again I am thinking if it was “real bad” I would have been more urged and even made it necessary for the pulmonary being the primary focus before the urgency of the stone issue. But he said what he said briefly and then he went back to talking about my gastro issues and said he did not like the way his self pay clients had been treated by a local gastro doctor so he was going to call over to Asheville and find a gastro doc that would work with on a low budget self pay status and get back with me asap. I leave and go home with a new appointment to return in one week after he gets some bloodwork results he drew on me that day.
Well a day or so after my appointment I get a call from a Doctor here in Hendersonville which should have been a clue as he said the gastro would be a Asheville Group but anyways this nurse says that she had spoke with my Doctor and they had made arrangements for me to be seen on a lower fee arrangement with a contract to pay as much as I can etc…and we made an appointment for Tuesday, June 12 at 3:00 pm, less than a week away. I am thinking wow great and how quick he got it all done and did as he promised. I am feeling so positive about it all….. Until I return to my GP to discuss that bloodwork he had drawn on me and find out this phone call and appointment I had received a few days ago is with a pulmonary doc not a gastro doc. I never clarified any of this on the phone with the nurse because he had said we would wait on the lung issue. I was confused now but he explained the reason being he had a change in the more urgent need being placed the lung issue being a more urgent need now than the gastro after he actually viewed the CT Scan on the CD I had left with him that day (last week) and when he looked at the scan images he saw that directly beside the mass/nodule that has changed in size just a little bit since 2007 is a lymph gland/node, namely a “Hilar Gland” and it is enlarged/swollen and this concerns him and puts my urgency status with my stomach on a different note as far as what’s most important between pulmonary or gastro etc…This was not a complete shock to me as I was already questioning it in my mind the CT Scan dictation report that I read myself, but I must say this set me back a bit and scared me too.
I didn’t know what to think or say at that moment except……OMG do I have cancer? He told me that is why I am going to the pulmonary doc. I ask him what exactly had made the sudden urgency change other than his response to me last week and he stated the enlarged gland was not mentioned in the dictation report but after he got caught up that day after I left he sat down and viewed the images on the CD I left with him. He was not comfortable with what he saw in the enlarged hilar gland and so he then took it to the lead physician where and when they both became concerned. Like I said earlier, the dictated note on the CT scan did not even mention the hilar gland enlargement which it should have. He went further to say moreso importantly was because the swollen or enlarged hilar gland is located right next to the nodule/mass and this created even more concern. He said last week he felt a need for caution but now after viewing scan his caution is now concern.
WOW. It’s been about 6 days since this happened and I have not talked about it to anyone really…maybe my Husband a bit because I am too scared to talk about it to any family or friends. My hysteria is all I can handle right now, Not my mom’s etc…. I have been determined not to get on the internet in frantic research and just WAIT but yesterday I was about to bust so I had to find something out to hopefully give me some peace and/or comfort and from all I read I got neither and I am even more afraid than I was when I left my GP’s office. It appears to me that I have more of a chance of it being a cancer issue than not. And….a biopsy will probably be in order to find out for sure so today I have research what a biopsy is and how they are administered to find out there are four types and all of them sound scary as hell too.
OMG and to make matters worse guess what??? I realized I already know/knew this doctor and he and I had some serious words regarding his treatment of my father in law two years ago. He was an Ass…A Jerk….Can it get worse? Yes I am sure it can like…. Will I go there Tuesday (tomorrow) and he might do that needle biopsy in a back room in the office with just Novocain??
All Day yesterday, I spent in consideration that I may have cancer, either lung cancer or lymphoma from what I have read and so today I have spent all day in panic and wonder of now if I do have cancer or concern of cancer what about the fact I have no insurance? Will I get compromised treatment, less than the best? Will they cut cost/corners with me because I have no way to pay for better or more comfortable test? Will they tend to do cheaper testing like that needle biopsy instead of knocking me out? If someone with no insurance gets cancer can I apply for some emergency medicaid etc????
Then when I am not freaking out about all this I am thinking and panicking over my MMT. Do I risk losing my MMT status? Do cancer patients get to continue their MMT? Will the clinic detox me???? I am beside myself Dr, Burson. I go from freaking the —— out inside to accepting my possible fate wavering back and forth with the only stable constant feeling I have is a constant desire to GET HIGH. This is just me being honest. I know getting high would be making matters worse, but the addict in me just wants to get a bunch of opana’s and just forget about it all for a little while.
I wasn’t going to post anything to anybody etc….but I can’t stand the feeling of lonesomeness and frailty. What can I do? What can I expect? My biggest fear being my addiction killing me before the cancer if I can’t remain on MMT. Will they just expect me to focus solely on the cancer, stop the MMT and risk my getting high? If I lose my methadone in this kind of state (cancer) I am doomed to get high for sure. Because in these circumstances I am sure I will get high without the methadone. Hell I wanna get high now and I am on 210 milligrams of methadone.
I know you must be thinking I am crazy to worry about the methadone issue if I have cancer looming over my head but I have no control over what all I am feeling, thinking or assuming. I have broke down a few times and smoked a cigarette here and there as stupid as that is. Smoking is by all rights the culprit, but my body was raging those times. I got on the patch yesterday and still had one cigarette.
I know I appear as a freak out worrier and drama queen and yes, I am guilty of all but I need some good solid advice and information. Please pick a topic or better yet pick a few…Cancer…being on Methadone if cancer…..biopsies…smoking…getting high….help me with some answers. ANYTHING WILL HELP IT CAN’T HURT.
Posted by janaburson on June 12, 2012 at 12:45 am
Oh gee. First of all, take a deep breath. Stay in the moment and try not to assume the worst. The fact is that you don’t know what this is – and probably won’t know until the doctors do more tests, which will be a while. You are going to have to live with uncertainty, which is difficult for all of us, but do-able.
On the bright side, I’ve never seen a lung cancer patient have lung cancer for 5 years without any treatment – surely it would have killed you by now, if it was visible in 2007. Still could be lymphoma or ten other things or turn out to be nothing at all. You just can’t let yourself get into the “what if’s” right now, because there are just too many possibilities.
as far as cancer in methadone patients – generally if the patient is still able to come to the clinic, they come to the clinic. If they get terminally ill and unable to come to the clinic, I’ve had Hospice take over, and they provide supervision over whatever opioid is prescribed. It may be methadone, may be something else, but that’s a decision that should be made by all of the doctors talking together. I have a feeling you will not be faced with this though so don’t waste time worrying about it.
by the way, if you have to have some expensive tests, you can get Medicaid once it gets up to a certain amount, then they will go back and pay retroactively, from what I understand. I’d check into that. If you need a bunch of tests it could actually qualify you for some benefits with Medicaid health coverage.
Biopsies – cannot be done without your informed consent. It depends on what kind of biopsy is needed as to how much medication you would need. I’ve had a bronchoscopy done while I was in med school, no sedation, watched the whole thing on a teaching scope but then I’m a nerd so it completely distracted me. Lung biopsies are done with numbing of the skin, maybe some sedation to prevent anxiety. Just make sure your doctors know you’re on methadone.
Look: your big problem with the methadone dose, QT interval stuff, etc worked out beautifully. Maybe it would help to believe this will all work out too – though if you do have a common duct stone, I’ll bet that sucker’s gonna have to come out.
Please keep us updated. I’ll be praying for you.
Posted by Tonya Redden Baldwin-Worley on July 1, 2012 at 7:28 pm
You were right…All is well besides something called interstitial lung disease from smoking but I have quit now for quite some time. I got approved for level 6 now the two week takehome phase and I am ecstatic as it’s not as far as a drive as some people make my travel time is a good 45 minute ride from where I live here in the NC Mountains.
I wanted to mention something though. My clinic was one of the last Benzo tolerant clinics around here until a few weeks ago. Now we no longer accept anyone positive for benzo’s even with scripts….If they show positive in the admission process they are told to detox off and come back but no admission for at least 30 days. The already admitted clients have to drop their dose to under 100 milligrams or given 30 days to detox off benzo’s. The no scripts clients were allowed to flunk screens but they had to forfeit takehomes but now under new policy they are being detoxed off after one more failed drug test. We still allow pot smoking but the pot smokers forfeit takehomes but my clinic is feeling the heat of mixing benzo’s and methadone. Why?????
Well, sadly to say we have lost 3 patients in 90 days that can be directly related to benzo/methadone toxicity. I was wondering your clinic’s view/policy on this??? I myself learned way before I knew what methadone was how dangerous Xanax was and suffered over a year detox off them back in 1990. That horrible detox seared/burned a “never again scar” in my mind that I have never touched them again so Thank goodness I do not have to struggle with this myself. I feel for the clients that have PTSD or panic disorder as years ago I suffered the panic disorder and…when I was at about 80 millgrams of methadone during induction I had a three week or so scare with panic disorder as a reminder of how debilitating panic can be. Thank God my counselor was right when he told me to hold out for stabilization that I was probably just having a temporary setback since my lifestyle (selling, searching and buying opiates) had changed so drastically to a place where I had a lot of time on my hands and the drama content was “in mourning” going from illicit use to maintenance use and sure enough when I got more stable it went away. But it was terrible for those three weeks so I feel for the person who has to deal with such.
I have found in listening to all the jibber jabber at the clinic over the new policy we have some die hard benzo users. Most that I have talked to are going for the detox of methadone instead of detox off benzo which I can’t relate to at all. In the last month we have only had 11 admits which we usually have at least 5 to 7 a week. I was just wanting to share a clinic story and wondering about other NC clinics.
Posted by shannon mchenry on June 30, 2012 at 9:38 pm
I am a recovering lortab addict, who also suffers chronic pain. Pain is a huge trigger for me, and I managed without mood altering meods for my first to yrs of recovery. It got to the point I was afraid I would get so frustrated I would end up trying to relieve pain “my way” My pcp is experienced and knowledgable about methadone, and prescribed it to treat pain. She only writes 2 wks quantity, and monitors me closely with screens and random pill counts. I am able to function and work, and I have my life back. I wanted to tell you my story so it would be understandable how very grateful I found your blog and that there are people like you in the world! I hope to never return to a life of active addiction, chasing, and trying to stay supplied on 30 pill a day habit. It is really not a “life”. I want to stress that my dr uses this to treat pain, not my addiction. I have a counselor, sponsor, and fellowship to treat that. Every piece of factual wisdom shared here adds to the probability I will still be in recovery the next day I wake up. My only worry is in 3 yrs my husband retires and we plan on moving to Alaske. I currently reside in small town Indiana and it was difficult to find a health care provider who did not have a fear of methadone induced by the media. I dread having to find one in Alaska, but try to stay in the day, when I get overwhelmed. Anyway, I appreciate all that you do, and am so grateful there are people like you in this great, big world. I appreciate your work, and sincerely mean that, from the bottom of my heart. Thanks again!!! A woman in a little town, Indiana : )
Posted by shannon on June 30, 2012 at 10:19 pm
Is there anything, along the lines articles or literature you could recommend concerning treating chronic pain in recovering addiction (vs. active.addiction) or something to take to educate doctors and dentists? Methadone has such a stigma that I procratinated sharing theinfo about my being prescribed this, to my sister who is a familyNP.She has been my biggest support and also suffered losing her sister to a pill addiction. She was wonderful tome, but I am her sister, not her patient!! Thanks so much!!
Posted by janaburson on July 1, 2012 at 1:31 pm
I’m so glad you’re doing well. Studies show high relapse rates for patients with opioid addiction who are prescribed opioids for chronic pain (up to 46%), so i don’t think they will help your case. I think your best tactic is to make sure your former doctor sends a letter saying how well you’ve done in the past. But I agree, that’s going to be a hard sell. Maybe you could agree to once weekly prescriptions for more accountability – more cumbersome, of course, but it may ease some of your new doctor’s worries about medication misuse in a relapse.
Posted by shannon on July 1, 2012 at 10:18 pm
Thankfully, I have done well. I was terrified of starting on this when my doctor first mentioned it, and tried this as a last resort. I take 10 mg twice a day, but I was scared of having to go through anything close to how my life was during active addiction. I think that just having a doctor I can be totally honest with, that I can email anytime and will contact me the same day, that I know does not treat me differently because I am an addict makes all the difference in the world. She knows my addiction is serious, but she makes me feel no different than if we were discussing my cholesterol or allergy. I am an addict, but I also have brown eyes-cannot change either fanct, LOL! I wish more drs were that way. Maybe if all of us try to be open about it and let drs see an addict is just an everyday person- a teacher, housewife, fireman……not just a stereotype. I worked in a dr office about 15 yrs ago, and I hate to admit it, but I did stereotype addicts and alcoholics until I realized I was one. I made a promise to myself that I refuse to be ashamed of being an addict- I had no control over it, much like I did not choose the color of my eyes, but my recovery is something I am very proud of. I have had drs who instantly changed the second I said the word addict, when I mentioned being a recovering addict to one doctor he wanted to refer me to a mental health center and would not even look at me. I almost cried. Is there anything else, you, as a doctor, could recommend for us to do to help drs, dentists, and nurses be more comfortable and open to discussing addiction ( especially prescription drug ) with us. I try to be open in the beginning, but a bad experience like I had can make me wonder what is best to do?!? Any other ideas? Thanks again!!
Posted by Tonya Redden Baldwin-Worley on July 1, 2012 at 7:30 pm
Oh BTW i also want to mention that Hendersonville (my hometown) finally got a suboxone clinic…No methadone clinic yet but we are getting more with it and not so closed minded I hope.
Posted by ismelltherain on July 30, 2012 at 7:42 pm
This is not a post to condone or condemn those using methadone to treat opioid addiction. Instead I would like to offer some hope to those wanting out. What I will say without going into great detail is that it is possible. I believe it became possible for me when my desire to be completely sober, outweighed my fear of living without medication.
I spent 20 years on pain pills and eventually methadone. The road out was not easy, but it was necessary. It was necessary for me because I knew I walked myself into my situation, and I would walk myself out. I have never been a religious man, though I cannot deny I had spiritual help. I can’t explain it other than to say when I was at my lowest, I knew I was beling helped.
My biggest fear was the unknown. I couldn’t find anyone to physically speak with about the crazy torrent of emotions passing through my head. I just wanted to talk to someone who had experienced what I was feeling, and to know I was going to be alright. I never talked to anyone, but I am 48 days off now and feeling wonderful. I will never say it was easy, but what I can say is every bit of the pain was worth it.
If anyone ever reads this and feels that fire burning inside, please don’t let it die. I have thought many times about what sobriety is and how best to accomplish it. Lucky for us, there are many ways people have succeeded. No one way is best. However, I think it all comes back to inspiration. Can you muster the amount of inspiration needed to push you through?
If you do get that inspiration and feel the need to speak with someone who has been where you are going, Dr. Burson will have my cell and/or email address. I have learned many things over the last year that I wouldn’t hesitate to pass on. Life is such a gift and we have one shot- we must all make it count.
ismelltherain
Posted by krissy on September 15, 2012 at 6:52 am
hello, my name is krissy. i actually came across ur website, wile i was googling “is it illegal for doctors (mental health facilities), do not accept u as a client if u are currently in treatment in a methadone clinic? also, since unfortunately i recently had to find a new m.h. provider after 4yrs. in treatment & on meds., that i was doing quite well on!! this new m.h. provider & i went over some of my past history, dx’s, & current meds….as well, as previous med. hx. all seemed to be going well with our 1st meeting, until he came upon the section of my pkt. of questions i filled out…& the dr. saw that i was in an outpatient methadone maintence program!! i honestly felt like i was a criminal, with how he then began to treat me!! he told me i was a liar, because when he was asking about street drug use..1of the questions was “had i ever done heroin”, i told him no…which was not a lie! im in treatment due to prescribed pain med use…that i couldnt stop on my own! this doctor proceded to tell me im a heroin addict & i lied to him, he called me suspicious, he called pharmacys that i told him i used to verify my medications, which i had no problem with…until he stated to both pharmacies that “he was calling regarding a suspicious patient he has in his office, & wanted to verify if i was on meds. i told him, etc.!! he also stopped me on 2medications that i have been on the last 4yrs. the medications being: clonidine 0.1mg. 3tabs.@ bedtime, & dextroamphetamine 10mg 4tabs. daily for
Posted by krissy on September 15, 2012 at 7:13 am
this is krissy…my post cut me off, & i just wanted to finish last part of it…im sorry! lol back to the meds. dr. took me off of cold turkey (after 4yrs. of doin well on the meds.!) was clonidine 0.1mg. 3tabs. @ bedtime, to help with my sleep. & dextroamphetamine 10mg. tab 4x daily, for my ADD. i have been a wk. off these 2meds. for a wk. now, im noticing alot of changes…none of a good feeling orbenefit!haveletters of compliance from my primary counselor that i have given m.h. dr.! why is does it seem no other healthcare providers, want to help
Posted by janaburson on September 16, 2012 at 1:37 am
Hi Krissy,
I don’t think it’s illegal for a doctor to behave in the manner you describe, but it is unethical, in my opinion. I feel depressed when I think of how many psychiatrists aren’t educated about methadone. You didn’t hide anything, and yet still got branded as a “suspicious person.” that’s sad.
I’ve had patients tell me similar things and with their permission, I’ve tried to call as an advocate for the patient. The opioid treatment center is focused on treating drug addiction, and the patient may need help with other mental health issues, so our center has told them to get psychiatric help. then when they do go, they get rejected. At first I thought naw, the patients are exaggerating. They weren’t.
I talked to a psychiatrist who refused to continue to care for a patient who started on methadone even though he’d been seeing the psychiatrist for almost a year. When I called to ask what her objection was, she said methadone “Was the opposite of everything she was doing to help the patient.” Mind you, she had no problem prescribing hefty doses of Xanax for months on end. I tried to get her to be more specific, as her answer was so vague I didn’t understand but she couldn’t be more specific. That’s often the case when you ask people why they object to methadone. they say things like “I just don’t believe in it.”
Your new doctor may feel like the amphetamine was too risky for someone with addiction, but I’m puzzled about the clonidine. That dose may drop your blood pressure during the night, though.
Have you considered making a complaint to your state’s medical board? What you describes sounds like your care didn’t meet the current standard of care.
Posted by Jeannie on September 25, 2012 at 8:04 pm
I am a 55 yr old female who is currently addicted to vicodin. I informed my dr of this and his answer to this was to cut me off. I live in Mohave County Az and can not find any drug treatment as far as detox. I went to a methadone clinic and said I did not meet the criteria as they thought I could just stop taking 10 pills a day. I was actually told to take tylenol and energy drinks to get thru it. I am on state insurance so it is very limited in Az. Even with insurance of my own there is no detox available. I have signed up for substance abuse counseling however they informed me they could not help with detox. I really do not want opiate replacement other than a short detox aid. I have tried over and over to go cold turkey but I get so sick I can not bear it and I work full time. I have never been or felt so desperate before. I almost feel like going to the er and saying I am going to kill myself so I can get help. I don’t want to kill myself however and that seems pretty intense to go to that extreme. I did look up on the treatment locater and every dr listed which was very small were no longer in this area. I just can not believe that someone who honestly desires help can not find it. I have spent alot of time looking also. Please give me some advice. I am trying to be proactive in recovery but I am feeling lost and without hope whatsoever. Sorry to sound so needy and whiny I just am at the end of my road here.
Posted by janaburson on September 25, 2012 at 11:13 pm
The ER may not be a bad place to start. If you are looking for medical detox, and there are no such facilities in your area, your local hospital may be the only option. At 55, opioid withdrawal is tougher than at 25, and you may get dehydrated more easily. You can also try the government’s website to find treatment in your area: http://findtreatment.samhsa.gov/
and don’t forget to consider Narcotics Anonymous meetings – they won’t help you detox but can lift your spirits while you are dealing with early recovery.
Posted by supershan47331@yahoo.com on September 25, 2012 at 11:29 pm
This is so sad to me. The same doctor who is licensed to hand these out should be able and knowledgeable about how to get OFF and stay OFF these. It seems people are penalized for being honest with their Dr. I really have thought about this a lot and I truly believe the solution for the painkiller addiction absolutely has to lie with physicians….I do not know the answer, but I guarantee that is the WHERE
Sent from my Verizon Wireless 4G LTE Smartphone
Posted by janaburson on September 27, 2012 at 10:23 am
If the doctor were to continue prescribing, she could lose her license to practice medicine. Once a patient tells a doctor that the prescribed medication is causing harm, it’s unethical to continue to prescribe.
However, I agree that the doctor should be able to refer (quickly) the patient for treatment, either for methadone or buprenorhpine, or for a medical detox followed by a moonth in inpatient residential drug addiction treatment.
In medicine we have a saying…you need to know how to land the plane before takeoff. In other words, the doctor should already be prepared to treat a patient who develops addiction as a complication of the treatment of chronic pain with opioids.
Posted by shannon on September 25, 2012 at 11:42 pm
Hi Jeannie!! I am Shannon and recovering from an addiction to lortab that started with being prescribed them following a back injury, I was taking 30-40 pills toward the end. I had never been in trouble in my life and was charged with prescription fraud. I had the same experience with a Dr cutting me off when I told him they were a problem, which does nothing to help. I could have had my mother take them from me!!!!! I have been in recovery for 3 yrs, now, 5 yrs the first time around. My email is supershan47331@yahoo.com.Jeannie, feel free to email me I’d you would like to talk….hang in there and remember that every night you can go to bed and not taken a pill that day is a GOOD day…no matter what else happens, or goes wrong- going to bed w a clear conscience and sober mind makes that.day a success……
Posted by Tonya Redden Baldwin-Worley on September 26, 2012 at 8:38 pm
Dear Jeannie….I am real sorry you are facing such difficulties when all you are trying to do is ask for help. I read that you are working and well I am sure on 10 tabs a day…you will be under the weather (putting it lightly) coming cold turkey off these. I am confused why you are being answered so mildly like you have nothing to worry about but some dehydration and low spirits that NA can lift (sorry Dr. Burson no disrespect but is this all you got?) You are likely to find the E.R. Staff not to sympathetic to your 10 pill a day habit, at least I was NEVER offered any help anytime I went begging for help and I did a few times. Will work allow you a sick period of at least 5 to 6 days??? Cause this will be the least I would say you will be able to get by with. Drinking lots of water will be a good idea if you are not puking and can keep it down…..This may be the place to suggest this but since no one is offering much more there is something called the “Thomas Recipe” you can find on youtube that tells you what otc meds can assist in a “White Knuckle” opioid detox if you must go this route. I personally would try a different methadone clinic as they seem to have different protocols. I know to be considered you have to somehow prove you have been addicted to opiates for at least a year I think. I myself am shocked they of all people were not helpful because 10 pills a day if nothing to scoff at. Were they just refusing you as you went in there telling them you wanted like a 3 to 5 to 10 day detox or something????Have you researched suboxone/subutex??? Maybe this would be agreeable as I have done this in a 10 day detox twice but it was 10 or so years ago before they offered it as long term opiate replacement. It was actually the best detox I ever had. I do not do well on it for longer than that. I myself have been on MMT now for three years because for 30 years every time I get off opiates for more than six months I get right back on them because I never feel better. I believe I suffer from Endorphin Deficiency Disorder. (EDS) and I am going to be a “lifer” as far as MMT/MAT. I am not saying that is the solution for everyone as I ould try all others first but it’s better than my other options when I look at the big picture for me. Once again I would look into finding someone that might consider a short suboxone detox or even methadone detox. Maybe you need to look at more like a six month to a year MMYT to just add some added insurance. Good Luck Keep Lookin and Dr. Burson is a great place to turn maybe she felt your post was not specific or sounded not needy. I am confused.
