Suboxone: Trading One Prison Cell for Another
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The day I realized I was a junkie began like any other. I woke up late on a Tuesday in 2001, rushing to get to a work meeting on time. Just the normal routine. The only difference was on this day I did not take the white tablet that had become my secret and constant companion for the previous year. I had forgotten to. In the middle of my meeting I began to feel sick. Really sick: sweating, stomach churning, disoriented, twitchy and anxious. I thought I was coming down with the stomach flu. By force of habit, I reached in my purse and took a pill from my hidden stash of Vicodin. In a matter of 30 minutes my flu symptoms were gone. The distress over getting sick was replaced by an overwhelming sense of dread. I knew what I had become.
I was in a death-dance with medication obtained from online doctors and pharmacies. Not a single soul who knew me was privy to this information. Looking back, I think people around me must have known something was up. There were mood swings, erratic behavior and outbursts. I was immersed in a high stress business, in a dysfunctional environment. The drama level was soap opera high, and getting higher by the day. Maybe I just seemed frazzled by the roller coaster my colleagues and I found ourselves on. Nobody confronted me when I would take pills in their presence (from a bottle of Tylenol no less). I would often refer to having bad headaches, which was true. The meds in that bottle however were not Tylenol. Hindsight being 20/20, I often wish I had admitted my problem then, and gotten myself into treatment. I could have saved myself 13 years of misery, secrets and shame. I guess I wasn't ready. We do what we do until it is more painful to continue than it is to face change.
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I was cloaked in denial. My wardrobe and obsession with appearances made it easy to blend in with the rest of humanity. Driving down the freeway on one of my increasingly frequent Mexican holidays, hair tossed by the breeze of a convertible, I looked like one more day-tripper. Inside, I was desperate to exorcise the hungry ghost who was surely running my life.
Fast-forward one year. In 2002 I was no longer working for the same dysfunctional company. I moved on to another even more dysfunctional firm that was headed (along with me) for disaster. My new job required moving to New York City. I was excited about the prospect of change and had fantasies of creating a new life there. In recovery this is well known as a "Geographic," but at the time it seemed like just the thing I needed.
The Internet was a tool I used to obtain prescription meds to avoid legal hassles. My scripts were legitimate, even if my claims of back pain were not. It makes sense that when I decided to get off painkillers I'd go back to the well. I searched my new city and found a number of clinics. Unfortunately they all relied on methadone to get patients off of opiates. I was adamant that I would never take methadone, and I put myself through three wicked weekend detoxes. These all ended the same, with me going back to the drug I simultaneously needed and hated. The drugs had stopped working. I was at the sorry place where taking pills was required for me to get out of bed in the morning. Unfortunately I had done damage to the lining of my stomach from the high level of acetaminophen in the drug I preferred. I was unable to keep enough of the meds in my stomach to get high; I could keep just enough down to stave off that awful brand of sickness every junkie comes to know well.
One Sunday in August 2003 I was out shopping with a friend. I had taken my usual ration of pills, but today nothing was working to keep me well. As we were walking down a steamy sidewalk I felt like I was going to throw up and pass out, not sure which would come first. I told my friend I felt faint and had to sit down. Once steadied, I excused myself for the rest of the day. I got home and knew my time was up. I went online and found a doctor who advertised outpatient opiate detoxification services. The ad claimed it would be pain-free and confidential.
A few days later I met Dr. N. He was an eccentric guy, which I would come to find was de rigueur for addiction doctors. He charged $1,000.00 cash in advance for his services, which I happily paid. I was given a prescription for Subutex, and about four other medications to assist with opiate withdrawal, covering symptoms from leg cramps to nausea, anxiety, and insomnia. I only found myself in need of and interested in one of those. Subutex is the brand name for buprenorphine which had recently been cleared for use in the US for detox and maintenance. Dr. N had arrangements with a few different pharmacies that carried the medicine for his "special patients." I was desperate, really sick and as scared as hell.
I took the first orange tablet, and within 30 minutes I felt better. In fact I felt more than better, I felt absolutely great, which in retrospect was not a good sign. I had a slight twinge of guilt, because I was most assuredly high as a kite. So this was the cure? I signed up then and there with no plan to ever stop taking my new secret pill.
