Question for Jackstem..Suboxone

[zofran]

Jackstem,

I have been reading this message board off and on over the years and have always been impressed by your knowledge, writing style, and the great support you give people on this forum.

I was wondering what your stance is on Suboxone use for opiate dependence/addiction. (Maybe you have already discussed this here somewhere but I have not seen it)

I believe Suboxone is a unique medication that is largely misunderstood by the general public and many health care professionals as well. For example, Suboxone has a "celing effect" that methadone and other full opiate agonists do not. I think all nurses, addicted or not, would benefit from a little lesson on how this medication works. I think Suboxone is just the begining of a new way of treating addiction...I would love to see the day when addiction is treated like the brain disease it actually is.

I am concerned that some health care professionals, AA/NA groups, treatment centers, and the general public think that people using this medication are not "clean" or are not in "real recovery." If HTN can be controlled with a medication and lifestyle changes, why not the disease of addiction too?

If a heroin addict(or a fentanyl addict:)) can use Suboxone to give him some freedom from the obsession and craving so he can focus on recovery and get his life back, why is this not "real recovery?"

Jack, you always give such thoughtful and educated responses so I thought I would ask what your thoughts are..

Thank you, zofran

[genaa75]

Well what if the IPN Dr , you had to go see agrees you have a serious painfull , longterm injury and stated i had to get off Methodone i was using for pain of couse prscribed , and switch to suboxone as a long term medication for pain management.......????

[jackstem]

Well what if the IPN Dr , you had to go see agrees you have a serious painfull , longterm injury and stated i had to get off Methodone i was using for pain of couse prscribed , and switch to suboxone as a long term medication for pain management.......????

First, let me say how sorry I am to hear of your ongoing struggle with pain. I've been there (spondylolisthesis).

The first consideration in any situation regarding medical conditions, especially those which may impair your ability to practice, or requires medication or other treatments which may impair practice, is to look at the Nurse Practice Act in your state. If might state specifically whether or not a licensee is permitted to practice while taking a controlled substance. If the wording is confusing, contact the state board for clarification. If they can't (or won't) provide the clarification, contact your state nursing association or IPN program for their policies and interpretations. If they can't (or won't) help you, contact a license defense attorney for a consultation regarding the legalities of practicing while taking subutex or suboxone.

I understand there are some states that allow a nurse to practice while taking suboxone. I don't know which ones allow it. Anyone know for sure which states allow suboxone while practicing?

Some articles dealing with this issue are listed below. Please note, I'm not necessarily agreeing or disagreeing with any of these articles. These are examples of the literature that's out there quoted as reasons to not allow someone to practice on suboxone. My personal opinion is until we have studies that show there is no difference in the cognitive functions and manual dexterity of a clinician who is on suboxone and one who isn't, then we must err on the side of caution. Subjective assessments that "I'm fine while taking suboxone" don't matter when it comes to the legal and ethical issues of impaired practice. It's not a matter of "fairness" or what's "right". When it comes to this issue and other in a licensed profession, it's what the law says.

• Editorial: "Buprenorphine Misuse, Abuse, and Diversion: When Will We Ever Learn?" Journal of Addictive Diseases, Vol. 26(3) 2007
  
• "Neuropsychological functioning in buprenorphine maintained patients versus abstinent heroin abusers on naltrexone hydrochloride therapy". Hum. Psychopharmacol Clin Exp 2009; 24: 524-531.
  Published online 3 August 2009 in Wiley InterScience (Wiley Online Library) DOI: 10.1002/hup.1050
  
• "Impaired decision-making in opiate-dependent subjects: Effect of pharmacological therapies". Drug and Alcohol Dependence Volume 83, Issue 2, 28 June 2006, Pages 163-16.
  
• "Cognitive Functioning During Methadone and Buprenorphine Treatment: Results of a Randomized Clinical Trial": Journal of Clinical Psychopharmacology: December 2008 - Volume 28 - Issue 6 - pp 699-703
  

The last study did state this in the abstract:

Our results indicate a cognitive impairment in patients receiving maintenance treatment with BUP or MMP compared with healthy controls.

Regardless of anything else said in that article, the BON and their attorneys are going to zero in on that quote and make their decision accordingly. Until there is research that definitively disproves this study, then I don't see much changing in the near future.

