Suboxone Program

Why Suboxone?

The simple answer is that in my experience it improves the rate of recovery from opioid dependence by over 1000% (one thousand percent) if used in the right manner. Twenty plus years ago when I started my experience with addiction, we stopped treating patients with opioid dependence because we were having close to 0% (zero percent) success rate. We did not feel morally or ethically correct in accepting someone’s money in exchange for treatment with such dismal results. As well, it was disheartening to have people so assuredly relapse after investing so much of ourselves in their care. Methadone maintenance has its drawbacks and requires an individual to go to the methadone maintenance clinic on a daily basis for their daily dose of methadone for as long as they are on the program. With Suboxone, we are able to achieve a success rate of close to 100% (one hundred percent) in the first week on an outpatient basis. The person can go to a regular pharmacy to fill their prescription and come to appointments when they are scheduled.

Rehabilitation of Coping Skills

When a person becomes addicted to an opioid drug, taking it becomes a major coping skill. It doesn’t matter what the problem, enough drug will make you feel fine. It takes a long time to rehabilitate frustration tolerance and regenerate coping skills. If a person is forced too rapidly to develop them, it is overwhelming and leads to relapse. This is the reason that we had such poor success rates twenty years ago. It was like sending someone the gym to start an exercise program with the heaviest weights first. With Suboxone, people taper very slowly (sometimes over more than a year) while they improve their coping skills through group and individual work.

Habilitation versus Rehabilitation

For individuals who started using during adolescence, there has never been a period of coping with adult concerns without the use of a chemical coping mechanism. Their ability to cope and to tolerate frustration must be developed for the first time; thus, they must be habilitated for the first time since there is nothing to re-habilitate. An individual who was coping with adult matters prior to some painful accident and resulting addiction needs to have their coping skills rehabilitated and any underlying psychiatric illness treated.

Opiate, Opioid, and Painkiller

The terms opiate, opioid, and painkiller are used interchangeably on this site; however, ‘opiate’ in the strict use of the term includes only those drugs derived from the opium poppy, ‘opioid’ refers to opiates and synthetic drugs which act like the opiates, while ‘painkiller’ refers to opioids as well as any substance that decreases pain including aspirin (which acts via a different mechanism).

The Disease of Opioid Dependence

Opioid dependence is a disease as is all chemical dependence. It is produced by a lifestyle pattern similar to the way that obesity is produced. There is permanent brain damage for which there is no cure. Here is how this happens: (the explanation that follows is fairly complex but it is oversimplified to make it understandable)

Hunger

If a person becomes very hungry, starts to get antsy. This feeling grows as the person approaches starvation. If a person is hungry enough, he will eat partially eaten food from someone else’s plate or found in a garbage can.

Need for Sleep

If a sleepy person is driving through the mountains and realizes that if he falls asleep, he will drive off the side of the mountain and kill himself that knowledge will not keep him awake if he continues to drive.

Need to Relieve One’s Self

If a person is driving cross-country and needs to use the restroom, the longer it takes to find a place in which to relieve himself, the more uncomfortable that person gets. If the person cannot find a restroom for a long enough time, the feeling will become unbearable and the person will use the restroom on the side of the road. This will occur even if the person is a lady and there is no available toilet paper.

Brain-Induced Urges Cause Behavior

There is a good reason for these things to happen. These things are necessary for a person to stay alive. It makes sense that there is a very strong part of the brain that controls these urges. This part of the brain is called the nucleus accumbens or the pleasure-reward center. It is located in a very basic part of the brain and is responsible for making us do everything necessary for us to stay alive and procreate.

The Nucleus Accumbens

If a person is not doing something necessary to stay alive, the nucleus accumbens with make the urge so strong that it is impossible to resist. It is in this manner that it controls voluntary actions.

Synapses and Neurotransmitters

Signals passed along through the brain do not use a simple electrical circuit. There are gaps between the nerve cells called synapses. For the signal to cross the synapse, there is a chemical transmitter (a neurotransmitter) that is released.

Communication of Urge Fulfillment

If a person has eaten, one series of signals in a particular pathway uses a particular series of neurotransmitters to tell the nucleus accumbens that the person has eaten and that it can quit sending unpleasant signals causing the person to crave food and to start sending signals of satiety. If a person has used the restroom, another series of signals in a different pathway uses a different series of neurotransmitters to let the nucleus accumbens know that the person has used the restroom and that it can quit causing signals of discomfort urging the temporary obsession to relieve one’s self and start sending signals of relaxation.