Posted by janaburson on September 27, 2012 at 10:18 am
Hello all,
I answered as I did because the poster made it clear she didn’t want maintenance treatment. At 55, she should be hospitalized to treat her withdrawal, yet she said she exhausted every known treatment center, and the center she did access didn’t make a referral. So I’m thinking she must be right, and there’s no medical detox facility. Therefore, what else is left except the hospital?
And I do feel a little hopeless when opioid addicted patients tell me they want a fast detox off opioids, but they don’t want to feel bad, and they don’t want to have to miss work. then they refuse to consider methadone or buprenorphine maintenance. I don’t know of a workable option, thus my lackluster response.
Jana Burson
Posted by Jeannie on September 28, 2012 at 3:59 pm
Hello Jeannie again, Thank you all for your replies, I am getting used to hearing nothing can be done so it is ok to hear the responses. I am against maintainence for myself only as I feel detox is where I need to start. Er in this county will show you the door and tell you to see your Dr, that is definite. Not only do I work full time I am a live in caregiver and never have a moment to myself so that is why I need to maintain some sense of normalcy. The person I care for has no one whatsoever to help and I have no one to call upon to takeover for me. I have never lived in such a rural community where even going to the store is a all day event. I will say the Dr who cut me off took me by surprise as I thought he would have given me some type of option on what to do. All the closed doors has given me a stronger will to keep moving forward. I am in substance abuse counseling and will hopefully find a open door there. Thanks again.
Posted by Jeannie on September 28, 2012 at 5:16 pm
Jeannie here, I did not want the maintanance treatment however would have considered if the clinic would have accepted me. They are the ones who said I did not meet the requirement. I am not looking for a quick fix in any sense of the word, I did not feel that asking for a detox would garner any negativity. If taking pain meds for the years I have and the amount is not enough requirement, then I do not what to say about that. Not all folks have the option of taking off work and responsibilities to go into cold turkey wd. Thanks again for the replies
Posted by janaburson on September 29, 2012 at 1:18 am
I’m not sure why you didn’t meet criteria, except that perhaps you didn’t have one full year of daily opioid use?
Posted by Jeannie on September 29, 2012 at 4:56 am
I was told by the counselor that going from my vicodin habit to methadone would be like a lamb to a lion, how tough it would be to come off of. I have been using for at least 3 years.
Posted by janaburson on September 29, 2012 at 4:56 pm
Methadone is tough to taper off, but you can lead a normal life once you’re at a stable dose, other than taking your dose of medication once daily. It sounds to me like you certainly did meet criteria to enter methadone maintenance.
On the other hand, I have had patients threaten me with legal action for “getting them addicted to methadone” when the only drug they’d been addicted to prior to coming to the OTP was hydrocodone. While it’s true they were physically dependent on methadone, at least they were alive and leading a normal life – not going out to look for pills every morning.
Posted by shannon on September 29, 2012 at 12:44 am
Jeannie, reading what you are going through absolutely breaks my heart! I wonder if your Dr would treat you that way had you developed a problem with any other medications he regularly prescribes patients.If so, I am glad he is not my Dr., I know most doctors do not want to deal with an addiction, but I think they should not be able to prescribe these medications to people on a regular basis if they do not want to deal with the outcome. I do not blame physicians for the current epidemic of addiction to painkillers, but to be honest in everyone that I know personally, a Dr was ALWAYS involved, maybe unknowingly, maybe 1or 2 people down the line, but in everyone’s painkiller addiction I know, 100% of the time a Dr is involved. It makes me so angry that your experience is the norm. These doctors are ok writing a prescription for #120 lortab 10/500 with 3 refills, but not ok with a patient being honest about a problem with medicine they prescribe!! I would also be angry if we were discussing insulin, blood pressure meds, or birth control. It is obvious discrimination that is applauded by people who know very little about addiction. My question is how to we stop it? Is there anywhere to make a complaint? I would love to ask your Dr how he would handle it if you were talking about any other medicine, such as an antidepressant- you aren’t supposed to just discontinue those suddenly. I would also love to tell him he should not prescribe things if he doesnt want to deal with a very common side effect….
Posted by janaburson on September 29, 2012 at 1:17 am
It is absolutely illegal in this country to prescribe opioids for a person who admits being an opioid addict. If the doctor prescribed opioids after the patient admitted to having a problem, the doctor would be commiting a crime. That’s been true ever since the 1914 Harrison Narcotic Act. The DATA 2000 Act that allowed Suboxone to be prescribed from an office was therefore a very big deal. It’s the first and only opioid drug that a doctor is permitted to prescribe in an office to treat opioid addiction.
Posted by Jeannie on September 29, 2012 at 5:06 am
I reread my original post and want to say I did not tell my dr that I was “addicted” what I did say was vicodin no longer worked for me and he made me write that down on a prescription pad, that was the extent of that conversation, sorry if I didn’t mention the exact conversation. My Dr is from Peru and I think he got nervous with me quite honestly, I think I was a problem for him and he was not sure what to do. He is a very nice Dr for the most part, I did overhear in the waiting room when he came out to talk to a patient that he would no longer prescribe vicodin to her, this in front of a full waiting room, that was shocking to hear, no matter what the patient problem was no one but the dr and her should have heard that. I don’t blame him for my problem it happens. I think after 3 years of daily narcotic use anyone would have a problem coming off, I just didn’t know how adverse telling the truth would be in that situation. I will get thru this.
Posted by shannon on September 29, 2012 at 3:05 am
i Even if doctors would discuss expected symptoms, and ways to treat them, immodium for diarrhea and those types of things, how long severe withdrawal is expected to last, or therapists to see would be acceptable. If another med was causing problems I would not expect a Dr to keep giving a patient that med either.
I was very blessed during my first shot at getting clean, and my Dr ( who is well respected in our community and not a pill Dr) did some things that were not law binding but very humane. He told me to meet me at his office at 1:00pm on his day off, and I told him everything, even the ugly stuff, stealing pills from my family, etc. and believe it or not, he called my sister to come back with us. My sister is an RN and he wrote a weaning schedule and prescription to me but handed them to my sister. I have no idea how it was documented, but my guess is it was written down like the 60 lortab he gave me the month prior. Some people may say this is wrong, but I do not see anything wrong. The only thing I said was I wanted to quit taking narcotic pain meds, If you read the pharmacy printout, it says if you use this medication regularly do not abruptly discontinue without consulting Dr. I have no idea if I used the word addict, but I do know I will never ever forgotten the kindness this man showed me and did not make me feel any more shame than I already did. He talked to me in the same way he would have if we were discussing any health issue. This was around 1998, and I wish all drs could be this way, even if they just wrote a prescription for immodium.
Posted by shannon on September 29, 2012 at 6:25 am
I am from Indiana, and to my knowledge, only 3 hospitals in the state even have a medical detox unit, and one of those stopped admitting people who were taking ” only opiates” because everyone thinks coming off those is not life threatening. I have always been told the withdrawals from these aren’t life threatening, but recently read of a woman going through withdrawals from vicoden in jail, she died from dehydration- from diarrhea and vomiting due to…… I was led to think I would feel bad, like the flu, 7 days and them be ok….WRONG! I had severe anxiety and anxiety attacks for six months. There is no fast fix coming off opiates. I was single coming off opiates and I had to work to provide for myself. Methadone made that possible for me. When I first started, I would take my dose and it felt like I wasn’t overwhelmed and hide a small lift in mood/motivation. That went away and I just feel normal, since I do not get the big , intense high of opiates or the horrible lows when u run out and have to chase it, I don’t have the obsession for them anymore and can function without every thought being when can I use or where can I get more pills. I have days painpills do not even cross my mind!! This is a miracle for someone who took 20-40 lortab 10/500 for 15 years. Since that is gone I do not fear being slowly weaned. I went to 12 step treatment 4 times, my only wish is that someone would have told me this was an option. I felt worse being told 12 step abstinence was the ONLY way and I continued to fail. I believe taking medication is a personal decision. I do not care about getting a token or any of that- I just wanted a LIFE! A go to work in the morning, do laundry, take out trash, sleep cause I am tired LIFE!! I finally have that and do not give a hoot what a program from 1935 thinks of it. In fact, I want to tell everyone there are medications now that they did not have in Bill w’s time and it helped me!!! If treatment centers won’t talk about options I will be glad to tell them. It seems like there are more people who fail 12 steps and feel hopeless like I did than ones who follow that way. In all honesty, I do not have any desire to sit in a room 20 years from now talking about what I did when I abused pills! That doesn’t seem like a balanced life to me at all. In my opinion, the defining characteristic of sobriety is living a balanced life. Medication gave me back the balance to get my life back!
Posted by janaburson on September 29, 2012 at 4:59 pm
Thank you. You nicely demonstrate that no one treatment works for everyone. I too feel patients need to be told about all evidence-based treatment options.
However, I must point out that most good 12-step meetings don’t talk about using drugs – they talk about how to lead a balanced life!
Posted by Tonya Redden Baldwin-Worley on September 29, 2012 at 9:55 pm
I was in NA for years and it worked off and on for me when I worked it too but I am surprised to hear anyone in MMT in support of themselves and/or their patients going to NA because it is evident from the first meeting especially in this NC area (not so much Daytona Beach FL) that NA does not welcome people on MMT/MAT.
Posted by Nikki Easterling on October 9, 2012 at 4:54 am
Thank you so much for your commitment and dedication. And for your obvious passion to advocate and educate. I have recently re-entered the addiction counseling field in an effort to support and expand buprenorphine. I wish they would “loosen” the licensing guidelines so we could expand this treatment option. It seems that physicians are suspcious and intimidated by the licensing process. Are you aware of the best way to get this message to lawmakers? We desperately need more prescribers in our area
Thank you!! You are a rare gem.
Posted by janaburson on October 11, 2012 at 1:22 pm
Hi Nikki,
I think education, education, education is the only way to go with lawmakers. I think some of the national doctors’ groups like American sociaety of addiction medicine and American Academy of Addiction Psychiatrists have people who lobby lawmakers, and maybe therapists and counselors could do the same.
As doctors start to get more education about addiction and its treatment, i think doctors will be more interested in treating addiction.
Posted by Tonya Redden Baldwin-Worley on October 12, 2012 at 9:35 am
There also exist this problem that once they are doctors they do not have to do too much to in the education area to keep up to date such as CEU hours are ones they can pick and choose and which to take. When I had that encounter with precipitated withdrawals and none….i mean none of the nurses and/or doctors in the emergency room even knew what this was. When I told the nurses and doctors about my dose of daily methadone they all were shocked one of them came back to my room later and said he had looked it up in some medicine administration book and he said I was lying as the maximum methadone a doctor could give me was something like 120 milligrams (I think this was pain related not MMT) but he refused to believe I took 210 milligrams of methadone daily. UNBELIEVABLE……… I had to fight them for 18 hours to help me.
Posted by James R on October 26, 2012 at 7:19 pm
My wife has been on suboxone maintenance for the better part of her life since 2002.
We live in a rural area in Northern Wisconsin , Where Suboxone providers are few a very far between. Her current doctor has asked her to quit smoking tobacco to remain on her maintenance,threatening to decrease dosage untIl she does , or if she dosent will be discharged when the reduced dosage gets to zero…
At most recent consult, Dr said if we did not like treatment plan then we should find a new doctor.. of course full well knowing there are no oyher doctors within 200 miles who are accepting pati?nts…
Is this a common practice ? What can we do?
Posted by janaburson on October 26, 2012 at 8:17 pm
tobacco only?? Or marijuana?
Posted by janaburson on October 31, 2012 at 7:58 pm
I wonder if her doctor thinks she may be abusing stimulants – it can be hard to tell Sudafed from illicit methamphetamine on a urine drug test without secondary testing. There are also some people who use Sudafed to excess – does your wife take more than directed by her ENT? Maybe her Suboxone doctor and her ENT should talk.
Posted by James R on October 31, 2012 at 8:26 pm
The doctor has all of her medical stuff right there in her tablet. All of wife’s doctors are at the same clinic. The UA test is pretty thorough though, it lists every compound individually. The doctors reasoning is that sinus medication can become habit forming….wife has been utterly truthful about all usage, pertinent and not to her treatment…
So where we are at now is in 3 weeks she goes back in for consult and if she has not quit smoking, then her suboxone will be further reduced…trying like hell to find another doctor b4 next consult, but all are Full-Max limit on patients… tempted to drive 275 miles to milwaukee to find her a doc.. but then i fear she will probably just opt for opiates once the drive is required…
What can we do to get on the same page w this doctor?
Posted by Nick on October 30, 2012 at 3:13 pm
Hello I’m a 54 healthy man who’s on a 40 methadone detox program, how can I get methadone pills instead of going to the clinic on a daily basis?
Posted by janaburson on October 31, 2012 at 8:09 pm
It’s illegal for a doctor to prescribe methadone from an office setting for the purpose of treating addiction. Any doctor with a DEA number can prescribe methadone for pain, however. For patients with addiction, often if they are prescribed a month’s worth of methadone, they aren’t able to take as prescribed, which can be fatal with methadone. Some patients who’ve been in addiction treatment with methadone and are extremely stable can manage their medications if prescribed once per month, which is why methadone patients can get a month’s take home after being stable for years.
Posted by Nick on October 30, 2012 at 3:14 pm
Just another Q. is it totally safe or private the info given here?; thank you just respectfully asking
Posted by janaburson on October 31, 2012 at 8:13 pm
Not sure what you mean – if you have a question or a comment that you don’t want posted, i’ll honor that but you will have to let me know. Otherwise, it’s on my blog. But I am the only person who manages my blog, sees people’s email addresses and of course I would never release those to anyone. Unless maybe if you wrote to say you were gonna harm someone. Then maybe I’d have to contact “authorities.”
Posted by Mindy on November 12, 2012 at 10:07 am
I have a friend with three crushed discs in her back no surgery is available bc it could do more harm than good. She has been on pain meds for almost 20 years and if she runs out of her script life really goes to hell. What can she do to get relief but also get off the lortab and opana she takes? Really worried about her. She also has krones disease.
Posted by janaburson on November 12, 2012 at 9:31 pm
She should talk with her doctor about this. Sorry, I can’t give medical advice.
Posted by Adrianne ( AC Gross pename) on November 24, 2012 at 3:21 am
Hi
Just saw your book. Will check it out. I am a Physiatrist in Ca in Recovery who just wrote a book about my addiction and recovery from pain/sleeping pills. It has been a long road but worth it
Posted by Kelly on November 29, 2012 at 10:56 pm
I just found out I am pregnant and I have been addicted to hydrocodone for about 1 yr. I want to quit because I’m concerned about my baby, but I have tried several times now cold turkey and I always give in at least 24 hour into the detox because of the w/d’s. I want to talk to my doctor about it but I am scared or embarrissed really. What are my options? Is there any kind of meds the dr can give me to ease the w/d symptoms or am I just gonna have to be more determined and go cold turkey. I’m really concerned about what my addiction can do to my baby so can u give me some advice about what to do. Thanks in advance.
Posted by janaburson on November 30, 2012 at 11:00 pm
Sorry, I can’t give you specific medical advice, but you must tell your doctor. right away.
And read my blog post from 12/16/10 about opioids in pregnancy
Posted by Aura Bailey on December 4, 2012 at 1:09 am
Dear Dr. Burson, During a narcotic pill count, is the prescribing physician allowed to detain the remaining pills if the count is incorrect? I ask this because I have been on oxycodone for two years and recently my physician required a UDT, which came up negative for any and all drugs. Unfortunately, I had run out of my prescription too early and hadn’t taken anything for about a week when I was tested. Despite this “hiccup” my physician prescribed the same amount of oxycodone and told me to return in two weeks for a pill count. I’ve encountered the same problem – I’m short on pills because I take two extra pills per day (I wake up at night in pain and that’s when I take the pills) and now I’m very afraid of what the ramifications will be. I’ve already lost his trust because of the negative UDT. I had told him that I had taken my Rx a couple of hours before going to his office and then I got hit with the “clean” UDT, which made me out to be a dishonest person (I was being dishonest). When I return to his office for the pill count and I don’t have enough, I’m afraid he’ll detain my remaining pills. I just don’t know what to do. I have legitimate reasons for my prescription, I just need two more than he’s willing to give …and it’s created quite an anxiety ridden situation for me. Thank you very much for your time and consideration of my problem. I really do appreciate your input!
Posted by janaburson on December 4, 2012 at 11:43 am
Sorry, I don’t know what your doctor will do, but please consider telling him what is going on with you. Staying on this prescription may not be in your best interest.
Posted by Aura on December 4, 2012 at 2:42 pm
Is it legal for a physician to take his patient’s pills?
Posted by janaburson on December 4, 2012 at 4:06 pm
I’m not sure about legal or not. I wouldn’t do it…they are the patient’s property, it would seem to me.
Posted by tesha on December 16, 2012 at 5:48 pm
Hi My name is Tesha, i Have been addicted to roxicodone for 6 Years now i have finally decided that im done,i dont want this kind of life anymore but i dont know what to do, the last roxy i had was last monday the 10th, i dont have any kind of sub except for i had 1 1/2 methadone wafer and ive been trying to take as little as possible everyday but it now almost gone, i guess i just need support because im very weak and i cant do this alone im really trying but its so hard my biggest weakness is getting pill sick, im so scared i dont do well with being pill sick and i dont wanna end up taking another pill i just need to know what to do? how do i control this sickness? i dont have AA or NA to go to im just by myself please help me get thru this, ill be waiting on your answer thank you so much for making this website also, Thanks again
Posted by tesha on December 16, 2012 at 6:08 pm
im sorry but please get back to me soon just because i dont know what to do and dont want to do another pill… thanks
Posted by janaburson on December 17, 2012 at 8:16 pm
Hello Tesha, and thanks for writing. The disease of addiction is too much for most people to handle on their own, so I recommend getting an evaluation at a treatment center to see which type of treatment is most appropriate, and also available in your area. this website is a great place to start looking: http://findtreatment.samhsa.gov/
I’m not sure what you mean about NA/AA – are there no meetings in your area, or are you saying you don’t want to go by yourself? You can try calling an NA or AA hotline if one is listed in your phone book – you can ask them questions and this may help you feel more comfortable.
Posted by tesha on December 19, 2012 at 10:01 am
yes you are correct i dont have a AA or NA in my area, I havent had any medication in 3 days since i weaned myself off the methadone however i do have the craving but i do keep trying to tell myself i dont want it ive done too good to turn back now but the thought is still there and i hate it, how can i get this out of my head? i found a suboxone doctor but i have no insurance and they are not cheap, so therefore i dont have anywhere to get an evaluation.
Posted by janaburson on December 19, 2012 at 8:51 pm
I’m sorry to hear that. Lack of money prevents many people in the U.S. from being able to access healthcare. If you send me your zip code I’d be willing to do some looking for you.
Have you looked into online recovery meetings? I’m not too familiar with the sites but I think you could google for them.
Posted by Tonya Redden Baldwin-Worley on December 17, 2012 at 9:38 pm
http://atwatchdog.lefora.com/2012/12/15/never-has-happened-in-13-years/?vm=14#post14
Come register at this site we are a methadone treatment forum…you can talk to quite a few like you….in your registration be sure to say in a message you are the person from this site.
Posted by Tonya Redden Baldwin-Worley on December 17, 2012 at 9:39 pm
Kesha I am sorry I meant to tell you who I was speaking too.
Posted by mecah on December 27, 2012 at 2:11 am
I need help, my husband had his fingers crushed at the knuckles and they were able to save and fix them. But this happened years ago, his hand works although his fingers are limited. He works in the oil field and says he had a cracked disk n his back but X-ray doesby show it. I don’t deny his pain but he completely abuses his meds. He has a script a month and breakthrough meds as Well, this is first month due to our marriage almost ending that he hasn’t had to buy more on the street. He completely denies it….as he nodds off, we have cigarette Burns on everything!! I know he needs them, I think, but I also know addiction because I’m a recovering addict. What do I do? He pays for his Dr visit before bills or his parole!! He tells himself he can’t work without them but takes them everyday and only works two days at most a week. I’ve griped, threatened, talked… two years ago he didn’t need them like this, he says he just didn’t complain but I know he is exaggerated it, he hurts but Geez my mom has ruptured disks and doesn’t take hers unless she can’t handle it. He says but she doesn’t work……he barely does either, hasn’t n almost two weeks and still takes them…….please help, I might need to just get divorced.
Posted by janaburson on December 28, 2012 at 10:08 am
I’m so sorry but I can’t give advice with such a complicated problem. This blog is for general information about opioid addiction and treatment, and you and your husband need to see a addiction specialist, in person, to get the kind of help you need. Even if he won’t get help, make sure you do. His doctor can’t give you any information unless your husband has signed a release, but you can give the doctor information. If she’s smart, she will do something to see if he’s misusing pills, like pill counts, random UDS.
Please also consider going to some 12-step meetings. Alanon or naranon are for friends and families of alcoholics and addicts, and you can get some good ideas and information there.
Posted by ktibbs on January 5, 2013 at 7:08 pm
Hello Doctor,
What a pleasure this is. What an amazing way to reach out to people to actually help! And you do this in your own time? Unheard of in today’s world – what a blessing you are! I would like to thank you so very much for your work! A true positive testimony to the well-being of humanity! I just can’t believe my eyes and my heart-senses! Thank you.
May I ask a question, please? I have been taking prescribed meds since 2009. My dosage started at 60mg per day of Norco. I am now prescribed 90mg per day – (2) 20mg of oxi and (3) 15mg of roxi. However, my tolerance to the substance is way beyond what I am prescribed – I have broght this up to my pain management doctor and they made a slight adjustment, but nothing too drastic. Anyway, I take 200-240mg per day, as that is what is needed with my current pain levels and I always cut myself short – every single month, by a minimum of two-weeks. Which leaves me buying friend’s supply to get me through the month, aka, the “pill-chase” (at not such an affordable price).
My question is two-fold; I think I may seek treatment using Suboxone. I do consider myself an addict, because my body/mind has become dependent upon the daily use of them. However, I do feel that if I was prescribed what I actually need, I wouldn’t have to purchase through friends and the stigma would be so much less on me. I know this all depends on my doctor’s decision, but if I was to seek counsel from him, telling him that I run short every month and have been for the past 6 months, is he likely to “label” me an addict or actually prescribe me what is needed? I want so badly to be able to tell him, but I just am really concerned of being labeled, thrown on the board, and rejected further service. I have been a loyal and “quiet” patient of his for over a year. Additionally, if I do decide to quit and turn to Suboxone for a trial perid to see if my pain levels are manageable as I ween myself down, is that strictly confidential between the Suboxone doctor and my pain management doctor? I am not going to doctor shop – I would love to be able to just tell my PM doc that this is my plan, and if it doesn’t work, may I come back? With all these laws in place, I feel trapped. And I really don’t feel like I should feel this way. If the sub goes well, I would contact my PM within this month and notify him. I guess in general, what is the privacy policy?
