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A Drs. Podcast regarding sub and problems with long-term use

Discussion in 'Detoxing From Buprenorphine/Subutex/Suboxone' started by Sluggo, Apr 5, 2010.

  1. Sluggo

    Sluggo Well-Known Member

    ((February 2018 Note from Admin)) The original podcast is no longer available so I removed it but here is a link for Dr Scanlon's article about the very big downside to Sub maintenance. There are more links for his articles within the next couple posts.

    PS "Guineveregetssober" is a wonderfully helpful site started by a former longtime member here at ODR. Besides this article you will find a treasury full of help and info there.

    http://guineveregetssober.com/suboxone-amazing-detox-tool-monster-maintenance-drug/

    this is a great talk....explains how sub works and that its 'harder to get off than any drug out there'.
    educate yourself. its great stuff from a doc that actually knows his stuff.

    "Suboxone - Miracle or Menace ??"
    I am seeing an epidemic down here in south florida with the prescription drug abuse. What I am most concerned about, though, is a medication called Suboxone/Subutex. Suboxone is an opiate that has been found to be a replacement opiate to help wean people off drugs. The problem is that people are now abusing suboxone like crazy. The same pain doctors that are prescribing opiates for pain are advertising that they are also doing detox with suboxone. They give people the oxycontin and then when the people realize they are addicted they keep the money coming in by offering the alternative of suboxone. http://pbod.org/suboxone-detoxification-treatment-information.html

    The problem is that few ever get off suboxone. It is an amazing detox tool to use, but the problem is that if it used for more than three weeks than it becomes harder to detox off than regular opiates (vicodin, etc.). I have done over a thousand opiate detoxes using suboxone and have had great success with it, but have never given it for more than 21 days. I would say that over 90% of doctor's who prescribe suboxone just use it for maintenance and thus no one ever gets off drugs. Furthermore the majority of suboxone dispensers are not psychiatrists or have any experience in addiction medicine. This medication is a cash cow for doctors as it creates a huge supply of patients who come in and pay cash only to continue the suboxone (some have been on it for years). The patient's once they are hooked in are usually seen by only the nurse practioner. I detox people in my office everyday, but have only been able to get 6 people off suboxone maintenance as the pharmacology is so different than other opiates that when taken for months it makes for the most horrific detox (I have spoken to these patient's at length and they are now in recovery and swear they will never take suboxone again because of the detox). I would rather have a patient come in addicted to 20 bags of heroin instead of being on a low dose (2mg daily of suboxone). The other issue is that since suboxone is an opiate the patient can never get into recovery fully as the opiate blocks feelings. A person never gets to experience, "Life on life's terms."

    I have not been able to find any publications that discuss what suboxone is really all about. Is this drug truly a miracle or a menace. I realize in time, by what I have witnessed by using this medication with so many patients, that the dangers of this medication will come to the forefront. The amount of prescriptions written for this drug is staggering and the abuse in the United States is reaching huge proportions. The problem is that for now it is looked as "better than the alternative - heroin, oxycontin, etc." I have spoken to agents at the DEA, other addiction psychiatrists, former opiate addicts in recovery, pharmacists, and pharmacologists and for the most part they agree that the current use of suboxone is a "timebomb".- Dr. Scanlon

    Edit by[guinevere64] 1/28/2011 to add
    It's too bad the link to this podcast is no longer active.
    Wanted to let folks know about this interview with Dr. Scanlan... with thanks to Chachie for the motivation to get it filed. --G
     
  2. OffSub

    OffSub New Member

    Just curious, anybody here used Dr. Scanlan to assist in getting off long term sub usage?

    Note from Admin February 2018;
    Here is a detailed article written by Dr Scanlan about how he detoxes patients from long term Sub use.
    After reading this I'm even more convinced than ever.
    Even after all these years, I'll never change my mind about this nasty drug. In my opinion it should ONLY be used as a detox drug.
    http://www.pbod.org/detoxing-suboxone-fear-caused-lack-knowledge/
     
  3. Ali_Montella

    Ali_Montella Well-Known Member

    I dont see too much information about Buprenorphine/Subutex/Suboxone which hasnt been mentioned on other sites/forums/blogs/boards Already!.

    Anything can and is harder to come off the longer your on it (dont need to be Eienstien to figure that out).

    Yes Sub is hard to come off the longer ur on it but not impossible. No long-term permaent affects either or proven 100%. Thats why I and like many others are still clean till this day even after long-term Sub use!.

