Dr. Bryan Wood and Family

Earlier this week, we began our conversation with Dr. Bryan Wood, founder of the SelfRefind Clinics based in Kentucky. Today, we continue with Part 2 of our interview with Dr. Bryan Wood.

Can you tell us about substance abuse in Kentucky and wherever else your clinics are located?

Kentucky typically leads the nation in the misuse and abuse of prescription drugs like opiates and benzodiazepines (per capita). Everyone has heard the phrases “hillbilly heroin” and “pillbillies” in relation to the Appalachian region and Kentucky in general.

Dr. Wood, I actually haven’t heard them, but those are very colorful terms!

We [SelfRefind] aim to be a force in changing the rankings and the perceptions. We have multiple clinics in locations throughout the Commonwealth and have treated just fewer than 7,000 people at this point. We have 48 physicians that work with us and we are furthering the availability of our psychosocial therapeutic services as we grow. We firmly believe “therapy” is an extremely important component of long-term success in recovery.

What are possible side-effects of Suboxone? When is Suboxone contraindicated?

The possible medication side effects of Suboxone are typically headaches, nausea, constipation, and occasional issues with intimacy. In the vast majority of cases these symptoms are self-limiting and resolve within 1-2 weeks. Rarely do we need to change the patient from Suboxone (buprenorphine plus naloxone) to Subutex (buprenorphine only), but we will if the symptoms are incapacitating. Less than 1 percent of our patients are on Subutex. Suboxone is really only contraindicated with true allergy to either of the chemical components, however, one should use caution if a patient also receives prescriptions for benzodiazepines or sedative medications. Care and consideration should also be given to those patients with true co-occurring psychiatric issues due to the difficulty of managing both issues. Pregnant patients typically are treated with Subutex and studies are persistently showing better outcomes for this important subgroup of opiate addicts; both for mothers and their offspring.

Maternal addiction is an important focus in my work—I am pleased to hear that Subutex is working for expecting moms.

My favorite answer to side effects plays like a commercial:  “Caution – possible side effects of Suboxone use may include lack of death, dramatic enhancement of personal relationships with family, children, spouses and friends, loss of contact with drug abusing acquaintances, vast improvement of financial status, drastically diminished felony risks, and overall improvement in life enjoyment; beware …”

That made me smile! I see this with many treatment-resistant addicts who have to be convinced to accept any kind of treatment.

I would say to folks who are against treating substance abuse (addiction) with medications (not ‘drugs’) to “WAKE UP”! Upon review of a very large body of research over the last 40+ years, abstinence and 12 steps-based treatment approaches have given society an approximate 8%-10% long term sobriety ‘success rate’. Anybody can tell that is not an acceptable outcome.

Unfortunately, what you say is true ,and it is extremely challenging for addiction professionals.

Medical society has proclaimed drug and alcohol addiction a true brain-based disease (NOT a defect of character) – it has its own special place in the DSM-IV R classification as a disease and its development, course, and treatment follows exactly the accepted chronic disease model. From those standpoints, addiction IS just like diabetes, hypertension, obesity and many other diseases of a chronic nature.

Nobody expects patients suffering from diabetes, hypertension, and coronary disease to just “buck up,” go to rehab, go to 90 meetings in 90 days, seek some form of regular counseling and beat their disease through enhanced wishful thinking. Right?  Why should modern medicine and society at large treat this extremely lethal disease with anything other than the best the 21^st century has to offer? And, by the way, a relatively recent Cochrane review of almost 4,000 people involved regularly within 12 steps programs determined it did not assist their recovery any more than patients not involved, and potentially the regular 12 steppers did worse.

My experience has been that 12 steps have value for those committed to recovery and even have value for those who aren’t, but I would be interested in reading the Cochrane review.

Like anything else in my 20 years in medicine, not any one thing is good for everybody.

I totally agree with you!

We used to use iced saline lavage for GI bleeding until several scientific studies showed it made GI bleeding worse; then we quit doing that rather rapidly. We at SelfRefind are determined to research what is the best comprehensive treatment for opiate addiction and then do THAT.

What do you say to critics who are against treating substance abuse with chemicals?

Sitting across from concerned parents, spouses, other loved ones and friends of addicts in our offices (who often express the common concern of ‘trading one drug for another’), I can confidently say after 2 ½ years, “We are trading a deadly ‘drug’ for an amazing ‘medication’ that, if included in the right kind of treatment program, will radically change his/her life from what it is now to what it actually can be.” I have saved more lives and families in 2½ years doing this than I did in my entire Emergency Medicine career. And, as it turns out, it is a lot more fun.

It sounds like you recommend counseling in addition to the use of Suboxone.

I believe Suboxone is probably the best ‘tool in the belt’ for treating opiate addicts, but it is still just one of the tools. Counseling (and I mean the right counseling specific to each individual) is extremely important for the best short-term recovery and most enhanced long-term recovery.

Where is Suboxone treatment available today?

Suboxone has varied penetration amongst the states. Some states have lots of providers, some states have much fewer. Clearly, no state has enough providers. Many studies have pegged the numbers at 8-12 million opiate addicts in the United States. That does not include the number of misuse and abusers who eventually become addicts. If one goes to the websites www.suboxone.com, www.naabt.com, and www.samhsa.gov (left panel), you can search for physicians that provide Suboxone treatment. Our website is www.selfrefind.com.

Thank you for that information. I send people to SAMHSA all the time. It is one of the most useful agencies.

We are strong believers in education about addiction in general and Suboxone in specific. Within reason, we are willing to educate anybody, anytime. Most clinicians that utilize Suboxone still have full-time practices in their usual specialty. We have retired from Emergency Medicine after a combined 40+ years in the field (I and Dr. Robin Peavler, my clinic and business partner) and devote all our resources in these areas.

Kentucky and the United States suffer from a literal pandemic of opiate misuse, abuse, addiction, diversion and death. We intend to make a very large dent in the disease before we are done battling. Addiction is an extremely lethal disease and a cunning foe for the patients. Addiction is NOT a character flaw; it IS a disease and should be treated as such. There certainly remains the stigmatic picture of an individual in the alleyways, living in squalor, looking for their next fix of heroin. But nearly 90% of opiate addicts are soccer moms, construction workers, businessmen, health care providers, lawyers, judges, pilots, car mechanics, restaurant workers … you get the idea. Nationally, nearly 75% of all addicts are employed [and have health] insurance. These are just regular folks with an 800-pound gorilla called opiate addiction choking their lives. We have a tremendously successful answer for the largest majority of these; we should use it.

Thank you for your detailed and informative answers. We appreciate you taking time out of your busy schedule to write your responses.

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    Last reviewed: 8 Apr 2010