Thank you so much, doctor. I truly appreciate your advice. Many Blessings
Posted by janaburson on January 6, 2013 at 3:40 pm
When treating addiction and/or mental illness, doctors and other care providers have to adhere to a standard of confidentiality that’s even more stringent that HIPPA. We can’t even say if a patient is in treatment with us unless we have a signed consent from the patient. However, your doctors may not be willing to treat you unless they are able to talk to the other doctors involved with your care. In other words, I think the Suboxone doctor you see will want to be able to contact your pain medicine doctor. And yes, if you tell your pain management doctor you are misusing your medication, she may decide it’s not appropriate to continue to prescribe opioids for you.
Deciding if a patient has developed tolerance, common to many pain management patients, or true addiction depends on psychological symptoms as well. If you use medications in ways not intended (e.g. snort pills) or use illicit drugs or alcohol to intensify effects, or use pain pills to treat bad moods, or obsess about taking pills, running out, getting more…those sort of things determine whether you have true addiction or a pain management condition that needs a higher dose of medication. Plus, are you functioning better on this higher dose of pain medicine than you did at the 60mg? Or is your daily functioning the same…or worse?
I advise you tell your doctor the whole truth. Clearly, what you are doing now isn’t working, and something must change.
thanks for reading
Posted by ktibbs on January 6, 2013 at 4:53 pm
Hi Doctor, Many thanks for responding so prompt – I am very thankful for this dialogue.
To answer your question regarding daily functioning, I actually do feel that I function better when I take the higher doses – I am clearer, as I am not in so much pain and my energy level seems to stablize – this is probably just due to the fact the my tolerance has risen.
My biggest concern is what seems to be a developing liver issue – which has been getting worse over the last six-months. I have had testing done on my liver and everything has come back normal. However, I can feel it swelling and I have lost so much energy – very heavy fatigue which has now turned to lower functionality. I want to switch over to the Suboxone so I can monitior and cleanup my liver. I do not drink alcohol, or involve myself with any other type of drugs. I actually take very good care of my body, from lessons learned – I eat well, stay on a balanced vegetarian diet, and practice yoga. This way of living is my new-normal for the past 4 years. However, this wasn’t always the case – I am 35 years old now, and I used to be very hard on my body, believing that I was invisible in my late teens and throughout my twenties, which has brought on numerous bouts of pain-stricken ailments – nerver damage, 4 blown discs, 1 of them almost completely gone, muscle spasms, and bad arthritis.
I want to be open and honest. I do not wish to keep any secrets. I have had the same PCP for over 8 years (I don’t doctor shop). I just do not want to be labeled and refused pain medicine down the road should I decide that life without the pain medicine help has become too difficult. I am an honest man, a business owner, a father of three, and a husband of 15 years. You are correct, what is happening now is clearly not working and only making matters worse – I will be doing the right thing and keeping everyone in the loop.
I sincerely thank you for your valuable input. I will be doing the right thing.
I hope everyone on this blog finds their light at the end of the tunnel that they are looking down – it is there, just have to walk a little farther to get to it. This doctor has done a beautiful work with this blog, which I hope everyone is so thankful for. Many blessings, everyone.
Posted by janaburson on January 7, 2013 at 7:33 pm
Unfortunately, buprenorphine (Suboxone) can cause liver inflammation, unlike most other opioids (unless they are in a combo pill with acetaminophen). but it sounds like this is your self-diagnosis and your labs were OK. It’s something to talk about with your doctor, though.
Posted by kylr on January 5, 2013 at 9:15 pm
I have been on methadone for 11yrs. From the street….is there anyway i can get on a real methadone prog.. I can inpatient. I really just want help and stability in my life so I can keep working and go to college but not have to worry about being sick… I’m not just trying to get drugs from the government I just want stability in my life for right now.. please help anyway you can. Ty
Posted by janaburson on January 6, 2013 at 3:44 pm
Please go to this website: http://findtreatment.samhsa.gov/
Also, try http://www.methadone.us where you can click on a treatment directory to see what’s available in your area.
Posted by jenny on February 7, 2013 at 11:41 am
Hi. I have been on MMT for 3 years. My current dose is 42mg which was working. All of a sudden i feel very anxious and nausea. They asked me over phone if i wanted to go up. I don’t know if i should. I’m on 5mg ambien, 25 mg seroquel, .5 mg of klonipin, and 30 mg of Prozac.. All ate taken only once a day. I take Prozac in morning, klonipin at 3 pm and the seroquel and ambien at night for sleep. 42 is the highest I’ve been so I’m scared to go up. I’m no small person I’m about 300 pounds and female. I told them i only want to go up 2mg call me paranoid I’m ocd. I am scared to go up. What do you think?
Posted by janaburson on February 8, 2013 at 7:15 am
I think you should see your doctor at your opioid treatment program, so she can ask you some more specific questions. There are many things that can cause anxiety and nausea besides opioid withdrawal, and your doctor can help you sort it out. I always make sure the patient isn’t pregnant, for example. Also, could your other medications be causing problems? If you read my blog you know I’m no fan of ambien and klonipin with methdadone, both because of the dangers of the combinations, but also because benzos have few indications for use past three months. But without knowing your medical history, all I can say is see your OTP doctor and voice your concerns. You may want to see her before you dose one day, so she can assess withdrawal signs during your lowest methadone blood level.
Posted by jenny on February 11, 2013 at 11:17 am
I know I’m not pregnant. My benzo hasn’t showed in my last 6 urines. I just got an increase of 2mg. They said my eyes were dilated and they took my blood pressure and stuff etc. they suggested 5 but i did 2. I want to get off the seroquel so i can get take homes. I also want to get off the Klonopin but last time i tried i got real sick. I thank you for your response. I have been on methadone for over 3 years.
Posted by JAN SPILLMAN on February 9, 2013 at 6:21 pm
Dear Doctor Burson,
Please first understand that I am a desparate woman that went on methadone for the wrong reason. I’d been in a really bad car accident on 10/07/11 and then again less than 3 months later, on 12/31/11! Both were caused by mechanical (and other) failure issues. I was lucky to escape with my life and after the most recent crash, was diagnosed with 4 ruptured cervical discs, 1 ruptured and one torn, thorasic disc, 3 herniated, 2 bulging and torn lumbar discs and several pinced nerves, torn tendons and muscles in both arms, although more severe on the right. I went to the emergency room only when I was able to get out of bed on my own and get a ride there, using my own insurance. That was a few days after the 75 mile crash, head on into a culvert.I did refused at the accident scene, as I was in shock and didn’t think I was injured enough to go to an emergency room, I was wrong. When I did though, I’d recently been on suboxone treatment for long term opiate addiction after seeing a spine and sport’s medicine doctor for many years after I had a bad fall at work and was injured in a car accident when I was rear ended in 2002. In 2009, I knew I still had pain but knew I was addicted and struggled till 2011 at which time I went with a friend to a church, where the pastor there was a suboxone doctor. I was able to detox from oxycodone with the suboxone but at least 50% of the time I took it (in small doses, like 2-4mg twice a day at most.)I would have terrible migraines and throwing up. It made me so ill. So, after the most recent accident, the emergency room wouldn’t give me anything for pain because Suboxone was on my recent pharmacy profile. They referred me to a ortho clinic that took several weeks to get an appt. The doctor there did MRIs, made a very nice report with friendly letter attached about how he would be willing to help me in any way he could and see me at any time. The truth was, he said he could NOT help me and referred me to a Neurologist for a nerve conduction study only. The Neurologist had to give me the results as he was going to send the results to this Dr. that had made no return appt for me and referred me to physical therapy as well. The Physical Therapist looked at the test results and did a quick exam. He said there was nothing he could do for me. with torn muscles and tendons in my arms, they needed to heal. He said I could come back to see him in a year. I haven’t yet. He referred me to massage therapy. He also told me that I could get pain relief from methadone and told me where the nearest “treatment center” was. Now, a year later, I’m worse than I was the day I saw the doctor. I cannot tell what is happening in my body really. I feel terrible all the time from the methdone and I need to know what is the quickest way to detox this drug, that stores in fat and muscle, out of my body? Please help me. No one will give me pain medication, which is what I need along with surgury. I can barely use my right arm. It’s filled with knots, scar tissue and calcium deposits. When I touch the tendons in my upper are, it send radiating, shocking pain down my arm to my fingertips.I have not be able to find a doctor in the area that cares about my health, at all. I know they are out there, but I’m having terrible luck finding a personable, caring, compassionate doctor. Many doctors, while I’m in the middle of telling them what my complaints are,, will interrupt me with a comeback of how sick they are. My old psychiatrist was the worst at that, but he wasnt’ the only one.
If you can give me some advice, on how to get off methadone without suboxone, I would be oh so grateful.
Posted by JAN SPILLMAN on February 10, 2013 at 1:48 am
Yes, I realize my case is very complex and I’m 46 years old and in bad health, but I think my best option would be to find a Suboxone doctor and make an appointment if I can find one that accepts my insurance, I’ve been researching for months, and just recently, we have had a couple of doctors in the city that are precribing Suboxone and if I can deal with sickness for a few days I should be able to start Suboxone(even though is my last ditch effort) and not stay on it for an extended period of time. I do very much appreciate your taking the time to read my comments(letters) and reply. I know MMT is the best for some people but it has caused way too many health problems, including insomnia and the inability to wake in the morning because of horrible withdrawal symptoms.
Posted by janaburson on February 10, 2013 at 1:36 pm
One of your comments said you wanted off methadone without Suboxone – I was responding to that, sorry.
Posted by JAN SPILLMAN on February 11, 2013 at 12:47 am
Oh, I do want off methadone without Suboxone, but the only way I can do that is if I have a substancial amount of money to get into a treatment center that specializes in methadone detoxification. Unfortunately, their methods haven’t been practiced for a very long time, but it’s much safer than the rapid detox method, which I can’t afford either. None of them accept insurance, so I don’t have many options. If I can find a sub dr that takes my insurance, I had some bad reactions to suboxone, but I think after a year on methadone, I could probably handle it, I just don’t want to stay on a suboxone maintanance program, I’d rather use Kratom capsules, but I’m on much to high of a dose, dropping to 92mg, tomorrow. Don’t have a clue how long it will take to get an appt but there are several docs in the area that are licensed to precribed suboxone. I remember less than two years ago, there were none. Your advice and opinions are appreciated.
Posted by JAN SPILLMAN on February 11, 2013 at 1:01 am
Before i got in my accident, there were only a couple of doctors in this city that presribed Suboxone and neither accepted insurance. I was living in a city about 50 miles away, which put me a lot closer to another larger city. I was told about a very inexpensive Suboxone doctor that was also a paster and I saw him until my first of the two major car accidents. That was why no doctor was willing to prescribe me pain medication, even after two major car crashes…because Suboxone was on my pharmacy profile. In fact, the doctor that performed my MRI suggested MMT and stated he could not help me. I’m in the process of applying for disability and have an appt with their doctor this week. I feel that my biggest mistake in life has been being poor. No matter what the reason, people judge you differently when you don’t have nice clothes to wear, make up, jewelry, etc. Everything went to my children and grandchildren but I feel guilty that my disabilties have made it impossible to do what I once did. Methadone hasn’t helped one bit. I wake up sick, sick, every single morning, sweating and feeling the flu like symptoms which make it so very difficult to even get out of bed to make it to the clinic for noon!! Goodnight, and bless you.
Posted by Lisa on February 18, 2013 at 12:39 pm
My 55 divorced sister in law is addicted to pain killers, methadone and other drugs. She has been in jail several times for “hit and run” car wrecks. She has alienated her only 25 yr old daughter and lost her job 2 weeks ago.
I am married to her only sibling – we do not know where to turn. She cooked thanksgiving- falling asleep every few minutes while cooking- eating in front of our family. Please advise us- do not know what to do! Thank you
Posted by janaburson on February 19, 2013 at 2:59 pm
Living with a person in active addiction is too much for most people. Thank God there are more resources now than ever before for the families afflicted by addiction. Treatment centers have family groups and family days, and many therapists are skilled at helping family members. There are 12-step groups devoted to helping family and friends of alcoholics (Alanon) and addiction (Naranon) in nearly every area of the country. Alanon does make a distinction between alcohol and other drugs, while Naranon is for families of people addicted to any drug including alcohol. However, in practice, many people attending Alanon do so because their loved ones use drugs in addition to alcohol.
Popularized by the TV show “Intervention,” some families hold these interventions for the addicted family member. An intervention usually contains certain elements: the addicted person’s friends and family gather together in the presence of the addict, they tell the addict how much they love him or her, they tell the addict how much their addiction hurts them, and what they want the addict to do about his/her problem. Usually this means going to an addiction treatment center. Families usually also tell the addict there will be definite consequences for non-compliance with their requests.
What if the addict won’t go to treatment? Unless you live in a state where you can involuntarily commit someone because of addiction, there’s not much you can do.
Some people deal with addiction in less directive ways. For example, in Alanon, the focus is kept not on the addict, but on the distressed family member or friend who is affected by the addiction. Alanon helps people deal with the dilemmas that appear with addiction, whether the addict is in or out of the home. Some people go to Alanon years after the addict is dead, because of the long-lasting emotional effects addiction can have. More about Alanon’s approach to dealing with the distress of addiction can be found at their website: http://www.al-anon.alateen.org Alateen is not for alcoholic teens, but for teenagers who have been affected by the alcoholism of a parent or other close relative, or friend.
Posted by Ross on June 3, 2013 at 7:39 pm
I am 28 years old and been suffering from a 25-30 pill a day addiction. I’m so tired of chasing being sick an not being able to be the proper father I wanna be due to my lack of having parents. I been to methadone clinics an did well on 110mg dose once per day. No cravings an not a single use for the three monrhs I was there. The closest clinic is almost two hours away an I had to go seven days a week. With my wife an I being young parents to two wounderful children an her working full time as well as me taking care of our family farming operation I could no longer afford to drive that every day. I live in a small town in southeast Tennessee where a lot of people go to doctors just to get medicine they really don’t need. I’m in desperate need of advice on how to get a local MD to prescribe me the methadone I need so I can have my normal life an the family I’m able to be a father an husband for when I’m not using dilaudid! Please I’m willing to listen to any an all advice I can get about how to solve this horrible issue.
Posted by janaburson on June 3, 2013 at 8:17 pm
Hello Ross,
It’s illegal for a doctor to prescribe methadone in an office setting to treat opioid addiction; that can only be done at opioid treatment programs which are heavily regulated by state and federal governments. In your area, there’s not a nearby opioid treatment program in TN, as you know. There may be programs closer to you in either Virginia or NC.
Have you looked into the option of suboxone? That medication can be prescribed through a doctor’s office, once the doctor gets a special license to prescribe, and SE TN has some suboxone practices.
Other treatment options are inpatient detox followed by a month or more of inpatient residential treatment. In your area it seems hard to access, at least for the period of time you need. With opioid addiction, a few weeks of treatment isn’t likely to work. It’s more costly, and you’d need to miss that time off work. Often that’s not a workable option.
If I were you I’d investigate suboxone options. you can go to suboxone.com or to http://buprenorphine.samhsa.gov to find a doc
Posted by jessica on June 27, 2013 at 10:50 am
hi my name is jessica and i currently attend a methadone treatment center located in knoxville tn.. my question was that is it true that if you are on a stable dose and having no positive drug screens for years that at that point with referral from the methadone clinic that an addiction expert can then take over and give you a rx of methadone? it seems like i read that a few different places..
Posted by janaburson on June 27, 2013 at 1:02 pm
No, unless the doctor gets special permission from the government. And the state. I doubt that would happen in TN.
Posted by John Doe on July 19, 2013 at 2:24 pm
Thank you doctor. You answered some of my questions. I am pretty sure I am going to need a root canal and kicked oxycodone and oxycontin cold turkey after over two years of daily use. I did not know if I could ever take pain killers again and I have a swollen jaw and a massive toothache. I was scared to take anything again as I never want to go through that withdrawal again. Was horrible. By the way, I don’t advise anybody do what I did. Cold turkey is brutal and some of the symptoms lasted 4 months.
Posted by Oxycontin vs The Family: Round 2 - Family Recovery Diaries on August 6, 2013 at 8:34 pm
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Posted by lisa.treadaway4708@yahoo.com on August 24, 2013 at 3:15 pm
Hi , my son is 26 and bn on soboxon for several years. He has a op addiction. He has found very good work $24 dollars an hr. but he now travels from state to state and is gone 3 months and then is back home for a week. Every doctor he sees after searching the world over will not take him again when he come back home after bn at work for three months. I know my son is not the only one in the world that takes this med and works out of state and travels. We live n Birmingham Alabama. Just wondering if u had any help on the subject. Thank you.
Posted by janaburson on August 25, 2013 at 10:51 am
Hello and thanks for the comment.
I don’t know of any doctor who would write for three months of suboxone at a time for a new patient. It’s not good medical practice. A new patient needs more care than he can get just coming to a doctor’s office four times per year; I would insist on some sort of counseling. I usually see my new patients every two weeks and eventually every month if they are doing very well. However, I have a few patients, in recovery for years and who have gone through good counseling, who I see every two months.
Work is important. But there may be things that are even more important, like getting good care for his opioid addiction.
Posted by Charles Holly on November 18, 2013 at 8:38 am
I I am trying to understand why I could take subutex sometimes and sometimes I can’t take subutex subutex works very well for me and I would like to get back treated with subutex to stop using opiates what can I do for me not to go to full withdrawal after taking subutex
Posted by janaburson on November 20, 2013 at 2:30 am
Since buprenorphine, the active ingredient in Suboxone/subutex, is a partial opioid, if you aren’t in at least moderate withdrawal before you take the first dose, it can cause you to go into withdrawal. I suggest you enroll in a treatment program to let a doctor help you.
Posted by Melvin Lee on December 2, 2013 at 6:20 pm
Can my doctors force me to see a psychiatrist and to get in a drug program in oder to receive pain medication for the serious injuries I have?
Posted by janaburson on December 3, 2013 at 12:48 am
No one can force you to see a doctor or get in a drug program if you don’t want to do so. But then, the doctor may not be willing to prescribe medication for you, unless you do.
Posted by nullc0re on December 10, 2013 at 8:16 am
I’ve been reading this discussion about whether NA/AA groups should “allow” MMT/suboxone patients to share/discuss their recovery experience. Their official stance is counterproductive. MMT and suboxone are legitimate methods of recovery. Many countries have government sponsored or subsidized MMT/suboxone clinics.
Look, it’s like this:
An addict in active addiction could die any day. Methadone has saved the lives of many, many people. I truly, truly wish someone in NA would have suggested MMT to me years ago. It would have given me those years back.
The NA folks discouraged me from even considering MMT, when they could clearly see me struggling. I was dying, and “one day at a time” wasn’t cutting it. I tried MMT to fulfill a probation requirement that I be in some sort of treatment program, and it instantly turned my life around.
I now own a house. I’m going to law school next year. And yes, I’m still very, very, very bitter, angry and resentful at NA and my 12-Step-bsaed IOP group for actively discouraging this life-saving medication.
Posted by Michael jefferies on December 15, 2013 at 8:43 pm
Why don’t you do this first instead of blogging go get to a methadone clinic and get on methadone for 3 years and get all of a methadone detox your body within let’s say eight days and see how you feel for the next month to begin feeling like a person again then go to your suboxone doctor and get suboxone to last year for a month at a time for 5 years and then try quitting suboxone within ob the say a month we’ll see how what kind of withdrawals you go through the same anybody else would go through you would much rather die and I’ve heard nurses taking care of babies that the mother would be better off if she had been addicted to heroin for the babies withdrawal would have been only a day instead of a full month
Posted by janaburson on December 15, 2013 at 10:36 pm
Well, no, you’re wrong.
If the pregnant woman didn’t get on suboxone or methadone, it’s much more likely the nurse would be caring for a very premature baby in the ICU with multiple complications. or that the baby would have died before being born.
This comment drives home the importance of telling patients that methadone and buprenorphine are not meant to be quick fixes. They are best if used indefinitely, for maintainence.
If a patient wants to be completely opioid-free from the beginning, don’t use methadone or bupe. They are opioids and they do have withdrawal, though addicts can feel and function normally while on them.
Posted by Rachel on December 15, 2013 at 9:45 pm
Hi Dr. Burson,
I wanted to say thank you for the hard work you do in the field of addiction medicine. I’ve been on suboxone since it became legal to prescribe in the US.
I’m only able to find one page here of people’s experiences (and found them very helpful) and am wondering if you have anymore pages like this one on your blog? Would you be willing to post a link if there’s more?
Thank you,
Rachel
Posted by janaburson on December 15, 2013 at 10:27 pm
Yes there are – look back at around the end of May of 2013, and I have an interview with a buprenorphine patient. But that’s the only patient interview. there are many comments throughout my blog from patients on buprenorphine; I don’t have the tach saavy to be able to tell you how to find them specifically.
Posted by rex hartley on January 18, 2014 at 3:22 pm
Just found this blog..looking forward to reading much more.3 years clean with the help of subs.
Posted by Raec on January 21, 2014 at 7:33 pm
Everyone should check out this new website. Prescriptionsanonymous.org
Cindy Mogil is also the Founder and author of “Swallowing a Bitter Pill”. She use to have a website 10 years ago but has recently decided to update her website and help through online consultations! Prescriptions Anonymous
Posted by kaila on January 24, 2014 at 6:09 am
I need help I use to take pain.pills to get high then I worked up a tolerance so I started on subutex which I wish I never did I didnt know ud withdraw off of them so I tried to get off them cold turkey and I got to day five I couldnt do it forst few days werwnt bad but 4 n 5 were horriable I started subs again I only take a quarter a day I heard about these natural pills for detox n witjdraw callrf wothdraw ease they help I wanted to try and I’m on depression n anxiety meds I dont want to withdraw thats why I take the sub idk what to do
Posted by janaburson on January 26, 2014 at 3:07 am
I think you need to find an addiction medicine doctor right away. How about getting on buprenoprhine from a doctor? you can go to http://www.buprenorphine.samhsa.gov
Posted by Dala on January 24, 2014 at 9:25 am
Hi,
Thank you for your nice writing on how to Cure addiction and I was reading it and I think my time is not wasted
Thanks
Posted by Joni on February 10, 2014 at 4:09 am
I find your blog very helpful. It helps me realize I’m not the only one. My question is, do you think an opiate addicted person should stay on Suboxone indefinitely or maybe the rest of my life or do you practice reduction off Suboxone until I am totally off? I have heard so many different things from different sources it drives me crazy. My Dr’s belief is a patient needs to eventually get off suboxone. I do not feel comfortable with that choice at all. I’m so afraid I will eventually go back to using prescription pain pills again. I’m so tired of Drs and government people who don’t know about addiction who think they have the right to decide what is good for me. Please tell me what your thoughts are on eventually stopping suboxone. Thank you for letting me vent.
