On the Horizon: Heroin Vaccine

aaaaaaahorizon

In a May issue of the Proceedings of the National Academy of Sciences, scientists at the Scripps Research Institute in California reported their success using a heroin vaccine in rats. The lead author of the study, Joel Schlosburg, works with Dr. George Koob, renowned and accomplished scientist who heads the team at Scripps.

This vaccine is still only in the animal phase of study. Scientists have developed a vaccine that stimulates the rat body immune system to recognize heroin and its metabolic byproducts. The immune system sees these substances as pathogens which must be got rid of, and manufactures antibodies against the compounds. After the antibodies bind to the heroin and its active metabolites, it gets further metabolized into harmless compounds that are eliminated from the body without ever crossing the blood brain barrier. In other words, the vaccine binding prevents this powerfully reinforcing opioid from ever getting into the pleasure centers of the brain to cause euphoria, or a “high.”

The first studies in rats are promising. This vaccine is postulated as a way to prevent heroin overdoses, since vaccinated addicts will no longer get euphoria from the drug. However, similar studies have been done with cocaine, and some human subjects could over-ride that vaccine by taking more cocaine, and were still able to get high. Dr. Koob says that with this new heroin vaccine, it would take a very large amount of heroin to over-ride the vaccine, or to cause an overdose. The rats in this heroin vaccine study didn’t try to load themselves with more heroin, a positive sign.

The vaccine wouldn’t affect opioid medications like methadone or buprenorphine, and so the heroin vaccine could theoretically be used along with these standard opioid addiction treatments.

Researchers took pains to make clear this vaccine is not a magic bullet. Once a vaccinated addict is subjected to cues associated with past heroin use, like being back in an old neighborhood, craving will still occur and the vaccinated addict may still use heroin in response to that craving, despite a lack of euphoria once it is used.

Also, it won’t be effective on most opioids contained in prescription pain pills. This means other opioids can still be useful if a vaccine-treated patient needs pain control… but it also means a vaccine-treated patient could still get high from non-heroin opioids. My fear is that a heroin addict would just switch to misusing prescription opioids.

Even with the vaccine, addicts still must have the psychosocial aspects of treatment in order to overcome addiction. It should be used as a part of a comprehensive treatment program.

Human trials may begin as early as the end of this year.

Schlosburg et.al., “Dynamic vaccine blocks relapse to compulsive intake of heroin,” Proceedings of the National Academy of Sciences of the United States of America, 2013 110 (22) 8751-8752.

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19 responses to this post.

  1. Posted by dbc910 on June 7, 2013 at 12:24 am

    Something about this scares me. Reminds me of the movie ‘I am Legend’, where a lethal virus was born out of a Cancer vaccine that combined with influenza ;o

    Reply

  2. Posted by Benjamin K. Phelps on June 7, 2013 at 2:19 pm

    Dr Burson, your fear is very valid. When I moved away from DC & back to Morehead City, NC back in 1996 to get away from heroin, I got here, started craving, & simply started filling scripts for Dilaudid, Demerol, & Lortab 10 (the latter a little later – like ’97) to take the place of the dope. ANY opioid would do, so long as it didn’t get me sick somehow or whatever. I found that Talwin NX made me hallucinate & the euphoria became dysphoria after taking more than a couple, so I stopped that very quickly. Then, I found that Demerol made me extremely nauseous if I was physically dependent on heroin or other mu-agonists b/c of incomplete cross-tolerance, so I quit playing w/that. I also ran to the E.R. a few times, feigning illness for a shot of this or that, & went to urgent care places for any cough or back pain, so as to get hydrocodone syrup or tablets (or even codeine or the likes). Bottom line: for hard-core addicts, opioids are going to be opioids. Once they know what the other ones are called & more importantly, where/how to get them, they’re not going to give 2 cents about not using heroin… They’ll just use something else. Unfortunately for me, at that time, MMT wasn’t yet available any closer than 2 hours away (Greenville & Wilmington, NC), both of which were too far away for me to drive to every single day… though I eventually tried in Greenville, only to end up SO dogged out from driving there at 4:30am every morning & back to work full-time in Morehead that I eventually got a script filled for methadone tablets so I could take a day off here & there. The 2nd time I went to do that in Greenville, I got caught in the pharmacy & put in jail, right beside the MMT program, which was run by Pitt Co Mental Health at that time. They brought doses over to the jail everyday for people w/misdemeanors. Those of us w/felonies had the pleasure of watching those guys drink their methadone while we kicked, vomited, writhed, & yelled in pain on our bunks from 10 feet away. Anyway, my point – I don’t see a vaccine that ONLY blocks heroin as doing much good at all, if any. Rats are going to be the ONLY ones that don’t know they could be getting the same effect elsewhere, unfortunately.

