kicking an opioid habitMy third patient of the day today was Tom, a 22 year old young man who I’ve been seeing for the past four years for treatment of addiction to opioids. We started out the session by talking about how good things have been going in his life since starting buprenorphine, a medication that efficiently eliminates cravings for opioids and that has been available by prescription in the US since 2003.

For several years now, Tom has been working full time. He has regained the trust of family members. He has become more confident in his own goodness, one component of the pathway toward greater self-esteem. The only stumbling block of the past few years was dealing with the attitudes of one family member who would tell him at family gatherings (whether or not she was asked) that because he took buprenorphine, he was not really ‘clean.’

Such an attitude is born of ignorance and can be dealt with over time by letting one’s recovery speak for itself, which is exactly what Tom has done.

Near the end of our appointment Tom shared his sadness over the loss of an old friend from his ‘using days,’ who died last week from an overdose of heroin. “It is sad that he never decided to get better” Tom said. “And I owe it all to you.”

“No,” I said. “Not everybody who takes buprenorphine does well. Yes, it is an amazing medication, but you are the one who made the decision to take it, to stay on it, to give up the need to deaden your emotions, and to turn your life around.”  And I meant every word I said.  Tom and I sat quietly for a minute or two before he left; thinking about how one never knows how life will turn out.

Today there is one man alive, and the other dead; two men who at one time appeared to be riding into the same sunset.  One got off the horse, and the other stayed on.

A bit later in the day I had a new patient come to my practice hoping for a spot in my buprenorphine program. It takes a special certificate from the DEA to prescribe buprenorphine for patients with addiction, and each practice can have at most 100 patients at any one time. The patient—William– was only 19 years old, but said that he had been using heroin for the past five years, most of that time intravenously. “I’ve been through so many treatments over the years that you wouldn’t believe it,” he said. “Two years ago my parents had me kidnapped and taken to a treatment center out West, where I was in residential treatment for over six months. It was a wonderful experience; I learned so much while I was there.”

“How long were you clean after you got out?” I asked, already anticipating his answer.

“Well, I was clean for six months while I was there.”

“But after you left? What happened then?”

“Well, I was using after two or three weeks. Once I got out of treatment everything went back to the same way it was before.”

I have heard similar stories dozens and perhaps even hundreds of times; people who went through long, expensive periods of residential treatment, sometimes having wonderful experiences, but followed by relapse in almost all cases. My description of these cases may anger some who work in the treatment industry, and to that I can only say, don’t shoot the messenger.