Posted by janaburson on February 11, 2014 at 3:39 am
The studies show best results are seen in patients who stay on buprenorphine (Suboxone). But every person is different, with different history and preferences. If one of my patients is doing well on buprenorphine and wants to stay on it, I fully support that. Opioid addiction is potentially fatal. People die in relapse, so the decision to taper off shouldn’t be made lightly. Most people would prefer to be off all meds but it isn’t always possible.
Posted by beth feinsilver cohen on February 12, 2014 at 10:02 pm
To the poster who has a problem with NA/XA Meetings, this is one of my persona l problems with them too!! I could have avoided so many years and of painful, emotional & financial troubles, had I just started medication . These people were adamant that no one who takes the medication ever succeeds , and that they are doomed to live in abject addiction all their miserable lives!! All the “happy joyous and free” and white knuckling it all the way , not being able to relax or be comfortable and finding it difficult to just think !! Cravings that occupy your every thought , asleep and awake!! I do not know why it is so easy for them to ignore the 50+ years of research done by major universities , medical schools and published in established journals and publications. Makes no sense for them to ignore such vital and important information that mean life or death for those they counsel. Treatment has made such a positive difference in my life . Addiction is not something cured in a few years , if ever!! We do have chioices and for those of you that have found success in XA I am so glad for you as I know it does help some , I just wish for me someone would have said “it is time for you to try different treatments”!! But in the end , I hold my self responsible you really do have to investigate every option available to you, if something is not working try to find a treatment that will.
Posted by ismelltherain on February 22, 2014 at 12:56 pm
Hi Dr. Burson,
Remember me? I’ve been away from writing for quite a while, but recently been toying with getting back to it. Either way, June 13 will be 2 years I’ve been opiate free. One of the things I find so amazing now is how much anger no longer rules my life. I do think I needed it to get through methadone detox though. Don’t worry, I’m still just as opinionated as ever, but I feel it’s in a more toned down, rational manner. Anyway, just wanted to say hello and that I’ve been checking up on you. 🙂 Glad your clinic is doing well as I have always felt you stand for what is best in a doctor-the patient.
Posted by janaburson on February 22, 2014 at 2:00 pm
Congradulations!!! That’s great news. Glad to hear from you.
Posted by southerncomfort83 on April 13, 2014 at 5:31 am
Jana I’m new here and wanted to message you but can’t figure out how so I just hit the first “reply” button I seen… I am a addict here is a bit of my addiction past..
at age 22 (now 31) I became so sick I hurt all over all the time couldn’t eat all I wanted to do was sleep had headaches everyday no energy at all just not myself I was working as a phlebotomist in a dr’s office with 3 providers 2 md’s and a PA. Not feeling good or like myself I started seeing the PA told him all my symptoms and him being a total quack and dirty old man would tell me I just needed to go home and “get a good piece of ass” then he would write me whatever pain pill he felt like writing that month… me hurting all over I would take the medication knowing I had a additive gene because my mother was also a addict it never crossed my mind to be careful instead I started feeling some what better got use to being “numb” started loving it! It was a awesome was to deal with life to deal with a bad marriage to deal with my mother dying to deal with any problem big or small in a years time I was hooked… Finally knowing myself I was hooked but no one else knowing …yet..
I decided it was time to see the Dr not the PA anymore come to find out I had been bit by a tick and had had RMSF The whole time for over a year! Had the PA done something besides be a ass I may have had a chance to go down a different path but anyway it happened and I pay every for it… I have been on subutex for 2 years now I’m doing ok but lately I have started hurting and aching all over again I wanna see a Dr but how do i convince them I don’t want a pain pill I just wanna find out why I’m hurting so bad again??
Posted by janaburson on April 14, 2014 at 1:10 am
I don’t know any better way than the way you just explained it – you’re doing OK on subutex but have pain and don’t want a pain pill, but rather would like a diagnosis.
Posted by southerncomfort83 on April 14, 2014 at 1:22 am
I guess I’m afraid they will tell me its not real pain because they say when you become addicted that your body no longer knows what “real” pain is but I know the difference subutex takes care of what I call phantom pain this is real achy bone joint pain one Dr told me after being dx with RMSF that since it stayed in my body for so long without treatment that I would always have flare ups and that my joints could have damage as well what are your thoughts about that?
Posted by janaburson on April 14, 2014 at 1:28 am
I don’t feel I can answer that one on a blog – too many variables. All I can recommend is keep talking to your doctors.
Posted by Cynthia on April 13, 2014 at 11:47 pm
I have been off pain pills over a year. I am still on 4mg suboxin film a day. No matter how hard i try icannot seem to taper any lower. i still feel like my life is a mess. My house is always dirty,I’m a crappy mother,i never have any energy.life just sucks now.i feel like pain pills ruined what ever chance at a happy life i ever had. My question is how long after quiting pain pills does it take to be normal again? Do i have to quit the suboxin for what i am looking for? I think back to the times before pain pills and my life was pretty good. Used to do lots of thing’s with the kids,managed to cook dinner 5 night’s a week and keep my house somewhat clean. Now I’m lucky if i cook once in two weeks.i feel like my kids are loosing out on a good life. The only good thing is i am finally financially ok after paying off all the title loans,payday loans pawn shops and ect from my former addiction. Any advise would be great.
Posted by janaburson on April 14, 2014 at 1:25 am
the short answer to your question, which I think is, “Will I ever feel OK off all opioids, including Suboxone?” is… we don’t know.
Many patients who have used opioids for a period of time feel lousy for a very long time after stopping them, with the fatigue you describe. Some patients feel a little depressed, irritable, and achy all the time. We call this post-acute withdrawal. It’s not as bad as full withdrawal, but it’s draining.
Why do some people feel this and others don’t? How long will it last? there’s no way to know at present. Clearly, it can last weeks to months, and it’s very hard to get through that without relapsing back to opioid use. is it related to the amount of opioid used, the length of time you used opioids, or some other factor, like genetics? All I can tell you is there’s much research going on about this now.
We don’t yet know how long is the ideal time to be on suboxone. some patients decide they want to stay on it indefinitely, since they feel so much better while on it. Opioid addicts probably need a year or two on suboxone to give them time to make life changes and address other issues, both mental and physical.
For now, if you feel bad on 4mg, I’d consider increasing the dose to see if you feel better on a higher dose. Yes, that will mean you’re on opioids (Suboxone) longer, but unless there’s a reason you must be off suboxone soon, why allow more time to get counseling, see a doctor to make sure there’s no other physical health issues going on, and continue to make progress financially? And for sure, talk to your Suboxone doctor since he/she knows your history. Explain to him/her how you feel.
Posted by Susan Strauss on April 25, 2014 at 7:17 pm
I attempted to inject subutex but missed the vain. It started as a rash but now looks more like purple streaks on top of light purple rash area. I don’t have health insurance but if this is going to kill me I’ll take the bill. It burns like fire is on my skin. Please help.
Posted by janaburson on April 26, 2014 at 2:22 pm
The only thing I can do is to tell you to go the the nearest emergency room.
Posted by AnnaJ on May 2, 2014 at 12:15 am
I’m hoping you might be able to give me some advice, as I’m in a bad situation, but unsure as to how to proceed without making it worse. My story is unique enough I don’t want to go into details even online… but in a (very small) nutshell, I am a chronic pain patient, tho currently with no doc/treatment (ACA/Medicaid transition screwups, yay), but I am able to have the prescriptions that I need to keep functioning in the meantime written, and pay a small fortune for them out of pocket. Which doesn’t include my extended release pain medication as it’s way too expensive, so doing my best with just the breakthrough pain med. Which was ok tho not great, as by now I’m rather used to being in pain all the time and know even with the extended release med, I’d still be in some kind of pain.
Problem is, my boyfriend is an addict and also has mental health issues including depression, finally got him into treatment last year, but visits are few and far between. Meanwhile, he’s no longer taking his prescribed meds on a regular basis – but he is taking mine. Technically he “asks”, in actuality there is no question he’ll get them, he’s got a variety of “reasons” I guess so he can pretend he’s not manipulating me and/or what he’s doing isn’t completely 100% wrong…. yes, I should have walked away a long time ago, but I didn’t, so that kind of advice isn’t helpful – I’m too sick and broke and in a new place where I hardly know anyone – so just picking up and leaving is not an option.
I want to go to the same mental health facility (free) and he even encourages me to, as obviously I’m extremely depressed now – well, that’s more my reason, he thinks they’ll get me on Medicaid, etc. like they did him – and, of course, he tells me to “omit some of the truth” – as in, not tell them he is taking my medications. Obviously, he doesn’t want to loose “the best of both worlds.”
I know I need to do something about this, for numerous reasons… I can’t keep living in so much constant pain with barely any relief, and going through withdrawals every month… first just one week a month, but he’s working his way up, this month it’ll be 1/3rd of my pain med prescription… and it’s certainly not helping him any. But I’m terrified if I tell the people at the clinic, I could end up loosing my right to be prescribed pain meds – and with chronic and incurable health issues, that’s not an option I care to entertain. I’ve looked through their privacy rights info and it’s still unclear… I don’t know if legally they have to tell “the authorities” what’s going on? I don’t need to end up being labelled an addict (if my pills were counted now by someone obviously I’d be way short) or as if I’m selling them?! I am at my wits end… I have never abused my meds, gotten early refills, etc., even without being able to afford the extended release med., etc., etc. – but now, along with all the other issues his addictions and mental health issues have caused, I have to worry that I’m the one that could end up in trouble or denied pain meds – while he’s being patted on the head and told they’ll get him help (sorry, I know that sounds really snide, so I do want to make it clear that I believe addiction is a disease and that his issues are just as serious as mine – part of why I’ve stuck with him and encouraged him, especially when he makes progress with treatment and kept us both with a roof over our head for so long)… when his job is done until fall in a few weeks he promises he’ll go for suboxene treatment, but can’t now ’cause there are too many meetings, etc. he would have to attend and he works too much for that… but I’m pretty sure once his job end there will just be another excuse, there always has been.
How do I let the mental health people or someone know what’s going on without risking my own right to pain medications? Or am I worrying about something I shouldn’t? I can’t find answers anywhere online, it’s an impossible situation to google… and I’m just about at the end of my rope.
Thank you for reading at least and I hope this makes some sense, pain is also scrambling my brain more than my health issues already do…
Posted by janaburson on May 2, 2014 at 2:50 am
The best solution is simple: don’t allow another person to take medication prescribed for you. It’s illegal, and as you noted, making his situation worse. You know he has a problem with addiction, so why are you giving him fuel for the fire?? What if he overdoses on medications you gave him? In some states you would be criminally charged, besides which you would of course feel awful.
Nothing good will come from giving away your medication. If you can’t or won’t stop giving it away, you shouldn’t be prescribed this type of medication. That may sound harsh, but it’s the only other solution.
Posted by Shannon on May 18, 2014 at 7:11 am
I have a pretty great question that I’d like to just Bluntly Ask.. The Story behind the question is very lengthy and basically, Neither Here Nor ThereThere to be honest. .
On each Suboxon Strip, there is a Code on the back. Is that code linked to the person whom it was prescibed to?
And if so, Is there anyway the public can access that program as well?
For instance, My young neice has been buying them from someone who gets them prescribed to them. She absolutely will not any type of information about who is selling them to her BUTTT the other day, I found the (whatever you call the thing that the strip comes in) and noticed that code thing onthe back. I don’t Want to take this to the authority’s due to my nieces involvement. However I want to know once in for all who she is getting them from so I can then alert maybe the clinic that distributes them of the patients wrongful doing with it. Idk exactly what i would do at this point but i just have to find out who this person is. Any help?
Posted by janaburson on May 18, 2014 at 11:42 pm
Yes, the code on the Suboxone film package is linked with a pharmacy and a patient. No, the public can’t access this; it’s protected health information.
I can’t think of anything you can do except talk to your neice and let her know how worried you are about her, and maybe offer to take her to get treatment in a safe, legal way that will also include counseling.
Police probably have the authority to track down black market Suboxone but you would have to go to the authorities to report this.
Posted by Jules on May 25, 2014 at 4:46 pm
GUYS – i got off 6 MSIR30’s daily and 8 Norco/Lortab’s, prescription for scoliosis, several herniated discs, after taking the for 20 years (gradual build-up to that level) –
like this: i used KRATOM from a quality vendor (first order was just lawn clippings, i think, but second batch was quality!). If cannabis is legal where you live, use the indica – the saliva just makes you feel crazy, so i hear.
FIRST, I got off the Norco/Lortab, since it’s SOO mentally addictive. Kratom really helped with the depression that goes from those evil pills! After that, i just had to deal with the pain from going off the morphine pills.
It took about 2 months (with a break from rehab’ing from the Norco) to get off everything. I am now relatively pain free WITHOUT pain pills.
Those pills can & frequently do cause ‘hyperalgesia’. They literally make your body have more pain!
It’s worth it – i really DO feel fine now without pain pills.
There IS life after pain pills.
Best part? I’m not attached by the nose to a nosey, distant, aloof, uncaring pain management doctor who takes about eleven – two week vacations a year, and is never there for you.
Just think: you could take the money you spend on pain pills and fly or drive to CO, and stay wherever you have to, to get off these drugs. But if you can’t do that, I’m TELLING YOU, the Kratom-does-work-for-pain-and-depression-while-getting-off-those-drugs!
Yes, in case you were wondering, there IS A GOD.
Posted by Virginia Hall on May 27, 2014 at 2:38 am
I have been on Suboxone for about two months now. As of a week ago my hands and arms are going numb and are hurting as well. In addition my feet and lower legs are swollen too. Do I need to find another treatment to stop my opiate use or will this side effect go away in time?
Posted by janaburson on May 28, 2014 at 1:23 am
I’m not sure. That’s not a common side effect of suboxone, though I’ve had methadone patients report swelling, and I know methadone causes some people to retain sodium which results in swelling. I think you should talk to your doctor.
Posted by Daff on May 29, 2014 at 2:45 pm
I wish I had access to your blog in 1998 when I started the methadone clinic. Your blog is informative and just really good reading. Thanks for sharing.
Posted by Lisa on June 7, 2014 at 7:45 pm
Thank you for helping me to understand this law on hydrocodone better.I’ve been on this medication for several years. How can a doctor prescribe this medicine for so many years to a patient and you go back for youre next months appt. And without notice he has closed his office and want open his door and you can’t even get you’re medical records in anyway. What law protects you from that.Where do you turn because you can’t even think and the pain physically is so overwhelming it becomes a mental issue.
Posted by janaburson on June 8, 2014 at 2:42 am
Legally, I don’t know what you can do. But you can file a complaint with the medical board of your state, describing the events.
Posted by Lynn on June 24, 2014 at 5:28 pm
My 24 yr old son is a chronic relapser – he continues to fall, but gets back up and is now trying again. He has Hep C and often complains of fatigue – he lives in Florida and I in MD. Is it dangerous to his health for him to try the vivitrol shot ? He can’t seem to get past 3 months 😦
Posted by janaburson on June 27, 2014 at 11:50 am
I depends on how bad his liver is – his doctor should be able to tell you. If he has damage from Hep C it could be too risky…but then again…so is opioid addiction.
Many people relapse often in recovery, especially early on. Has he already tried methadone and/or buprenorphine?
Posted by lynn2609 on June 27, 2014 at 4:32 pm
He is adamant against using methadone. He has used suboxone in the past but easily misused it (of course this was years ago when he wasn’t as serious about his recovery). He has been off and on for approximately 7 years and has been in Florida for the last 4 – presently he is in a halfway with IOP and a sponsor and as usual he thinks he can do it this time. Maybe he can but his recurrent relapses always occur around 3 months of sobriety and he has 5 weeks. I have been advised by his sponsor to stay out of and not discuss his sobriety. Probably a good idea?
Posted by Johnb46 on July 15, 2014 at 8:49 pm
A big thank you for your article.Thanks Again. Great. aaffedcdddcd
Posted by Gini on July 21, 2014 at 2:00 pm
If you seek treatment for pain pill addiction are you covered under the HIPPA privacy act. Will your employer be notified?
Posted by janaburson on July 21, 2014 at 11:38 pm
No, your employer should not be notified.
Posted by Kim K on July 30, 2014 at 10:08 pm
Hello
I’m a 40 yr old single mom of a 17 yr old girl and was diagnosed with MS in 2007. I’ve never had flare ups til this year. My mother pretty much all of my life has been a pain pill addict. From codeine to lortab to methadone to norco and more. I was a cheerleader thru HS and she never once came toy games. It was my passion. I remb her sleeping. She’s been to prob over 5 rehabs. We’ve done the family counciling. We def have had our share of family trauma. Who hasn’t. She absolutely thinks she is not an addict. That she has serious pain. She takes 90 Norco, 90 Valium, 120 muscle relaxers and more. She’s has had seizers for years and years from encephalitis and her addiction. My daughter has watched this like I did growing up. She was a good grandma when she quit for a while. I have an older brother that won’t help. Everyone has turned their back on her but me. My daughter will not have anything to do with her anymore. I don’t know what to do for this addict that I’ve grown so cold towards. I feel like I abandoned her but yet she doesn’t think she needs help. I feel like I’ve tried everything and now suffering with my MS from the tremendous stress. Do I just cut her off? If I do she’s completely alone.. She gets messed up and falls and blacks her face. Been thru so many hospital visits. Had a horrible retal prolapse? Her rectum was so stretched from being constipated from pills they had to remove 2 1/2 feet . So many seizures. So angry. I just don’t know what to do
Posted by janaburson on July 31, 2014 at 1:07 am
You eloquently express the suffering families of addicts experience. I don’t think anyone can tell you if it’s right to cut your mom off or not…please get some counseling help for yourself to help you make the best decision. Also, consider Alanon as a way to talk to other people going through the same thing, or Naranon.
Posted by Alan Clark on August 9, 2014 at 2:48 pm
Dr. Burson, this blog is so great. I’m 30 years old and started opiates when I was 14, unfortunately. I have been attending a clinic for almost 6 years. I had gone to one before this and was not a good patient and exagerated the amount of methadone I needed. Finally, i moved to another state and switched clinics. I ended up going fro, 180mgs down to 90mgs, which is what I really needed. I would probably be dead or at the very least, in prison, had I not seeked actual recovery. There have been a couple slip-ups with marijuana since then, but MAT is a god-send when using it is inteneded. I stumbled across your blog about 2 months ago and wanted to thank you. Your knowledge and perspective is very refreshing among medical professionals. I’ve come across several physicians that view methadone as one doctor told me, “trying to pop a pimple with a sledge hammer.” He was a board certified addiction medicine specialist. He was prescribing me Suboxone but hated methadone (he’s also an “recovered” addict). It amazes me the stigma that methadone patients receive. My point is, thank you. Your advocacy and the accurate information you distribute is a wonderful weapon against the misinformation and propaganda anti-MAT individuals spread, even some medical professionals, sadly. Thank you, thank you, thank you and please keep up the good work.
Posted by janaburson on August 10, 2014 at 2:15 am
Thank you for the thank you!
Posted by chasidydianne on September 5, 2014 at 1:38 pm
Hi, my name is Chasidy & I recently began treatment with suboxone 16mg a day. At my first Drs appt the Dr was very nice & explained to me how the suboxone works & he said that it might not take away all my cravings but that it should take care of the worst of the he also said though that sometimes when a person who has been addicted to opiates for a long time like myself (over 16 years) that methadone may be the best option. And after just a short while on the suboxone Im starting to believe him although some people say I should give this medication some more time to work. Im am worried though that if I continue the suboxone for longer that my tolerance is just going to get higher & higher & then a low dose of methadone might not be enough & if I am to switch to methadone I prefer to stay on the lowest dose as long as possible. Is this a valid concern? At the moment I am miserable everyday the suboxone is proving fairly good at keeping the dopesickness away but its doing little to nothing for my pain witch in turn leaves me feeling like a need a pain pill from the moment I wake up. Im taking handfuls of OTC pain relievers & sleepaids with very little relief & hardly any sleep. Is it true some people do better on methadone & if so is it better to make the switch as soon as possible? Thank You
Posted by janaburson on September 9, 2014 at 12:08 am
with buprenorphine (Suboxone) you won’t develop a tolerance to the anti-withdrawal effect of the medication, so you won’t need to continue to go up on your dose for that reason. But pain is a different issue than tolerance. Also with Suboxone, there is a ceiling to the amount of opioid effect you get from the medication, which occurs in most people at around 24mg per day. You can take the dose higher than that…but you won’t feel any added benefit.
Methadone is a full opioid. If Suboxone is too weak and doesn’t control withdrawal symptoms, methadone is the next step. As a full opioid, there’s ceiling, so no, taking Suboxoone won’t make your tolerance too high for methadone.
Medication-assisted treatment of addiction is like chemotherapy: you get the best results when you take enough of a dose to do the job. Otherwise, if you try to keep your dose low, you are more likely to have relapses to illicit opioids
Posted by Cooper on September 13, 2014 at 3:03 pm
Dear Jana
I was hired at a Methdone clinic as a counselor under supervision after being laid off from a non counseling job of 17 years. I desperately needed a job and qualified for supervision because I had enough psych hrs with a non psych degree. There has been no training on how to counsel at this for profit clinic. I want to learn how to help these people but don’t know how to counsel and was given handouts on various subjects such stages of recovery, triggers, coping skills and relapse prevention and told to use them for counseling. I don’t judge and was told to use a person centered approach, cbt and motivational therapy. I spend my weekends researching these methods but still don’t know what to ask or say during counseling and feel inadequate and dread each session. Can you recommend some books that give samples of sessions or will teach me what to say to the clients? Some clients don’t care and continue to have positive UAs but some truly want help.
Posted by janaburson on September 14, 2014 at 3:28 pm
I’d say the fact that you have a passion to learn to do your job better you are already going to be a great counselor!
Here’s a blog entry from long ago, directed at your question:
I have a fair number of methadone counselors who read my blog. I’m often asked by these counselors what books I recommend, which is like asking me what kind of dessert is good. The list is so long. But here are the ones all methadone counselors should read:
1. Medication-assisted Treatment for Opioid Addiction in Opioid Treatment Programs, by the Substance Abuse and Mental Health Services Administration. This is better known as “TIP 43,” because it’s the 43rd book in the series of treatment improvement protocols published by SAMHSA. You can get any book in the series for FREE! Yes, this book and several others are free resources. The website is: http://store.samhsa.gov. While you’re there, order TIP 40: Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction, and TIP 35: Enhancing Motivation for Change in Substance Abuse Treatment. Then browse around, and see what else interests you. This is a great website, and all addictions counselors should be very familiar with it. There’s great material for counselors and their clients.