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Here are some things I did not find out in my exhaustive search for a panacea. According to addiction specialist and former addict Dr. Steven Scanlan, "Suboxone (buprenorphine plus naloxone) is a powerful opiate-an anesthetic to emotional pain. It immediately alleviates anxiety and depression and makes a person feel more emotionally stable. A lesser dose of Suboxone (2 mgs a day) will block an estimated 80 percent of a person's feelings, while higher doses can make a patient practically numb." He goes on to say that the studies that are done on the drug and its effectiveness as a recovery tool only report on patients for about a month post detox. The studies are paid for, run, and reported on by guess who? The pharmaceutical company that holds the patent on Suboxone. Currently there are no long-term case studies of patients on buprenorphine maintenance.
I learned the hard way about the side effects of opiate replacement maintenance. In the first year I felt and behaved a lot better than when I was choking down 10 or 12 Vicodin a day. The first indicator that there might be something else going on was the onset of dental issues which required my having four teeth pulled. The other issues were harder for me to connect to my buprenorphine use. I found it hard to wake up in the mornings, and even harder to get any place on time. The weirdest part was that I didn't care. My personality had morphed into someone different than the me I used to know. Over the course of four years I lost my career ambitions. The only thing I did with consistency was keeping my appointments with Dr. N. I continued working, but too often found myself suddenly and inexplicably sacked. It bothered me, but I never had the presence of mind to see that my behavior had gone from company "superstar" to being the first and easiest person to get rid of. I fell into survival mentality. I took lower and lower level jobs, keeping a roof over my head, but letting everything, particularly my sense of self-worth, slide. I also noticed that my hair was thinning in the front, like a man with a receding hairline. This concerned me greatly and I began seeking various potions that promised to restore my formerly glorious mane.
Some people can point to a specific event that catapults them into a moment of clarity, where they know what has to be done. I had those moments in active addiction. With my new companion buprenorphine I saw no reason to ever live separate lives. Ten years and eight jobs later I finally started to see the light.
The action of Suboxone in the human body is unusual. It is both an agonist and an antagonist to opiate receptors. To make it simple, this is a safety clause and creates what is called a ceiling effect. The body can only absorb so much of the medication, the rest is excreted. I read the literature; I scoured the Internet for every mention and study of Suboxone that I could find. I was convinced that I knew everything there was to know about the maintenance protocol I was on.
Once more I was wrong. Long-term use of Suboxone has a litany of side effects on the body. To be fair, opiate use does too. Chances are I would be dead if I hadn't found this medication to create a bridge between my addict ways and a clean life.
I'm not writing this to detail all of the possible negative outcomes of Suboxone maintenance. I'm simply telling my story, in the hope that one person who reads it thinks carefully and behaves more mindfully during the course of their treatment than I did.
Some awesome things happened when I stopped using. I was finally able to have a real relationship without the elephant in the room. I met a man who became my closest friend, and fell in love. When the economy imploded in 2008 we moved to his house in the mountains, and created a simple but happy life. Along the way we raised a cat, two dogs and became members of our new community.
A few years into domestic life, my partner suggested that I consider discontinuing buprenorphine. I was getting tired of the expensive monthly doctor visits that my insurance didn't cover, as well as the cost of the medication itself which was almost $400. The drug that once freed me felt like a dangerous albatross around my neck. I talked to three different doctors before I found one who was willing to try and help me get off the big B. As recently as 2011, the majority of physicians with buprenorphine maintenance patients claimed that 95% of those who go off the medication return to their drug of choice. Certain I would not be one of those, I kept up the search until I found a doctor who would treat me.
My new doctor was another eccentric named Dr. John, prone to making a series of bizarre comments over the loudspeaker in his always-crowded office. One thing I can say for Dr. John, he took this work very seriously. There were mandatory weekly office visits, where I was required to take urine drug screens and have blood drawn. Dr. John created an aggressive schedule of titration for me. Every two weeks, I went down 2 mgs. Over the course of a few months I was feeling shaky emotionally, but proud to be down to 4 mgs a day. Fast-forward another year (yes it's amazing how fast the years of my bupe maintenance have passed by). I decided I wanted to get really healthy again. I had gained 40 lbs. of fat, the result of intense cravings for sweets I never had before. I started a fitness regimen and lost more than half the weight. Then I went out and did the one thing that would make sure I continued exercising on a daily basis. I rescued a Border Collie puppy. A particularly bossy little guy, he woke up promptly at 5:45 a.m. every day and put his cold (but very cute) nose in my face. If I didn't rise immediately, a mind-bending shriek of barking would ensue. This got me out of bed and into the world at a time I'd slept away for the last decade. For my birthday I asked not for the usual trinkets, but for a Nutri Ninja blender, a device able to turn kale, spinach and bananas into a delicious drink that supported my nutritional needs. I can't overstate the changes I made in terms of eating habits and exercise for my ability to decrease buprenorphine use. I take a series of supplements to help restore the neurotransmitters in my brain which have become atrophied from having the medication attached firmly to opiate receptors. In order to feel good again naturally, I had to jump start my body and brain. I take B complex, L Tyrosine, a supplement for hair and nails, fish oil, 5 HTP and melatonin in the evenings to help with sleep. This combination is working, and I am now down to 1 mg a day.
