Friday, December 4, 2009

The "Other Side" and an intriguing comment

Many of you know that I work at a high school. It's a great job, because part of my duties is registering new families & students. I am usually the first face parents see when they come in with issues about their student. I've come to know many of the high school kids, and I'm aware of their personal struggles-- though I am bound to confidentiality.

I also spent three years working with the high school ministry at my church.  One of the most memorable events was a six week small group. I'd have six to eight high school students and we'd talk about really "deep" things.  The kids didn't have to be a believer-- they could be seeking.  Many a tissue was passed around, because many tears of pain were shared-- including my own.

My point is this-- I have learned how precious it is when a teenager or young adult lets you into their world.  Our high school pastor used to say it takes a lot of work to gain their trust.

I'm there with my son.  Sometimes, my son and I are alone in my car, and he'll start to open up. He'll say something to me about how he is feeling.  Trust me, this is not manipulation.  He is sharing with me his fears.  These are short moments, but I consider them small gifts from him.  I don't share all of what he says on this blog. I consider these to be sacred-- between us. 

I so want to understand what's hurting him. Why?  I see my son so incapable of dealing with stress.

I am always appreciative when an addict lets me into their world-- not the facade, but into their deepest feelings.  It helps me to try and understand, because that's what I want to do.

I regret that my life never including a college degree, nor onto a Master's Degree.  It was my dream to be a licensed marriage family therapist.  

I believe that God gave me many gifts, as he does to all of us.  I'm just comfortable with adolescents. I'm not afraid of them, and I don't dislike them.  I watch the kids at my school, and I am very comfortable talking to them, teasing them, and learning their names.  I notice the invisible kids. 

I have added "Trapped In Addiction" to my blog roll. Ron sent me the link. It's his son.  I hope that Alex will continue to blog.  One day, I hope my son will write something for this blog.  He knows about it, but doesn't ask to read it.  Maybe he will-- when he's ready.

I received this comment, yesterday.  It was anonymous, so I don't know the credentials of the writer. Still, I found the information interesting. I thought I'd pass it along for you to read. It's about suboxone and methadone:


Hi there. I just stumbled across our story and just wanted to give you a little better idea regarding the difference between methadone and suboxone.

Both medications are opioids--synthetic opiates. Suboxone has another drug added--naloxone--to discourage the crushing and misuse of the medication. In addition Suboxone has a ceiling effect--a dose at which it ceases to be more effective if increased past. Methadone does not. Studies have shown that, in general, pts who need more than about 60mgs of methadone to control their symptoms don't do well on Suboxone, and the average needed dose of methadone is 80-120 mgs. Suboxone and methadone are really targeted at two different populations, with some degree of overlap. Suboxone is targeted to those with lighter habits of shorter duration. Methadone is targeted to those with heavier, longer habits. They both work in basically the same way however.

Some people find that suboxone makes them feel depressed, anhedonic (unable to feel normal pleasure), etc. We don't know why this is--some feel it may be due to the effects of the naloxone addition or the fact that buprenorphine itself is a partial opiate agonist and may possibly decrease the brain's production of natural endorphins. However, once the pt. is stabilized on the medication, neither drug will cause a high or euphoria, so there is no reason to assume that your son wants methadone so he can get high on it, etc.

Some folks only need short term treatment with MAT (medication assisted therapy) and others need long term treatment due to permanent impairment of the brain's ability to produce endorphins caused by long term opiate abuse. Many loved ones try to urge their family members to leave treatment before they are ready and this leads usually to disaster. The relapse rates for those leaving methadone treatment are 90% within the first year. However, for those who remain IN treatment, the success rate of Methadone treatment is higher than any other treatment for opioid addiction, by far.

I wish your son all the best and hope things go well for him.

It's Friday. I'm ready to unwind.  I'd love one weekend, at least, of no drama.  Just peace, a fire, and time with my husband. Just the two of us.

13 comments:

Barbara aka Layla said...

Debby,

We have the same focus of our blog today! Alex :)

I am glad you can have an impact on so many young people's lives. I think its good for them to see that adults CARE. Not all of them have that at home, which is heartbreaking.

I hope you get the quiet weekend in front of your fireplace with hubby :)

Fractalmom said...

Debby - Anonymous said "The relapse rates for those leaving methadone treatment are 90% within the first year. However, for those who remain IN treatment, the success rate of Methadone treatment is higher than any other treatment for opioid addiction, by far."

