The Anti-Addiction Pill That's Big Business For Drug Dealers | Hacker News Reader

The Anti-Addiction Pill That's Big Business For Drug Dealers

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88 points0xbadcafebee45 comments

I started taking suboxone 5 months ago and it (almost literally) saved my life. Before finding out about it, I thought I was going to be stuck in a hell-hole of heroin dependence forever. You wake up one day and realize that you are completely fucked, and that there's nothing in the world to help you. Suboxone changed that. I started taking it, with no/minimal side-effects, and immediately stopped doing heroin, stopped craving heroin, stopped everything. Finally, I can live in peace without there being a short-fused time bomb just waiting to blow up inside of me.

Thanks to suboxone, I can program and think and live again.

So does this mean that the opiate addiction is still present, but satisfied by suboxone? In other words, if you stopped taking suboxone, would the heroin craving come back?

Yes, the addiction is still present. If I stop taking suboxone I will start feeling a little bad (depression, etc) by day 2 and will start withdrawing (feels like a really bad cold) on day 3. By day 4, I would be throwing up and unable to move/function.

The only downside of suboxone is that due to its long half-life, the withdrawals last a long, long time. With heroin you are out of the woods by day 4 or 5, but with suboxone, withdrawels last weeks/months.

Try getting your dose of Suboxone to less that 1/2 mg for at least a few weeks. Then try stopping again. You might need to take micro doses every other day for weeks before you can stop completely. Remember, we have been conditioned to believe it's harder to get off of through a lot of hysteria, and drama. It's almost like a negative placebo effect.

It is immediately clear that is too addictive for all but the worse cases. What would happen if instead of taking this stuff you were supervised by a physician during withdrawal? Would you be addiction free after 2 weeks?

Addiction is not just a physical process. I chose to go on Suboxone as dealing with the mental effects, the life changes I needed to make, and my already existing depression on top of heroin withdrawal was infeasible.

So, while yes, the "physical" part may be done, the rule of thumb that my clinic gave me was "Half the time you were addicted". I was an addict for 6 years, they work on 3 years clean before I'm truly "cured".

Soboxone targets opioid receptors differently than heroin and, while it is technically a "replacement therapy" it is almost impossible to overdose on and more difficult to use on a continual basis for recreational purposes (the "positive" effects of the drug decay rapidly with continual use. To answer the question, one does experience withdrawal effects if they use Buprenorphine for a long enough time, however some professionals in the Recovery Industry (tm) use it to do a "fast taper" which is a more aggressive treatment over a short period of time in which the patient only takes Buprenorphine for a week or so to reduce the pain of heroin withdrawal (but not completely eliminate it) and then taper the dose of suboxone quickly before the patient has time to grow dependent. Yesterday's discussion of Wikipedia's accuracy notwithstanding, the link below actually does give some useful jumping off points.

http://en.m.wikipedia.org/wiki/Buprenorphine

In short, users can get "strung out" on suboxone but if used in certain ways (I.e not for the long term "maintenance" that the pharma companies make their money on, but as a short therapy to quiet some of the discomfort experienced during opiate withdrawal, it can be effective and safe and not lead to long term use.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3150159/

Suboxone still works through the same receptors as morphine or heroin (see the wiki link).

One important difference is that it's a partial agonist at the mu receptors rather than a full agonist. That makes the effects someone self limiting.

I didn't say that it targets different receptors. I said it targets them (i.e. the same receptors) differently. I failed to go into the details of how it targets them differently (wasn't sure if that LOD was called for, or in good taste, considering that this is not a site about pharmacology or neurochemistry). I did see the wiki link... (I wouldn't have posted it if I hadn't.) Thank you for clarifying though! (BTW, I think that you meant somewhat not someone in your final sentence.)

(wasn't sure if that LOD was called for, or in good taste, considering that this is not a site about pharmacology or neurochemistry).

In my experience, detailed knowledge is always welcome on Hacker News, especially if it comes from another highly technical field outside software.

