Comment by Scaevolus | Hacker News Reader

Comment by Scaevolus | Hacker News Reader

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Treating opiate addiction with suboxone (one of the most effective methods) is largely blocked by bureaucracy: http://slatestarcodex.com/2015/02/02/practically-a-book-revi...

"They are worried that suboxone, being an opiate, might be addictive, and so doctors might turn into drug pushers. So suboxone is possibly the most highly regulated drug in the United States. If I want to give out OxyContin like candy, I have no limits but the number of pages on my prescription pad. If I want to prescribe you Walter-White-level quantities of methamphetamine for weight loss, nothing is stopping me but common sense. But if I want to give even a single suboxone prescription to a single patient, I have to take a special course on suboxone prescribing, and even then I am limited to only being able to give it to thirty patients a year (eventually rising to one hundred patients when I get more experience with it). The (generally safe) treatment for addiction is more highly regulated than the (very dangerous) addictive drugs it is supposed to replace. Only 3% of doctors bother to jump through all the regulatory hoops, and their hundred-patient limits get saturated almost immediately."

That reminds me how a lot of countries are currently in the process of making illegal "Kratom" which is used by a lot of opium addicts as a way to self-medicate their addiction withdrawal.

Those are some great points and it probably should be more readily available. But I still have some issues with Suboxone and the way it is being used. It seems to be pushed as a lifetime substitution for illegal opiates, rather than a tool for tapering off opiate dependence. When I was involved with someone in this situation, I couldn't even find anything official about how to go off the Suboxone, just anecdotes from people who had done it themselves. The doctors seemed perfectly happy to prescribe whatever dose you wanted, as long as they got their fees. And the smallest dose available was 2mg, which is apparently too much to drop off from, meaning that to taper you have to manually cut doses into small fragments. All together, it just seemed extremely sketchy to me.

The smallest dose of buprenorphine is 0.4mg.

I was a heroin addict from 16yo, until just before my 22nd birthday. I've been clean ever since, 4 years this past August. This is entirely down to my state government's excellent opiate replacement therapy program, and buprenorphine. It literally saved my life.

The clinic builds a plan for you specifically, and adjusts it every few months. They provide counseling, advice and medical help. We don't pay them, the government does. The doses themselves cost $5 per day.

I'm impressed, it sounds like your state has a system that is almost incomparably better than mine. Grats on staying clean.

Yes, although I'd point out that a dependence on a low dose of Suboxone is really not that big of a deal; it being a partial agonist means that it doesn't really have adverse side effects over the long term unlike full agonists like traditional opioids or methadone. It may prevent relapse over the longer term much more effectively than abstinence.

I definitely agree with a point you raise however about the availability of lower doses - 2mg is far too high to jump off of, or even 0.25mg for that matter. Suboxone is commonly prescribed at FAR too high a dosage, 8 to 16mg or even 24mg, when in reality 4mg is plenty for almost everyone, and 2mg will work in many cases.

The withdrawal of Suboxone can at first glance seem not all that bad compared to traditional opioids, BUT - it lasts for at least a month, if not 2 or even 3. Suffering over a long time period is a LOT harder than people think. So, I think the pragmatic - and humane, for that matter - is simply to let the dependent person choose. Many may choose to discontinue it of their own volition if they are given the space to determine their own tapering plan and see how it goes. Forcing them into something is likely to cause far more harm than any perceived (to say nothing of actual) benefit.

> Suboxone is commonly prescribed at FAR too high a dosage, 8 to 16mg or even 24mg, when in reality 4mg is plenty for almost everyone, and 2mg will work in many cases.

Says who? We tried that when I got clean. I required 26mg to hold my withdrawals at bay for a full 24 hours.

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