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Comment by afarrell | Hacker News Reader

Here is a psychiatrist presenting the flaws of rehabs and an argument that governments also need to allow widespread use of suboxone to treat addiction:

http://slatestarcodex.com/2015/02/02/practically-a-book-revi...

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And if you want to talk about social justice, this is what drug replacement therapy (suboxone)-based rehab looks like in some of our southern states. Addict is remanded by a court to the care of an outpatient treatment facility. Addict must show up at that facility every day with $10-$15 in hand to buy their dose. If they miss a day, the treatment center has the authority to send the addict to prison. Some treatment centers will engage a kind of payday loan scheme to allow the addict to catch up on payments later, for a price.

If the addict has felony priors (most do, using is a felony in many states), they will have a hard time finding a job, and an even harder time paying for food and shelter, on top of the $280-$450 a month for their subs. It's a form of indentured servitude, with pharma being the beneficiary. Some resort to criminal activity to support their state-mandated habit.

> The best guesses by outside observers is that for a lot of them about 80% to 90% of their graduates relapse within a couple of years.

The problem with this statement is that you can go back to using drugs, but in a significantly lower risk pattern than previously. E.g. if you were shooting up heroin, but switch to smoking weed. This is actually pretty common, so these top line relapse rates dramatically understate the efficacy of these programs. That's not to say they're super effective, but I think there's at least something to be said for intellectual honesty.

There are lot's of funny statistics where people will redo rehab several times if they fail. But, only once if they succeed.

The same is true of prison. First offenders are much less likely to go back than the 'average' prisoner.

Suboxone is just dope from a dope man in a lab coat. All suboxone does is switch addiction from opiates or opioids, to opioids. I've known more than a few people who were detoxing from suboxone say it's easier to kick heroin.

I had a very close ex-girlfriend who went on subs but wanted desperately to get out of the whole game.

After I went to an inpatient treatment center and learned from the professionals there that kicking subs was way harder then heroin, and saw with my own eyes a few people there who were having a bitch of time.

I ended up telling her this, and strongly advised her to get back on heroin for a week and then kick...she followed my advice and thanked me for profusely as she tried the sub detox taper and couldn't make it work.

Suboxone for heroin addicts is like benzodiazepines for alcohol withdrawal. It should only be used in the initial withdrawal period for a short period of time.

The proper protocol is to substitute the short-acting heroin for the longer half-life Suboxone. This stabilizes the blood levels, thereby eliminating inter-dose withdrawal symptoms.

The dose is supposed to be titrated to zero over a few weeks. Otherwise you'll just end up swapping on addiction for another.

It's a shame, because Buprenorphine is a really good medication when used properly.

That's why addicts should only use suboxone to get over the initial, physical withdrawal symptoms and only take it for maybe a week and then taper it down. Suboxone is a far worse thing to detox from because the half life is far longer than opiates -- something like 36-48 hours.

Suboxone is a Godsend if you only use it to get over the initial w/d's

I see no problem with using any drugs as a step-down. But what is happening is Pharma is lobbying state governments to employ suboxone as a long term maintenance solution.

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