Addicts can face troubled recovery
Mon, Jul 16, 2007
By ALAN SVERDLIKThe Brunswick NewsThe terrifying tales Dr. William Daniels hears every day at the hospital jog his memory and rend his heart, for they evoke the private hell he inhabited for many years. The tears, the shivers, the queasiness, the evasions that encrypt the truth – they could all be his."I was a junkie and a drunk, so I was left out to suffer and withdraw by myself," recalls the Focus By The Sea physician, a guiding light of a movement that is trying to revolutionize the treatment of opiate abuse. "I was told that (withdrawal) was not going to kill me, so deal with it."Daniels, who weaned himself off painkillers and alcohol cold turkey, is one of a growing number of Georgia doctors who prescribe Suboxone, a pill that cushions the crash but makes it extremely hard for addicts to return to the life.
William Daniels, physician at Focus by the Sea, tries to downplay the stigma of drug abuse when helping addicts in recovery. (Michael Hall/The Brunswick News)
| Suboxone is more than another hyped new med that makes people feel better. It's a truth serum that helps the deeply wounded exhume buried chapters of their pasts, and it's a lubricant to group therapy, addiction specialists say. Suboxone has come to define an entire sector of the recovery field, but it has its detractors, and they're as passionate as the drug's proponents."Suboxone may become to substance abusers what insulin is to diabetics," said Dr. Aaron Hurowitz, who treats opiate users out of several offices on the north side of Atlanta. "Patients ask me, 'When can I get off this stuff?' I tell them I'd rather them stay on Suboxone the rest of their lives than relapse."An opposite view comes from Jennie Leyva-Jones, who runs an opiate rehabilitation clinic not far from Hurowitz's offices."Suboxone has too many similar, if not identical, properties to the painkillers it's supposed to combat," she says. "When a doctor hands out a prescription, you say 'yes' because you assume it's safe. It's not."Listening to its prescribers explain how it works, it sounds like Suboxone performs some form of jujitsu in the cerebral cortex. Its active ingredient is buprenorphine, a mild opiod painkiller that was once used during the neonatal period, usually two weeks before and after a mother gave birth. As a patient withdraws, the buprenorphine masks the symptoms because, like any opiate, it activates pleasure receptors. At the same time, it blocks the effect of any of its more powerful cousins."When the Suboxone molecule enters the neuron, it attaches to the receptor and protects it from any other opiate," said Dr. David Faulk, a Brunswick psychiatrist who writes prescriptions for Suboxone. "The big benefit is that it's extremely difficult to abuse and become addicted to."The pharmacology of Suboxone has spread through clubland, where its antagonism to customers' pills of choice makes it as unwelcome as an undercover cop.What scares off anyone with a yen for shooting dope from trying Suboxone is that taken intravenously, a secondary ingredient, naloxone, enters the system, inducing immediate withdrawal.Approved by the U.S. Food and Drug Administration in 2003 but slow to enter the market, Suboxone is not the only antidote to opiate abuse available to patients. There are still methadone maintenance clinics (the closest one to Brunswick is in Jacksonville) around, which taper addicts off giving them controlled doses of methadone, also an opiod derivative. The original concept behind methadone, which can be taken by mouth when mixed with juice, was to eliminate the addicting props of the drug culture – syringes, spoons, lighters – and then slowly lower the milligrams. A debate is intensifying between the new wave of Suboxone partisans and the methadone traditionalists."There are different schools of thought within the circles of addiction medicine," Faulk said. "The old school saw the positive effects of methadone in the '70s and '80s, but the new school is staunchly pro-Suboxone."Faulk is clearly in one camp. "Methadone is a recreational drug, but Suboxone isn't," he said, and Suboxone, while still a controlled narcotic, is much easier to come off of. No matter the degree of withdrawal, Suboxone is a cake walk compared to the after effects of longtime use of OxyContin, Lortab and Percocet, said Dr. James Berman, who specializes in addiction both in private practice in suburban Philadelphia and at the University of Pennsylvania."The flu times 50" is his metaphor. "Runny eyes, runny nose, goose bumps, simultaneous sweats and chills."Coated with an orange flavoring, Suboxone is absorbed under the tongue. It is a highly expensive remedy. A supply of 30, 8-milligram tablets at a CVS pharmacy runs almost $200. Some independent pharmacies charge between $140 and $150. Most prescriptions call for between one and three a day.Faced with the prospect of withdrawal, most addicts, even those without insurance, will spring for Suboxone, several prescribers say.Daniels at Focus By The Sea, for instance, says many people spent just as much money or more by purchasing opiates from offshore pharmacies that advertised on the Internet, which led them to addiction and eventually to his St. Simons hospital."If I had a nickel for every OxyContin addict who maintained on the Internet, I'd retire right now," he says.At Focus, there is no protocol that establishes how long a patient should stay on Suboxone. At some point, though, they "bite the bullet," Daniels said.In therapy, Daniels tries to play down the stigma of drug abuse, calling it a health, rather than moral, concern.His own struggles sensitized him, he said.Clean since 1988, when he went through detoxification, Daniels began drinking in his teens and graduated to a daily diet of codeine, hydrocodone and oxycodone. He got kicked out of four halfway houses for breaking the rules."I was always blaming the (person) I was working for or the (woman) I was married to when things went wrong," he said. "But finally I realized that I was the common denominator in all these situations."He wants his patients to be able to confront their pasts as he has. And Suboxone, he finds, helps them dig deep for that cache of hurt that started their descent into addiction.
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