Totally, my error for not adding value with some additional information in my last comment. Thank you. :)

1) some introductory material on receptor theory:

http://en.wikipedia.org/wiki/Receptor_theory

Yes, I know Wikipedia, a more comprehensive intro to basic neuro is "Principles of Neural Science, 5th Ed" (http://www.mhprofessional.com/product.php?isbn=0071390111)... It's large book but the de facto standard.

2) a reference to some basic pharmacology with respect to opioid receptors that includes a summary discussion on receptor interactions (i.e. full agonists/antagonists/partial agonists):

http://www.ncbi.nlm.nih.gov/books/NBK64236/

3) some explanation per the specifics of the mu receptor (click on this only if you are truly thirsting for knowledge on the mu receptor):

http://www.iuphar-db.org/DATABASE/ObjectDisplayForward?objec...

Have a nice night!

Heroin cravings never leave, it's the physical withdrawal you want to avoid.

That's extremely misleading and generally over exaggerated by anti-drug advocates. The cravings get weaker as the weeks progress and by a full year or so, they're completely gone. What remains is the nostalgia. You think back on the time you were doing them and remember how good you felt (while conveniently forgetting all the bad times) and you crave it like you crave something from a memory.

For me, (8 years clean) it's like remembering Christmas morning when you were a child. Now that I think about it, it's almost exactly like that. I don't crave it like a cigarette (You don't have an "urge"), instead it's like recalling a happy memory and feeling nostalgic. Why it's misleading is because the same could be said about virtually anything you can feel nostalgic about.

Mm, that's not completely true, however it depends on how you define "cravings". In my experience, anyway.

If you don't mind me asking, do you continue to take it? Or if not, how did you know when to stop?

Yes I still take it and have not lowered my dose since going on it. I've noticed that my mood on it is much higher than it was before I started doing the heroin (which I started in the first place because I was depressed and suicidal), leading me to believe that it has significant anti-depressant potential even in opiate-tolerant individuals. Also, there's some history in the literature of it being an effective anti-depressant[1]. I haven't lowered the dose or stopped it because I am afraid I will end up in the same situation as I was before and start using again.

[1]http://en.wikipedia.org/wiki/Suboxone#Antidepressant_potenti...

Why not just taper down to the minimum dose where you still get sufficient antidepressant effects? Especially since psychoactive drugs are typically prescribed at levels way beyond what is actually necessary.

As an interesting aside, the company that makes Suboxone attempted to prevent generic companies from entering the market.

Apparently there have been a number of poisoning caused by children taking Suboxone tablets. What Reckitt (the maker of Suboxone) did was create a new dose in the form of a film that dissolves in your mouth. Each film came in a seal packet that was difficult for children to open.

Once the patent for Suboxone was nearing expiration, Reckitt introduced the new film dose form and pulled the tablets off the market. Once the patent expired, Reckitt asked the FDA to deny approval of any new generic forms of the tablets in the interest of public safety (in essence giving them an additional patent life as the film was a new patent).

The FDA didn't believe the risk was enough to stop generic versions of Suboxone and two new generic forms were approved earlier this year [1].

[1] http://www.drugfree.org/join-together/government/fda-approve...

Suboxone has helped me beat my 6 year long opiate (heroin) addiction. It has it's own issues. I'm lucky enough to live in Australia, where it was simple to get on the program, and it costs me $5 per day (less if I pay two weeks in advance).

I'm currently on 8mg, down from 28mg a year and a half ago. Ask me anything :)

Ps. I'm writing a book based on my experiences at the moment. You can find a draft chapter here: http://jgirvin.com/the-things-we-do.html

'Reindeerspotting' is a good watch if anybody's interested. Subutex/Suboxone has its merits, but it's not a silver bullet.

http://en.wikipedia.org/wiki/Reindeerspotting:_Escape_from_S...

Unfortunately Subutex/Suboxone come with it own set of problems:

Detox drug is Georgia's new habit - http://www.nytimes.com/2006/06/12/world/europe/12iht-drug.19...

Suboxone: The New Drug Epidemic? - http://americannewsreport.com/nationalpainreport/suboxone-ne...

How a nation of junkies went cold turkey - http://www.newrepublic.com/article/113051/

"The government spent tens of millions of dollars developing Suboxone."

