Aarghh! (he said, moaning in frustration…) I realize that it isn’t so much anger that shortens our lives as much as the repression of that anger—so pardon my venting! I just finished an appointment with a patient who described something that is all too common, and that really makes my blood boil.
I’ve seen ‘Tom’ in my practice for about three years, since he presented with severe heroin addiction. He once made good money working in the financial industry, but was reduced by addiction to a shadow of his former self. He had infections in his arms from using needles, to the point of being in danger of losing one of his arms because of destruction of the limb’s blood supply. He had tried stopping dozens of times without success, having only several ‘clean days’ in a period of ten years. He was beyond desperate; he truly believed that he would die from his addiction. In fact, he believed that he would likely die soon.
Tom did very well with buprenorphine, as do many people in his position. The people who tend to do the best with buprenorphine from my experience are those who are convinced that they cannot stop using, who are aware of the dangers of their addiction, and who utterly hate their dependence on opioids. I see younger people have less success, in my opinion because they are less aware that there is such a thing as ‘death,’ and that bad things really do happen to people.
Tom was amazed at the effects of buprenorphine. For the first time in years he could choose to NOT pick up—a wonderful relief that must seem bizarre to non-addicts. The first days on buprenorphine are a Godsend to those resigned to the same, miserable obsession, morning after morning and day after day; those who kept shooting or snorting regardless of the shame from broken promises to stay clean– made on the lives of every person they hold dear.
Over time, Tom did well in other ways, besides avoiding heroin. He returned to long-forgotten hobbies. He began opening up to his wife again, and they worked to heal the damage wrought by years of lies and secrets. And little by little he began to feel OK about himself again, as he processed the shame that had become a central part of his personality.
I try to facilitate that process, by the way, by helping recovering addicts understand and believe that their addiction is a disease. I point out that while they had some role in the start of the disease, people have similar roles in the early stages of many, if not most diseases. I help them realize that they have been punished enough, and that at some point they have the right to hold their heads high again. I recommend that they avoid developing too large an ego, as righteous anger is a dangerous trait for any recovering addict. Instead, they should find the humility that most people find in recovering from any chronic illness, the humility that we all find when we realize that we are mortal beings. And at the same time they should give themselves a break, make amends where due, and feel a sense of pride for working hard at doing the right thing.
Unfortunately, at some point Tom began to resent the fact that he was taking buprenorphine. I have read about such resentments from people on my forum and witnessed similar attitudes, albeit at a lesser rate, from patients in my practice. I don’t understand the attitude, and I know from my observations that the attitude is dangerous for opioid addicts, since the relapse rate in people who stop buprenorphine approaches 100% over the long term. Of course I understand the desire to be off all medications and go back to a time before the person was addicted—just as I understand the desire for world peace. I imagine that many patients with heart disease look back fondly to the period before their first heart attack, but I don’t think that they are as likely to resent the coronary stent that saved their lives, or the cholesterol-lowering drugs that add another ten years of time with their grandchildren!
I have literally witnessed cases where parents ‘intervened’ to get a son or daughter off Suboxone, precipitating episodes of relapse with severe consequences—even death in one case that I know of. What a horrible shame! That situation, by the way, is the background behind the title of the book that I am slowly sharing here, entitled Clean Enough.
Tom made today’s appointment in order to tell me what had happened. He caught a flight to one of those places advertised on the internet to ‘get you free from Suboxone.’ He paid about $10,000 to stay in their facility for ten days, much of the time watching movies about the greed of doctors and the pharmaceutical industry, who work together to ‘keep you on the drugs that make them MONEY.” I pointed out to Tom at this part of the story that in the three years I’ve known him, my total fees have run to less than $2,000—compared to the $10,000 collected by these jokers, not counting the cost of the flights to and from their facility.
The detox center gave Tom a proprietary blend of amino acids and other essential nutrients (I’m thinking of a movie right now where the character stifles a cough that sounds like ‘bullsh%$t!). The blend was supposed to prevent withdrawal and ‘treat his injured neurons.’ I started to explain that the amino acids and other molecules in such cocktails do not cross the blood-brain barrier, which is only one of several reasons for the lack of any evidence in peer-reviewed literature that such infusions do anything at all. And they didn’t do much for Tom; he said that he felt horrible from the withdrawal that was forced over his last five days there (I typically recommend those who insist on stopping buprenorphine taper the medication over several months).
Tom shared this information with me, and also told me that he was using again, starting the day he got home. The detox center has no advice for him now, other than to pony up another $10,000 and try again. He is wondering if he should go on Suboxone again.
I think of the Dr. Seuss story that my parents read to me about 45 years ago called ‘The Star-Bellied Sneetches.’ An inventor had a machine that put stars on the bellies of Sneetches, silly fictional beings lining in the land of Dr. Seuss. The Sneetches with stars wore them boastfully until they became passé, when another inventor seized the opportunity and created a machine that removed the stars. By the end of the story, Sneetches stood in line to go through one machine and then circled back to use the other, as money poured out of both machines.
I treat opioid dependence with buprenorphine because I know, without a doubt, that doing so saves the lives of those who take it appropriately. It angers me that there are people with a machine that ‘undoes’ what I do, and that some people are eager to pay ridiculous sums of money to use it! The lesson for readers with opioid dependence is summarized by another old story about ‘looking a gift horse in the mouth.’ We finally have something with the potential to give suffering opioid addicts their lives back. If you are in the position to benefit from buprenorphine, I encourage you to be grateful, find contentment if possible, take your medicine… and get on with life.