2. Pain Pill Addiction: Prescription for Hope, by….me. Hey, it’s my blog, so of course I’m gonna list my book. At least I didn’t put it at number one. But seriously, I do think my book describes what opioid addiction is, why this country is having such problems with opioid addiction now, and the available treatments for this addiction. I focus on medication-assisted treatments, which means treatments with methadone or buprenorphine, better known as Suboxone. After reading my book, any substance abuse counselor should be able to talk intelligently with patients and their families about the pros and cons of medication-assisted treatment. I tried hard to base this book on available research and not my own opinions, though I do state some of my opinions in the book. My book also has summaries of the major studies done using medication-assisted treatments, so that if you need resources to prove why methadone works, you’ll have them. OK. I’m done blathering. Order it on EBay and you’ll save some money.
3. Motivational Interviewing by William Miller and Stephen Rollnick. This is a book all addiction counselors should have… and read. I’ve learned so much about how to interact with people as they consider if, how, and when to make changes in their lives by reading this book. The authors demonstrate how the Stages of Change model easily fits with this style of counseling. There are some solid examples of how to incorporate MI techniques.
4. Cognitive Therapy of Substance Abuse, by Aaron Beck et. al. This is a venerable text describing cognitive therapy as it applies to substance abuse. The book is relatively concise, but it’s still dense reading. Get out your underliner because you’ll want to find some parts to read again. The dialogues in the book that serve as examples are instructive. This book has been around for some time, as texts go, since it was published in 2001.
5. Narcotics Anonymous Basic Text, by Narcotics Anonymous World Service. Now in its sixth edition, this is one of the books that serve as a foundation for 12-step recovery in Narcotics Anonymous. If you are a counselor who’s in recovery, you’ve probably already read it. If you’re not, you need to get it, read it, and be able to talk intelligently about the 12-step recovery program of this 12-step group. The AA “Big Book,” which is AA’s version of a basic text, has much of the original old-time words and phrases, and speaks mostly of alcohol. For these reasons, some addicts won’t like the Big Book as well as the NA Basic Text. However, the Big Book does have a certain poetry that will appeal to others. (….trudge the road of happy destiny…) You can order it at http://na.org or go to that site and download it as a pdf.
6. The Treatment of Opioid Dependence, by Eric Strain and Maxine Stitzer. Written in 2005, this is an update to a similar title written in the 1990’s. This book reviews the core studies underpinning our current treatment recommendations for patients in medication-assisted treatment of opioid addiction. I don’t know why more people haven’t read this book, because it’s relatively easy to understand. Don’t make the mistake of assuming it will be too advanced for you. Get it and read it.
7.Addiction and Change: How Addictions Develop and Addicted People Recover, by Carlo DiClemente. This book describes the paths people follow as they become addicted and as they recover. It’s focused on the transtheoretical model of the stages of change, so named because it can be used with many counseling theories. I think this is a practical book, and easier to understand than some texts.
8. Diagnosis Made Easier: Principles and Techniques for Mental Health Technicians, by James Morrison M.D. This is an improvement of his earlier book, DMS IV Made Easy, written in 1992. At any work site, addictions counselors will have to be familiar with the criteria used to diagnose mental illnesses. Since around 30 – 50% of addicts have another co-occurring mental illness, you need to be familiar with the criteria used to diagnose not just addiction, but these other illnesses as well. And this book makes learning relatively painless. It’s practical and easy to read, and based on common sense. It contains many case examples, which keep it interesting.
9.The American Disease: Origins of Narcotic Control, by David Musto. This book has been updated and is on its third edition, but so much has happened since this last edition in 1999 that the author needs to write an update. This is an interesting book, and it moves fairly quickly. This information puts our present opioid problem into the context of the last century or so. As an alternative, you can read Dark Paradise: A History of Opiate Addiction in America, by David Courtwright in 2001. I included this book, but be warned it’s heavier reading. This author is an historian, so maybe his writing style didn’t resonate with me as much. Still, he has much good information. You can’t go wrong with either book. You could also read The Fix by Michael Massing, which is another book about the history of addiction and its treatment in the U.S… This last book doesn’t focus on just opioid addiction, but still gives all the pertinent history. This book is written by a journalist and will keep your interest. It was written in 2000.
10. Hooked: Five Addicts Challenge Our Misguided Drug Rehab System, by Lonnie Shavelson. This book, written by a journalist, follows five addicts through the labyrinth of addiction treatment. You’ll see the idiotic obstructions addicts seeking help are asked to negotiate in our present healthcare system. I was angry as I read the book, seeing obvious simple solutions that couldn’t be enacted for one administrative reason or another. Let this book make you angry enough to demand change from our system. Be an advocate for addicts seeking treatment.
Posted by Tim Smart on September 16, 2014 at 9:52 pm
Hi. First off id like to thank you for taking the time to do this for people. Youve saved more lives than youll ever know. My question is…I take suboxone 3 8mg/4mg strips per day. Prescribed. I go to an addiction specialist. The drug is said to have this amazingly long half life and last a long time. I dose first thing in the am 2 films then a third film in the evening. Im also being treated for severe pain by same doctor. I find that when I wake up in the mornings I feel like shit. Have been on it 8 months now and clean. Have taken more sub than prescribed here and there but havnt touch ir morphine my d.o.c. . Why is it that its not lasting for all those hrs for me? My doctor says he has patients who forget their dose sometimes and don’t even notice…I wake up in wd daily. Can you please tell me why this is?. I’m 6°6“ 195 lbs. 24mgs suboxone daily minimum. Thank you and hope for. a reply soon.
Peace
Posted by janaburson on September 17, 2014 at 1:32 am
I don’t know why you are having this problem other than possibly the medication isn’t strong enough. Have you asked your doctor for advice? Have you asked him if methadone would be more appropriate? Have you felt bad for the whole 18 months? could there be another medical issue going on?
Posted by Sick &Tired on September 18, 2014 at 1:55 am
Hello Dr,
I just want to vent a little. The state & fed rgualtions is absurd on addiction treatment, especially in Tn where I live. The government makes it so easy to get hooked on these pills then all of a sudden tell you no you can’t have them. I agree about Tn having so many opioid addicts & overdoses but yet they want to crack down on people getting help instead of cracking down on the quack doctors who run these pill mills. It blows my mind. I’ve been an opioid addict for 10yrs and I can’t afford to loose my job & check into rehab. The suboxen program is the only thing that’s helped me continue to be a somewhat normal productive member of society. And most people will relapse but to punish them for that is wrong! They will have a major heroin epidemic like crack was in the 80s because of there nonsense. Mark my word thanks and keep writing
Posted by Jessica Lingerfelt on September 29, 2014 at 8:26 pm
Hi- I am from NC and went to college at Appalachian State. I became addicted at the age of 20, starting my addiction in college and at 24 I began methadone through an opioid treatment center. I turned 28 in May. I am currently on subutex and had made the change over to this from the methadone this past April and have tapered from 16mg of subutex to 4mg of subutex, which I am still currently on. I am getting ready to leave an impatient rehab where I have been since July 1st in Smithfield, NC with my 2 year old and will return on October 17. I have tried to find a doctor there to continue my 4 mg without having to go back to a clinic. Any names would help.
Posted by janaburson on October 3, 2014 at 12:45 am
You can check http://buprenorphine.samhsa.gov or try http://www.suboxone.com
Posted by Jada on October 24, 2014 at 4:48 pm
Jana I was hoping u could help me. What is the process for transferring from one clinic to another? Also will infractions from my current clinic follow me to my new one? Or will I start over?
Posted by Jane on November 3, 2014 at 3:30 am
Please help!… The last few years I’ve been abusing pain meds and I need/want help to get off them. I don’t know how to do this alone.. I’ve tried, but I get extremely sick and cannot function at all. Work, kids, etc, life in general. I don’t feel that I can share this with anyone and don’t know how to seek help?… Don’t have much of a family support system, single mom, no husband or bf and I don’t feel comfortable telling my family doctor this. I’m ashamed I’ve allowed pain pills take over my life.. After 3 surgeries for broken bones, pretty close together, coupled w/ the loss of my cousin/brother at a young age in a tragic car accident, and even after my bones healed, I felt that continuing to take the pills was taking some of the emotional pain away from my life as well.. and I don’t know how to stop. I’m certain most peoples advise would be “go to rehab” but that simply is NOT an option for me. I have nobody to care for my children, and I will lose everything if I cannot work, including the roof over mine and my kids heads. I also understand that I’ll lose everything if I don’t get off the pills as well… But there must be another option out there for me due to this situation?… I’ve never been to meetings, spoken to anyone about this, in fact, this is my very first time reaching out at all. I’m accustom to doing things alone, and I’ve tried stopping about 4-5 times, or weening myself off, but I keep getting sick, which causes a chain reaction in not taking care of kids, and losing work and money to pay the mortgage. Hoping somebody out there can offer some options or solutions besides rehab. Thank you.
Jane
Posted by janaburson on November 6, 2014 at 3:06 am
As hopefully you’ve read on this blog, office-based outpatient treatment with buprenorphine (better known as Suboxone or Subutex) is an excellent option for s person like you, with the disease of opioid addiction. You can go to http://buprenorphine.samhsa.gov and click on your state to find a provider in your area. Or similarly, you can find an opioid treatment program, most of which use both methadone and buprenorphine.
Posted by Kim on December 6, 2014 at 4:59 pm
Jane, I just read what you wrote and wanted to tell you MY story of recovery and addiction…. My name is Kim and I am a 46 yr old opiate addict. I began taking opiates after a car wreck and then became firmly addicted after severe problems with female issues that resulted in 5 surgeries in a one yr period, followed by a complete hysterectomy. Unfortunately I knew very little about addiction then and assumed I could just stop the pills once the worst of the pain was over. I began to have flu-like symptoms and a headache so I went to the ER. I was given antibiotics and a shot of Demerol for the headache/body aches. It was only then that I realized it was not the flu but withdrawals I was experiencing. This was at the time when Vicodin and other brands of hydrocodone were really getting handed out like candy. I lived in a small town with an old DR that actually was nicknamed DR Feelgood because of his lax prescribing habits. One week Id get hydrocodone, the next time Tussionex cough medicine (it has 10 mg of hydrocodone per tsp) then Percocet, Tylenol with Codeine etc..After that I began having my husband and even friends to go for me. Id give them money to go they would give me the prescription. This went on for about 5 yrs and then Stadol nasal spray came out. It was supposed to have been “non-addictive” but of course this was NOT true! I became addicted, switching between the Lortab 10’s and the spray. After 8 years of this my tolerance was huge. I could take 12-15 Lortab 10’s every 6-8 hours. I know that’s unbelievable but I did. I weighed 350 pounds and was in and out of the hospital constantly, Surgeries and illnesses alike…One day I went to a next door neighbors when I was very bad in withdrawals. He was a vietnam vet and always had pills of some sort. I got a Dilaudid 4mg from him and started to take it. He told me if I put it in my mouth he’d never give me another one. I was thinking what does he expect me to do with it?? He told me to sit down and he got out a hypodermic syringe and that was the day my life went downhill faster than it ever had before. Being addicted is bad enough but IV addiction is a whole other animal. I ended up using Dilaudid, Morphine , Demerol, and Oxycontin..those were my preferences. After awhile the cost was eating me alive. I was an assistant manager at a large chain hotel and NO ONE knew. I had kept a dirty secret from most everyone. I was raising 3 daughters alone and couldn’t allow my habit to become known. I began buying Heroin because it was cheaper. That changed things yet again. If I was dope-sick i couldn’t go to work..I also began stealing. I had never stolen even a pack of gum in my life yet here I was. I would rent out the room, take the money and not put it in the system. I had a friend that was an addict and a housekeeper there so when she came to work , she would clean that room first before she began her other rooms. It worked for awhile but when I was caught got fired. No charges were filed but I had a nasty stain on a perfect work record. At this point I ended up moving from one state back to my home state to be with my grandmother and dad. My kids were getting to be in their teens and knew what was going on somewhat. I knew I had to stop. I was so tired of the mess, the game of it all, the way I felt and the shame. I researched Methadone treatment and Suboxone. I knew I had a huge tolerance and habit and most of what I read made me pretty sure that Suboxone wasnt for me. It was more expensive, and I had no insurance for one. Several people I had talked to said that Methadone would work better with my tolerance and long history as well plus Id have a personal counselor as well, which I knew I needed. By now I was also positive for Hepatitis C, severely Diabetic and Insulin dependent, had terrible neuropathy, Fibromyalgia, chronic bowel problems ..more than I can list here as far as medical issues. I needed to stop if I wanted to live. I got on a local Methadone program and I haven’t looked back ONCE! My 11 year anniversary is Feb 19th 2015. I couldn’t be more proud and I am happy to have joined LIFE again. I’ve lost weight and re-married.. I have a 4 bedroom home that’s only 4 years old and I drive a Lincoln! I could never have dreamed of being here and wouldn’t be without being in MMT. My twin girls are 24 and their oldest sister is 25. I have 2 grandsons and one on the way. The girls are so happy and proud of their Momma and tell me so every day. I have a loving husband and my family is very supportive as well. My 94 yr old grandma says this is all she ever wanted for me..that brought tears to my eyes hearing it. I’m no longer even tempted to use pills even tho my husband is prescribed them occasionally for a bad knee and being a diabetic Im around needles 3 times a day with no temptation or trigger there either! I’m on 130mg of methadone and I take it every morning when I wake up. I go to my clinic once a month because I have earned the right to have take-homes for that long which is the highest honor in MMT clinic. It says TRUST! I haven’t had a single dirty UA except for the one when I first walked in the door. I wanted to tell you this LOOOOONG story to show you that even the worst can benefit from Methadone therapy. Now not everyone has the same story don’t get me wrong. There’s people at the clinic that are not working the program, they have been going for 10 years and still have to come and be dosed in front of staff every single day! But that’s because they are still living the “old” lifestyle. You have to decide YOU want to change, Not for your parents or spouse but because YOU are sick of it and know there’s NO FUTURE in being an actively using addict. Im still an addict but I am not USING anymore. I know that if I’m not careful and committed to my recovery I could slip back. But I choose not to. I let the medicine do its job and I do mine. I only associate with sober living friends and family and I keep myself busy with positive things. Its hard in the beginning but it does get easier and Im thankful for all I have today considering where I WAS!! Not everyone agrees with MMT..but it’s in my opinion that this is my life, my body and my choice for recovery!!! If you would ever like to talk..ask me ANYTHING! I hope you find a way to get yourself into a program that works for you. What did it for me may not for you and vice-versa. Im just saying that MMT was my saving grace. God led me here and Im not leaving!!! Good luck in your endeavors! Thank you Ms. Jana Burson for the opportunity to tell my story! I LOVE LOVE this blog!!! Sincerely K. Collins /East Texas
Posted by Kim on December 6, 2014 at 5:04 pm
One thing I forgot to mention was that with the Methadone therapy I had no withdrawal symptoms even at the level I was at. I was so scared of withdrawal as Im sure most opiate addicts are and so I wanted to add that just in case you were wondering . As I said before If you want to talk or ask any questions Id be very happy to helpor even just to listen. Again good luck!
Posted by fleentjtecumseh on December 15, 2014 at 3:20 am
im trying to find some information on ua because my clinic in Oklahoma is administrative detoxing me you have 4 dirty uas before you get in trouble i had two then in November they took two ua one on the 9 and one on 15 it was a normal ua okay so there not supposed to be able to use two in one month like this but now that im fighting it they changed their story saying that i was in group and appeared drug affected but i wasnt and that they did an onsight but if i was drug affected then they would not have dosed me after group but what really happened is i came in the next day and as normal ua it just said ua okay so i went back signed my initials and did my ua and i left but if it was an onsight they should have stick tested it right there with me not sent it off i have appealed but been denied 2 times i have been in the clinic for 4 years and up until November last year i was on phase 5 every since thirty days after i tranfered doing very good i was on phase 3 two months ago they are taking me down very fast i am on 96 mg but i have been on methadone for 7 years 4 thru this clinic which i was pregnant when i transferred and 3 at another clinic wich i had a perfect record bbut since i trasferred i have to attend 3 groups a week 1 when i was on phase 5 and listening to all horror stories about using what is that going to do it made me want to use but also you can buy anything at the clinic and i mean anything i have got worse since i transferred here im very scared and just not sure what to do anything helps im afraid with all the years ive been on it that i will be very sick im also bipolar and manic depression but wont take psychological medication so i am very afraid of what this is going to do to my mental state i talked to my counselor about transfering and she told me she would make sure that doesn’t happen she shouldn’t be like this to people i am 27 and have three kids they are not only hurting me but also my family if this doesn’t work im afraid that i will wind up back where i started Thanks
Posted by lilgirllostn1980 on December 7, 2014 at 6:12 am
K Collins I too am a long term mmt pt. I have been going to mmt for over 14 yrs now. I’ve tried to taper from mmt and realized it wasn’t time for me yet. A lot of ppl don’t think I should still be on mmt and some even say I’m not in real recovery because I’m still dependent on an opiate but I don’t care what they say. I look at it this way, you would never tell a diabedic dependent on insulin to control their diabetes to stop taking insulin or a person dependent on blood pressure meds to control their HTN to stop taking blood pressure meds. I would never tell someone who is dependent (noticed I say dependent not addicted) on opiate replacement therapy to control tier addiction to stop taking their medication either. Do I want to stay on MMT for the rest of my life? No but I would rather remain dependent on methadone to manage my addiction than to ever go back to the way things were. Even though it’s expensive since my insurance doesn’t pay for it, it’s hard to find a family doctor to treat me because of their lack of knowledge with ORT, I have issues with kidney stones about every 6-7 yrs and I HATE the way I’ve been treated and my legit pain managed in those situations but I would still never go back to that life, ever! Have you had any issues with this? I also attend a clinic in east Texas. I go to behavioral Heath group in center Texas. I was curious where in East Tx you are from but understand if you prefer not to say. I would still love to hear about your experience as a longer term MMt pt.
Posted by Mary on February 5, 2015 at 7:03 am
Hi….wow this is hard I will try to keep this short but it is complicated and frankly I’m confused and scared. I was diagnosed with severe gastroparesis 5 years ago it caused so many problems I had 4 j tubes all got infected with MRSA and had to be removed I also had 4 G tubes same story second verse, 2 major surgeries for bowel obstructions and finally a Bilroth I with an additional small bowel anastomosis in hopes of obtaining better drainage. When I got sick I weighed over 350 lbs I’d had type II diabetes since age 15 and it had done its damage. I was also diagnosed with fairly significant pulmonary hypertension I was on oxygen 24/7 it got so bad that I had to be hooked to a suction pump 24/7 as well due to the unrelenting vomiting, I have been to the Mayo clinic and UCLA as well as basically every specialist in Las Vegas. I have been on TPN 3 times, finally my weight was down to 110 I looked like a skeleton and I knew without a doubt that I was dying. I went on hospice I have been kicked on and off hospice 3 times in the past 4 years, I have been septic more times than I can count, I’ve coded and had hypoxia for over 10 minutes thus I have some mild brain damage…I do not know why I am still alive nor do my doctors, I have never been a spiritual person but have found myself becoming more so as of late anyway…I started off taking my pain meds as prescribed but of course they stopped working my dose was increased and increased, my tolerance only continued to rise, finally my pain doctor at the time said I was on the max dose and could not give me any more, shortly after that I went on hospice, even on hospice with pain meds up the wazu I was still in pain….this is when I started to abuse them…it started with taking extra orally and by the time I hit rock bottom I was injecting handfulls of crushed dilaudid and Benadryl directly into my port one day I missed my port so bad the whole are turned necrotic and I could see the entire port sticking out though the through the skin…I still continued to use through the necrotic tissue….finally I was so sick with a high fever and a pulse in the 180’s that I was taken by ambulance to the ER by this time I had lost EVERYTHING my home, my friends, my pets, my health , my job, everything…I really did not care if I died or not and had not cared for a long time. But withdrawl scared me I had been briefly through it before but I was going through it BAD now. I went on methadone and have been clean for 3 months. I know this was horribly long but I feel you had to understand the story to understand the question….I am legitimately sick…last weekend I had stomach pain so bad I prayed for death…I’m so scared that I won’t take anything but my methadone, ibuprofen, some Xanax for my anxiety attacks (in proper doses) and of course my plethora of laxatives, enzymes and stomach meds. I do not know what to do when I have true pain as I am so scared to relapse, so I just sit there and prays for it to go away curled up in a ball sobbing for the pain to end…through death, through anything…frankly if I was not raised a catholic I would have committed suicide long ago…if I go to the ER and take a dose when the pain is horrible will that cause me to relapse or will I be ok…I’m so confused and I truly, honestly do not have any idea what to do….please help…sick and tired in Vegas…Mary
Posted by Mary Eskew on February 5, 2015 at 4:34 pm
Dr. Burson,
Last night I spent an hour weeping and sobbing pouring out my story to you here on this blog waiting anxiously for some reply, some ray of hope, some direction, see this is new to me because I’ve only been “on the methadone wagon for 3 months” and because when I read your blog and the responses to your patients I thought finally here is a doctor who gets it, how few and far between are those. I can assure you they don’t live in Las Vegas. And I eagerly arose this morning to see if you had given me any words of wisdom or if anyone else whose walked my path had at least and do you know what I found? That my entire post had been erased…like I never existed…thanks a lot for that…I did not use any bad language or “triggering phrases” as they say, and still I get erased…I am SOOOOOOO frustrated, maybe there really are no doctors who care after all, maybe if I don’t say exactly the right thing…you can’t give the exactly right “politically correct” response. I give up, so many addicts say no one really cares as long as you stay out of thier perfect life and don’t cause them grief…I guess they’re right, I feel hopeless…never mind.
Mary
Posted by janaburson on February 5, 2015 at 9:48 pm
No, not erased – I just didn’t have time this morning to approve posts during the night.
You describe what has happened to many people – they begin taking pain meds correctly, for medical reasons, but at some point develop addiction that interferes with the ability to control how much they are using. This can happen to anyone.
It sounds like you are saying you have intermittent severe abdominal pain and not withdrawal pain, at least since you’ve been on methadone the last 3 months. Are you sure you’ve had a complete medical workup of this present pain? sometimes that means sticking with one doctor long enough for him/her to get to know you, see what tests have already been done, and evaluating during an acute attack. So there are 2 issues – finding out what’s causing the pain…-treating the pain when it occurs
I can’t offer medical advice, of course, but there’s nothing wrong with going to the ER with these episodes. People on methadone still have medical issues that cause pain, and sometimes need to take pain medication. That does put them at risk for relapse, but there are strategies for reducing the risk, like asking a dependable non-addict to hold the pill bottle, telling the doctor both in the ER and at your opioid treatment program all about your medical issues.
I approve short-term pain meds for my medication-assisted patients frequently. We try to use non-opioid ways to manage pain if possible…but it’s not always possible, like with surgery, or a broken bone. Just like anyone else, a patient on methadone who breaks a bone needs pain meds. Yes, we need to take measures to help them not to relapse, but that can be achieved. In fact, due to opioid tolerance, sometimes our patients need 15-20% more opioids than a non-tolerant person in such situations.
My recommendation is that you find a good primary care provider, who is willing to collaborate with your physician prescribing the methadone, and ask them to communicate each time you have a flare of abdominal pain.
