alternative recovery

The Puritans of Sobertown

by recoveryhelpdesk on November 2, 2012 · 1 comment

A Call From A Rehab

I got a call from a patient at a residential drug treatment center today.  He had been using Opana pretty heavily, and decided to go to rehab to get his life back on track.  He had broken up with his girlfriend, and his little girl was staying with his mother.

They’ve been giving me a Suboxone taper to help me detox from the OPs, he told me.  At first, I felt okay and I had some time to do some thinking.  I think I understand why I’ve been using.

It’s the pain and the sadness I feel inside, and it comes out in anger, and it gives me an excuse to use.  But they’ve been cutting my dose every day.  And now I’m feeling pretty sick, and my mind is foggy and I can’t really focus.

If I keep using, I’m not going to be able to see my daughter.  And I’m afraid.  I want to be on maintenance.  Methadone or Suboxone.

The staff here are pressuring me about it and telling me I don’t need it.  I had to use the client phone to call you because my counselor wouldn’t approve.

Why Am I Not Surprised?

I know this rehab well.  Like most rehabs, this one doesn’t really offer much rehabilitation.

Like most rehabs, this one offers nothing more than short-term detoxification; and some basic, incomplete and biased recovery education.

Science and practical experience make it clear that even after detox, the addiction itself remains alive and well.  For most people, detox alone is not enough to establish a real recovery.  So why the hostility toward methadone and Suboxone, two proven treatments that promote conditions of safety and often set the stage for true rehabilitation?

Most rehabs are based on the Alcoholics Anonymous 12-step model.  Many rehabs are staffed by people who go to AA and embrace the AA culture.

This isn’t all bad, of course.  There is a lot that is good in the 12-step model and culture.  But along with the good, sometimes comes some of the less good –like black and white thinking, rigidity of approach, resistance to change based on scientific and medical progress, a visceral animosity toward medication-assisted recovery, and an unexamined affection for dangerous and ineffective tough-love approaches.

No More Business As Usual

We’ve made a lot of progress in our understanding of the brain, addiction and recovery.  But most rehabs are still doing business as usual.

It’s time for residential drug treatment programs to integrate medication-assisted treatment into their client education and aftercare plans.  The result will be fewer post-discharge relapses, fewer post-discharge overdoses, fewer repeat customers, more reunited families, and more recovery.

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Naloxone is an inexpensive medication (about $1 per dose) that can be safely administered by anybody who is present when somebody is experiencing an overdose caused by taking too much heroin or prescription pain pills.  Naloxone blocks the opiate receptor sites in the brain and reverses the overdose.

Watch this video to learn more:

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In Powerlessness Most Dangerous Form of Parental Denial, I suggested that even more dangerous than a parent’s denial about the fact that their child has an addiction, is a parent’s denial that there is something they can do about it.

“Exhausted, confused, sad, angry, hurting and grieving parents of addicts often come to feel powerless,” I wrote.  “It’s no wonder that many parents come to feel powerless.  Addiction is complex and challenging.  On top of that, parents are often told by those they turn to for support or expert advice that they are, in fact, powerless.”

I urged parents to understand that they can “BOTH establish healthy boundaries AND actively support their loved one in establishing the conditions of safety, stability and opportunity necessary to build a lasting recovery.”

I am quite aware that this is no small task.

One parent who is struggling to both establish healthy boundaries and actively support an addicted son put it so well:

“It is a tough choice over and over, because right action simply isn’t easy to define each time.”

It’s so true.

The standard, one-size-fits-all advice to parents to “detach” and let their loved one “hit rock bottom” is seductive in that it offers a clear direction to exhausted parents caught in a confusing whirlwind of devastation.

It is harder, in a way, to suggest to parents that they should struggle on even as they are faced with tough choices over and over, with no clear or easy answers.

Life is messy, as the saying goes, and life with an addict in the family is all the more messy.   It’s important to honor the effort.

Parents don’t have the absolute power to stop addiction.  But parents are far from powerless.

Parents who choose to can find opportunities to influence the outcome of their child’s addiction.  However, playing an active role requires a willingness to think things through independently and make tough choices over and over, even when there are no clear or easy answers.  Further, it requires striking a difficult balance between healthy personal boundaries, and healthy recovery support.