Where is this coming from? It was developed by a private company.

listen to the podcast, your answers are there, but it sort of amounts to the government having to bribe the manufacturing company to develop it (because doing so would break a ton of laws) and it is unpatented, so the company that makes it issued some pretty harsh demands.

Please be fully aware of the risk of precipitated withdrawal when considering taking bupe. If you're an addict, you shouldn't take it until the withdrawals hit full swing.

What about ibogaine? It's a naturally occurring substance and has been used to treat addictions for all sorts of hard recreational drugs. It's also the prime drug that's always mentioned when talking about breaking addictions.

Hell, it has entire religious movements dedicated to it. It's the Lisp of drugs.

It's certainly no miracle cure, nor is it even particularly effective for a lot of addicts. Two of my aquantinces attempted it. One stayed clean afterwards for about six months, the other was back on it in weeks (he passed away a year later due to an overdose).

Of course, n=2 does not a theory make, however their experiences certainly put me off it enough to not attempt it. I'm on Suboxone ORT instead.

Naturally occurring means nothing. Opiates are naturally occurring too.

I suspect the private prison industry, some in law enforcement and politicians do not want this drug readily available. It could be significantly disruptive to their wallets and positions of power.

This is actually a really good point, and I'm glad you backed it up with concrete evidence.

Only take bupenorpine if you are really addicted to heroine. Doctors who prescribe for opiate addiction are allowed only 100 patients. They(Doctors) will drag you in for needless expensive visits. I say only if you are really addicted to opiates, because I see people switching to this drug because they "think" they are addicted.

The drug is not something you want to get addicted too.

If you do end up on this drug, try to find a doctor who's not trying to make money off your misery. Might be hard?

There's two forms of bupenorpine. One has a opiate blocker (nalaxone) in it--It is expensive. Try to get your doctor to prescribe generic bupenorpine. Once you get bupenorpine in your brain, your craving for opiates will diminish. If it dosen't you need to do the whole 12 step dance.

The high of bupenorpine wears off after a few months, so it's no panacea. Remember, you will be addicted to another drug, but at least it's legal. Try to take the smallest dose possible. The slight euphoria wears off! People don't understand that? After a few months you will be addicted to another drug. Your Doctor will become your drug dealer. The fun wears off real quick. I have no reason to lie. And yes--I'm just one person. You're not reading the results of a well done double blind study.

There's a lot of misinformation about this drug--even among the MD's who needed to take a special class in order to prescribe it.

Again, don't start it unless you've bathed your brain in opiates for a long time. A while is not a few months. Even if your hooked to the gills on smack, the media makes detox so dramatic. I've seen people scared to death, thinking they will die from withdrawal. Dying s very rare, unless you have the health of Jerry Garcia.(huge addiction, obese, and diabetic, etc). If you are realitively healthy you can taper off. This goes for Alcoholics too. You don't necessarily need to spend your last 40 grand on high priced Promices. Taper, Taper, Taper. Ten percent a day. Doctors won't tell you this because of the small chance you die--liability.

Again, don't start this drug if you can. They don't know the long term effects. If you are one of the unfortunate ones, and use bupenorpine, make the best of the situation. I have heard of peope getting off it, but they taper their dose, and have a fair amount if decipline. If you are trying to get off bupenorpine, stay off the drug recovery websites; everyone exaggerates, and the stories will just scare you.

My honest, blood written advise is Never take opiates. Especially, if you even think you have a slightly addictive personality, or biology? Don't take that free Percocet offered by you friends. I honestly feel long term opiate use, or buprenorpine use damages the pleasure centers of your brain.

Good Luck--and please save any lectures. This is just my opinion.

Delirium Tremens is no laughing matter. Most alcoholics won't get it when they go through withdrawal, but those that do will very likely die without medical treatment. With modern medical treatment, the death rate is 'merely' "5 to 15%".

I don't think most people treat alcoholism as seriously as it deserves; myself included.