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  3. Posted by Jason on June 14, 2013 at 8:23 pm

    Sorry if this is the wrong section to post random thoughts about Suboxone/Doctors. The number one thing I’ve learned from taking Suboxone for 5 years is less is more. I feel 100 times better when I take half of what I’m prescribed. The other things I’ve learned is that Suboxone sucks for pain managemnt and most Doctors don’t care.I would guess none of us here are lucky enough to have Dr, Burson as our Doctor. My doctor has performed multiple painful procedures on my back, I have titanium plates in me, blah, blah blah, and he swears Sub works for pain. If only he paid as much attention to the facts as he does my billing I might be better.Sadly he is my 4th Doctor and I’ve lost hope on finding the right one. These Docs know you need them because withdrawal and they abuse their power. I found a great site: http://www.propublica.org
    At the top of this site there is a tab that says “Dollars for Docs” here you can enter a Doctor’s name and see if they’ve received kick backs and from who..apparently my Doctor hasn’t paid for lunch, dinner and drinks in a long time.

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    • Posted by Benjamin K. Phelps on June 15, 2013 at 12:55 pm

      Jason, you need to be REALLY careful what you post (& I don’t at all mean that to sound like a threat of some kind or anything like that). When you post that you are only taking half of your meds, the question arises IMMEDIATELY for any doc treating you: Where is the other half of the meds I prescribe to him going? This is a SUPERB way to lose your treatment &/or takehome medication. I’ve watched people talk themselves out of takehome medicine more times that I care to remember by doing this exact thing – like the patient that Dr Burson had tell her that he took his takehome dose early every week, which she promptly rescinded from him. And truth be told, you can’t blame the doc for getting up in arms about it. If s/he smells the slightest HINT that a patient might be hoarding/accumulating, selling, giving away, or in any other way not taking as prescribed the opioids they’re being supplied with, the doc knows that it’s HIS/HER license on the line. You have to understand that when somebody ends up in an emergency room in a comatose state, & the ER doc finds an empty bottle of methadone or Suboxone in the patient’s pocket (or half full or whatever) w/the name of a specific doc on it, this does NOT lend credence to our case that MMT & MAT are feasible treatments, that they enable us to live normal lives w/o all the lying, crime, & irresponsible drug use, & most importantly, that they don’t pose a horrific danger to the community. We already face enormous opposition from parents, law enforcement, & politicians b/c of the perceived danger to the community that they believe these treatments post, despite that they’ve been proven to HELP communities, not cause further damage. Those things said – I understand that YOU personally may not be doing ANYTHING whatsoever that is bad or negative w/your medication. I, for 1, do NOT consider having an extra day of medication stored at home for emergency purposes (I have encountered such emergencies a couple of times in 10 years on MMT, & having to go to the ER to be dosed at a rate of about $800 per dose is NOT an acceptable solution) to be a bad, evil, negative, or otherwise problematic thing. BUT MOST DOCS DISAGREE, & even if they don’t, the clinic rules do. Every clinic I know of will absolutely accuse you of diversion for trying to be sure you never end up sick b/c of a snowstorm or faulty alarm clock (& I’m not talking about people whose alarm clocks seem to be faulty every week or even 1 time a year… I have only had the problem of my alarm not working 1 time in 10 years). It’s very unfair to insist that a patient face being horrifically ill or paying almost $1000 for a single dose, rather than have a single dose at home locked away, but that’s neither here nor there for the purposes of this conversation. Obviously, your last name is not used in the above comment, & I don’t care to know who you are. However, if you post anything that gives somebody else a way to deduce who you are, this could lead to big problems for you w/your doc. PLEASE BE CAREFUL about this. And though I may or may not need to say this, I will: When you post that you’re not following the prescriber’s directions exactly, you are announcing that you are, in essence, self-medicating. You & I may agree that taking LESS than prescribed shouldn’t be a bad thing if you don’t truly need the amount you’re prescribed – & even your doc may agree. However, b/c of the intense scrutiny around MAT & MMT, we’re not supposed to do that for ANY reason. The DEA doesn’t want you to have even a single extra dose of methadone or Suboxone in your possession, & this is why the docs & especially the clinics have so much to be upset over. I’ve been tempted to taper myself in the past when my doc didn’t continue my taper automatically (he wrote for a couple of weeks, then had them stop for further instruction at that point, meaning I could not continue tapering until I could get a new appointment w/him. He was out of town for 2 weeks at that point, leaving me paying for treatment 2 weeks longer than I had intentions of doing so. I was VERY angry about that.) But the fact of the matter is, there is NEVER a time when they will find it acceptable that we take any other dose than what they wrote for, except MAYBE if they tell you to decrease if you need & then write you for less than you need next time so that you can use up the extra tablets. They’re not usually keen on that, though. Okay, so you & everyone else gets my point. I don’t mean to sound like a butt-head, & again, I probably agree w/your views on most of these things. But I’m trying to make you aware of what can turn out to quickly be a fairly big problem for you of your own making if you’re not careful. If I hadn’t already seen it happen so many times, I probably wouldn’t have thought enough of it to write this. Incidentally, even though buprenorphine is considered to be a decent pain medication, the way you take it (as a maintenance med for addiction) is NOT the proper way to dose for pain. The same is true for methadone – it’s excellent for pain, but not when dosed at once daily. In order to dose methadone for pain, the daily total dose is supposed to be divided into 4-6 doses so that it can be taken that frequently throughout the day. This is b/c the painkilling properties of it don’t last as long as its ability to stave w/drawals. So perhaps you need to discuss this w/your doctor. If he still absolutely refuses to budge, you could choose between trying to divide your dose, as I just described (I don’t know how well that works w/Suboxone, but I doubt it works that well. Furthermore, Suboxone/bupe has a ceiling effect at the equivalent of about 60mg of methadone. That’s a potent dose, but it’s still less than many pain patients take. Hence, you may need more than what bupe can do for you. In that case, the 2nd option you have would be to leave this doc & find a pain clinic or doc that will give you methadone for your pain, which will also treat your addiction at the same time. The tricky part is that some pain docs will do this, some won’t touch you if they know you’re an addict (including in recovery). If you refuse to be on methadone rather than Suboxone, I don’t know what to tell you at that point. But have you considered getting on methadone at a clinic instead of Suboxone? You can get to monthly takehomes in many states (we can in NC), & at that point, it’s really no different from a doc’s office for the most part. It’s MUCH cheaper than Suboxone & the price is NOT dose-dependent, as it is w/Suboxone. Furthermore, it’s a better painkiller b/c it’s a full mu-agonist, rather than a partial (as Sub is). You don’t have a dose-limit with it, some clinics will split-dose you, & regardless of whether they will or won’t, you can always do so yourself once you’re on takehomes. Split dosing is NOT the same as taking it early or not taking it as prescribed – at least not in the opinion of most of the docs & clinics I’ve had any experience with, b/c you’re still taking the proper dose on the proper day. And from the point-of-view of someone who’s been on both, methadone w/d’s aren’t really any worse than Suboxone w/d’s, in my own experience. I was in UTTER HELL with either 1 if I didn’t taper very slowly. Best of luck to you.

      Reply

  4. Posted by Jason on June 15, 2013 at 8:56 pm

    Thank you, Ben. I appreciate the advice although I think I finished the book Moby Dick faster than your post, it was still good advice. I have always finished my precriptions with maybe one or two left over to the next appointment.Remember I said I feel better when I take half not that I always take half. if I always took half I would be in more pain and withdrawal. And my Dic knows I sometimes take less. I guess when he found out that I took myself off of fentanyl, never have failed a drug screen and pay over $600 a month for suboxone when I used to pay $50 for fentanyl, there’s trust there. And sorry, I’m not afraid of the ramifications of free speech and/or the DEA. I’m 100% legal