    If people have other under-lining issues then it makes that just bit harder to come off. If people naturally have anger, bad temperament, a jelousy strait, insecurities, anxiety etc then if course it'll be much harder. The Personality/mind has to change first before a pill or whatever detox aid can be used as a tool to Recovery. But telling one they will have permanent long-term affects doesnt sit too well for their Recovery so try to educate yourselves people and dont get down by negativity and some mis-information. Everyone is different, how a detox is one person does not necessarily mean that detox will be the same for other!!!....

    A sub detox does not just depend on the duration of use and the amount but the personality and mind of the individual. Not everyone has the same mentallity, attitude, age, drug/opiate history, pshycal shape, character etc. People react differently to detoxes and what i mentioned above has a bearing on the outcome of detoxes and sub detox.

    First option should always be alternatives to Subutex/Buprenorphine/Suboxone. But if necessary then a short-term stint on Sub. But one thing is for sure its not impossible to come off & lead a clean sober happy life, just like it's not impossible to come off a SAO or whatever. Yes Sub is one powerful substance thats why it should be used wisely if used at all. If one is on it long-term then a slow low steady taper to the lowest dose possible is a must. When some folks jump from a higher dose and/ordont do a proper taper then of course they tend to struggle for a long time so hence of believing long-term affects. But it's not just about that, its also about how we think, our life-style, attitude to people and ourselves & the points i mentioned in the last paragraph. Thats right educate yourselves & look at this from an open mind. If there are really long-term permanent affects then there won't be so many people clean like me and many others. The withdrawals and PAWS are always there but those can be minimized but certainly dont last forever. So like i said dont get too down people and just focus on the future. What is in the past is past so better to concentrate on the future. I would advise alternatives to sub if one has not started sub but to ones who have regardless on how long u've been on it then a taper is the way to go the lowest amount possible and excercise if possible. Thinking with an open mind and changing the mind for the better. Minimizing any problems in life u have and just thinking positive and to the future. It can be done without any long-term affects, remember that!.

    Good-Luck People and i wish you all a Speedy Recovery!.
     
  4. Sluggo

    Sluggo Well-Known Member

    ali - from what I remember on your other rants...you're always slammin docs that don't know what they're talking about. now you're slammin docs that do.
    while I congratulate your efforts to get/stay clean Ali...as you mention many times...everyone is different. Some folks struggle to get off sub, and your arrogance does little to help their efforts. My way doesn't work for everyone, and neither does yours.

    Sharing experience without judgment is a great way to represent sobriety.

    I graciously thank the admins for the 'ignore' feature now.
     
  5. Ali_Montella

    Ali_Montella Well-Known Member

    I didnt say anywhere on this topic about slamming docs or about being pro doc. I believe i've made a fair enough judgment and opinion here. How you can come up with saying its arrogance and a rant only God knows.

    And just like you said what WORKS for one DOESNT mean it works for others. Which is WHAT I said on this post Sluggo, lol gosh!. I dont know how you came up with this to be a rant, think and read again Sluggo lol. I clearly point out what folks can do to minimize withdrawals/paws even though it might not work for some folks but better to try then not to. And never once claimed it was easy but did claim its not impossible. Where is the harm in this advice?..Your just contraditicing urself here. And where does arrogance come into this?..You just seem to be bad judge of character Sluggo, reading without giving thought. I only tried to explain to people there is hope & encourage them in their recovery and how this became to be a rant or arrogance i don't know. If you dont want to accept it then no need to direspect it. Please try to read carefully what i say before saying something totally irrelavant and out of the blue.

    Good luck people and i wish u a speedy recovery!.
     
  6. Brian3383

    Brian3383 Well-Known Member

    this is really good...thanks sluggo :)... thank god i kicked methadone before I would never get on anything that had the term "maintenance" in it...i know what that demon feels like.
     
  7. dremland

    dremland New Member

    Dr. Scanlan is my partner and I can have u talk to one of patients who has agreed to talk to people about his detox from Suboxone. He was on it for over 3 years.
     
  8. Bonita

    Bonita Well-Known Member


    It was nice to hear a doctor know what he was talking about FINALLY!!

    I wish more of them were around. Thank Dr Scanlan for saying the words, not that I need confirmation that sub really sux for maintenance and I paid dearly for that mistake.:D
     
  9. guinevere64

    guinevere64 Well-Known Member

    Well holy sh!t, I'm only four minutes into this podcast and already I love this guy for his integrity and humility. A physician who admits he became an addict, then asked for help, got into recovery, and made a "career choice" to help others like himself. Then he says something we all know but hardly ever hear spoken aloud: that most physicians have a low opinion of addicts and dislike treating us. Can't help liking somebody to says the truth.