I spent a ridiculous amount of time on websites and forums reading about other people's experiences getting off the medication. While some research is helpful, the amount I did created a paralyzing fear of "jumping" off the meds at even the smallest level. I read with intensity every story of individuals who did not feel right months or even years after their experience with buprenorphine. As an interesting counter point I found out that 1 in 100 people can stop taking the drug and experience no withdrawals. This is definitely not my experience, but the research indicates such anomalies do exist. I wouldn't count on being one of them, and my best thoughts are to fortify the body, mind and spirit, and titrate slowly on a weekly or bi monthly basis until you are down to a point when you can walk off into your own sunset.
I allowed buprenorphine to be a defining factor in my life for a decade. I can't change that fact. What I have received as a result of reducing my dose is renewed drive and clarity. I don't feel overwhelmed or hopeless about the future. It's humbling to have gone from a solid six figure paycheck to busting my brain to make ends meet, but I still have a mind and skill set that, once dusted off, have proven themselves viable.
I will continue to titrate for the next few months until I am 100% free of medication. I have experienced withdrawal symptoms, from cramping legs to stomach pains, insomnia and a loss of appetite. The most notable symptoms, however, are mental. I’ve walked through bouts of anxiety, hyper emotionalism, grief and rage. Even so, my fear of withdrawal was far worse than the actual physical symptoms. The body is a miraculous machine that adapts to what we expose it to. The mind makes change much more difficult.
In order to get my head in the right place to complete this process I have had to humble myself daily. When I am running I ask the god of my understanding to help me overcome my fears and move forward in the process. I ask the universe to support my efforts to get clean. I say it out loud to the trees, grass and squirrels, I say it to my dogs, I say it to my partner, but most importantly I say it to myself and it is working. I wish I could end this story by saying today I am 100% free of buprenorphine; I guess that is another tale. But this is my story today. I feel better than I have in many years, I look better, and my once dormant career is on the upswing in ways I never would have imagined.
While I have attended 12-step meetings and still do on occasion, that isn't the secret sauce which has made my progress possible. This thing is a painstaking process of engaging free will to make changes. Some big, and some small. Very small in fact.
The companies who manufacture buprenorphine/naloxone in all its combinations and manners of ingestion didn't bother to create it in strengths lower than 2 mgs for use in addiction recovery. It is available in smaller doses but illegal to prescribe to recovering addicts. Anyone trying to get off the merry go round knows all too well that trying to "jump" from 2mgs to 0 is a mean feat. I've read the stories of people who have jumped from this dose and higher, suffering through weeks and months of withdrawal. Some don't make it, and either relapse, go back to maintenance, or die somewhere in the middle. I consider it unethical, and possibly criminal that companies making untold millions off of this "miracle drug" have no clearly articulated strategy for getting off of it.
From the time of my first visit with Dr. N in 2003 I stayed on buprenorphine for over 10 years. I did my research about the medication anonymously because it was my dark and dirty secret. Having nobody to talk to about what was going on was isolating, as was the entire arc of my addiction. I became practiced at the art of deception. I pretended that I was on a medication for an illness like diabetes or high blood pressure. I needed it to live and that was that. Even though in the back of my mind nagging questions lingered, I ushered them aside.
Ultimately I am responsible for my choices, and I am dealing with the consequences of avoiding withdrawal for so long. I cut my little orange strips into tiny slivers, taking one minute amount less every few days. Sometimes the experience reminds me of the phrase "death by paper cuts." Alas, the drama queen within is alive and whining.
Have I learned anything from my time in exile? A lot I suppose. I learned that I am fearful and strong, self-loathing and brave, prone to self-pity and selflessness. Like most people I'm chock full of dichotomy and complex. Mostly I'd say I've been brought down to earth. I no longer think I am better than other people because I have a glamor job or earn more money. Losing my grandiosity has been a blessing. Being a worker among workers, well that's not always so fun. Sometimes I do regret the past, and there are days I'd love to slam the freaking door on it. But I don't have those options if I want to have any measure of contentment. Today simple contentment is key, as is my three-mile run with a bossy puppy. Good luck to all of you walking this path. It's both harder and easier than you expect, but it is worth it.
Dee Crash is a Marketer and Music Business survivor. She lives in New York.