    Reply

    • Posted by Benjamin K. Phelps on June 16, 2013 at 12:35 pm

      Jason, your apparent sarcasm is duly noted. I did not say anything about censoring your speech or the DEA coming to get you. I said the DEA doesn’t want you to have extra doses (& by extension, they don’t want docs giving patients a single extra dose above exactly what is needed – which is why pharmacies are so strict about not filling them early & have limits on how many tablets & refills that can be given, depending on the schedule of the drug) & that’s why you should expect your doc &/or clinic to have a problem with it. Do & say whatever you like, & by ALL means, feel free to believe that the money you pay & clean urine samples you donate ensure you some trust & favor. But the fact is, knowing that you have extra doses on hand & still continuing to give you even more puts your doc at a HIGH risk of problems in the event of a DEA audit – which Dr Burson can tell you does happen regularly & that they aren’t always nice or even remotely close to it often times… I PROMISE you, you’ll find those things you’re trusting to give you a good name don’t ensure you squat when anything calls your compliance into question with an auditor or the clinic/doc office staff themselves. But your efforts to flip the situation by suggesting I’m getting high on my medication b/c I did what I ALWAYS do when I write by making every effort to be thorough in describing my intentions behind what I wrote (which caused it to run rather long) was rather transparent & low-down. To the extent that it’s not worth discussing the merit of it (or total lack thereof). I mean… REALLY? THIS is how you thank somebody for trying to have your back a little? The bottom line is this: if you dropped a fentanyl dependence that easily & well on your own, why do you NEED addiction treatment meds? And if it’s for the remaining cravings, that STILL leaves us with the question of why your doc is refusing to treat such a trusted patient with anything for pain except Suboxone – which isn’t even indicated for treating pain? You can count on it – in the eyes of docs, you are an addict & will be treated as such at all times when it has been made known to them. So if you want to advertise that you have extra doses lying around, again, please feel free to do so. I just thought you might APPRECIATE knowing that it can cause you BIG headaches if the doc catches wind of it, if only in the form of having to show up to get meds more often at the doc’s office. But perhaps you have the extra time & money to spare for that…. Or just don’t like anybody to offer you the occasional word of advice. Please excuse me for my misguided concern.

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      • Posted by Benjamin K. Phelps on June 16, 2013 at 12:52 pm

        ***REGARDING THE ABOVE POST I MADE***: You know, I can’t decide if I think I read the right inflection into your replies or not – if I had a knee-jerk reaction to your reply (particularly the 2nd), then please accept my apology. Even if it was intended to be sarcastic, I really over-reacted, & I shouldn’t have. So I’m saying that either way, I apologize for my words today – my original post was not meant as a “warning”, but as a friendly word of advice that we can get ourselves into situations we wish we hadn’t, particularly with MAT b/c of the red-tape around it, which in turn creates TERRIBLE environments at the clinics & docs’ offices that dispense our meds. There are MANY instances where patients would be given the benefit of the doubt in any other situation, but not in MAT/MMT. It sucks that we live with that & bend to the whim of OTP’s & docs that show absolutely no trust in their relationship with their patients. I’m not talking about trusting to the point of being taken advantage of… I’m talking about using a little clinical judgment instead of just yanking takehomes every time somebody breaks wind, as many, if not most OTP docs seem to do. But anyway, if you are comfortable with putting those words out there, then that’s all that matters. And no, I’m not over-medicated – I’ve been dosed for 6.5 years at the same dose, followed by dropping 35mg to where I am for the last 3 years. Not only do I NOT feel euphoric, I also don’t feel what I’d describe as “good” a lot of the time. I have Meralgia Paresthetica in my left leg that is severe & isn’t helped at all by MMT (as I’d expect), I have some other issues (I believe it’s either chronic fatigue like my father has had since 1988, fibromyalgia, which he also has, or both – but since I have no insurance, I can’t afford to go find out). Methadone doesn’t cause euphoria after you stabilize – it’s not at ALL like short-acting full agonists in that way – when you’re over-medicated on methadone, you feel like total dog sh*t. You just get nauseous, queasy, & sleepy (which is NOT the same as a nod). Yes, those who are chronically over-medicated might appear to be nodding (& if they take other depressant meds, they may indeed achieve a nod), but usually you just feel REALLY sleepy, & that sucks when you have a job to do or even when you don’t – it gets really old falling asleep every single time you sit still for 2 seconds. I was over-medicated for about 5 days around 4 months into treatment in 2004, & I immediately asked to go back down 10mg b/c I felt so terrible. I never went back up again to that level, & I’m FAR below it now.

  5. Posted by Jason on June 15, 2013 at 9:18 pm

    Ben, I just realized I’m a little worried about you. I remember when I was taking the full agonists I would write long posts sometimes almost as long as your posts because I was high and in a good mood. I think you should discuss with your PCP and be honest with what you want. I’m here for you if you need an honest talk. Take care!

