When I was using drugs, the idea that I might be an addict was a source of great shame. I wasn’t ashamed that I used drugs; that wasn’t my problem at all. No, I was ashamed that I’d lost control of my use, that I couldn’t quit when I wanted to, that I couldn’t handle the withdrawals.

I also didn’t want to be like “them”, you know: addicts, junkies. I wasn’t that sick, was I?

My use was out of control for a long time before I got help. I thought about getting help - but I didn’t want to say to my family: I am addicted to pain pills, and I need treatment. No way did I want my friends, or my job to find out. What would they think of me? How could I face everyone?

I feared the stigma of having “addict” all over my medical records too. Many of us know how doctors treat patients who are “drug seeking,” and I imagined it would be a hundred times worse if I was an admitted addict.

So I suffered, and I suffered some more. Finally, the suffering was worse than the shame (but only very slightly) and I decided to call for help.

What Was It Like?

Amazing. And scary, but not shameful. In fact, the health care professionals I’ve worked with throughout my addiction recovery - from doctors to therapists to research coordinators - have been some of the most respectful, kind and empathetic people I’ve ever known. It was among these people that I first began to really understand that my addiction is a medical problem, not a moral problem.

By the time I decided to get help, I knew I wanted to try Suboxone treatment. This meant I needed a diagnosis of “opioid dependency,” which required meeting with a doctor. My doctor was an addiction specialist, and he was so non-judgmental that it was a relief just to talk to him.

The first appointment was just me answering a lot of questions about my drug use. That was the scary part, but it was also really eye-opening. The questions were like:

• What kinds of drugs are you using?
• How much?
• How often?
• Do you ever drive when you’re high? (That was a big slap upside the head for me, I’m sad to say.)
• Do you do anything illegal to get your drugs?
• Do you hide your use from others?
• Does your drug use effect your job? Your social life?

By the end of that interview it was abundantly clear to me that I was addicted to pain pills. It was also clear that I wasn’t being judged for my problem, no one was going to slap a scarlet A on my chest and expose my faults to the world. I was among people who both wanted to help me and had the means to do so. I made an appointment to come back in a couple of days for my first dose of Suboxone.

When I arrived for my “induction” (that’s what they call it when you start Suboxone treatment) I was in moderate withdrawals as I hadn’t used in about 30 hours. I felt pretty crappy indeed, but hopeful too.

My doctor told me how to put the pill under my tongue and let it dissolve. I started with half of an 8mg pill, and went to sit by myself in the lounge and read a magazine. The taste was bitter and I wasn’t used to holding anything under my tongue like that, but my word…that first dose of Suboxone was a revelation.

Within 20 minutes my nose stopped running, my legs weren’t aching, no yawning, no coughing, no stomach cramps. It was like this huge wave of relief washed through my body. By the time I took the other half of my dose and walked out of the doctor’s office, I felt normal.

All day long, I felt normal - by which I mean good. I felt like myself, a feeling I hadn’t experienced in a long while. I had no cravings. I didn’t feel euphorically high, but I was in a good mood.

I went to work that day, and the next, and the next. I was able to fulfill all my family obligations and I even had the energy and inclination to do fun stuff on the weekend. It wasn’t perfect, but it was close enough. And I didn’t have to tell anyone what I was doing unless I wanted to.

I remember feeling sorry that I’d waited so long to get help once I realized what getting help would be like. I’m not saying that I took Suboxone and lived happily ever after. But Suboxone has given me the stability to sort out the mess that I made of my life, and to work on healing my body and my spirit. It also reminded me of how good it feels to be clear-headed and in control - now I don’t want to risk losing those things ever again.

What About You?

So what are you waiting for? There really is no need to suffer more, or for your addiction to progress further before you make the call and ask for help. Believe me, if I could do it, so can you.

I was looking around the other day for information about what happens when you mess around with your Suboxone prescription or try and take it other than prescribed. We’ve talked a little bit about the effects of Suboxone and how the naloxone sends you into opiate withdrawal if you try to dissolve the tablet and inject it. But here’s a case of the same result—opiate withdrawal—when someone tried to skip a few days and stockpile their buprenorphine pills then take them all at once to get high. Here’s a quote from the discussion at the Medical Journal of Australia:

The Buprenorphine-Spawned Opiate Withdrawal Incident

By diverting his dispensed medication, our patient collected 11 buprenorphine tablets (8 mg each), which he took in one day. The result was not respiratory depression, but instead severe opiate withdrawal lasting four days — this scenario has not previously been reported. This case highlights features of the unique pharmacology of buprenorphine and some key issues for its use in the management of heroin dependence.