    As for using suboxone long-term, I agree with Bonita, but then again she and I jumped off suboxone at the same time and both had a bit of a crash. I was on suboxone for eight weeks and I certainly could have done with only four, but I was afraid of zero milligrams. ... Maybe some folks do OK having been on suboxone for a long time, but in general I think the suboxone forum here bears witness to the overwhelming majority who have a tough time healing after long-term exposure (i.e., >3 weeks, as the doc says).

    Janice, thanks for the link. --G
     
  10. Ali_Montella

    Ali_Montella Well-Known Member

    I do agree with you on some points Guinevere but we dont know each invidual's circumstance & situation. Majority jump from a high dose and don't taper as properly as they should and some spike and go the yo-yo route. But nonetheless of course the longer ur on Sub the longer u have to taper and the more prepared u have to be and more time and effort u have to put in order to detox and not everybody has this on their side so thats why one should look at other alternatives then going the sub route. But also other factors come into this i.e state of mind of the individual, any worries in life etc, all this does reflect how we heal and how quick or slow we heal. Even am on working Voluntarilyina my Loca Detox Centre and explaining to Patients about Buprenorphine/Subutex/Suboxone/Buprenex & advise them their best bet is to be on Sub (if they want to go that route) only for the short-term and be prepared much as possible and know the outcome. I know not everybody has the time to do a taper, not everybody has the time to sort out any issues and not everyone has the time or ability to do vigerous excercise so thats why sub is and should not be for everybody period!. But you healed didnt u Guin? i healed? many people have healed albeit it from sub or meth or heroin etc. I know how it felt wanting answers about sub and fearing withdrawals os thats why i work at my Local Detox Facility to give people some answers, to help them and support them much as possible and not to make any mistakes or be mis-informed. But yes i do agree sub should not be for long-term but if they are long-termers out there then all i can say its not impossible to heal from it, it can be done. Just be prepared, research much as possible, be determined and start your journey to recovery and do the best u can.

    God-Bless & Peace!.....
     
  11. Sluggo

    Sluggo Well-Known Member

    so yea....i healed. so does that make shooting dope for 10 years okay?

    folks need to be informed about all of sub...the good and the bad. i think the doc does that quite well without quantification from us. it doesn't serve anyone to discount their experience.

    j
     
  12. Ali_Montella

    Ali_Montella Well-Known Member

    Healed as in getting away from sub!. Away from the sub withdrawals and paws. Not relying on sub anymore etc. But as for healing our drug/opiate seeking behaviour and personality then thats another beast altogether. And only we alone can sort and decide about that. We have to help ourselves before anybody or anything can help us.
     
  13. jdude

    jdude Well-Known Member

    Gosh..sometimes I wish I took a class in diplomacy instead of adventures with slide rules. :eek:

    Dr.Scanlan has removed the obfuscated and somewhat mechanistic approach to harm reduction involving sub treatment.
    Some folks base recovery on a physical taper. With posts,threads, and queries ad infinitum on a physical aspect that transcends the emotional/mental anguish. Those very same folks may boast ad nauseam regarding their own emotional and mental epiphany that facilitated the recovery process. Perhaps even fringing on a narcissistic obsession. How significant and collective those very issues are is an individual process.

    Dr. Scanlan points out the in the geometry of recovery, we can bend and twist one line...maybe even two all we want. But it will never form the equilateral triangle of the recovery process.

    The sub is a tool in recovery. His concerted emphasis on the proper use of that tool is refreshing,welcomed,and collaborated by those of us collected up by the desperation it's targeted at. We can use a monkey wrench to drive in a nail, but the results may not be what we expected.

    For me I had to come to a point I took me out of the process. I was powerless and had to trust in a higher power to start my process of restoring my sanity. My prayer was asking for rain in a drought...my faith carries the umbrella.
     
  14. guinevere64

    guinevere64 Well-Known Member

    I listened to the rest of the show, and what I appreciated was how simple Scanlan kept it. The fact that he spoke from experience as an addict who detoxed off fentanyl with suboxone added credibility to his medical education and experience.