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  6. Posted by Jason on June 16, 2013 at 7:20 pm

    Ben, I’m starting to get a knee jerk reaction to your knee jerk reacton and this is a vicious circle we’re in right now. My first impulse is to lash out at you for your holier- than-thou rants, and call you a pseudo intellectual, If i were to analyze you I would submit that at some point you were in the medical field and this is where your dependence started. Although somehting just flashed across my mind indicating you were/are in education and this seems to make more sense becasue you appear to feel you have more knowledge than most. But I digress. .

    You can lie to yourself and say you’re not getting high on Methadone and maybe high is the wrong word,but you are feeling some kind of euphoria that may give you energy or some crazy typing skills. Whatever it is, you need to come to terms with this
    Take care! I am still here for you if you need to talk!

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    • Posted by Benjamin Keith Phelps on June 18, 2013 at 5:58 am

      Ok Jason. #1, I’m not nor have I ever been in the medical field. #2, I’m not nor have I ever been in the education field. #3, I’m not holier than thou. I’m an addict, just like you. And while I may or may not know more than you – I really don’t care. I just hoped I could help you avoid a headache you probably don’t want to begin with. But no matter. #4, why are we back to me getting high on methadone b/c I write long messages? It would seem that there’s really no way to prove OR disprove this theory of yours. So why are you keeping after that? This discussion was about a concern I mentioned to you, & my perception of your response to me – which for no good reason, included an accusation of me getting high. Ok, so if I say you’re getting high on Suboxone, then we’re now in the same boat – & neither of us can prove to the other ANYTHING. So then what? I just don’t get where you are going with that?

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      • OK Jason,
        I’d prefer you NOT accuse one of my faithful readers of getting high based on the length of their posts. Maybe you don’t realize it, but to someone who has struggled to get and stay into recovery, being accused of using drugs is highly offensive.

        The studies show that patients on methadone maintenance are not impaired and can drive, operate machinery, etc., so saying a person is getting high on methadone just doesn’t hold water.

        Methadone in a person not used to taking methadone is completely different. It can impair and kill an opioid-naïve patient, or a methadone-naïve patient.

      • Posted by Benjamin K. Phelps on June 24, 2013 at 12:41 am

        Dr Burson, I thank you VERY much for making that point. The truth is, it’s less that I am offended by it & more that it hurts to be accused of that. Not to drag up Jason’s comments, b/c I have accepted his apology… But in the event that someone else reads this & it resonates w/them – PLEASE think before you make such an accusation against somebody else if you don’t truthfully know they’re intoxicated. The reason it hurts to be accused of that is b/c only God knows how hard my struggle has been at times – & yet I’ve done the right thing at most points in that struggle since I started MMT – though I’m far from perfect & I have certainly had my slip-ups in the past. I am not special – ALL addicts struggle in this way. But that’s why it’s so difficult to be accused of using when you haven’t…. & for it to be by someone that you can’t prove 1 way or the other to… That has a way of really punching you in the gut, b/c your character & honesty is being called into question & you can’t straighten it out!! I have no way to show the many readers here whether or not I’m euphoric & nodding while writing my posts, & I don’t want them thinking now that this is the reason my posts are long – it’s not. I ALWAYS write detailed messages & posts – I did in my letters home when I was in prison & had no access to opioid maintenance or even illicitly besides on maybe 3 occasions. I like to cover all my bases that I think a reader might wonder about when I write. If I think you might have a question in your mind about a statement I wrote, I cover it as best I can the 1st time around, so you don’t have to write back & ask (or just eternally wonder what I meant). So my posts always end up long. But many people tell me they enjoy reading them, so I feel like it’s not a bad thing. And in the event that ANYBODY out there really does believe that I think I’m smarter than everyone else, or that I’ve got this thing figured out, PLEASE know that I don’t AT ALL think those things. I’m finding my way each & every day, just like all the other addicts & patients out there. Yes, I read & research A LOT about MMT in particular, & MAT in general to a lesser extent, but I do that so I can share what I learn & know about what I’m participating in, instead of blindly following rules & taking things I know nothing about. There’s way too much misinformation out there if you simply listen to people in the clinic line… that stuff drives me crazy sometimes! But they don’t know any better than the things they’re saying, b/c that’s what they’ve been told or overheard. That’s why I research as much as I can – & it doesn’t make me any better than them – it just means I can hopefully give them some correct information when they need it, & maybe steer them away from some wrong info they’ve gotten hold of. The fact is, that IS helpful & needed sometimes. And if I can help others w/their addiction, I feel like maybe that makes mine just a little less pointless that it happened. MAYBE my addiction will make just a little more sense in the world if it helps somebody else not get addicted, or to get away from their addiction. That’s just how I look at this thing. But again, I thank you, Dr Burson for your words of wisdom & for your defense of me.

