With 37 years’ experience in the field of addiction medicine, I would like to address some of the controversy surrounding buprenorphine (Suboxone-type drugs). Medication-Assisted Treatment with Suboxone-type drugs is right and is life-saving for some patients. Prescribing an opioid medication for someone seeking help for opioid dependency may seem odd and confusing, but when used appropriately, MAT can save lives. There is abundant research to support this.
The problem of opioid addiction is enormous. Overdoses are our number one killer in Tennessee and the U.S., exceeding car wrecks. Doctors prescribe opiates too often. America with 5 percent of the world’s population uses 99 percent of the world’s hydrocodone. Tennessee and Alabama lead the nation in opiate prescribing, with nearly three times as many prescriptions per citizen as other states, like California and New York – 143 prescriptions per 100 people in Tennessee. Fifty people die from opioid overdoses every day and 2.1 million people are addicted to opiates.
Treatment has been shown to be far superior and much more cost effective than incarceration. We have filled our prisons with people who needed treatment, and the problem has grown worse than ever. Buprenorphine (Suboxone-type drugs) is harm-reduction therapy – control, not a cure. It takes away the craving and its unique ceiling-effect property protects against overdoses and getting ‘high’. Patients, properly selected and followed closely, feel normal and function normally, engage in treatment programs, and participate more fully in family, school and work activities. We often hear from patients that Suboxone-type drugs are like a miracle, and for those who leave behind the addiction lifestyle and develop a healthy lifestyle, this must seem true. But Suboxonetype drugs are not a miracle. Stopping them abruptly will still cause withdrawal and the cravings and addiction behaviors will likely return.
Treatment medications must be only part of a comprehensive program to help the patient stabilize, work a recovery program, and live a better life. It is important to understand that medication does not ‘fix’ chemical dependency. Medication treatment is not an alternative to other care. Counseling, psychosocial support and education in relapse prevention skills all take time to integrate into a person’s life. The brain of a chemically-dependent person needs time to heal, to develop impulse control to counter the urge to use drugs.
What about “Just Say No”? Abstinence-based programs (AA, 12-Steps) work quite well for alcoholism, but opiate dependency is another beast. Research has shown that abstinence-only programs lead to relapse in more patients than those treated with medications for addiction. Nora D. Volkow, M.D., director of the National Institute on Drug Abuse, testified before congress that buprenorphine-containing medicines, when administered in the context of an addiction treatment program, can effectively maintain abstinence from other opioids and reduce harmful behaviors. She also said, “Medication-assisted treatments remain grossly underutilized in many addiction treatment settings, where stigma and negative attitudes are based on the misconception that buprenorphine or methadone ‘substitute a new addiction for an old one’.”
In some patients, the brain chemistry is such that an abstinence-only approach is doomed to failure because the physical addiction is so strong, oftentimes genetic. The patient who is dependent on opiates has a much better chance of recovery with prescribed buprenorphine (Suboxone-type drugs).
Well-meaning legislators and bureaucrats in our state have proposed numerous bills and regulations that impede proper standard of care treatment for this terrible brain disease. Failure to understand that addiction is a complicated brain disease, rather than merely bad behavior, allows some to see addiction as a choice. No one chooses to live this horrible, destructive lifestyle. Failure to recognize the difference between the office of an addiction medicine specialist and the scourge of ‘pill-mills’ is short-sighted, superficial and dangerous. Please, let us not elect and support legislators and appointees who wish to throw out the baby of proper addiction treatment with the bathwater of ‘pill-mills’. Research results suggest that long-term care strategies of medication management and continued monitoring produce lasting benefits. Drug dependence should be insured, treated, and evaluated like other chronic illnesses. Treatment decisions on the use of FDA-approved medications for addiction should be made only by
skilled physicians.
John B. Standridge, M.D
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It is letters like this that "brainwash" laypeople on drug addiction vs drug dependency. One would read your post and think that all people who take opiods for pain are on greased pole to addiction. This is not true.
The DEA, FDA and CDC have hijacked the topic of "Chronic Pain Management".
I do agree with the writer that those that become addicted willfully destroy their brains and have limited coping skills. These are the people that are destroying the treatment of legitimate people with chronic pain. These people need to stay out of and away from pain management clinics.
This entire topic is disgusting and misguided, causing "Opioidhobia" by misinformed, judgmental and non scientifically trained doctors and many others. Many of these people have no
expertise in the area at all. These are the people that are responsible for the increase in heroin on the streets.