As someone who recently went through DT's (been sober a year and a half) I can tell you for certain they are no laughing matter. I've done hallucinogenics like LSD and mushrooms before, but nothing prepared me for the nightmare of Delirium Tremens. I couldn't close my eyes because of the awful visual hallucinations that played out like a kaleidoscope from hell, each image a broken face in a box, grinning fiendishly. On top of that I had miserable auditory hallucinations that sounded like bad people whispering just out of earshot. I'd advise any heavy drinker who may be physically dependent to seek medical help and not try going cold turkey.

Agreed in that few people treat it with the seriousness it deserves. In fact it's almost a joke for many people - "haha, I'm such an alcoholic" etc. I'm sure if they'd ever seen the real effects of alcoholism they'd think twice about throwing terms like that around.

I drink a decent amount of beer and wine so I'm pretty far from tee-total, but misusing the term "alcoholism" bugs me a great deal.

In my case it started to become obviously serious when I woke up with the shakes and needed some to feel right and stop shaking. I didn't really take it that seriously before then.

> Ten percent a day. Doctors won't tell you this because of the small chance you die--liability.

Why taper that fast? What's the rush? Most people seem to assume that if a drug has a shorter half life it means you can taper off it faster, but I've never seen any evidence (albeit I'm not an expert) that the speed at which your neural chemistry can reset itself is at all correlated with the half life of the drug.

Its not fast if you consider its 10‰ of previous dose. As you approach zero dosage reductions get smaller. Rule of thumb I've seen is 30‰ every 4 days. Close enough.

OT, but note that ‰ means "per mille". So 10‰ is equivalent to 1%, not 10%.

As someone on Bupe, you're very correct with a lot of this post. ORT is not something to be taken lightly. It saved my life, career, and future, but that's because my situation was extreme.

You pop some oxy pills once a week? You're not addicted physically. You don't need bupe, you need support (professional and family, preferably) and a desire to stop.

That said, suboxone was a life saver for me -- but it's still not great to have the orange, citrus handcuffs. I'm on 8mg down from 28mg 1.5 years ago, and it's not been easy.

Well worth it, though.

Despite its flaws, calling the 12 step program a "dance" is pretty offensive. This coming from a someone who's father died of alcohol withdraw when I was young, and 4 immediate family members in the program.

*edit: Also, while your post was primarily about this pill and addiction surrounding it, I can assure you my father wasn't like "Jerry Garcia.(huge addiction, obese, and diabetic, etc)." In fact, he was in his mid-twenties, and an all-state wrestler and football player in high school, and very athletic after. Sometimes, it has nothing to do with your health, but the seizures which can come from withdraw and an inadequate and unequipped healthcare system.

To be frank, I find your post to be very insensitive and offensive to those who have been through situations like this.

As this is not Facebook, I have a hard time understanding why your feelings matter. To make matters worse, that "dance" comment had close to nothing to do with what he was saying, making your -and my- comment an utter waste of thread-space.

> Remember, you will be addicted to another drug

True, but there is a ceiling to the effects, so your dose can't escalate endlessly. It also blocks other opiates, by binding very tightly to the receptor.

Addict in recovery. I'm glad I was never pigeonholed into Suboxone treatment. Once you are addicted its no better getting off of than Methadone: a month of withdrawals vs what could have been three days.

>This goes for Alcoholics too.

This is terrible advice, there are a million non-addictive anti-seizure meds you can be put on so you don't just fucking seize out while at the store. Gabapentin through sodium valproate. Benzos are just a replacement addiction, though, and are just as dangerous to kick.

My withdrawals, every time I went through them (before I was truly ready to quit with the support of my family, and the addiction clinic here) lasted a lot more than 3 days.

Part of me wishes I had been locked in a room and dealt with it. But the other part of me knows that Suboxone gave me the band-aid to let me heal the other problems in my life, to tackle my addiction in full -- to deal with my depression, to get a stable job and place of residence, etc. etc.

And it worked for me. It doesn't work for everyone. I'm tapering now, and it's not too bad thankfully. I'm lucky in that regard.

Ibogaine treatment is the best way to get over heroin addiction (apart from strong will power of course).

I was going to write something much stronger in response to this, but I've decided this will suffice:

You are wrong, and frankly generalisations like that will get people killed.

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