  7. Posted by Jason on June 20, 2013 at 7:14 pm

    I did not mean to offend but looking back I can see I did. I truly apologize and I wish Ben the very best with our common struggle.

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  8. Posted by Jason on June 26, 2013 at 12:41 pm

    Thank you, Benjamin. I really feel terrible that I insinuated that. Truth is, I’ve grown tired of of being dependent on medication (Suboxone) to feel normal and to get through the day and I took it out on you through this post. I sincerely apologize. I also apologized to the staff at my Doctor’s office for my behavior when they presented me with a bill for procedures that my insurance would not pay. So, it was a bad week for me, but I learned a lot. 1. That I am partly id not solely responsible for my situation. 2. That you never really know what someone else may be going through and to think I may have impacted someone’s path of rehab realy put things in perspective and I can’t apologize enough. PLease chalk my comments up to someone who;s on a daily struggle and is coming to terms with being an addict. After reading what you’ve gone through I can tell you that your posts TRULY help, educate and inspire. As does this site. I wish you the best and look forward to your posts. Hang in there! Look who hat the long post now 🙂

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    • Posted by Benjamin Keith Phelps on June 28, 2013 at 3:42 am

      Jason, it’s late so I’m gonna do a short post for once, but I just wanted to say that I know how you feel – ceding your life over to the rule of a clinic or a doc’s office gets VERY tedious & old after a time. Many of them, if not most, don’t seem to have much concern for how drastically they can & do affect our lives when they make snap decisions on a whim. So after having had them do that to me a few times, I’m all too aware of how you feel about having to rely on medicine to make your life normal. I only hope that you are able to STAY clean if you decide to come off. As I’m sure you’ve read already, we all can get through a taper; it’s staying off that most of us are unable to accomplish in the long run. I hope that your situation is different (& for some, it is). As far as apologizing more &/or feeling bad about the previous posts, no further apology is needed. All I ask is that you remember how powerful such a thing can be & the effect it can have on someone who is struggling to stay clean & has been succeeding so far – I’ve known many who would say “Well, if I’m gonna be accused anyway, I might as well go for it!” Thankfully, I’m not at that place. But in terms of me, your apology was accepted the 1st time, & I hold no hard feelings. No worries. Good luck in your efforts to reduce & eventually stop your dependence on Suboxone (& all other opioids). I know how difficult (if not downright impossible) this can be, so you have my best wishes & support. If there’s any questions you have about this process that you think I might know any answers to that would help you, don’t hesitate to ask. As I said before – what I’ve studied & learned, was ALL in the effort to be able to help those who suffer as I have, or to help prevent those who may be about to end up there if they aren’t careful. Take care & keep us updated on your progress.

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  9. Posted by Jason on June 29, 2013 at 12:28 am

    Hi Benjamin! Thank you again. I had an awakening experience this AM. I was at my Doc’s office for my monthly follow-up/re-fill (not a procedure this time) and as I was coming out and up to the window to recieve my scrip, there was a guy in front of me telling the secretary “Ok, ok I will take care of it next week, I just don’t want to be sick.” Then the secretary goes into a long-winded very rude tirade about how this guy needs to keep hi payment promises and that on such and such date he promised to pay this and that. I felt for him..I’ve been there. Then the other person behind the counter shuts the window and starts talking to the scretary. I thought Nice! She’s going to tell that lady how rude she is being. WRONG the secretary asked to speak to him outside. They went out and I got my scrip made my next monthly and off I went into my next battle..The pharmacy. But as I walked out of the office, the whole floor could hear the secretary (no one was around though) firing off dates this guy went to see other Doctors and what scrips he got, how many, etc. and he should still have way more than enough medicine. My first thought was to stick up for him and tell her how she had no idea what it was like to be sick (maybe she did) and she should have that conversation in private but then I started to get this good feeling inside and went aroun the corner by the elevator and listened. You see, I was that guy getting bitched out for doctor shopping, begging for one more try knowing there would be more trys and it felt so good to be the one on time and not having to come up with lie after lie that they don’t believe anyway. It was very therapeutic (sp?). It was like a meeting but better. I can’t explain why but I know you know. I wanted to tell him to hang in there and about my experience but this guy, I felt, had been there done that and we all know you have to want it and maybe this was his rock bottom he was hiting. I don’t know but it helped me at a time when I felt like giving up on Sub but knowing I would slip up. Seeing that guy go thru what I have many times reminded me that I didn’t want to be there again for any reason. She told him no more and to leave.I felt for him because I knew he didn’t want or could even get the high, it was more about not getting sick which is terrifying. By the way, Pharmacies suck but that’s a whole other conversation.