I hope this helps!
Posted by Mary on February 6, 2015 at 4:02 am
Thank you for your response and I’m sorry about my rant but it is very confusing and difficult when you do not know who to talk to and if you do go to the ER they treat you like a leper and just let you sit there and suffer in agony because you’ve made a bad choice with poor discretion in your life, at least in the usual ER doctors have not been very willing to help…I am a genuinely sick person and this is very frustrating. I have been told by several doctors that my life expectancy is limited most are amazed that I am still alive, I get angry and leave even experts in the fields of gastroenterology and gastroparesis because they tell me there is nothing else they can do, I have done every suggestion, every surgery, and procedure they have recommended and frankly they have only succeeded in making me sicker…they told me to lose weight at one point I was so sick I was down 190 lbs I looked like a walking skeleton, they told me to get a gastric pacemaker, I got it…I have had it adjusted 7 times and it has not helped I vomit at least 4 times daily. I carry vomit bags in my purse at all times. I had the bilroth 1 surgery I became so septic I was in ICU for almost 2 weeks my wound partially dehissed I was in the hospital a month and a half and then in rehab almost 6 months longer. I have grown a lot since then emotionally, when I realized doctors do not have all the answers many including myself thought they could cure anything except maybe really bad cancer or heart disease. I thought certainly they could cure this what I thought at the time was a simple stomach condition. I have suffered so much both with my disease and at the and at the hands of incompetent doctors, then I became an addict which I accept full responsibility for no one shoved those pills in my mouth, but you would think that my medical issues would outweigh the addicts problem and I would be treated like a human being when I am legitimately in pain. I have so many adhesions and so much scar tissue I am no longer a surgical candidate, I have a horrible abdominal hernia, I push my intestines back into my abdominal cavity multiple times a day it’s very uncomfortable but they won’t touch me. My heart caths are done yearly and the pressures between my heart and lungs continue to rise yearly. So please understand I don’t really mean to vent at you but at life. It seems no matter how hard I try there seems to be no happy medium between controlling my pain, suffering uncontrollably, and being an addict. I’m sorry I was harsh I’m just really frustrated, Thanks for your time though I really do appreciate you listening. Your one of the few who actually will.
Posted by Goblins of Addiction, Dr. Jana Burson on February 18, 2015 at 6:55 pm
[…] Thanks to Dr. Jana Burson […]
Posted by nichole webb on February 18, 2015 at 10:49 pm
I am trying to find a doctor in the boone area or wilksboro area that can prescribe me methadone.
Posted by janaburson on February 20, 2015 at 12:41 am
Any doctor with a DEA number can prescribe methadone for pain, but not many are willing to take the risk. It’s too easy to overdose with methadone, particularly if the patient misuses it and takes more than prescribed. And it’s illegal for a doctor to prescribe methadone for addiction in an office setting. Methadone can only be prescribed for addiction at opioid addiction treatment programs that are licensed by the state and federal governments with oversight by DEA, DHHS, etc.
Posted by lilgirllostn1980 on February 20, 2015 at 2:09 am
You may want to check out this site to find a provider near you
http://dpt2.samhsa.gov/treatment/directory.aspx
Posted by ladycajin22 on March 22, 2015 at 5:16 pm
I take zubsolv 1.4mg/.36mg tablet under tongue one a day. I really want to get off and completely sober and not dependent on any of this anymore. Don’t get me wrong I love the creator of this medicine! It saved my life and my family life by doing exactly what I was promised it do and they was able to switch my 20-25 a day loratab 10mg Watson brand pill withoy a single problem or withdrawal symptom! I was actually able to go to work that same day!!! I tapered Down over 9 months ago and went from the zubsolv 5.7mg/1.4mg once a day tablet down to 1.4mg/.36mg twice a day and about 3-6 months ago I went down to 1.4mg/.36 once a day not did not have one issue or withdrawal when tapering. But with that the problem is since I’m already on the lowest dose and just rather quit cold turkey or taper off within 60 days. Here is the problem : this med is a security blanket for me and scares me that if I quit cold turkey I’ll be miserable for 3-6 months. Is that true or does the physical withdrawals only last about 5 to 10 days? I have a kid to take care of and can’t be out miserable for that amount of time. If the cold turkey or tapering method doesn’t work. So I have any other options?
Posted by janaburson on March 27, 2015 at 12:55 am
Please talk with your doctor about if, how, and when to taper. Everyone’s situation is different.
Posted by Michael Anderw DeBolt Jr on April 9, 2015 at 10:14 am
I am taking OxyContin for severe Neropathy and ran out for 2 days because I gave some to my wife. I Was so sick. Freezing while sweating. It was truly one of the worst days of my life.
Posted by Terrie Mckone on May 5, 2015 at 2:00 am
Hi jana, l was wondering if u know how long xanax stays in the system . Yours faithfully Terrie
Posted by janaburson on May 5, 2015 at 3:02 pm
If you mean how long it can be detected in the urine, around 2-3 days.
Posted by Andrew angelos on May 12, 2015 at 7:05 pm
Can you tell me statistically what’s the best plan for tapering off suboxone. My program is closing due to and insurance issue. I started my program last feb 27 th. I was already on suboxone that I was getting off the streets for about 6 months. I was put on a dose of 16 mg daily. This last March they reduced my dose to 12 mg daily. At the end of April I was told the program was going to end due to ins not paying for services rendered. There are 2 other suboxone programs in the area. Although very hard to get to. I’ve spoken with the office and they are going to discharge me on Thursday with one month of meds. Make me laugh because they know that it takes 3 months to get into another program at the least and with this program closing all the people are going to flood the other programs. I’ve been addicted for over 10 years. I didn’t ever really want to stop taking bupe it’s hard to say but I feel like something’s missing when I’m totally clean I don’t feel right I’ve tried it twice for over a year. With the current problems I’m facing I’m planning on tapering off . From experiance I believe that 2 mg reduction every two weeks should keep detox symptoms negledgable. I would much prefer to do a very slow taper the plan was to wait a few more months and reduce to 10 then a few more months then to 8 and so on. Unfortunately I don’t really have that option anymore. I’m concerned that the ins problem will follow to all other programs. Can you tell me from your experiance what the best plan is for tapering. I really like the work your doing wish I would have found your blog years ago.
Posted by janaburson on May 13, 2015 at 2:13 am
I feel for you. This is a bad situation. Can you offer to pay the doctor out-of-pocket to stay in your program or is it folding completely?
I can’t give specific tapering advice. People are so different in how fast they can taper.
I can tell you that for my patients, when they want to start a taper, I usually start at lowering 2mg every 2 weeks, as you say. Then I wait to see how they feel with that and we kind of take it 2mg at a time.
I hope you can find another program in time so you don’t have to taper before you are ready.
Posted by Andrew angelos on May 14, 2015 at 5:08 am
The program is dead for whatever reason. Since I used to get the subs off the street before the program I know how powerful this drug is. I know that I can take it every other day and since I found out I’ve halfed my dose and taken every 48 to 56 hours. I’ve been able to avoid most detox effects. Although I have been way less motivated to do things. I have tools to redirect and am using them. I have only detoxes off subs once from what I remember if I get down to .5 mg a day or every other day it seemed to be tolerable but lots of hard work. What I’m wondering is with the exposure you’ve had to people on suboxone does that sound fairly accurate. When I detoxes I was in jail and they gave me so many different things I was out of it for 3 days.
Posted by janaburson on May 14, 2015 at 11:52 pm
yes, it does.
Posted by Andrew angelos on June 18, 2015 at 12:14 pm
I live in a rural area there are not many addiction doctors near. The doctors that are here are full. I was in a suboxone progr for a year and a half and the program was ended for one reason or another. There are no program that are accepting new patients. The program discharged all of us with one month of medication. Do you know if a regular doctor can prescribe methadone or subutex just for the taper and detox of suboxone. I know a special licence is needed for the care of addicts and the prescribing of suboxone is it possible that a doctor without this licence could care for me for the taper and detox. He’s wouldn’t be treating addiction?
Posted by Michael Anderw DeBolt Jr on June 20, 2015 at 6:49 pm
I know what it’s like to be in pain and I know what it’s like to live pill to pill I don’t know which one is worse. Then you have to take the pill even when you’re not in pain because if you don’t you’ll be sick so once you start taking the pills the pain doesn’t have anything to do with it anymore. What an insane existence.
Posted by Christina on July 1, 2015 at 8:10 pm
I had oral surgery 2wks ago, because I’m currently receiving a prescription for suboxone I wasn’t given any pain meds, which i was ok with and understand, but in turn i ended up taking more suboxone than i should and now I’m out 2days before my appt. If i went to the er would they give me enough til my appt?
Posted by janaburson on July 2, 2015 at 1:10 am
I doubt the ER would prescribe suboxone. I think your best bet is to call your suboxone doctor and explain the situation.
Posted by Shari Blackwell on July 14, 2015 at 7:00 pm
Hi Jana, I am an LPN and the Site Coordinator of a MAT program in Athens, OH. I have seen so much progress in the people who are truly working a program. Our program is very strict and we follow all DEA guidelines. The problem in our area are the cash clinics that appear to only want to make big bucks and care very little about the patient. Diversion is a real problem and we go to great lengths to try and minimize that problem. One of our biggest problems is the fact that we need more doctors to help with the number of people on our waiting list. Any suggestions on how to recruit Doctors? Have a wonderful day. Shari Colmer Blackwell
Posted by janaburson on July 15, 2015 at 1:30 am
I’d suggest going to the ASAM (American Society of Addiction Medicine) website and look at the list of ASAM doctors in Ohio. These doctors are more likely to be knowledgeable about addiction and its treatment, and more likely to have an interest in these issues.
I’m glad to hear Athens has an MAT!
I grew up very near there, went to Ohio University in Athens.
Posted by Cwills on August 27, 2015 at 6:43 pm
Hi, I’m waiting to get on the intake at my local clinic. If I start to withdraw can I go to the emergency room and get help?
Posted by janaburson on August 28, 2015 at 2:25 pm
Yes, though the amount of help you get may vary widely. I would hope that at a minimum, you would be given fluids if you have dehydration from nausea/vomiting and diarrhea. Clonidine can also help with many of the symptoms.
Posted by Greg Rt on August 30, 2015 at 9:58 pm
Hi Dr.Burson, I sent you 2 links to articles that think addiction is not a disease.I was pretty sure you would like to read them. I’ve been reading and learning much from your blog over the last 2-3 years.It helped me realize my recovery with Suboxone would’ve been lightspeed faster had I participated in talk therapy with a counselor.I knew I just needed the Suboxone and I could figure out the rest.I was very wrong, obviously!I’ve been on Suboxone therapy and Zoloft, Wellbutrin, and 1.5 mgs. Xanax per day for 7 years. I won’t wean off until I’m retired in about 15 years.I’m a skilled craftsman, journeyman union floorlayer for 32 years, without Suboxone I would have no energy,and I can’t take off work for 2 years to get over opiates.Every single person I’ve ever seen quit Suboxone or Methadone did not and still do not work.One bit of contention I’m REALLY getting tired of reading is not to prescribe benzos with Suboxone or Methadone.I take 3 .5 mg. Xanax a day with 1 8/2 mg. Suboxone, 1 100 mg. Zoloft, and 3 .75 mg. Wellbutrin.They all really help with my main problem Body Dysmorphic Disorder.After 7 years of the same meds at the same dose, I’m doing allright, KNOCK ON WOOD! The 80 mgs. of Oxycontin I was prescribed for 4 years because of a bad truck accident, helped get rid of my depression while being prescribed it.It seems Doctors are surprised to hear me say Oxycontin was the best antidepressant I’ve ever taken!I’ve had depression my whole life, I just didn’t know it until my Suboxone Psychiatrist said my main problem was depression 2 years ago.I never told him until then I’ve spent about 20 hours in operating rooms with plastic surgeons.I don’t look much better if at all.The little bit of Xanax I get each day is EXTREMELY IMPORTANT to me, as I can function normally in social situations.That drug it seems is tailor made for me.My life would be miserable without it.The Suboxone is just as important for energy levels.My skilled construction job is fast paced, heavy lifting involved, and work has to be perfect. You can print this email anywhere you would like. Keep up the great work, you’re an EXCELLENT HUMAN BEING! Thank You, Greg OBrien
Posted by Amber on September 1, 2015 at 3:14 am
Been in prison 2 years just came home very bad urges to use pain pills….can I go on suboxone?
Posted by janaburson on September 5, 2015 at 12:17 pm
The short answer is “probably.” Your doctor will ask about your complete drug use history to decide if that’s the best treatment option. If you have not yet used any opioids and aren’t physically dependent, an opioid blocker may be a better option. Naltrexone is available in a daily pill form and also in a once-monthly injection. The latter is the best option since you don’t have to remember to take a pill once a day. But see an addiction medicine doctor to get the best answer.
Posted by A New Start on September 9, 2015 at 6:41 pm
I am recovering opiate addict, now 8 months clean. Before my addiction I was an avid writer. Since entering treatment I have immersed myself in the world of recovery literature and your blog has been a tremendous help in motivating me to write again.
I am now working with other treatment centers and various online publications to provide articles and content on recovery, addiction and everything in between.
Thank you for your continued efforts.
Posted by Jaime Webber on September 11, 2015 at 5:17 pm
I have been on methadone for almost 10 years.I am on 65 dose liquid mixed with juice.I was addicted to oxycotin after the suicide of my brother.I have not used for 10 years this April 30 2015.I now cannot get off of methadone.I have a 8 year old boy who is extremely active.Adhd diagnosed.I am a single mom with very little support.I have tried several times to slowly wean off methadone but everytime I get to 25 I have to stop.Depression and exhaustion unbearable to raise a child.I suffer from anxiety and depression and extreme fatigue Chronic hepatitis c.I worked all my life at a nursing home and since I have been on methadone I cannot work.I am on antidepressant citralopram 40mg.I need help off of methadone I cannot live like this anymore.I am so tired I cannot enjoy life anymore.My son is what keeps me going and my mom.
Posted by janaburson on September 13, 2015 at 5:16 pm
Methadone treatment alone should not make you so tired that you can’t work or enjoy life. It’s possible there’s another undiagnosed illness causing your fatigue, so I advise you see your primary care doctor pronto. Hep can also cause fatigue, and it is now curable with an oral medication. Untreated or partially treated depression can give you fatigue, so talk with your doctor about that too.
Even if you have an unusually sensitive system and methadone gives you fatigue, talk to your opioid treatment center about trying buprenorphine.
no one medication works for everyone, but now at least we have a second medication to try.
Posted by John on September 20, 2015 at 3:04 am
I have been taking Suboxone for 4,5years consitally, I’ve been prescribed 3 a day. Recently I’ve been getting pain in my inner foot, would that be related to my usage?
Posted by janaburson on September 21, 2015 at 1:11 am
right foot or left foot?
Posted by Heather on September 22, 2015 at 4:29 am
So, I had a dual addiction meth and opioids I have been clean off of the meth since April 1, 2014. I have found myself being pulled back to the opioids recently as I have been having chronic pain. I haven’t used anything hard just taking codeine(but I am back to my old ways of snatching them out of my dads bottle with out him knowing) but I find myself craving the hard stuff to get rid of the pain. I hurt bad daily and have talked to my doctor and there isn’t much he is willing to do for me. My question is can I get on Methadone maintenance for the chronic pain and so that i stop taking my Dad’s script. I know i am horrible for doing it.
Posted by janaburson on September 23, 2015 at 11:42 pm
methadone maintenance at an opioid treatment program is really intended for people with addiction, who have lost the ability to control their use of opioids. If you have not lost control you may do OK at a pain clinic, where the doctor can prescribe 30 days’ meds at a time.
However, the fact that you feel bad for taking your Dad’s medication raises the question – are you in control of your opioid use now? I hear some warning signs.
I’d encourage you to go back to your doctor and be honest about taking your dad’s pills OR go to the opioid treatment program, and let the doctor there do a full assessment to help decide the best course of treatment.
Posted by ajunkiesblog on October 18, 2015 at 11:57 pm
Hi,
I’m in recovery and on MMT. I like reading your blog i think you understand addiction better than anyone i know. I’m interested in getting a hold of a naltrexone kit, for many reasons. I live in Seattle, WA. I’d rather not go to my primary care doctor. Can you point me in the right direction? Thanks
Posted by janaburson on October 20, 2015 at 2:29 pm
I’d Google Harm Reduction Coalition in your area, or call your local Health Department. Either of them should be able to help. I know Project Lazarus here in NC sends kits to anyone: http://projectlazarus.org/ if you can’t find a kit locally.
Posted by ajunkiesblog on October 18, 2015 at 11:58 pm
Did you get my last comment ?
Posted by Cindy Straub on November 9, 2015 at 9:42 pm
Hi Jana,
I just stumbled across your blog. I am a Nurse Practitioner in Palliative Medicine, who has also been treated with chronic opioid therapy for over 10 years for back pain, following 3 surgeries, spinal stenosis, and spondylolithesis. I had tried so many times to wean off the Norco, (mostly because I did not want to be labeled, as you and I know happens to people who take opioids daily) however, due to both withdrawal symptoms and worsening pain, I failed every time, until I was put on Suboxone. what a blessing! I was able to slowly titrate off without withdrawal symptoms. I still deal with severe back pain daily, however, it is not any worse than when I was taking opioids, and when I need it, I will take a dose of the Suboxone for pain.
I also want to comment on your discussion about mid-level practitioners prescribing Suboxone. I work in the hospital setting, and although Palliative Medicine is not Pain management, we frequently get consulted to help with pain management when patients who are receiving chronic opioids, drug addicts, and patients on Methadone or Suboxone are admitted, given the complexity of managing them. Through my own experiences as both the patient and the practitioner, I think Suboxone has a place in more than just addiction. Following surgery, trauma, etc, many patients are prescribed opioids for weeks, then sent home with or without a prescription; either way, there is no taper considered. These patients begin to go through withdrawal which includes worsening pain, and not understanding what’s happening, seeks out more pain medication. And so the cycle begins. for some people, proper tapering off opioids would be successful, but for those, like me, using Suboxone can help with that process.
Also, why shouldn’t a mid-level practitioner be able to prescribe Suboxone if they work in an addiction clinic with proper staffing?
Posted by janaburson on November 10, 2015 at 2:31 am
I too think buprenorphine can be tremendously helpful in the treatment of pain. But in its sublingual form, it was intended only for the treatment of addiction under the DATA 2000 law. Doctors do use it for pain, off label, but many insurers won’t cover it when prescribed for pain.
We can debate whether a mid-level practitioner should be able to prescribe it…but for now, DATA 2000 allows only MDs to prescribe buprenorphine sublingually for the treatment of addiction. Under DATA 2000, midlevels can’t prescribe it.
That may change soon, and the 100 patient limit is probably going to lifted in the near future.
I think the limits imposed by DATA 2000 are already irrelevant in my area of NC, where mid-level practitioners often prescribe buprenorphine despite the law, and doctors often have many more than 100 patients on buprenorphine. So that raises the question of how important are the regulations anyway.
Posted by Cindy Straub on November 10, 2015 at 8:09 pm
of course, we could always use Butrans, which should give the same benefit, just without the abuse deterrent, which in mine, and many others, is not needed.
Posted by rudy on December 13, 2015 at 5:05 pm
my name is Rudy I have been addicted to hydrocodone for 5 yrs and can not stop taking them. iv tried several times with terrible results I have tried everything. wondering if I should get on suboxine. or will I stay addicted to that. I have to due something before I go insane.
Posted by janaburson on December 13, 2015 at 11:12 pm
there’s a difference between addiction and physical dependency. Worst case scenario – you end up physically dependent on suboxone for the rest of your life…you can lead a normal and productive life while on suboxone, other than taking a dose of medication each day.
sure sounds like better than what you are doing.
http://buprenorphine.samhsa.gov
Posted by Mary Kinney on January 9, 2016 at 12:56 pm
I left a reply and I think it should have been asked here can you please look at the replies and give me your opinion about my situation . Thank you
Posted by Kim on January 27, 2016 at 5:54 pm
My husband is a chronic pain for over 10 years never took and medicine ever before Dr started him with injections and 5 mg percocet he then tested liver test was fine then he up him all the way to 30mg my husband did not ask then 80 and 30 as breakthroughs he then called for shot only and biller messed up i called medicare to get things straight then they called hollered cursed me and dismissed my husband i felt guilty for doing this to him and did not want him to die so i had methadone pills from my mother before she died and gave them to him he actually felt less pain. Now he still needs shots but I am very scared about telling doctor what i did. Please help. I did extensive research they seem better and he seems great i hope by me doing this will not ruin his chances of getting spin a l injections and also now he feels methadone working better and i do see the difference. I feel to tell the truth he did great he is off all his previous medicine and he is getting normal no more depression and anger.
Posted by janaburson on January 28, 2016 at 2:09 am
I think your husband needs to tell the doctor everything, so that his doctor has all the information to make the best choice possible.
Posted by mnr1996 on February 3, 2016 at 2:57 am
My new doctor just prescribed me suboxone, knowing I’ve been on 60mg of methadone for 3 years. Will I be ok to transition after 72 hours?
Posted by Andrew angelos on February 4, 2016 at 7:33 pm
It sounds like your working in a program whare people come in and get their meds and eventually they can earn the right to take home doses so they only need to come weekley. I was under the impression that suboxone was intended for people to have take home prescriptions. Does your clinic have a much lower rate of relapse and dirty pee tests. I would guess that if someone has to show up and test to get their meds they would be less likely to slip up. I would like to know what the duration of suboxone use should be. In your opinion anyway. I’ve been on suboxone for about 2 1/2 years. I personally would like to stay on my 4mg dose forever. Unfortunately I’m not in any program and havnt been for about a year. So I can’t be sure how long I will be able to stay on suboxone. I can get down to 2 mg a day and even 1 but when I go more than 48 hours I detox and I hate it. How long will the detox effects last on average. Is it going to take a month like methadone. Mental preparedness is key I know but what other things can help in your opinion to ease the detox from suboxone. Is it possible to find a doctor that would prescribe this drug to me on a maintenance basis without having to go to weekley or monthly appointments or is that just part of getting that drug. I’ve been a user of opioids for about 20 years with serious abuse of norco and morphine about 10 years ago. I’ve been totally clean for periods of a year or more a few times during all that time but I’ve never felt quite right when I was. I don’t feel like I’m abusing my suboxone. What are the long term effects on a persons physical and mental state if suboxone were to be used for a prolonged period of time. It seems to me that the enhancement of the quality of life I get from he medication outweighs any adverse effects I may have. Thank you for taking the time to write these articles and answer questions and comments. Have a great day.
Posted by tylogirl27aax on April 15, 2016 at 3:26 am
Can you please write about Relistor – opiod antagonist that doesn’t cross the BBB, for Opiod Induced Constipation? I am wondering if it is used for Buprenorphine, and if there is a reason I haven’t yet heard of any Bupe doctors using it?
