More than ever, patients have easy access to information once read only by scientists and medical professionals.  And at the same time, doctors have reduced the time spent with patients during appointments.  The result has been an increase in internet-educated patients, who come to appointments armed with data from package inserts, information from internet health forums, and stacks of questions from net-savvy relatives.

There is a good side to this process, of course.  Patients are wise to take greater interest in their personal health, and to be knowledgeable of medications that they are taking.  And whether good or bad, the situation is necessary, given the abdication by many physicians of their roles as educators.

But there are downsides to the situation as well.

Let me start by saying that I realize that this post risks placing me in the camp of those who worry that the world is falling to pieces– an opinion that I am reluctant to endorse.  I have always thought of myself as one of the ‘hip’ parents, and someone who is accepting of pop culture. But I came across something recently that deserves mention in a blog about addiction.

Has anyone listened closely to the lyrics of ‘last Friday night,’ a song by Katy Perry? For those who haven’t, the lyrics fall short of criticizing bad behavior:

Yeah we danced on tabletops, And we took too many shots, Think we kissed but I forgot–  Last Friday night– Yeah we maxed our credit cards, And got kicked out of the bar, So we hit the boulevard– Last Friday night– We went streaking in the park, Skinny dipping in the dark, Then had a menage a trois– Last Friday night– Yeah I think we broke the law, Always say we’re gonna stop—Whoaa– This Friday night… Do it all again…

I like Katy Perry, maybe even more after her ‘Sesame Street Scandal.’  And as I was looking up the exact lyrics to the above song I came across a very funny music video on YouTube, featuring Hanson, Kenny G, and Corey Feldman, that uses the R-rated lyrics for a PG storyline.  Society lives another day.

I recently received the following question from a reader:

Dr. Junig, I made a horrible mistake after almost a year of doing well on Suboxone.  A friend gave me a Vicodin tablet, and on impulse, I took it.  I’m afraid to tell my doctor because he has a zero tolerance policy, and he will probably kick me out of his treatment program.  What should I do?

I have received a number of similar messages over the years, including messages written after a person told his/her doctor about a relapse, resulting in discharge from treatment.

Without allowing for suspense to build up, I’ll admit that I find such ‘treatment’ to be barbaric.  A person who has relapsed is in a very precarious position, usually feeling ashamed, afraid, and embarrassed– the very feelings that are likely the most powerful triggers for drug use.  What, exactly, is the benefit in discharging a person in such a condition?

Opioid dependence has a significant mortality rate, especially during relapse. When a person is discharged for relapse and later dies from overdose, who was served?

When Suboxone first became an option for treating addiction to pain pills back in 2003, some people were excited about having a cure for opioid dependence. Those people were mistaken.  It is true that Suboxone has been a huge benefit for treating opioid dependence, but the medication cannot cause the permanent changes in the brain that would be necessary to prevent relapse.  Instead, in order for the medication to work, people must do what they do with other medications—keep taking it.

I recently read an article on another web site that advocated a certain person’s ‘method’ for rapid opioid detox.  I went to the primary web site for the developers of that method—pulled to the site in the same way that I am drawn to watch late-night commercials for get-rich-quick schemes or male enhancement products.  On the web site I read that they have a new reason to take large sums of money from those addicts fortunate enough to have money, and unfortunate enough to believe their hype— a special, rapid way to change brain function.

As I’ve mentioned, I receive several e-mails each day asking questions about opioid dependence.  There are a number of confusing opinions, attitudes, and regulations that ultimately get in the way access to treatment.  And with opioid dependence, access to treatment can mean the difference between life and death.

One area of confusion relates to the use of methadone to treat opioid dependence.  Methadone is a potent, low-cost pain medication.  While a month’s prescription for Oxycontin may retail for $400, $500, or much more, a prescription for a similar amount and potency of methadone costs less than twenty dollars.

Besides treating pain, methadone is used to treat addiction to opioids through highly-regulated programs.  Laws allowing for these ‘methadone maintenance clinics’ were enacted in the early 1970’s, to counter the surge in heroin use that began in the late 1960’s .  The clinics were located mainly in inner cities, where most of the intravenous heroin addicts were located at that time.

Over the past ten years several corporations have purchased, consolidated, and refurbished methadone clinics, moving them to suburbs and rural areas to match the dramatic increase in addiction to heroin and other opioids in those areas.