    Reply

    • Posted by Benjamin K. Phelps on June 29, 2013 at 11:44 am

      Jason, 1st, I’ll warn you up front of the obvious – I ended up writing A LOT here. Sorry for that, but I just re-read it & didn’t see where there was anything I wanted to remove…. Hopefully, you enjoy reading it, & aren’t put to sleep instead! You’ve been warned, lol. So anyway… Man, the person that wrote that message I’m replying to is the person I was wanting to talk to when I 1st wrote you! That’s the person who knows that he’s doing well, but remembers how easy it could be to be right back where he’s been before… And the 1 who knows better than to take any of this for granted :o) We never know how someone will react when we reach out to them – & I had felt really bad that my message(s) were coming across as high & mighty or better-than in tone when it wasn’t how I was meaning them at all. I try to treat EVERY other patient (MAT or MMT or even abstinent sobriety) as I would want to be talked to & treated, b/c I’m SO used to what it’s like when you’re not treated as such. This is not about bringing up any of the negative misunderstandings from that situation, only about just wanting to say that I’m glad that we’re communicating like we are now. We’re in a common war against a nasty disease, & in a sense, against our own selves. We usually accomplish SO much more & make things so much easier on ourselves when we join forces, rather than fighting by ourselves & against others.
      As for the guy at your doc’s office – wow. It’s not uncommon to encounter that very situation, but it’s ALWAYS very difficult (to the extent I can’t even express it strongly enough) to have to watch it. I don’t know about how you are w/this, but I find it SO VERY hard to have to watch someone deal w/impending withdrawal. I always want to do everything I can to help them. In our current situation though, what can we do? We are stuck in a very real impossible situation – we can’t give them our medicine at all, we don’t want to get involved w/trying to help them find illicit drugs (& God knows I can’t even stand it when they ask… b/c I’m doing well, so I don’t want to EVER get involved in trying to find drugs around town again, even if I know the general area [which we ALL do] & people to look around), & we don’t want to enable them to continue to relapse (or if it is really JUST for the purpose of not getting sick, we still don’t want to risk them ODing the 1 time that we try to help them or something of that nature…). So it’s just an all-around impossible set of circumstances, but yet we KNOW all too well what they face if they don’t find an answer to their problem soon. My clinic has begun a new policy in the last several months of not dosing people when they return from ANY trip to the hospital – whether admitted or not (unless they’re unaware of the ER visit) – until they see medical records & you are seen by the doctor. I’ve been told that on the weekend, you’ll be dosed but MUST see the doc immediately on Monday. HOWEVER(!!), I’ve now seen NUMEROUS people get turned away w/o being dosed when they were released from the hospital, after doing EVERYTHING they were supposed to do, all b/c the clinic had a problem getting hold of the medical records right away. A girl yesterday came in after a 2-day stay, & they escorted her out of the building w/o dosing her. That’s probably the 7th or 8th time I’ve witnessed this. What scares me is that they’ve NOT posted this policy ANYWHERE, nor have they published it in the handbook. Hence, NONE OF US know what the real policy is, nor how to make sure we don’t get caught up in it if we’re released from the hospital. The way this is being handled is as it happens to each individual, & people are being sent home to relapse, just as my clinic does when/if someone isn’t able to give a urine sample when asked on any occasion. I have a REAL problem w/this! I have NEVER EVER not been dosed for ANY reason in the past (before this clinic) – & I’ve NEVER EVER not given a urine sample when asked. HOWEVER, I have been diagnosed w/Paruresis (bashful bladder), which is 100% mental, yes. But it’s 100% real, whether mental or not. The way it works for me & those who have it is that the more pressure we’re under to go RIGHT THIS SECOND, the more we lock & cannot squeeze a drop. Also, in public restrooms, most of us have a really hard time w/complete silence if someone else is in there at the same time. I can’t STAND that! What happens is that I stand there, & my mind immediately goes “This other person is going to wonder what you’re standing there for when they don’t hear the urine start flowing in a second, & they’re gonna start to think you’re doing something perverted or trying to look at them” or something like that – it’s totally subconscious. But when that happens, then I can’t go even longer. SOMETIMES, I can eventually