What Anonymous DIDN'T say is that for them to remain in MMT (methadone maintenance therapy) and have the good success rate, they stay in it literally for life.

Methadone is a replacement for heroin. That's why it works. It tickles the same opiate receptor in their brain that the heroin does. That's why it works.

When they get weaned off methadone, they go straight back to using.

If your county has medicaid and your addict can GET on medicaid and the MMT program ACCEPTS medicaid then it isn't cost prohibitive. If not,and you have to pay for it, it currently runs about 100/week or more. For the addict to eventually stay on and get a job is possible, and then pay for the treatment themselves, theoretically possible. There are many nurses and doctors who go to the MMT clinics, along with lawyers and other professionals.

for someone with virtually no marketable skills like many of our addicted children, a minimum wage job is not enough to pay for MMT AND rent, food, car, insurance, gas etc.

So, there are some things they left out.

The first two times my daughter went to MMT we paid for it and it is expensive. The third time, she got on welfare and medicaid is paying.

If they quit, she will go back to using. She did before.

Some addicts cannot stop. They HAVE to have that opiate receptor satisfied.

So, for them, MMT is a LIFELONG necessity.

It can be managable, some MMT clinics give you 'take homes' after the first six months or so, meaning you don't have to make the drive daily, but only 3 x a week, then they let you have a weeks worth of take homes at a time, dropping your commute to once a week. The cost doesn't change though, LOL, and MMT's are a HUGE business.

Figure it out. Roughly 5-600 clients at 100 week each is $60.000.00 a WEEK, or $3,120,000.00 per YEAR !!The methadone costs them pennies per dose, about $.70 per dose ($21,840 per year) The doctor whom they hire to be there makes about 100 k a year. The one nurse makes about 35k a year. The counselors each make about 35-40k a year. Do the math !! The owners of the clinic are CLEARING before taxes roughly over 2 million a year !!

That's what Anonymous didn't tell you.

Dawn

Cheri said...

Debby,

Between your anonymous commenter and Dawn, you have a comprehensive understanding of the methadone-assisted treatment for addiction. That's valuable information, and now it has been passed on to your readers. That's a God-thing! He truly does know how to fill in the gaps in our lives.

You said: "I regret that my life never including a college degree, nor onto a Master's Degree. It was my dream to be a licensed marriage family therapist."

You may not be licensed by the state to be a therapist, but with this blog and the connections God is giving you, I see Him fulfilling your dream of helping families. You may not have an academic master's degree, but you have The Master's Degree, which is turning into an awesome ministry opportunity. He is giving you beauty for ashes. (I too wanted to be a counselor/therapist. I have a bachelor's degree in Psychology, but I didn't pursue the masters, so I "shot myself in the foot," as far as any credentialed work in that area, but I see that God is opening the back door and fulfilling my desire to help people, through Glass House Ministries.)

You also mentioned that you have a love for teens and young adults, and truly want to understand addiction from the addict's side of things. That is truly a gift. God will use you in a mighty way; He already is.

My mom was an alcoholic, and I too needed to understand the why's and how's of the illness... needed to know why she chose to surrender her life to that addiction for a decade. God has helped me with that over the years.

Anyhow, sorry to ramble so. I just want to encourage you that you are making an impact and a difference in your world. And God is hearing your prayers for B and others.

Blessings,
Cheri

LisaC said...

Your blog and the comments were full of really important and informative information. I can't explain it, but I'm sitting here crying at this point. Oh well, I will stop. Thank you, everyone for sharing your knowledge.

Mom of Opiate Addict said...

Very valuable information. I am glad we all have each other to lean on and learn from.

Angelo said...

That dude doesn't know what he is talking about. Everything in his post was miss information. Please take it down. He made up the whole thing methadone verse suboxone. You can do a simple research methadone an suboxone and see he is wrong in all the points he mentioned. Actually, he said some people feel depressed on suboxone. Suboxone is being used as an anti depressent. He lifts peoples moods up. Also he said the dedppression maybe caused by the naloxone in the suboxone. It doesn't even get absorbed by the body. It is there so no one can crush it and inject it. Please remove his post so people do not read the wrong info.

Angelo said...

Also, methadone is mood and mind altering not like suboxone which you take more and it does nothing because of the ceiling effect. You can use while on methadone not on suboxone. You may feel it if your on a low dose suboxone but the suboxone will block alot of the heroin effects. If on methadone and it's payday you can have a ball.

Anonymous said...