Jack

[SWS RN, ASN, RN]

I have not posted for a while. And I have written on this topic before.

That being said, this is something I am VERY passionate about and I PERSONALLY KNOW WHAT I AM TALKING ABOUT!!!!!!!

Due to multiple surgeries (bilateral hip and bilateral knee replacements) and having been diagnosed with an autoimmune disease that destroys joints, about 10 years ago--I know from PAIN...

Having been Legally prescribed very large doses of opiates and taking them for many years--I also know from ADDICTION....and although I did not take the meds to "get high"--they definately altered my perception. My tolerance became extremely high and my doses increased accordingly. I finally ended up in a situation where I was using the narcotics just to feel "normal"...ie stay out of withdrawal...and despite the enormous amount of narcotics--I still had continual pain.

I finallly did not want to live worrying about if I would run out of drugs before I could get another script...essentially my pain management doctor became my pusher...

Again, I want to reiterate that I have a legitimate medical condition that causes pain and my scripts were all legally obtained.

I went on suboxone...BIG MISTAKE.....

Please Please believe me when I say that suboxone is HIGHLY ADDICTIVE.....

and yes, It does alter your conciousness...

those of you who don't believe this have not lived--really LIVED without IT!!!!!

and then realize how flawed your thinking, conciousness and memory is under the influence of suboxone and how wonderfully clear you can be without it!

I took suboxone for 9 months--at the prescribed dose--did not abuse it.

After I researched it--and it was originally developed for pain control--and it is being used for pain control again, it did not make any sense to me to be taking an addictive drug to get off of an addictive drug.

Please believe me when I tell you that the withdrawal from suboxone is BRUTAL.

I went through withdrawal for 17 days and nights-withdrawal from "regular" narcs lasts about 3-4...

I would go and sit on the beach all night because that was the only thing that would keep me from losing my mind.

I have now been drug free... with the exception of Aleve occaionally, for 19 months...over 1 and 1/2 Years of Glorious sobriety.

I NEVER EVER believed I could get off of the narcotics and I darn near couldn't get off of the suboxone.

The real miracle is, while I am not pain free...my pain level is about 90% less than when I was on MORPHINE...and OXYCONTIN...and is easily managed with NSAIDS.

I am one of the staunch believers that one can not be fully in recovery while using suboxone or any of the benzos either....I also kicked a 10 year xanax addiction.

My addictionologist/psychiatrist is also a believer that Suboxone is the new "methadone" and is being overused and abused.

My opinions are not just supposition...I actually lived the addiction to narcs...and the addiction to the suboxone and I would just like to let everyone know that getting off of everything can be done.

It's not pleasant...

and I did the detox at home--I could not afford in patient treatment...but it can be done.

THis is the most difficult thing I have ever accomplished in my life and the accomplishment I am the MOST proud of...

I never thought I would say this either...but I am a Grateful recovering addict!

and Jack--once again, you awe me with your knowledge and eloquent delivery.

Much love and luck to you all.

sws

[jackstem]

Way to go SWS!!!! :yeah:

Thanks for the kind words...all knowledge has been gained through 90% "field research" (for newcomers, this means using!) and 10% reading and workshops/continuing education for peer advisors.

When we don't understand a disease process and/or the medications and other techniques for treating and managing that disease, then we become nothing more than glorified volunteers. How in the world can we effectively care for someone with a disease when we have no idea how the disease happens, how the target organ(s) are affected, what the signs and symptoms are as a result of the pathology associated with the disease process in the target organ, which techniques, procedures, and medications (if any) are indicated, and what the possible complications of these therapies include? If I'm not a health care professional it's understandable that I would not understand all of this stuff. But if I'm a licensed professional and I don't understand this stuff, then I'm not fulfilling my professional and ethical responsibilities.

I think it's safe to say a large percentage of nurses, doctors, and other health care professionals have no idea what they're doing when it comes to this disease, explaining why there is such a mess when it comes to dealing with addiction.

A great article titled: "What if We REALLY Believed that Addiction was a Chronic Disorder?" Definitely worth the read (only 8 pages).

jack

[all_over_again]

posted without sufficient thought...