“Before buprenorphine, people struggled with opioid dependence largely on their own. Yes, we had twelve step groups—and still do—but twelve step groups place the responsibility to get one’s act together squarely on the back of the using addict.”

I think it’s important, and deserves to be mentioned, that there is another option to 12-steps that existed long before bupe and works similarly – methadone. I’ve read a number of your blogs where bupe is hailed as a miracle drug unlike no other that revolutionized the treatment of opioid addiction but that’s not entirely true. Methadone works for the same reasons bupe does. The differences are actually not major but they are apparently significant enough to where either drug does not work for everyone but the other one may. Because of this I think it’s unfortunate that the benefits of methadone is not mentioned. I wonder why that is? Your blog is read by addicts, friends and family of addicts and professionals who treat them and I think it’s important that they are educated about the alternatives and that methadone is no better or worse than bupe. It would be very unfortunate if those people who don’t do well on bupe are not aware of the alternative which works great for a lot of people. Unfortunately way too many people view methadone as just legal dope while bupe is viewed as a medication for a disorder. Fact is that they are both medications for a disorder. I really wish that both medications were mentioned when talking about medical treatment of opioid addiction.

While I’m at it I wanted to correct a coupld of misconceptions that many bupe patients seem to have about methadone – that methadone causes tolerance because it’s a full agonist (as have been discussed on your forum) and isn’t as useful because it doesn’t have a ceiling effect like bupe does. Neither belief is entirely correct. Sure, you do develop a tolerance to methadone over time but it should in no way be compared to other agonists that require frequent increases in dose to get the same effects. Fact is that when methadone patients reaches the dose that are right for them they can stay on the same dose getting the same effect for many years. I know people who have been on the same dose for 15 years. When tolerance is developed over time only minor increases are usually needed and the patient will be stable on the new dose for many more years.
Methadone does not have a ceiling effect in the way bupe does but it does have a different kind of ceiling effect. Increasing one’s dose above the ideal dose for that person the effectiveness or positive effects are not increased. Instead the person experiences symptoms of being overmedicated and they are not pleasant. It just causes extreme fatigue and drowsiness, no high or euphoria. Oddly enough the patient doesn’t develop a tolerance to this higher dose even if it’s taken for a long period of time as would be the case with other full agonists. The individual’s optimal dose remains the same regardless of how long a higher or lower dose is taken so in essence methadone does have a sort of ceiling effect.

Don’t get me wrong, I was thrilled when bupe was finally approved and released on the market because more people could now be helped. It truly is a wonder drug for thousands of people. But for those like me who had some nasty side effects from bupe it’s important to know that there is an equally effective alternative and I wish you would mention that in your blogs.

Thank u for posting this article! I’m dealing with this exact situation right now. I was in an outpatient treatment center that also had a sober living. 6 of 8 people in the house relapsed and they gave me a second chance but kicked me out two weeks later cuz my parents lied about paying rent and cuz I wasn’t functioning well due to my untreated BPD, PTSD and ADHD. In all my rehabs I am labeled a “problem client” cuz of my mental illness. After they kicked me to the curb, I was staying at friends houses and in hotels for several weeks and was using/self medicating. They made me sign a consent to talk to my parents to get rent money and so they told my parents I relapsed. So now my parents refuse to pay for my prescriptions, so im so depressed and anxious, making a viscious cycle. I have to be clean to get a job to pay for my perscriptions, but I need my perscriptions to not be severely depresses and concentrate and get things done My parents finally let me stay at their house for a few weeks until I relapsed again because a friend called me and I was severly depressed that day so i caved. My parents saw me nodding and i eventually admitted to it. Without even asking what happened, they assumed I wanted to get strung out. They said I had 48 hours to get out and said I can’t come around my Syounger siblings until I want to get clean. To them relapse- along with nearly everything else in life- if I truly wanted to be clean and get my life back together I wouldn’t have relapsed. But thats where they are wrong. I almost think it was a cry for help! So here I am back to square one. Homeless, staying with friends, broke… And now strung out. Yesterday, I knew I needed to go back to rehab or do something. But my parents won’t pay for rehab again, and it hasn’t worked the 3 other times I went, in fact I felt like a worthless failure. Not to mention I have a different philosophy on treatment than most programs it’s so much deeper than “sobriety.” So yesterday I went to the methadone/suboxone clinic and signed up. He explained the way it works – basically stabilize the withdrawal symptoms so u can stabalize your life, then get off slowly- and it made sense to me. It’s the opposite of 30 day programs where u rapidly detox, leaving u very emotionally unstable, then attempt to stabalize your life. Im already feeling so much more hopeful. I wish that more people realized that relapse doesn’t always mean the person doesn’t want to get clean so they abandon them, therefore causing more pain and hopelessness, making it even harder not to relapse. I feel like I might be able to get my life together. Thanks for this post. Maybe a family will come across it at the right time and be able to reach out to their suffering addict and reach out to help instead of kick their ass to the curb… And btw sorry for the rambling…