Archives for Relapse

Addiction

Guilt by Association?

A local District Attorney wrote to me last week to express his concern about the increased diversion of buprenorphine.  I often sense an undercurrent of tension when I cross paths with attorneys, aware of the different attitudes that we hold that arise from our different roles in society.

The DA wrote about the dramatic increase in overdose deaths in the Midwest.   Overdose scenes are often littered with a variety of substances, ranging from bags of heroin to...
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Buprenorphine

Sudden Infant Death from Buprenorphine?

In a recent Google search about Suboxone and pregnancy, one of the top links included the frightening statement that Suboxone and buprenorphine have been linked to SIDS or sudden infant death syndrome, commonly called ‘crib death.’

The statement was from a health forum where a woman wrote about taking Suboxone during pregnancy.  She wrote that her child went through opioid withdrawal after delivery, recovered, and then died two months later from SIDS. ...
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Addiction

A Tool, Not a Cure

Please review my prior post, as my comments will refer to an email in that post.

There are many directions that we could take as we review that message.  My overall impression, as I read the letter, was of a person struggling to accept the reality of his condition.  Over and over, the person repeated the same behavior, starting Suboxone, stopping, and thinking this time will be different.

One thing...
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Addiction

A Typical History

I received the following email last week.  I considered trimming it down, but the story is well-written and describes a history that is similar to that of many of my patients.  As usual, I will write a follow-up post in a week or so.

Dear Dr. J,

I have read many of your posts over the past few years. Like many, I started out disagreeing with your comments and insight, while blaming my inability to...
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Addiction

Tolerate THIS, Part II

I have been struggling with Part II, primarily because there are no easy answers to the situation.  I realize that I could easily criticize whichever path a doctor suggests for our imaginary patient.

As an aside, I believe that a major reason for the lack of sufficient prescribers of buprenorphine in some parts of the country is the ‘damned if I do, or damned if I don’t’ scenario.  All docs are aware...
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Addiction

Buprenorphine for BPD?

I would like to discuss a comment from a reader:

I have been a recovering addict for 12 years. I was addicted primarily to Lortabs (active ingredient is hydrocodone) and Ultram. I was never an extreme user but I was consistently trying to modulate my feelings and feel better. I also have been battling BPD (Borderline Personality Disorder) for a very long time which appears to be my primary issue. I have been...
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Addiction

Aftercare Made the Difference

I relapsed in 2000 after seven years of sobriety, and my attachment to opioids progressed much more rapidly than during my initial addiction.  I wrote a post a number of months ago that described ‘living on two levels,’ and that was my experience at the time—as if one part of my personality was frantically taking ever-increasing doses of dangerous narcotics while the other part, horrified, looked on.

Eventually my behavior caught the...
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Addiction

What’s My Excuse?

I’ve shared my opinion that traditional treatment methods for opioid dependence— residential, usually step-based treatments—are a waste of limited resources.  I’ve written that relatively few opioid addicts successfully complete such treatments.  And many of those who ‘clean up well’ after two or three months die from relapse and overdose, months or years down the line.

Those who disagree with me sometimes pointedly ask “if getting clean without Suboxone is impossible, how did...
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Addiction

Saving ALL The Starfish

I have several blogs and forums, all part of the mission to educate people about opioid dependence and buprenorphine.  Because of my online presence I am frequently contacted by reporters or journalists, and asked to provide my opinion about some aspect of opioid dependence.  The requests have become more frequent over the past year, suggesting that either my name recognition has increased, or that there is greater awareness—finally—that an epidemic of opioid dependence...
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Addiction

If A Tree Falls…

In my last post I mentioned that one of my patients on buprenorphine had relapsed. Relapse on buprenorphine reminds me of the philosophical cliché, ‘if a tree falls in a forest and nobody hears it, did it make a sound?’ For those not familiar with the cliché, the question and the answers--from standpoints of science, art, and metaphysics—are discussed in great depth, I just discovered, on Wikipedia. I...
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