    I had never heard anyone explain how unnaturally a partial-agonist works on the body—how it upregulates the receptors after a certain amount of time not solely because of its own actions on the body but because of the relationship the body forms with the partial-agonist. What I understood him to say: the body is built for a full-agonist. Nowhere in nature, or in physiology, do you find a substance that only partially activates a receptor. And when the body is exposed over an extended period of time (>3 weeks) to a partial agonist, it becomes confused—sort of becomes "extra-hungry" if you will, looking for that full jolt... it wants to adapt in the way it does to a full agonist and build tolerance, so it starts building new receptors out the wazoo. And because suboxone is so damn strong and because its half-life is so long, when the body builds those new receptors, it super-glues itself to them and will not let go. ... I need to go back and listen to that bit again to make sure I understand what he was saying. Actually, I want to talk with him.

    I also did not know fentanyl is the only opiate that kicks suboxone off the receptors. No wonder I went into such terrible precipitated withdrawal. Amazing.

    I knew that the average rate of sobriety after one year for inpatient rehabs is 3 percent, but I had never heard the rate for addicts who work a thorough fifth step is 60 percent. Like to know where he got that number. If it's viable, it's a great one.

    I had so many more questions when that interview was over. Mostly about what to do about the medical establishment looking for a pharmacological "cure" for addiction and always pushing more pills at pill addicts.

    I admire any physician who can operate within the medical establishment but also espouse views that puncture its tough membranes and allow for him/her also to operate outside it.

    At the top of my list of things I admired was his bald-faced statement that he tells patients he will help them detox once, and if they fail they need to seek inpatient treatment—so he's not a revolving door; that they need to work for what they want; and that he does not wish to make a ton of money in his business. That he sees physicians all around him using suboxone as a marketing tool, rather than a detox tool, and that this is bad practice. He spoke in plain language. I heard the program working in him. This is what the program does: it cleans up distortion and allows us to see and act clearly. Man, I so appreciated it. --G
     
  15. FunkyBoss

    FunkyBoss Member

    I view his upregulation theory as speculation. I'm not saying he is wrong, just that I could find no evidence to support that hypothesis after a thorough review of journal literature. Regardless of whether Dr. Scanlan is right about upregulation leading to worse withdrawal, I think that he is a smart man whose ideas should be taken seriously. Forgive the big words used below, I'll explain any of it that you want.

    You could cite a study to me about how opioid receptor upregulation in certain areas of the brains of cocaine users was correlated with cravings, but I would just cite you another study that shows that alcohol cravings are correlated with opioid receptor downregulation in certain brain regions. Drug withdrawal is complicated, and you have to look at what happens *inside* neurons to really understand the big picture of opioid withdrawal in my opinion. Regardless of whether you take a partial or full opioid agonist, you will be affecting the same intracellular second messengers, just less so in the case of the partial agonist.

    You pointed out other properties of buprenorphine that help to explain the sort of withdrawal that it causes:

    1. It's a long acting opioid. Do we know of any other long acting opioids, agonist or partial agonist, that do not lead to a lengthy withdrawal? I do not believe so.

    2. It's very potent and slowly dissociates from mu opioid receptors. A half of a milligram is sufficient to give many people without a tolerance strong opioid effects. People who have been injected with buprenorphine have reported that they believed they were injected with heroin. Buprenorphine may be a partial agonist, but it more than makes up for any lack of G-protein activation at any one mu opioid receptor by strongly binding to lots of opioid receptors for extended durations.

    I think most people do not realize that opioid antagonists actually upregulate mu opioid receptors (this can be observed after the withdrawal symptoms caused by an opioid antagonist have ceased). The idea that mu opioid receptor upregulation can explain withdrawal after long-term buprenorphine use seems rather far fetched to me when there is a total lack of scientific evidence to back the idea up.

    I believe the key thing about buprenorphine that can lead to uncomfortable withdrawal after long term use is the fact that it fails to promote mu opioid receptor endocytosis. Because of this, buprenorphine may lead to a greater development of tolerance than a similar drug that does promote mu opioid receptor endocytosis (Development of tolerance and sensitization to diff... [Psychopharmacology (Berl). 2006] - PubMed result). The more time you spend on opioids that do not promote mu receptor endocytosis, the more tolerance you are going to develop, partial agonist or not. Endocytosis is necessary to resensitize opioid receptors, and buprenorphine can block that process. I can't imagine how anyone could think that blocking a large portion of opioid receptors from being resensitized for months would lead to an easy withdrawal. If buprenorphine were a full agonist rather than a partial agonist but retained all its other characteristics, I can guarantee you that the withdrawal symptoms would be far worse. There's nothing particular to being a partial agonist that should lead to the sort of withdrawal that buprenorphine causes after long-term use... I believe that the withdrawal effects can be simply explained by the drug's combination of potency, slow receptor dissociation, long half-life, and failure to promote mu opioid receptor internalization.