It’s not easy.  But the stakes are high, and the potential rewards are worth it.

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suboxone tablets Suboxone maker Reckitt Benckiser Pharmaceuticals Inc. confirmed recently that the company has decided to stop selling Suboxone tablets in the US.

No more little orange pills.

The company will continue to sell Suboxone film (small strips that dissolve under the tongue).

Suboxone is a treatment for opioid dependence.

Reckitt says that the change will likely happen within the next six months.

Issue One: Child Safety

The company says that the move is motivated by a desire to help keep children from gaining access to the medication by mistake.  Children can die from an accidental overdose if they swallow the medication.

Unlike tablets, film or “strips” are individually wrapped, and data from the US Poison Control Centers shows that this has resulted in safety benefits for children.

Maybe I should just thank Reckitt for watching out for America’s children, and end this post here.  But I have to admit that I am not feeling that warm and fuzzy about Reckitt’s announcement.

One line in their press release bothered me.  It reads, “The pediatric exposure safety issue is not related to the active ingredients found in both Suboxone Tablets and Suboxone Film.”

Really?

Reckitt is trying to say that the issue is the packaging, not the medication.  And it seems like they may be implying that since Suboxone film is better packaged, it solves the risk to children.

But if the pill bottle was full of Skittles and not Suboxone, we wouldn’t be worrying about children overdosing.  And we wouldn’t need to worry about individual, child-resistant wrapping of Suboxone film.

The statement seems a little less than accurate and more than a little self-serving.

Damn skippy the risk to children has to do with what is in the bottle or the wrapper!  We need to be clear about that.  Packaging changes may help reduce the risk, but the switch to film doesn’t solve the problem.

WARNING:  KEEP MEDICATION, INCLUDING SUBOXONE TABLETS AND SUBOXONE FILM OUT OF REACH OF CHILDREN

Reckitt wants to look like the responsible adult in the room by volunteering to discontinue access to Suboxone tablets.  But they have a financial incentive to make that move beyond the altruistic desire to protect children.

Suboxone in tablet form lost patent protection in 2009, but Suboxone in film form is still protected by patent.  If Suboxone film becomes the standard, Reckitt doesn’t have to worry about competition from a generic version of the medication coming into the market.

And even if altruism is part of the motive here, I can’t help but believe that profit motives delayed the decision to pull Suboxone tablets from the market until after Suboxone film was FDA approved, manufactured, marketed and selling well.

Issue Two: Access To Suboxone Treatment

If Reckitt is in an altruistic mood, how about supporting access to generic versions of Suboxone so that more people can afford the treatment?  Instead, Reckitt is working to make it harder for competitors to enter the market.

Now that Reckitt has decided to stop selling tablets, they have submitted a “Citizens Petition” to the FDA asking that the FDA require that anyone who sells a generic version of the medication in tablet form in the future be required to individually package the tablets.  This would increase the cost of the generic tablets and make it harder for the generic maker to compete in the market.

Funny, they never did that when they were making the tablets!

It will be interesting and revealing to see if Reckitt will continue to sell Suboxone tablets outside of the US without individually packaging the pills.  Time will tell.

I am not one to bash drug companies just for the hell of it.  I fully recognize the huge benefits many people have experienced from Suboxone treatment.  I see it every day.

That’s why I would like to see generic Suboxone available.

With $1.2 billion US dollars in Suboxone sales in 2011 alone, I think Reckitt has more than recouped their research and development costs and can survive some competition.

If you want to keep generic competition out of the market Reckitt, how about lowering the cost of the medication?  You will allow more people access to Suboxone treatment, and make it less likely that another company will make a generic version of Suboxone to try and compete with you on price.

Win-win!

 

 

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Stop Fatal Drug Overdose: Don’t Use Alone

by recoveryhelpdesk on September 23, 2012 · 0 comments

Prevent Fatal Drug Overdose: Don't Use Alone

Overdoses often turn fatal because nobody is around to call 911. Make sure someone is nearby to get help in an emergency. Don’t use alone!

Look here to learn more about how to prevent or respond to a drug overdose.

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