8 thoughts on “Suboxone and Methadone Maintenance Therapy: Don’t Our Children Deserve Better?

  • November 4, 2015 at 11:55 am

    As a psychiatrist and buprenorphine-certified prescriber, I agree with your reservations whole-heartedly. Who wants to give an habituating medicine to an already-habituated person? For me the deciding factor about prescribing buprenorphine is the degree of functional impairment over time, the length of time on and dosage of opiates and the response to treatment.

    For a first timer who is devoted to sobriety from opiates, has recently gone through rehab and participates in a comprehensive relapse prevention program with 12 Step and/or intensive drug counseling and psychotherapy, I wouldn’t want to see the person on medication. I would support them in every way possible to remain completely opiate free.

    However, there is a significant group of individuals with multiple relapses and failed rehab attempts despite extensive behavioral interventions and treatment for comorbid psychiatric disorders. They experience what can best be described clinically as prolonged opiate withdrawal syndrome (POWS) Their lives have descended into chaos. They steal from their parents, commit every illegal act imaginable to find opiates, lose custody of their children, drop out of school and often wind up in jail. When “sober” these individuals spend months (even years) either craving opiates or thinking about opiates to the degree that their cognitive function is severely impaired. To a person, they say that once they have become habituated, their never feel right again, no matter how much they work at getting and staying sober.

    I have recently begun working with top scientists in the field of opiate receptor research to see if we can better define POWS clinically and at the molecular level. It appears that there is a genetic predisposition to POWS. Something has gone awry in the brains of theses individuals and it’s time to figure out what long-haul damage opiates do.

    In the meantime, for POWS patients under my care, buprenorphine therapy gives them back their lives back and gives hope (to them and their loved ones) that there is life beyond opiates.

    I urge everyone who cares about the scourge of opiate abuse to support POWS research and get their local, statewide, and national government agencies involved in the research initiative.

    Reply
    • September 26, 2017 at 1:20 pm

      Thanks you for this.suboxone has given me my life back. And yet dr.s are now trying to drop and get patients totally off suboxone I believe because of the DEA and this will have life altering effects. This is not good

      Reply
  • November 8, 2015 at 10:56 pm

    There is only one proven effective treatment for opioid addiction: indefinite maintenance on either methadone or buprenorphine. There isn’t a single well done study in the world documenting efficacy of any “abstinence” based approach. In contrast there are 100’s of RCTs done worldwide, plus dozens of meta-analyses documenting medication treatment. Opioid medication is the first-line recommended treatment by the WHO, the CDC, and US Depts of HHS, VA and Defense. And don’t believe the hype about Vivitrol (long-acting injectible naltrexone). The only evidence of effectiveness is one study done in Russia (where opioid medication treatment is not allowed), that was funded by the company that makes it! (No bias there, I’m sure.)

    Dr. Grohol, this was not vetted well. It should be taken down and replaced with something based on fact, not fiction.

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  • November 19, 2015 at 5:36 pm

    This article is a shameful example of how “professionals” in the addiction treatment industry engage in baseless fear-mongering and intentionally misleading the public because the author is personally invested in a different form of treatment. This article should be retracted immediately.

    Reply
    • September 26, 2017 at 1:16 pm

      I completely agree…this article should be taken down. This is completely wrong. As someone who has been on suboxone for years and as a professional nurse working on her masters….this is disheartening. I have a child and to say they shouldn’t be in my care because I’m on suboxone is absurd. Actually, someone on suboxone I believe has less of a chance of relapse than someone who isn’t. Opiate users have such a low success rate of staying clean. Most relapse. And I’m talking about people who aren’t on suboxone or another form of maintanence. I also work in the field of substance abuse. I’m my experience people on suboxone actually have little to no cravings and do not get high and only feel normal when taking it. So my argument is someone who is totally off everything but has a history of opiate use and relapse is actually more likely to relapse when having children under their care or just in general. people on suboxone have clear minds and are on it in the first place as a safe guard and if they have been on it for a long time can’t use as it is a blocker of other opiates. This isn’t including other drugs though such as alcohol or cocaine as an example. But in my experience suboxone decreases and leaves little to no cravings of all drugs as the naloxone ingredient is the same that’s given to alcoholics to decrease cravings and actually decreases all cravings to other drugs as well for whatever reason. So these folks actually have a safeguard to all drugs as opposed to addicts in recovery who aren’t on it. Mixing with antidepressants or things of that nature and the argument that it will intensify suboxone effects is another topic. But this is just knit picking.

      Reply
  • December 28, 2015 at 8:50 pm

    As a person who is a consumer of science article.I have noticed that scientists and persons who claim to be doing evidence based approach also a personal history and their own biases.

    I too would be concerned about Methadone and Bupernorphine in a home with children and

    Reply
  • December 28, 2015 at 9:20 pm

    (Am using a cellphone given the size. I type with one finger and apparently I press the “submit comment” and as I was scrolling it shoot and post before I was finished, I wish there was a way to edit one own post when this happens and allow me to complete the post. Unfortunately my laptop is out for a while)

    As I was say I too be concerned about Methadone and Bupernorphine in a home with children and teens. I would think the practitioners had strategies to tell their patients)

    I think your article is drawing too many extrapolated conclusions.

    Thank heaven Dr. Willenbring comments and clarifications. So far in my following his blog Substance Matter, I have no reason for not trusting his credibility, ethics and knowledge in the sciences.

    I think we haven’t reached the level of technology where abstinence based approach is as effective as are frequently claimed without an independent review. I hope one day we will.

    We need to be more honest with ourself and neither fool ourself or anyone else. The late Dr. Paul Meehl was a clear thinker when he observed clinicians. So was Bernard Russell called it “The Dominant Passion of the True Scientists”. If we are good scientists and clinicians we don’t need some much marketing”

    Reply
  • April 6, 2016 at 4:59 pm

    I think these are great ideas to do because it can really help someone slowly come off an addiction. I know this only works with certain kinds of addictions but it would be smart to have this treatment if you really wanted to get off the medicine. I also think it would be helpful for your family to slowly wean off the drugs.

    Reply
 

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