The comments on this blog and the blog are very insightful. Methadone is not a treatment. Treatment is sending someone to detox and rehab sot that they can be drug free.

See the ways that OxyContin has harmed people then read the comments at www.banoxycontin.com.

Steve
http://novusdetox.com

clean and crazy said...

yeah i just read his blog as well, great stuff, i love blogging i need to post but i am trying to catch up on comments so busy this time of year!! i hope for you to catch the spirit of the season and take a moment to smile, there was a dolly parton line in a movie she said "Smile it increases your face value!!" i love that line. smiles are also very contagious.

Anonymous said...

Theres def some good input on here but Id like to add a few things.. With suboxone an addict must stop dosing for at least 2 or 3 days if he even wants a chance at getting high as its half life is about 37.5 hours. Even then it is still hard to get as high as you normal would unless you dose a lot heavier than normal which can be deadly. Hence this makes it more difficult for the addict to use as the relapse must be pre-meditated.

I dont have personal experience with methadone but from what I have read an addict can still get high during maitnence. Pretty much all they have to do is skip a dose or take their dose first thing in the morning so they can use later that evening. Granted it still binds to your opiate receptors, all you need to do is dose a little bigger than usual to get the desirable effects. A lot of addicts prefer this drug because they can easily binge and then go right back on the methadone without feeling much of anything.

An ideal setting would be for the addict to cold turkey with comforting meds to ease the hell of withdrawal and help keep the addict somewhat sane. All Methadone and Suboxone does is fill the void for the addicts opiate of choice which does not allow the brain to heal. It is basically like a cancer patient in remission. To truly beat this beast you must eliminate all opiates/opiods and allow your brain to recover. Yes it is extremely tough as I know from first hand experience but it can be done
Ryan

Anonymous said...

Methadone blocks the effects of other opiates at a dose of around 80mgs for most people--varies somewhat. Therefore it is untrue that people can take methadone, then go and use that evening. They CAN use, of course, but it would be pointless to do so as they would feel nothing. A blocking dose is important for many patients. It forces them to find other ways to deal with problems as they come up instead of using opiates.

I am "anonymous" who wrote the first comment. I no longer have a Google account (cannot recall my password if I ever did, lol) so that is why I posted as anonymous. My credentials are these: I have a college degree in registered nursing, I have completed schooling to be a licensed chemical dependency counselor, and I am a certified methadone advocate with 5 years experience in patient education and working with communities to educate them about MMT. I also sit on the Board of Directors for NAMA (National Association of Methadone Advocates) and TOTA (Texas Opioid Treatment Alliance) and have had the privilege to attend numerous national conferences and lectures on the topic of MMT by nationally recognized experts in the field. I am also a person who was addicted to Rx opiates, and whose life was saved by methadone treatment after many years of the horrors of active addiction and many many struggles to get--and remain--clean.

Fractal mom is correct when she says that in order to remain successful in treatment, MANY (not all) pts must remain IN treatment long term. However, this is true of countless chronic diseases, both mental and physical--diabetes, schizophrenia, epilepsy, bipolar disorder, etc. Methadone is NOT a cure--it does not heal the altered brain chemistry. It simply supplements the missing endorphins, creating a more normal brain chemistry. The pt--while still needing good support and resources, in many cases, no longer must struggle as well with crippling depression, anhedonia (inability to experience normal pleasures), anxiety, extreme irritability, etc.

Is it "better" to not have to take medication? Of course--in ALL cases of illness. Medications ALL have side effects, cost money (do they ever!) and require time and effort to get and remember to take. Nevertheless, for those who NEED medications in order to function normally, they are truly a blessing--and that includes methadone AND suboxone.
(continued in next post)

Anonymous said...

(continued from previous post)

Fractal Mom is again correct in that methadone clinics cost a LOT of money for private-pay patients--many of whom do not make large salaries. The clinics are a sort of "medical ghetto", treated differently by insurance companies, zoning ordinances, etc. Many pts who have been doing well on treatment for a decade or more continue to have to show up every week to get their meds. Federal Regulations allow as much as a month's worth of medication for those who have met the 8 point take home criteria for 2 years or more but not all states allow this. Advocates are working for a change in law to allow long term, very stable pts to get medication from their own doctors and to receive counseling only on an "as needed" basis and this is being done experimentally.