Posted by janaburson on April 19, 2016 at 2:38 am
I think very few of my patients would want to risk opioid withdrawal by taking this medication. Relistor is supposed only to affect the opioid receptors in the bowel, and not cross the blood-brain barrier to cause opioid withdrawal, but the prescribing information does mention this as a possible side effect. I have not recommended it mostly due to the expense compared to increased fiber, increased water, and Miralax as needed. Plus, I don’t want to risk my patients going into withdrawal.
Posted by Mandy on April 19, 2016 at 12:00 am
I have an appointment on Tuesday and I’m going to finally let the doctor know I’ve been struggling with Pill addictions. For almost 7 years now I wanted help before but have been too afraid to get it now my fear is how is the doctor going to treat me and what is going to happen at the appointment.
Posted by janaburson on April 19, 2016 at 1:40 pm
You have an illness and your doctor should treat you like you have any other illness. If your doctor doesn’t know much about addiction treatment, she should refer you to a doctor who can help. You have every right to expect to be treated respectfully and kindly. If you are not, then that’s on your doctor, not you.
Posted by Chris Wolf on May 23, 2016 at 11:04 pm
Hello Dr.
I have been following your blog since I started Suboxone treatment for pain pill addiction back in August 2015, and have found your writings very informative and enlightening. Thank you so much for your invaluable information you provide.
Here in a nutshell is my story.
I was a 40 to 60 mg per day Vicodin user for several years before finally seeking help and finding a Suboxone program here in California. I started at 3mg of Suboxone and after several weeks stabilized to 2mg per day. I started tapering by .5mg in December going at my own pace and for the last 6 weeks have been on .5 mg daily. My last .5mg dose was this last Thursday 5/19.
The only relatively serious withdrawal issue I’m having on day 4 is the insomnia and RLS. Last night I probably got about 1 hour of sleep total which is not boding well as far as work is concerned. I actually had to leave 1/2 day because I was so mentally tired.
My question to you given the information I provided; Is there anything I can take over the counter besides Amino acids, and melatonin or Benadryl to help me sleep? Any suggestions?
Chris
Posted by janaburson on May 24, 2016 at 1:23 am
I’ve found that clonidine can be very helpful with insomnia and the restless legs. Ask your doctor – she would probably be willing to prescribe it for you.
I’ve heard from other patients that a hot bath can help with aching of legs and restless legs…but then I’ve had another patient say that cooling his legs worked better – he said he took the sheets off and ran ceiling fan.
Hang in there and I hope you feel better soon!
Posted by Don on May 24, 2016 at 3:06 pm
All are very good suggestions and somewhat standard for helping to get through withdrawal and taper. The other thing I’ve both personally used and saw suggested is gabapentin. It really helps with RLS and allowed me additional sleep. Most everyone who stops buprenorhine says that sleep is the very last to return. Most say it takes a month or more to get back to 8 hours a night. They usually see around 5 hours after the first couple weeks – all without meds. With clonidine, gabapentin and Benadryl as needed, you should be able to get 5 or more right away. Good luck!
Posted by Chris W. on May 27, 2016 at 12:05 am
I followed Dr. Burson’s suggestion and went back to the Clinic to speak with the Dr who run’s the Suboxone program. Of course I had to re-establish myself as a patient and pay the monthly fee, but that’s totally fine with me. As a returning patient, I also get to talk to my counselor who is just fantastic.
Anyway, long story short, Doc gave me a script for Clonodine, and also suggested Melatonin would be ok to take as well. Last night l I took .2 mg of clonidine, my amino acids, and 5 mg of Melatonin before bed, and that got me a little over 5 hours of sleep. This compared to the night before when I probably got a total of an hour and some change.
If I continue to get 5 hours sleep, and improve as I time pass’s then I think I will finally be able to live opiate free.
Thanks again Dr. Burson, and Don for your advise as well.
Chris
Posted by KNick on June 2, 2016 at 5:18 am
Is Opium an opiate or opioid?
Posted by janaburson on June 10, 2016 at 1:11 am
It is both!
the term “opiate” means any substance derived from the opioid poppy, which opium is.
the term “opioid” includes substances made from the opioid poppy and also the man-made drugs that stimulate the opioid receptors like opiates do.
Opioid is more inclusive.
Posted by Dede on June 21, 2016 at 3:06 am
Was on 40 mg methadone for 3 years and higher dose prior (12 yrs total) Have gone down to 20mg in order to start suboxene. Mono is unavailable so what would be safe number of days to be in methadone w/d before suboxene dose starting w/2mg up to 6 if needed. As I know everyone is different am just looking for approximation to avoid precipitous w/d, which terrifies me. Thanks so much.
Posted by Dede Ferraro on June 21, 2016 at 4:56 pm
Thanks for having this wonderful forum. Approximately how long after weaning from 40 to 20mg methadone must I safely wait to take suboxene? My Dr is not considerate of precipitated w/d and would have had me taking it as soon as I felt sick! Any info greatly appreciated!
Posted by Cheryl on July 1, 2016 at 3:21 am
I had my c2 nerve cut and about half my c2 bone cut away along with other tissue cut away to get a desmoid tumor cut out of my neck. I see a pain management specialist. Fri he prescribed buprenorphine for my pain because it’s the only thing my insurance will pay for.
After googling it I’m so scared to take it also I’m not addicted to anything I’m in a lot of pain.
Posted by janaburson on July 5, 2016 at 2:21 am
Please don’t allow Google to interfere with what your doctor has recommended. If you are unsure, talk to your doctor again.
Posted by Blake M. on July 5, 2016 at 7:01 pm
*Question:
We are having problems with my husbands ex who has been addicted to pills for around 15 years. She had a terrible back injury which led to surgery. She has screws in her spine. My husband says this is when she first started taking pills (she needed relief). Since then she has been taking prescription meds as well as buying them on the street. She’s had cocaine addiction as well but we believe not at the moment. She is now on Suboxone. My question would be… Would a Dr. Prescribe someone with that background suboxone? I thought this drug was just for heroine or meth users? We just want to know because of my step-daughters situation. Her mom has been acting very erratic, flying off the handle, threatening court etc. we’ve all gotten along for 7 years and we are wondering if this drug could have anything to do with her behavior lately. If you have any info that could help us understand her better. Maybe help us understand what she is going through, that would greatly help us out.
Thanks
Posted by janaburson on July 7, 2016 at 1:34 am
Yes, Suboxone is prescribed for people who develop an addiction to pain pills or heroin. It’s helpful for addiction to any opioid. However, it does not help with addiction to other types of drugs like methamphetamine, cocaine, marijuana, alcohol, or benzos.
I do not think Suboxone would be the cause of erratic behavior, but she could certainly have other issues.
Posted by Laneleigh on September 1, 2016 at 5:05 pm
Hi Doctor I’m 26 and I’ve been on pain pills for a while now it started because I had stage 3 CANCER and of course Overain cancer is very painful and comes with a lot of smytums and I had it foe almost 2 years be for I know what it was because my local hospital treated me diffently because I had no insurance at the time and the day I got back my on OBGYN told me I had a tumor so large that it hard grown to my others overly but the point is I had been is so much pain over those last few years that the hospital would just give me pain meds instead of helping me so I ended up being cut hip bone to hope and have a full hystarectme at the age of 21 and was told I couldn’t have a children and this was my 2nd CANCER the first was in the eyes so one eye was removed and the other has very lower VISHION but after taking the pills for the chronic pain for those few years I looked around a noticed what CANCER had done to my life and everything and everyone I had lost because of it and at that point I started taking them to just be numb from my body’s pain and my life’s pain as well what I want to know is how does Suboxone work could you please let me know mainly does it make you not want to take them anymore? Will it really help with actually pain? And what happens if you take pain pills with Suboxone? And in your option Suboxone or methadone? And why?
Posted by janaburson on September 13, 2016 at 12:44 pm
please talk to your doctor about your concerns; given your specific medical history, you need someone who is familiar with you to answer these questions
but in general, yes, when it works, suboxone makes you not want to take pain pills. some people get pain relief from suboxone and some don’t. In studies, suboxone and methadone showed about the same amount of pain control. If you take pain pills with suboxone the high is blocked but you may still get some pain relief
Posted by crystal on November 22, 2016 at 3:06 am
Does butrans patch interfere with suboxone induction?
Posted by janaburson on November 28, 2016 at 1:54 am
No – it is the same medication as Suboxone, buprenorphine.
Posted by Robert mancuso on December 22, 2016 at 5:04 am
I been on a buprenorphine treatment plan for about 4 years. I get 2 x8mg a day.I never have had any problems with my drug testing in that time.I don’t do anything to jepeardize myself from being expelled from the program. But now the holidays are here and I don’t see my doctor for about 22 days from now. I wanted to smoke 1 bowl or a few hits off a joint. I just wanted to check before I even attempt to do it would it show up on my next visit??? I would only do it the one time. I’m checking before I would even think about it.Its not even worth it, if it would possibly show up. Its sucks you can’t even smoke a joint on the holidays at a Christmas party coming up. I feel left out on the fun. I use to smoke over 10 yrs ago and remember how relaxing it was and how my sense’s were heightened. Please respond A/S/P,
I’m drug free besides if I decide to do or not. More then likely if I don’t get a response my mind will be made up that I won’t do, even if I get the OK. I will decide whether it’s worth it or not. Just wanted to hear a oppinion from someone wise on this subject thanks again. Merry Christmas!
Posted by janaburson on December 24, 2016 at 2:15 pm
If you smoke, it’s possible you will have THC detectable in your upcoming urine drug screen. It depends on your doctor whether this would jeopardize your program. I can tell you my response would be to continue treating such a patient, but maybe see you more often. I would also think it’s worth exploring other ways to have fun and feel a part of holiday festivities, aside from drug or alcohol use.
I doubt you would be doing as well as you have been without developing other ways to have fun, relax, and feel festive.
Posted by jay on February 4, 2017 at 6:07 pm
I’m just wondering if they put u on silent drop if only on 9omg how much they would drop at a time and how often
Posted by janaburson on February 5, 2017 at 6:12 pm
I’m not sure I understand your question.
Posted by JOHNNA on February 12, 2017 at 2:32 pm
Okay nowexplain to me how you get off Suboxone… Because now I’m hooked on it.. If I don’t have it I am sick just like the pain pill addiction… Anyone can explain this to me please do.. Would love to get off this drug and be DRUG FREE…
Posted by janaburson on February 14, 2017 at 12:25 am
Please talk to your doctor about when and how to do so.
Don’t have a doctor?
Then go to a doctor, or an opioid treatment program.
Yes, Suboxone (buprenorphine) is an opioid. The goal isn’t necessarily to take people off of it. If they are able to take it like prescribed, they can have successful recoveries – just like with methadone.
Posted by Robert on February 14, 2017 at 3:38 am
I have the same exact problem. I been on 2 8 mg buprenorphine tabs a day for the past 5 yrs, and just want to be off all these unecessary meds, which is subs for me too.The problem with telling my doctor about this, is I want to tell him, but even if I do tell him and he weens me down to nothing, because I tried it myself a couple times. I end up either sick and or a lack of dopamine to the brain and get severly depressed for a long period of time or I feel very anxious and moody, and like almost like I’m going to go into convulsions, and shortness of breath, and lower severe back pain were I can’t even stand up, or just plain old sick to my stomach. What kind of life is that?? And no I’m not trying to say I’m looking to feel something, but just to be normal. I was down to a crumb of a pill a day, until I finally said I’m not improving, so what’s the use of feeling this horrible. So I took a whole 8 mg tab and felt so much better and I just didn’t want to suffer 1 more day. If I let a doctor help me do this and it don’t work, I’m afraid i won’t be able just resume taking my meds and who knows how long I would have to suffer. It’s absolutely insane!!! I been on pain meds 8 yrs previous to taking subs for past 5 yrs. So that’s a total of 13 yrs of being on opiates because of my back and neck. What I’m saying is I don’t think I can handle being in such discomfort for such a long duration and not be able to just go to medicine cabinet and get instant relief, especially if I don’t improve in time. I wouldnt be able to just go take a pill. I probably would have to start all over again, and my doctor would probably say u went this long, so I’m not going to put u back on it. So then what? That’s why I’m scared of telling my doctor, I may just be cut off for good. If there’s any alternatives out there please share with me, because I love to not have to take nothing again. If I would of known back then what I know now. I would of never put myself in this position and started these meds. Thanks I would like to hear some ideas or opinions out there. Because this is just horrible.
Posted by Kylee Stuard on February 17, 2017 at 11:33 pm
The only problem with pain killers such as Percocet is the fact that those who abuse them or aren’t in real need of them are ruining it for the rest of us like myself who use medications responsibly. I live in Cincinnati (Ohio having the worst fear of Feds and the strictest laws. I’m in my 20s I have back/neck trauma, severe spinal stenosis and sciatica. I live in horrid pain every single day of my life to the point it’s debilitating. But do you think I get any prescription help? NO and it’s because of junkies who ruin it for the rest of us that are in need. They take one look at my age and they dismiss me, tell me that I need swim therapy or physically therapy…which have all been a scam with zero results. The pain medicine isn’t the problem, it’s the cowardly doctors that live in fear of the Feds. It’s all a pharmaceutical lobbyist game. Not to mention the Feds are going after the WRONG drugs that actually kill people such as ones that are made in a person’s lackluster kitchen lab. Disgusting that doctors don’t do their jobs anymore. Really sad and they should be ashamed. Yet? they have NO problem handing out nasty drugs like neurotin like candy that damage every organ and are Completely ineffective for conditions such as mine.
Posted by K on December 18, 2017 at 5:24 am
I am a 52 year old grandmother of two, I’ve been taking the same medication at least for the past 5 years, dilaudid 8 mg, norco for my break through pain ( I never take it, doesn’t help. ) I take gabapentin for severe nerve pain, blood pressure meds, seizure meds, shots for my multiple sclerosis carisprodal for muscle spasms and Ritalin for when my days are super sluggish. I am disabled, my vision is affected, my strength, I have epilepsy, severe pain, really severe in my left arm due to a not so successful neck surgery, I have spinal stenosis, sciatica ( got shot in the nerve at 23 ) ( worked in the medical industry ) ( needed a hepatitis shot ) ( instead got shot in the nerve ) and now I have chronic sciatica on top of everything else. Carpal tunnel, you name it, pretty sure I got it. Anyhow, thankfully I have an amazing pharmacist, that never makes me feel anything more than just a patient she really cares about, who truly needs her meds. Unfortunately, because of a disgruntled ex employee, who called the DEA on my pharmacist, I had to find another pharmacist just for one cycle. Let me tell you, being disabled it’s really hard for me to get around, I thought this shouldn’t be too hard to just get my meds somewhere else for one month, boy was I wrong, I was treated like I was a leper, a druggie, I hAve never been so humiliated in my life, mind you, I’ve NEVER filled a script early, I’ve NEVER paid cash, I’ve NEVER Dr. shopped, I go the same time every single month, my Neurologist writes me the exact meds every month ( in fact I had him lower the qty. ) but 7 different pharmacies said NO, NO, No!! Awful!! Meanwhile, I went well past my 30 days. I was worried I was going to have a seizure, quitting my meds suddenly. I did notice my pain was so severe, I wasn’t withdrawing, but maybe I was??? What do I do in a situation like myself? Luckily my pharmacist referred me to a colleague who filled my meds without making me feel like a leper. Maybe I’m on the wrong site, I’m curious wether being in so much pain ( because I hadn’t felt the true pain in so long ) I’m obviously dependent in the sense that I take the same amount everyday. What does someone like me do? My liver and kidneys are perfect. Oh I also take a MS shot every other day and another type of bp med. in total I take about 11 or 12 types of pills.
Am I addicted? That’s the last thing I want to be. Any suggestions would be awesome.
Sorry for such a lengthy message.
Posted by janaburson on December 18, 2017 at 10:54 pm
For a complete answer, you can read my post of 3/17/2011
Posted by Kimberly Mark on September 6, 2017 at 10:00 pm
I really need some advice. I have been on methadone for 12 yrs and a split-dose for 7 yrs. The clinic I go to recently got a new doctor who does not like split-doses. The clinic requires yearly in house EKG’s. I had open heart surgery in 2013( congenital heart defect) so I have always brought in copies of EKG’s done by my cardiologists. Some how those were lost and I had to request copies, which takes 6-8 weeks. 4 weeks later she said I didn’t bring them in fast enough and took my split dose away. Everyday I am nodding out in the morning and in withdrawal as the day goes on. Because of being in withdrawal my BP goes up to 180/100. I have been to the ER, my doctor and have had the clinic take my BP in the morning before dosing. With all of this she refuses to do a peak n trough and refuses to give me my split dose back. I don’t know what to do. any suggestions? and yes, I have been clean for 12 yrs, no arrests, no lost bottles nothing
Posted by Christy Hubert on December 5, 2017 at 6:38 pm
I love your blog. I have every new article sent to my email and save them in their own folder to read when I am feeling like a failure for still being on methadone after 5 years. I know, that’s nothing compared to some people but I told myself 75mg and 3 years MAX and here i am 5 years at 140mg.
Anyways thank you for the endless tidbits of knowledge, humor, and hope you provide. It does mean a lot to me.
Christy
Posted by Sue. Bowler on January 24, 2018 at 5:48 pm
I’m in desperate need of 39 year old addiction to Methadone. Jan. 29th, Tuesday. My pain Dr. has me scheduled for a induction. Says to take my last dose age of 40mg day before, n no Meth after that day. The next day 29th, wants to start me on 8 mg. of Buprenorphine that day. Dr. there was an ingredient taken out that use to cause withdraw??!! Says I will NOT go thru any withdraw.
I live in Florida on Gulf Side
I am 66 years old n like I mentioned, been on Methadone maintaintence for 39 to 41 years. Was going to various drug clinics thru the years till I moved to Florida 11 years ago. Then introduced to pain clinics. I’ve NEVER been on any other drug. Always did well on Meth.
So now I’d like an honest Dr. to be truthful about what to expect with this meds transfer. Feeling I need another Dr. to do this induction.
Any advice, help, PLEASE contact me.
I’ll appreciate any n all the help I can get, I am serious about getting off of Meth.
Thank-you for your time
Sue Bowler
I do live in Florida. On the gulf side, one hour from Sarasota.
Posted by janaburson on January 27, 2018 at 1:04 pm
I have a different method – I usually ask for the patient to dose on methadone at 40mg or less for at least a week, then skip 2 days, then see me so I can assess the degree of withdrawal, and usually start buprenorphine on the third day.
If you take 40mg one day and buprenorphine the next, I’d worry about precipitated withdrawal, but please talk to your doctor who knows your history better.
It’s not the naloxone in the combination buprenorphine/naloxone product that causes precipitated withdrawal; it is the buprenorphine itself. It’s a partial opioid, instead of a full opioid like methadone, but it has a higher affinity for the opioid receptor, meaning that if there’s any methadone left on your opioid receptors, buprenorphine will strip it off immediately. This is what causes the sudden withdrawal.
Posted by Sue on April 11, 2018 at 5:30 am
I’m searching for any n ALL info on long
time addiction to opiates.
Going on 39 years with out coming off for any period time,
Please I’ll appreciate any n all suggestions .
Posted by Jerry on May 8, 2019 at 8:46 pm
Hello Dr. Burson. I unfortunately have been barred from driving at my job because of my legal use of Buprenorphine. After several attempts to prove my stability, (letters from my doctor and several submissions of studies om Buprenorphine and driving) I cannot break through to the doctor that I am ok to drive, not to mention I perform safety sensitive functions 6 days a week. I am almost at the end of my treatment, currently at 0.4mg a day. I have a promotion that is in limbo and may lose all of my seniority if I don’t clear this up quick. You may or may not be able to answer my question. My question is, a Buprenorphine urine test with a cutoff of 10 ng/ml, what dosage do you think would fall under that cutoff? Any help I would greatly appreciate.
Posted by janaburson on May 16, 2019 at 1:37 pm
Sorry, I don’t know the answer to this. I can tell you I had a patient taking .25mg SL per day and she was still tested positive on my point-of-care test.
Posted by GL on May 16, 2019 at 6:12 pm
Thank you for your help. My last dose was 0.25mg SL last Thursday at 10pm. I am currently testing negative as of yesterday on dipstick tests with a cutoff of 10ng/ml. I submitted a sample for UA on Tuesday and will know results tomorrow. Thanks again.
Posted by TN MD on June 11, 2019 at 7:14 am
Dr Burson,
I am a physician in TN and one of my patients just linked me to your blog re: TN’s new rules for OBOT’s. The Dept of Mental Health here is strangling us in what I perceive to be an effort to drive ALL treatment into their hands! I’ve had their compliance personnel come in 3-4 times, write up all kinds of nit picky paperwork dings, then charge me $500 for the “honor” of having them come in to look at my clinic and send me 20-40 pages of “non-compliance” issues that need addressing. As an example of their issues, I needed to have an “employee” file on myself despite being the sole proprietor and owner of my own practice. I had to pay a licensed private detective to do a background check on myself and even show that I’ve been trained in how to leave my clinic should there be a fire. I also had to show training proof that I was totally knowledgeable about the clinic policies that I myself created 7 years ago!! It is absolutely absurd and that doesn’t even touch the clinical things you cited in your blog. To sum it up mildly, all clinical medical judgement has been stripped away in lieu of the “smarter” mostly non medical never in clinical practice bureaucrats!!
Only 15-20% of clinics initially signed on to this; I did because I figured they would go after those who don’t. So far, they’re all over those of us that signed up and are not psychiatrists!!! I’ve been ready on more than one occasion to tell them where they can stick their mental health licensure, but I know my patients would suffer most. I’m ready though to jump across state lines should they continue this monstrosity for much longer. My patients would definitely follow!! Hope you never get saddled with this: nothing worse than basically having your clinical judgement taken away after being a doc for 25 years (10 years doing this).
Posted by janaburson on June 12, 2019 at 12:51 am
I don’t understand – what did you sign up for? Going to 275 patients? I am sorry to hear practice is so difficult in Tennessee!
Posted by Fannypanny on July 21, 2019 at 1:41 pm
Can a dr or law enforcement get fired for this or are they protected
Posted by janaburson on July 23, 2019 at 12:40 am
I’m not sure what you’re asking
Posted by Kayce Godar on May 23, 2020 at 11:17 am
I’ve been in MAT for 6 years but living in recovery for 4 years now. I’m slowly lowering my dose to eventually complete my treatment.
I love my clinic! They are wonderful but the questions I have they dont have the answers too.
Questions like – 1) when I’m sweating all day in texas, on my feet from the time I wake up till I go to bed.. why is my dose suddenly not making it through the day? Current dose 75mg
2) will my body adjust to the heat or am I going to notice the difference all summer long?
3) questions about methadone & pregnancy in general.
How do I find these answers when my Doctor is never seen?!
I feel like you do amazing work. Being there for your patients. I dont have that privilege at my clinic with our Doctor. Bless him for having the clinic available to me though.
Thanks so much
Posted by Geminib on June 21, 2020 at 5:32 pm
I feel the same about my NJ clinic. When you ask a question you get different answers from the counselor, to the supervisor, doctor, etc. Trying to “do the right thing” is difficult when no one seems to know the correct answers. So frustrating.