Yikes. No bueno. But I can understand his logic behind it. Usually backing off your drug of choice for a few days can help you feel it a little stronger when you take it again, right? Especially if you take it in such a large dose. But bupe ain’t your average opiate, apparently. I’m completely intrigued by what they call buprenorphine’s “unique pharmacology.”

The Burning Question of Buprenorphine-Caused Opiate Withdrawal

Now, I’m assuming that this person took Suboxone and not Subutex and that the naloxone must have kicked in for some reason. I’m also assuming that he took that as per usual, that is letting them dissolve under his tongue rather than injecting the drug. Because if he injected it, there is no mystery. Or if he took other opiates (heroin was his drug of choice and apparently there were some relapse incidents, though it doesn’t say how many days passed between relapse and restarting his buprenorphine regimen) and then took Suboxone without waiting for the detox to begin, that makes sense, too. But if they were Suboxone pills and he took them as prescribed or if they were Subutex pills and he took them in any form at any time after relapse, then I simply must know why this happened.

What Do You Think?

Anyone have any ideas? Theories? Perhaps experiences of your own that may illuminate this quandary?

Incidentally, the person in question was transferred to methadone treatment and his withdrawal subsided when buprenorphine wouldn’t ease his symptoms. Just goes to show that buprenorphine isn’t right for everyone and that methadone and other opiate detox methods are still viable and valuable.

According to the Associated Press, there’s some new research out that says exercise may help prevent substance abuse. Well, of course it does! We knew that, right? But it’s always nice to be validated by the scientific community.

The United States government is pushing for even more research in this area, something that explores the effects of “regular” activity as opposed to the “runner’s high” achieved after a really intense workout. In other words, can normal people like us who aren’t athletes benefit from exercise in the area of drug and alcohol use prevention?

Drug Addiction Rewards and Exercise Rewards

It’s all about the reward system in the brain. After prolonged periods of drug and alcohol use, this is one part of the brain that suffers long-term, if not permanent damage. It’s harder to feel happy or even normal without drugs once you’ve grown dependent on getting high. This means that events that “normal” people may be able to take in stride seem more like a mountain than a molehill to those with opiate addiction issues. The stress of the incident can make an addict want to use, to manually trigger the reward system in the brain to numb the drama. Since you can’t always avoid triggers during opiate detox, exercise is another possible solution.

Clues That Exercise May Fight Drug Addiction Relapse

Here’s what the Associated Press says researchers have found to support the idea that exercise can be an important part of a relapse prevention program:

*  Rats were less likely to ingest amphetamines if their cages had running wheels, suggesting exercise stimulated a reward pathway in the brain to leave them less vulnerable to the drug’s rush.

*  In people, exercise acts as a mild antidepressant and relieves stress. Depression, anxiety and stress increase risk of alcoholism, smoking or drug abuse.

*  Volkow is intrigued that attention deficit disorder and obesity both involve problems with the brain chemical dopamine, one system that drugs hijack to create addiction.

*  Baby monkeys who do not play enough in childhood have problems controlling aggression when they’re older. The most aggressive tend to have defects involving the feel-good brain chemical serotonin — and binge-drink when researchers offer them alcohol.

*  Back to rats, physical activity increases production of growth factors and stem cells in key brain regions important for learning and mood; increases formation of blood vessels; and strengthens communication networks between brain cells.

Exercise, Schmexercise… Bring Out the Bleach

No, not to sanitize the rig. Personally, when I feel triggered or feel any of the emotions that used to precipitate a run, I get out my arsenal of cleaning supplies and a bucket of old rags and get to work. And I don’t mean light dusting. I’m talking pulling everything out of the closet and reorganizing in earnest, pulling the refrigerator and stove away from the wall to scrub the floors beneath, getting on all those projects that tend to get put off during normal life. It’s a workout with a tangible result at the end.

If you’re using Suboxone to detox off of opiates, then you may be going through it with relapse triggers. Do you work out to fight off the impulse to relapse?