go after a few seconds – but a little sound in the bathroom (besides us talking) usually helps tremendously, b/c I then don’t feel like they’re in the stall next to me, wondering why they don’t hear my urinating or something yet. So when a person (at my clinic, it’s a woman for everyone – a nurse) is observing urine testing, & 100% of ours ARE observed, & staring at my crotch, I lock up tighter than a tick. I can stand there & squeeze for HOURS & still not get a drop out if I don’t hold my 1st urine of the day before going. I have to need to go to the point of being in PAIN to be able to go on demand while someone watches. Even then, it’s difficult. And we have to give to a point above the temp strip on the cup, which is yet another difficulty, b/c I can sometimes squeeze just a tiny bit, but then the stream stops. Okay, so you can see why this worries me, right? I don’t want to, after not relapsing to opioids for YEARS (literally), have a relapse SOLELY b/c I was sent home w/o a dose b/c I couldn’t pee on demand by the end of dosing hours. Most clinics just count it as a + if you don’t give a sample that day. Not ours – we’re all about punishment at my clinic. Another aspect I have a REAL problem with. I pay for this treatment, which doesn’t give me unlimited say over my treatment &/or no accountability, but I feel like I deserve better treatment than to be handled like an inmate in prison for a crime. And we used to have to TURN & FACE the observer a year or 2 ago!! That was INSANE! All b/c they were afraid somebody was gonna try to sneak 1 past them & they wouldn’t catch that person. My whole thinking is this: You’re not in this to catch every single person that uses, every single time they use… You’re in this to carry out the rules required by law, which includes periodic testing. A person MIGHT use & sneak it past you for a time… But eventually, if s/he’s using regularly, YOU WILL EVENTUALLY CATCH HIM/HER. I just don’t get the idea that they’ve GOT to catch everybody every time…. Nobody’s going to be good or perfect enough to live up to that anyway.
      Yeah, I know I’ve REALLY gone on & on this time…. That whole policy at my clinic of not dosing us on their whims just REALLY pisses me off in such a big way. I’m in the process, now that I’ve got full-time work, of getting financially to where I can move back to a private clinic – 1 that treats me like a human being in a medical treatment program, instead of a deviant who wants to get over on them at every possible point. That has a way of making you REALLY suffer when you depend on medication to be normal, as you said earlier. Hopefully, the guy at your doc’s office getting caught has learned something from this experience. Hopefully, he won’t be so unfortunate as to go use to stay out of withdrawal, & OD in that process. I really hope that won’t happen. But if it were to, I don’t know that I could blame the office for not having given him extra meds when they KNOW (not suspect) he’s getting extra meds elsewhere… Like I mentioned to you before – it’s their LICENSE & LIVELIHOOD on the line w/that! Also, IF (& I doubt it’s the case, but…) he’s out there selling those meds, they have to be SURE they’re not accountable for having supplied him w/a basically unlimited supply for that purpose! It’s a difficult situation all the way around, in reality – for him, for the doc & his office, & yes, even for you – the bystander who has to watch it & feel bad for a person who is like you used to be, & whom you likely felt an urge to help in some way. And I’ll say in a heartbeat that in those cases, it IS tempting to want to give the person a single pill to get them through the night… But we know we can’t short ourselves of our own recovery medication. And that’s not being selfish (well, it is, but in a GOOD way!) You NEED to be all about your own recovery & well-being… so that you don’t end up back where he is! There’s nothing wrong w/telling him to keep his chin up, or that things CAN indeed get better for him. But that might not be the best time, considering he’s likely madder than a hornet at that problem & likely would just want to punch you in the mouth if you won’t give him a pill while you tell him that…
      Anyway, in closing (whew!…), Jason I’m glad you’re doing well – well enough to recognize that you DON’T want to go back where you’ve been in the past. And ONLY YOU know whether or not that’s likely if you taper slowly. So I can only leave it up to you, of course. But you have my support, no matter which road you take, & you can ALWAYS reach out – whether it’s to me personally, or to all of us – whenever you are wanting to feel that support, whether in a taper situation OR in staying on your meds but feeling tired of needing them. Trust me – we ALL feel that – A LOT!!!! Take care, man.

      Reply

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