Posted by Geminib on June 21, 2020 at 5:28 pm
I was wondering if you work under a state funded methadone program? If so, does your program allow the use of medical marijuana with state card?
Posted by janaburson on June 21, 2020 at 11:42 pm
No, I don’t.
And NC has not legalized marijuana.
Posted by Mary M on July 27, 2020 at 7:26 pm
I came across your blog while researching information on tapering off suboxone. The stories you shared about the 3 women who successfully ended suboxone treatment was inspiring. I like them have been on suboxone for more than a decade. I tapered myself from 16 to 4 mg/ day where I stalled for 2 years until restarting my taper again 6 months ago. I have zero concern of relapse. I began suboxone treatment to end my abuse of prescription pain pills. It’s a long story but my issue is not with wanting a high but rather an almost irrational fear of withdrawal. Particularly the mind racing, restless leg, skin crawling feeling like you are losing your mind feeling that descends midway through the night leaving me feeling like I’m Completely alone on the planet at 4:30 am battling a Vicious alien who is trying to take my sanity. I can not overemphasize how terrified I am of withdrawal. Anyway, I began tapering again and in 6 months I went from 4 to 1.5 mg/day with minimal problem, and had stockpiled about 50 8mg films. I planned to just keep cutting them smaller and smaller and taper so gradually that I could hopefully bypass any withdrawal at all. This was about 6 months ago. At my last appointment (also about 6 months ago) I told my doctor I had gotten down to 1/8 plus 1/16 (1.5mg/daily) and asked him if he could prescribe 2 mg films even though I had a stockpile of 8mg films because Cutting them into 16 pieces was not easy and the next decrease would require me to cut them into 32 pieces. My doctor congratulated me but said Nobody carried 2 mg films. Having read your blog, I knew they existed but he even called several pharmacies for me and no one had them. So currently I’m cutting 8 mg films into 32 pieces and at this point I’ve had to cut 1/32 piece again as going from .5 mg/ day to .25 was leaving me feeling moderate withdrawal so I bumped back to 1/32+1/64= .375 mg/day. I have searched tirelessly to learn the actual physical process going on inside the brain during suboxone tapering. One article vaguely referenced the process of the drug letting go of the receptors in the brain. At less than one 8mg film a month, I falsely started to believe I might actually be able to evade that alien I’m so terrified of. However, the 2nd night after my recent taper from .5 to .25, I woke up in the middle of the night with the restless skin crawling out losing my sanity horror just as intense as any thing experience even when attempting cold turkey off prescription painkillers. So now I’m wondering if any suboxone at all is going in, does that mean my recent will remain completely blocked and I’ll have the same horror to face whether I wean to .125 mg every third day as I would have had if I just stopped suddenly 6 month ago at 4mg/day? I can’t find anything in the internet about the physical process Of unbinding receptors, etc. I’m the kind of person that can handle any challenge better if I feel like I understand what is going on. I don’t even know if this is still an active blog, but I would really appreciate any information anyone could provide to help me better understand and prepare for what lies ahead.
Posted by janaburson on July 28, 2020 at 9:03 pm
If you ask pharmacies to order the 2mg for you, most will do so.
I think every person is different regarding the speed at which they are able to taper. But I think you would have less withdrawal dropping from .125mg than from 4mg per day.
I’ve often wished some drug company would make a .5mg film, or tablet. Lots of people have trouble with that final 2 milligrams.
Keep trying – I have patients who spent over a year tapering off the last 2 mg that are still doing very well.
And there’s nothing wrong with staying on Suboxone, though your expressed preference is to taper. I hope your doctor is helping you with this.
Posted by Max on February 23, 2021 at 5:36 am
Anneal I believe makes 2/.5 bup/nal. pills. I tapered from 16mg to 4 mg and have beem stuck at 4mg. I CAN get to 2mg.but anything lower and I am tired all day.These little 2 mg. Pills are powerful. That scares me. I’ve been on subs for 12 years. I’ve been a union CARPENTER for 37 years and have 5-7 YEARS to go. Used to be near elite WEIGHTLIFTER. Been 15 years since I trained. 22 years of that had built a strong back etc.that is still good. Getting back would help get off subs I hope.They help with pain and energy. That’s reality. I have a very physical and MENTALLY challenging job. Scared that I am USELESS without at least 2mg but 4 mg. works fine. That is 12 mg. Less than a year ago. To me methadone and subs work exactly the same. Everyone at a methadone clinic shows up because it gives people energy period. Subs are the same. I was in a bad wreck, oxys,etc. is how I got started. I was 39 and a top powerlines when I was ran off the HWY by an 18 wheeler hit a 30 ft. tall light pole broke it of knocked it 100 ft up into the air. Hwy patrol said being built like a brick out house is only reason I’m still here. Long ago that was, not so much like that now. I miss training but opiates were all about working and staying working. Alcohol or any other drugs did nothing for me. XR benzodiazepines at 1.5 mg. per day is a gift from God. I don’t abuse the XR and never run out before the script is supposed to run out. Instant release I can’t take.They din’t last and I always wind up taking MIRE THAN I’m supposed to. XR is self regulating. They work so well for me many other patients have tries and are successful with them also. The XR gave me my life back.
Posted by Izzy on August 15, 2020 at 10:58 pm
I have a question. I’m taking a small dose of suboxone once a day. Is it safe to have a couple drinks 12 hours after my dose and around 12 hours before my next dose? A couple shots of whiskey a day calm my anxiety. Thank you.
Posted by janaburson on August 17, 2020 at 6:00 pm
FOr several reasons, no, it is not safe. Please talk to your prescriber. Also, your Suboxone bottle should have a warning label on it.
Posted by Dom Barnes on February 7, 2021 at 4:42 pm
Hello, I saw your video on YouTube. I wanted to ask about the letter that you wrote I couldn’t find it I wanted to present it to my physician as I am currently in a methadone clinic now my dose is 48 mg I also have been looking into Kratom I’ve also been looking into benzodiazepines and research chemicals as a way to get off of methadone I don’t want to take these other routes I am interested in your tramadol route, could you please help
Posted by janaburson on February 7, 2021 at 11:44 pm
I think you have me mixed up with some other doctor. So far as I know, there are no evidence-based ways of getting off methadone by using tramadol or kratom. I would recommend you talk to your doctor and make it clear that you wish to taper off methadone, if that is your desire. It’s an important decision, and you want to do all you can to prevent a relapse during or after taper.
Posted by Ila Congdon on February 22, 2021 at 7:27 pm
Yay! I finally found a blog about opioid addiction and methadone/suboxone. I have many questions to drum up. Hi to everyone. Ila
Posted by Max on February 23, 2021 at 5:47 am
I actually responded for the 1st time today. Responding and saying hello to you is the second time! I forgot protocol and didn’t say hello on the first. Been on subs for 10 years. Down to 4mg. which I thought would be impossible and still be a hardworking CARPENTER. Methadone clinic for 2.5 years was kind of a nightmare because I never had time to go to the meetings so I had to show up everyday. Never again! Hopefully I’ll see a question and answer if I can.They Trying to notice specific emails can be difficult.I receive way too many each day. Max
Posted by Ila Congdon on August 25, 2021 at 4:11 am
Hi Max! Thanks for your text. I am closer to the correct dose on Methadone but it’s very high and I STILL am sick every morning and get hot flashes and that ICK feeling in afternoons at times.
I was on high doses of Fentanyl before I was accepted on methadone. Funny, I had no problem getting scripts for pain but when my scripts weren’t enough I started using heroin which was basically Fentanyl!!
It took years to get methadone due to my chronic pain condition. I find it strange that it is easy to get opioids but not methadone.
I live in Canada so it may be different here than in the USA.
Have you ever been on methadone?
I have had to supplement once a week with a bit of fentanyl while my dose was going up. It’s still difficult for me to NIT supplement when I am not 100% and still feel daily pain. However, I never could have stopped at all without methadone!!! I have a massive tolerance for my size and gender and it’s frustrating that I started on methadone 18 months ago and am not perfectly dosed and going daily to pharmacy!!
Thanks for reading my vent. I am happy to have found this blog. It is important to talk about this subject.
Thanks Max!
😊
Posted by Max(Greg) on August 26, 2021 at 12:36 am
Hi Ila,
Glad to hear from you and truly hope you are feeling fine.I have to start checking this site more often as it is an excellent source of real life good info that can and will help you.I was fortunate to see a JanaBurson Blog email in one of my email accounts today. I had to give some thought as to how to answer you because there are so MANY VARIABLES THAT INTERTWINE in everyone’s opiate addiction career and the longest part, the recovery. I’ll try to keep this concise and therefore easily digestible.The long version is interesting but not appropriate for your answer. If you ask, I’ll write the long version for you! Be careful what you wish for! Anyway, I was in a wreck,at 39, a 195 pound weight lifter, I was put on 2/ 40mg. OXYCONTIN per day in May 2003.I stayed on those as long as I could.You can have the flu and still work a high stress heavy construction job.I did! THE DOCS stopped the of OXYS at the end of 2007.I MEDICALLY detoxed and tried SUBOXONE.Works great.I started with 4 8/2 mg. subs per day.One year later I was taking 2 8/2. One year after that and for 7 years I was taking 1 and 1/2 12mg.buprenorphine/3.5 mg naloxone.That doc retired and I wound up at a methadone clinic for 2.5 years. 175 mg. per day.That SUCKED!!!!!! At 5:00 a.m. there are 200-300 people in line and I started work at 6 a.m.I had to get there by 4:15 a.m. usually everyday. No time for classes so I had to show every single day at $18 per day.Heartburn and that whole system drove me to get MEDICALLY detoxed off methadone and 3 mgs. of immediate release Xanax from a doc that coordinated with the methadone clinic. Of course I was procuring an extra 60 2mg. bar Xanax a month! I know about your struggle with tolerance, it also sucks.At one time I was procuring 20 extra 80 mg. of oxys per month to go with the 60 40 mg. oxys I was prescribed.One day I took 6 80 mg. oxys. Definitely did not feel good.That was My wake up call for the first medical detox off of a substance. Fentanyl is extremely dangerous Ila.You just don’t know the strength. That is what I’ve been told. I could never bring myself to inject any substance. 195 pound weight lifter guy is DEATHLY AFRAID OF VEIN SHOTS! And, I KNEW I WOULD KILL MYSELF,PERIOD,IF I EVER TRIED HEROIN. I DO EVERYTHING TO THE MAX. UMMMM, HEROIN WILL KILL YOU IF YOU ARE LIKE THAT!. I HAVE NOTICED PEOPLE THAT SUFFER FROM DEPRESSION,MINES UNDER CONTROL NOW(DON’T JYNX IT GREG!), ARE USUALLY VERY HIGH I.Q. FOLKS THAT THINK TOO MUCH!!!!! THAT’S AS BASIC AS IT GETS, BUT WE WILL TRY ALMOST ANYTHING TO MAKE THE DEPRESSION GO AWAY.All of us discover opiates help you feel good! Makes that depression GO AWAY! Then you are in for the whole addiction career. I’M SURE THIS IS NOT NEWS TO ANYONE READING THIS. I am so ECSTATIC TO BE BACK WITH A SUBOXONE DOCTOR WHO HAS SUCH AN EXCELLENT TEAM. My current doc qualified my previous sub doctor! This doctor I have now has a physician assistant that interviewed me and I could not take my eyes off hers for 15-20 MINUTES STRAIGHT. She was carefully watching my every facial expression,tone,etc. I made. NOT sure how to say this, but she is a 40ish super model looking PA and I’m a guy, that’s one reason, the other is she read me like no one else ever!!!!! But, she asked me if I had an anxiety problem! I almost fell off my chair.I said YES VERY MUCH SO AND I DO NOT KNOW WHY. I asked about extended release Xanax as I had just read about it.Immediate release Xanax is not good for me because I take them too often and run out! Sound familiar!!!! The XR XANAX is a GODSEND! 1mg. per day really works! Benzodiazepines work the best for me, just not the immediate release.I don’t run out of the XR.Now, there are many other patients on .5 or 1 MG. of XR Xanax, generic, at this practice.It really is a gift from God for me.The doc has me down to 4 mgs/1 mg. naloxone per day which I NEVER EVER THOUGHT I COULD GET BY ON! I have a heavy construction job so the subs, testosterone replacement therapy and XR XANAX work for me.It gets better Ila.The physicians assistant also diagnosed me with ADULT ADHD 6 months ago and prescribed 2 mg of GUANFACINE.I’m on 3mg now.I actually have a real personality again.I don’t want to JYNX this, but now, after 18 years I started Powerlifting again.It’s coming back fast and muscle memory is a VERY REAL THING!!! I have a gym in my basement, 1200 pounds of Olympic weigjts, DEADLIFT platform, power rack etc, and used it religiously for 20 years straight until I hit the light pole at 80 mph.Pain killers killed off all my good habits and hobbies.The ADHD medicine seems to round out everything and I’m in a pretty good place.I take 30 mg of CYMBALTA for pain.It really works.It takes 3 months to kick in like GUANFACINE.You have to have a bit of patience and do what these very smart folks in these medical practices ask you to do.All of the sudden I can have a conversation with anyone,again.It’s been a long time.My sense of humor is really coming back.The confidence from lifting weights, very recent, all helps.I had no idea GUANFACINE would work with the other low dose scripts I take.I’ve always had ADHD.I just didn’t know.All the remarkable life changing scripts and advice have happened in the last 3 years since I was lucky enough to be referred to THE EXACT RIGHT MEDICAL PRACTICE FOR ME.The doctor is very cool.He is only 5 or 6 years older than me, but he is a real mentor.How do I say this, we usually talk about fine women, fine cars, current events and about 10% me! IT WORKS! OBVIOUSLY I TALK A LOT THESE DAYS.It’s like a “YOU NOW HAVE A PERSONALITY AGAIN SWITCH” has been activated.I do not want to JYNX any of this, and I still have things to work through to become the guy I know I can be, but the adult ADHD diagnosis has really been a major discovery and the GUANFACINE is doing it’s job.This is the short version Ila!!!!!!!! My friends have noticed a change for the better, especially in the last 3 months.And I know for a fact they can do without my ,now,non stop talking.Some people like it.They tell me to keep going!!!! So Ila, even when you think life sucks and nothing is getting better, boom, you might get diagnosed with ADULT ADHD like I did at 56 and it changes your life. I don’t want to JYNX this but women have noticed the built 57 YEAR old guy, I’m just a guy, “not all that” , but I was not expecting this.It’s a side effect of maybe looking like you have something good going on.I don’t know.All I know is that I’m going to keep doing what the exceptional people at the addiction medical practice advise.and my newer personal habits like weight training, etc. I left my own very well equipped home gym for 18 years.But now I’m back.I got my LES PAUL out the other day.It’s been 2 years since that happened, EXCEPT I PLAYED IT the other day.Ila, keep up all the great work you are doing.I can’t feel your physical or mental pain or how well the SUBOXONE helps with that.I’ll pray for you that you won’t need any fentynal supplementation as soon as that could possibly happen.I sure as hell am not perfect.I did medically detox off methadone and regular Xanax which led to the addiction practice that has done so much for me.I GOT VERY LUCKY. Getting on a non pay methadone program in the U.S. is ridiculously hard if you make a standard living.It should be very low cost and available to millionaires.Methadone keeps people in a job and not doing maybe some not to cool things to self medicate to manage what I think is depression for almost all opiate addicts, at first.Then of course you need them to stop from going into withdrawals. I’ve been there many times. Who am I though.That’s just been my personal experience. I laughed and blew off my adult ADHD and the GUANFACINE for the first 3 months because the GUANFACINE made me tired and I was too cool to have ADHD.Well, I forced myself to start religiously taking the GUANFACINE.Now I take it in the morning because it boosts everything.I cannot sleep on it now! And it’s been close to 12 WEEKS on it and it is another Godsend it would seem.Ila I.hope I didn’t bore you to death with this.I was supposed to be off SUBOXONE right when covid19 got dropped on America.My doc has kept me on 4 mgs/1 mg. per day. It is about as perfect a dose as I could ever hope for.I thought 12-16 mg for life until 3 years ago when I was referred to this practice from the hospital counselors I was working with. My doc is very strict but I have stayed in line for the most part.NO ONE IS PERFECT! You can strive for perfection and that is coming back in a good way for me.It’s just at a higher level than normal and the effort to get there is somehow easier.Ila, NEVER EVER TAKE EVEN JUST A MINUTE AMOUNT OF SUBOXONE WHILE ON METHADONE!!!! I took half of an 8/2 I found in the blue and white reckitt benkiser wrapper while on 175 mg. of methadone.That was the 2nd worst withdrawal of my life!!!! Ila, to me, it sounds like you are very close to figuring out your SUBOXONE dose and letting the small bit fentanyl go forever.You’re doing the big things correctly.You’ll get there. Subs are much more powerful than you think they are.Once you wean down and stay there you’ll see.Hopefully by then you won’t supplement with the small bit of fentanyl. Again, I can’t feel your pain so it’s not very cool for me to say”just stop the fentanyl”. You will eventually get tired of messing with it, I hope.That’s why I quit oxys.All the money, going to get them from a doctor and someone else.You get tired of all that and you stop.I’ll can only hope you get to that point or try something else for pain.Again, I laughed when my doc prescribed CYMBALTA for pain.I mean I laughed really hard!!! But, I forced myself to take it.60 mg was way too much.The last thing I want to be is “WIRED” and that’s what it did.We went to 30 mg and it works. Some back pain is very difficult to deal with.I know.I had it.It’s good now.Keep up all the great things you are doing Ila and eventually you will get lucky too.Yeah, this was the short version!!!!! Good Luck with everything!
Posted by Evie Murphy on November 15, 2021 at 2:34 am
Hi from Danville, VA!
I know we must be close to one another geographically, and while that doesn’t mean diddly really, I like the idea that someone so knowledgeable about MAT is so close to me in this little podunk rural southern area. In addition to the people at the clinic here of course, who are absolute gems. Tends to be the kind of place where addiction medicine is hard to come across and quality treatment even less likely. I’m in Crossroads here in Danville, and it’s surprised me as being the best clinic I’ve been in, out of seven. The worst so far was in the DC area, with a close second being Las Vegas. My clinic in Baltimore was great, but it was also enormous and one of literally dozens: Baltimore has been handling opiates for a long time, and if ever a city was indicative of the positives of MAT it’s that one. Still a city with a huge drug problem, but their treatment options, in number and variety, are incredible. I’d love for MAT to be as common everywhere as it is there, simply because addiction is everywhere and the treatment options ought to at least partially reflect the need. One day, surely. It just has to happen, right?
I recommend your blog to my counselors and the med staff. We have some fantastic nurses at my clinic, truly, and while I had a bad experience with one counselor (he’s gotten handsy with a couple of clients including me, eventually he’ll get caught with proof and they’ll HAVE to act) the others I’ve met and my current counselor are incredible.
You’re doing important work, I feel from reading much of what you write that you know this. I know you hear this a lot but I love to say it–methadone is the reason I’m alive. It’s the reason I’m a business owner, able to go back to school, able to not just live indoors but have held a lease for more than six months (three years, actually, longer than I’ve lived ANYWHERE as an adult), have a successful relationship with my partner (who is also in recovery) AND my family (most of whom cut ties with me for their own good, we’re getting to know one another again), have healthy friendships, time for hobbies and working out, and I have three dogs and two cats just to round things off nicely. Things are incredible. This is a life I owe directly to methadone, and of course my decision to be and stay in treatment and my determination to do something with the life I had to fight so hard to keep. I had a LOT of help getting here, and many of the people who did the most good for me were treatment professionals like you. You really are doing such important work for people who often don’t have a lot to live for. The medication is just the start.
Posted by janaburson on November 16, 2021 at 2:18 am
Thank you!
Posted by Th3lung on August 30, 2022 at 3:15 am
Do you think a 10+ year methadone maintenance patient (daily dose 80mg) should be receive punitive reduction in their daily dose because of multiple benzo + tox screens? They get to stop the taper-off when next months tox screen pops up *IF* they can produce a benzo negative tox screen. Thoughts? I think it goes against everything methadone & opioid use disorder treatment stands for.
Posted by janaburson on September 3, 2022 at 1:36 pm
The reductions in dose are likely for safety reasons, not punitive. Methadone and benzos don’t mix. I’ve had too many patients die from that combination.
Ideally, if the patient is unable to stop taking benzos, he or she should be offered a transfer to an inpatient detox unit for extra help, and the methadone dose left the same.
Posted by Th3lung on September 4, 2022 at 10:31 am
A level-headed response, I appreciate it.
Posted by ITSME on September 4, 2022 at 1:29 pm
Hi, Dr.
Love reading your blog. My question is do you have any advice on how to come off of the methadone without going inpatient in a facility? I have been at my clinic for about 6 yrs now. Im currently at 40 mg and detoxing slowly 1 mg every other week. I had tried this before and had gotten down to 15 mg but then pandemic hit, my mother passed, and at same time trying to deal with a spouse whose pill addiction now turned into a heroin addiction (i never went that route just pills) so I increased my dose again because I was definitely not in a good head space. Also, when at 15 mg. I would wake up at about 4 am every morning profusely sweating and my back killing me. I didn’t feel “dope sick” but I did think it was beginning of menopause (I’m 50) because at that time my period was not coming every month but I believe now it was because of all the stress and anxiety I was having because my period is back every month again now but I’m definitely in beginning stages of menopause. Do you have any advise on how to deal with those last few mgs because I want to be done with this program. I find it more stressful to me then ever before and I want to be done. TIA
Posted by janaburson on September 4, 2022 at 1:48 pm
Yes! You have more options since you are down to such a low dose.
You can continue as you are, slowly bringing your dose down. Reducing by 1 milligram per week is a slow pace, but you may need to slow it down even more when you get to 10-15mg, since by then, each milligram is a bigger percentage of the whole.
You can ask your primary care doctor to prescribe clonidine (if your blood pressure permits) to help with some of the autonomic nervous system symptoms of withdrawal like sweats, diarrhea, and the like. It doesn’t seem to help much with muscle aches, though. Also, if you can do some sort of aerobic exercise, that seems to boost natural endorphins that help with feelings of well-being.
It should be relatively easy to switch to buprenorphine if you want to try this. I usually ask patients not to dose for two days once they are at 40mg or less, then start buprenorphine. Some facilities offer low-dose buprenorphine induction. For some people, it is easier to taper off buprenorphine than methadone. Also, buprenorphine is available at office-based practices, a less restrictive setting than opioid treatment programs.
If you haven’t already done so, talk to your counselor about how to handle relapse triggers like strong negative emotions, being around people with opioids, and medical occurrences that could require opioids.
In my opinion there’s nothing wrong with staying on medication for opioid use disorder, but you stated your goal was to be done with this treatment due to stress.
best wishes & let us know how it goes!
Posted by ITSME on September 4, 2022 at 2:41 pm
Thank you so much for all of this useful information. Unfortunately our counselors are not much help. Usually young and just out of school. I find your blog much more useful and beneficial. I will keep you posted. 🙏🤞