    Endomorphin-1 and endomorphin-2 are endogenous neuropeptides known to be partial agonists at human mu opioid receptors. Morphine, an endogenous substance as well, is known to be a partial agonist at some splice variants of mu opioid receptors. I'll provide references if you want them. I recommend against making conclusions based on whether or not you believe a drug may be an endogenous substance; you have to take into account the concentrations of endogenous substances in the brain, which would not come close to the concentrations of buprenorphine in the brain after just one 2mg pill.
     
    Last edited: May 1, 2010
  16. Sluggo

    Sluggo Well-Known Member

    Suboxone - Miracle or Menace ??

    I am seeing an epidemic down here in south florida with the prescription drug abuse. What I am most concerned about, though, is a medication called Suboxone/Subutex. Suboxone is an opiate that has been found to be a replacement opiate to help wean people off drugs. The problem is that people are now abusing suboxone like crazy. The same pain doctors that are prescribing opiates for pain are advertising that they are also doing detox with suboxone. They give people the oxycontin and then when the people realize they are addicted they keep the money coming in by offering the alternative of suboxone. http://pbod.org/suboxone-detoxification-treatment-information.html

    The problem is that few ever get off suboxone. It is an amazing detox tool to use, but the problem is that if it used for more than three weeks than it becomes harder to detox off than regular opiates (vicodin, etc.). I have done over a thousand opiate detoxes using suboxone and have had great success with it, but have never given it for more than 21 days. I would say that over 90% of doctor's who prescribe suboxone just use it for maintenance and thus no one ever gets off drugs. Furthermore the majority of suboxone dispensers are not psychiatrists or have any experience in addiction medicine. This medication is a cash cow for doctors as it creates a huge supply of patients who come in and pay cash only to continue the suboxone (some have been on it for years). The patient's once they are hooked in are usually seen by only the nurse practioner. I detox people in my office everyday, but have only been able to get 6 people off suboxone maintenance as the pharmacology is so different than other opiates that when taken for months it makes for the most horrific detox (I have spoken to these patient's at length and they are now in recovery and swear they will never take suboxone again because of the detox). I would rather have a patient come in addicted to 20 bags of heroin instead of being on a low dose (2mg daily of suboxone). The other issue is that since suboxone is an opiate the patient can never get into recovery fully as the opiate blocks feelings. A person never gets to experience, "Life on life's terms."

    I have not been able to find any publications that discuss what suboxone is really all about. Is this drug truly a miracle or a menace. I realize in time, by what I have witnessed by using this medication with so many patients, that the dangers of this medication will come to the forefront. The amount of prescriptions written for this drug is staggering and the abuse in the United States is reaching huge proportions. The problem is that for now it is looked as "better than the alternative - heroin, oxycontin, etc." I have spoken to agents at the DEA, other addiction psychiatrists, former opiate addicts in recovery, pharmacists, and pharmacologists and for the most part they agree that the current use of suboxone is a "timebomb".

    - Dr. Scanlon
     
  17. guinevere64

    guinevere64 Well-Known Member

    What is the citation for this, or the original link? curious where this was first published.
     
  18. 65Fury3

    65Fury3 New Member

    WOW...just wow! I'm new here trying to taper off sub as well. My sub doctor did'nt know more about this stuff then the guy that bags my groceries. Not puting down the sacker, but just using that as an example of NOT knowing a darn thing about this crapola.

    Wish I had THIS doc! Oh well, I'm down to 1mg and won't be on it a full year...with God's help!!!
     
  19. justin77

    justin77 Well-Known Member

    This makes me severely depressed.
     
  20. Cristene23

    Cristene23 Member

    i had NO idea getting off suboxone would be this hard. i'm new here and so grateful i found it. i went from 2mg's to none and was about to throw my 5 years heroin free right out the window. i since have split that in half. better than nweedles in my arms. but you're right. it's better to know ALL the good and bad. i thought i could get off this no prob. i mean it isn't methadone (which i kicked). wow. i was wrong. i had no idea. cool that theres a podcast. never thought to look for anything like that. thank you all for posting.
     

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