Drives Control Voluntary Behavior

It is in this manner that these and all voluntary behaviors necessary to stay alive and procreate are controlled. This small part of the brain will make us do whatever is necessary to continue our existence and ensure the survival of our species. This effect of the nucleus accumbens may also be referred to as a ‘drive’. It overrides fear, guilt, shame, embarrassment or any other emotion in order to accomplish its function.

Addictive Drugs Mimic Neurotransmitters

Every drug that a person can become addicted to mimics the effect of one of these neurotransmitters. For example, a person can use cocaine which acts in the pathway to stimulate the nucleus accumbens and it sends signals that the person is happy and satisfied and that there is no need to eat or to sleep.

Addictive Drugs Over-Stimulate

Drugs of abuse and addiction overdo this in a major way. There is not mild stimulation of the pathways as there would be in the case of sending the appropriate level signal simply to stop a certain urge. There is over-stimulation.

Addictive Drugs Destroy the Pathways

If any mechanism is overused, it wears out quickly. And as is the case with every part of the body, if it is abused, it becomes damaged. It is so with these pathways that send signals to the nucleus accumbens and once it is damaged, it will never be the same.

Moderation Lessens Risk

If a person (who had never been addicted) only used the drug for a short period of time in low doses, the risk of breaking down the system is minimized. This is why there is even a consideration of use of opioids as medications.

Addictive Potential

Each drug, each person, and each route of administration have a specific addictive potential. These interact to produce different rates of addiction among different people at different times.

Drug Addictiveness

Some drugs like crack cocaine break down the system more rapidly. Heroin will break down the system faster than codeine will. Alcohol and the chemicals in marijuana break down the system much more slowly. Opioid drugs generate addictiveness much faster than alcohol or marijuana.

Individual Addictiveness

Some people are more addictive than others. Some people start with weaker systems due to genetic reasons. This tendency would be inherited the same way as facial features or body type. Some people start to use the chemical at an earlier age when the brain circuitry is developing at a more rapid rate. Some people are exposed to a drug prior to their birth or as a passive recipient of the chemical in childhood. People who have impaired ability to cope or increased levels of frustration because of a physical or mental illness or situational stressor are more subject to addiction.

Route Addictiveness

Oral use of a drug is generally less addictive than intravenous use.

Tolerance

As these pathways wear out, it is easy to discern because it will require more and more stimulation to achieve the same effect. The person will have to use more and more of a drug of abuse and/or combine it with other drugs to achieve the same result. This is called tolerance.

Withdrawal

The pathways can eventually wear out to the point that they cannot function without the additional chemical stimulation. As this develops, the person can feel no satisfaction without the added effect of the drug. Thus, without the substance, the person will feel some level of hunger for the substance (as if it were a requirement for life like food), feel antsy (as if one were diligently looking for a restroom on a long road trip), and grumpy (as if one were in need of sleep) along with other unpleasant feelings. The more worn out the system is, the worse this effect which is termed withdrawal. There are drug specific withdrawal syndromes but the bad feelings are common to all.

Comparison to Other Disease States

It is somewhat like the person who has a bad knee or a bad back. Once it is severely injured, it is never the same. It might get to where the person with the bad knee can walk and live without pain or problems but that person will not be able to run in a race. Once the knee is challenged again, it quickly degenerates to the point of the original injury or worse. The person with a bad back can heal to the point that there is not constant pain but that person will never be able to help a friend move. If the back were challenged in that way, the person would soon be in severe pain and in bed.

Maintaining an Opioid-Free Diet

If one stops using the drug, this status must be maintained by rigidly adhering to an opioid-free diet. If the opioid-free diet is broken, it means severe relapse and failure. It would be like a person going on a weight loss diet with the knowledge that cheating even once assured failure.

Permanent Brain Damage

This is why opioid dependence is a disease. There is permanent damage to the brain. It does not matter whether the individual was taking the painkiller for pain or for recreation, the effect over time is identical. The result is the same for codeine, hydrocodone, morphine, or heroin. The damage can start with one drug and continue with another.