Lastly I wanted to comment on the suboxone remarks made by "Angelo" I believe it was. Suboxone itself is a partial agonist. Even pure Buprenorphine, without the added naloxone, can cause an antagonist effect if the patient is tolerant of opiates. I once tried Buprenorphine to treat my own addiction, back before it had been officially approved for that use and was still considered experimental. At that time only a few doctors--addictionologists--were licensed to Rx it for the purpose of treating addiction. It came in injectable ampules and the patient was given ten ampules, 10 syringes, and instructed to inject one ampule under the skin twice daily for 5 days. There was no naloxone in this form. I used it as prescribed and it did not control my desire to use. In addition, it made me feel extremely anxious, a feeling of "impending doom" as they call it. This is something I have since read about in a significant number of cases and some doctors are questioning whether it MAY have an effect on the natural endorphins. Is this known to be a FACT? No, not at all--just a theory at this point--but one that seems to make some sense.

Suboxone DOES have a ceiling effect and this is exactly why it does not work well for a majority of MMT patients. It is designed to treat those with milder addictions of shorter duration--perfect for someone who perhaps was taking 10-20 vicodin per day for 6 months to a year. (that is just an example). However, the likelihood that it would work well for someone who was shooting IV heroin in large amounts for ten years is much smaller. Methadone doses can be increased to control symptoms in the heaviest of addicts--suboxone cannot. They drugs target two different patient populations, with some overlap. But BOTH drugs treat ONLY opiate addiction--they do NOT treat cocaine addiction, alcoholism, etc. Poly-addicted pts may require additional help.

Thanks very much for listening and I wish you all the best--and your loved ones as well.

Anonymous said...

Wanted to add one last thing--methadone takes about ten days to clear the body. At a blocking dose, a patient would have to do FAR more than just "skip the morning dose" in order to feel a high from another opiate. It would be a minimum of several days or more before the drug would decrease in the body (it has a VERY long half life) to the point where another opiate would be felt, and before that time would arrive, the person would be QUITE ill from withdrawals. Therefore, the person cannot just elect to skip a dose or two and get high--it does NOT work that way--not on a blocking dose. Again doses below 80mgs or so may allow a pt to feel some of the effects of other opiates and this is why those who continue to test positive for opiates are encouraged to go up on dose.

Additionally, methadone does not attach to all the opiate receptors like most opiates do. It leaves about 30% open to encourage the brain to produce endorphins if it is still able to do so. Therefore even those on MMT can begin to heal their brain chemistry while still in treatment.

However if the brain is unable to heal, all the time in the world won't help. There was a recent TV special about the baseball star Jose Canseco called the LasT Shot. In it, Jose talked about his long term abuse of anabolic steroids. The drug use had shut down his body's ability to produce testosterone in normal amounts and he was suffering the effects of this lack. A physician prescribed testosterone supplements for him. Jose asked the doctor if he would be required to take them "forever" and the doctor replied "Yes, quite possibly, because sometimes the damage done to your ability to produce testosterone is permanent". It is the same with endorphins. For many many years it was thought that the only "right" treatment was to take NO drugs at all. However, we now understand more about endorphins and the brain's natural opiates. The word itself means "morphine from within" and when Bill Wilson of AA wrote the Big Book, no one knew they existed. However, before Bill died, he had Dr Vincent Dole, the founder of MMT, as a trustee I believe it was, of AA, and he stated to him that he wished Dr Dole could find "an analogue of methadone for the alcoholic". He knew that AA does not work for everyone, and saw how effective MMT was for opiate addicts. Bill was always interested in science and progress and if he were alive today I am sure he would look sadly upon the disapproval of MMT voiced by so many 12 step members. The 12 steps have done a lot of good for many folks it is true--but their success rate overall is quite low and even more so with opioid addiction (I include NA in this)mostly due to the brain chemistry issue. Because it works for some is no reason to thus infer it will work for everyone. I gave it my ALL for many years--attended thousands of meetings, did service work, worked the steps, had a sponsor who was wonderful, and managed to remain "clean" for four years at one point. Those were the most miserable 4 years of my life, mentally and emotionally. I did not slowly begin to improve, my brain did not "begin to heal", things did not get better, and I had no idea why. I felt I must just be a big loser, or that I must be doing something wrong somewhere. I only wish I had known then what I know now.

The 12 steps have a saying that goes "Insanity is doing the same thing over and over, expecting different results"--yet people are often told to keep returning to meetings and doing THAT same thing over and over despite countless relapses and failures. No one treatment method works for everyone--not AA, not MMT, not Suboxone. We need as many tools as we can get to combat this disorder.