By Linda Napier
One morning, when my daughter was 12, she was having some getting-ready-for-school issues; what to wear and other middle school dilemmas. I reminded her that she would miss the school bus if she didn’t get moving and I wouldn’t drive her if she did. She sighed and rolled her eyes.
Of course, she missed the bus. She ranted and cried when I stuck to my promise to not drive her then left to walk the four miles to school. She opted out of riding her bike because helmet-head is definitely not cool.
After she left, I started to feel guilty. Was I being mean and unreasonable?
That evening she told her Dad “Mom made me walk to school!” Then laughing, she added, “Look at the blisters on my feet!”
Her response wasn’t angry or resentful, as I’d expected it to be. She seemed proud of herself, more confident and may have even grown up a little.
Holding people we care about accountable, giving them credit for having the resources to follow up on their commitments is really what love is all about. When we respect them, have confidence in them, they learn to respect and have confidence in themselves. It’s usually easier to do it ourselves, but what’s the message? “You’re incapable; I can do it better than you”?
Today, I prescribe Suboxone to patients in treatment for opioid addiction. The medication, Suboxone, is not a cure. More like a “lifejacket,” it helps keep people from using opioids as they journey through treatment to recovery. This requires commitment, time, honesty and hard work in individual and group counseling learning skills to cope with and address anxiety, depression, childhood trauma, PTSD and chronic physical, emotional and spiritual pain. It means leaving user friends and family behind and finding a community where you feel respected and loved. Discovering what gives life purpose and meaning, and taking some steps toward fulfilling those dreams are also required. And this is just the beginning.
Suboxone contains an opioid, buprenorphine, a partial opioid agonist that produces the same effect as an opioid (euphoria, respiratory depression) but milder. Full opioid agonists are drugs like heroin and oxycodone. The second medication is Naloxone, an opioid antagonist that blocks the opioid receptors so that the body doesn’t experience the opioid effect. Suboxone is taken under the tongue where the buprenorphine is readily absorbed but the Naloxone is not. If this medication is abused (snorted or injected), the Naloxone will block the opioid receptors and cause immediate opioid withdrawal symptoms.
Under the U.S. Department of Health and Human Services, the Substance Abuse and Mental Health Services Administration says that “medications such as buprenorphine (Suboxone), in combination with counseling and behavioral therapies, provide a whole-patient approach to the treatment of opioid dependency.”
It certainly doesn’t make sense to prescribe an addictive opioid like buprenorphine to replace the heroin or other opioids unless it’s prescribed along with observed urine drug screens where a technician observes the patient as he/she urinates. You have no idea how much can be bought online to falsify a urine drug screen (Google “Whizzinators”). Drug screens are done to be reasonably sure that patients aren’t using other substances like alcohol and benzodiazepines that can cause serious health risks or death when taken with Suboxone. Samples also confirm that patients are taking their Suboxone (not selling it) and can detect other illicit drugs in their system.
“You gave me structure when I needed it, even though I didn’t know it at the time” a patient recently told me. Most patients in early recovery don’t initially see the value of counseling and therapy groups. Their motivation is to get the Suboxone prescription, which makes it a great tool to keep them coming in for treatment.
As a patient progresses, the Suboxone dose should gradually be decreased with the goal of discontinuing the medication altogether. If this isn’t the goal, then again, it’s simply replacement of one opioid for another.
I have no objection to people being prescribed Subxone alone with minimal to no counseling or behavioral therapies, if that keeps them from using opioids, but that’s not treatment! Let’s call it what it is: “harm-reduction” or “maintenance.”
Let’s begin by holding people accountable. If a person who is opioid-addicted wants help, let’s give it to them but let’s not replace one opioid for another. Let’s demand and support structured programs with requirements for treatment group and counseling participation as well as observed urine drug screens. Accountability, so important for recovery, can only develop if patients are required to show up on time and as scheduled for treatment groups and counseling and commit to the work that’s necessary if a person wants to have a chance at lasting, long-term recovery.
Linda Napier is a family nurse practitioner who began treating opioid dependence along with primary care in Jonesport two and a half years ago. She now works full time in addiction medicine in Ellsworth and Southwest Harbor.