There are tens of million people suffering from chronic pain that are not addicted at all. Only physically dependent and tolerant which is not the same thing as being addicted.
You have "demonized" opioid prescribing. Reading your post "stigmatizes" millions of chronic pain patients that are legitimately prescribed an opiate and takes it "as prescribed" and do not abuse it.
Your post is full of "misconceptions". We have enough stress worrying about misguided, biased and incompetent state boards removing the licenses of facilities actually caring for and helping those in chronic pain.
Tim Mason
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Mr. Mason,
Wow, you certainly speak your mind. Too bad I have dealt with some members of my own family who have been addicted to opioids. Only one was because of pain management. The others got the pills for self-medication and profit. Hydrocodone abuse/addiction is a very widespread problem, much more rampant than you are apparently willing to admit. When "pain management" pill mills prescribe hundreds of thousands of pills to their customers, something is wrong. Especially when it is a known fact that most of these pseudo-medicos don't even examine the "patients".
I realize that there are a lot of people who live with chronic pain. I also know that many of these folks have a legitimate need for opioids. But not everybody who gets a prescription or hydrocodone is in pain. And a true medical doctor should be able to spot the difference. The pill mill quacks can't or don't care.
Dr. Standridge's letter was a plea for legislators not to go overboard in trying to combat this plague. It was also an explanation of the problem and treatment methods. I presume that the M.D. after his name means Medical Doctor, so it can be can be taken for granted that he just may know what he's talking about.
Ed Bradley
East Brainerd
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After reading Tom Mason's indictment of Dr. Standridge's post - I can't help but wonder where Mr. Mason gets his information and if it is possible he completely misses the point. Nobody wants a single person dealing with chronic pain to suffer for one second. Mr. Mason accuses Dr. Standridge, an expert in the field of addiction and the medical director of a local treatment center, of demonizing the over prescribing of opiates.
What Mr. Mason clearly doesn't understand about the over prescribing of opiates - the epidemic began years ago and started, in large part, with illegitimate "pill mills" calling themselves legitimate pain management clinics.
Like it or not, Mr. Mason, prescription opiate and heroin addiction has been at epidemic proportions for years and continues to grow. There are a number of excellent documentaries produced in recent years. All explain the situation much better than I can in a couple of paragraphs. Google 'opiate documentaries', Mr. Mason. I think you will be enlightened as to the realities of pain management, prescription opiate and heroin addiction. I hope you will then realize the power of denial and misinformation.
Dr. John Standridge, as an expert in science and biology of addiction, is part of the solution. His understanding of addiction and chemical dependence goes far beyond our average doctor. Addiction is his focus - not unlike other doctors focusing on other areas. With all due respect to Mr. Mason - I think I'll listen to the expert on this particular topic.
George Parker
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I couldn't agree with Mr. Mason more. Chronic pain is horrible and the group that experiences it most are those 55 and over who have worked their entire lives in an occupation that takes its toll on the lower back and the knees and feet. Not a doubt in my mind that everyone reading this knows at least 10 people who fit into this category.
Here in Tennessee we are those that were raised to do the right thing, the legal thing. We're under a real doctor's care, we don't abuse our scripts and most of us take one tablet in the morning in order to get out of the bed and tend to our responsibilities and one at night in order to sleep through the pain. Most of us have Medicare and have experienced that medication going to the top tier with the highest co-pay simply because of the problems with the drug addicts here. You know the ones, their pictures are on the net for "doc shopping" every week, to get those pills to sell on the streets. I would say the average age of those criminals is under 40 and quite positive none of them have a job because now it's too easy to sign up for assistance, food stamps, medical care, housing etc. The senior? Oh they're working part-time because they're paying rent, they're buying their food, they're paying their utilities, they're paying for their insurance and now they're paying higher co-pays. They don't get raises because the cost of oil is so low....I'm guessing if things continue like they are they'll never get another raise.
Forgive me for not feeling sorry for those that have turned an older generation's life into a nightmare. Don't blame it on their doctors, those fine folks are doing the best they can. I've been told by more than one professional that the pain meds they prescribe for their patient are being "taken" by the older kids. Even though the patient desperately needs that med the "kids" are thieves and take them as fast as the patient can get them and if they don't take them they're on the street selling them. You know who you are and you should be ashamed of yourself.
All you hear on the news are complaints from young people, college kids that "can't find a job", Black lives Matter and professional protesters, you never hear from the generation that helped build this country and are now slowly dying because they can no longer afford to buy decent food, or freeze to death because they can't turn the thermostat up or die of heat exhaustion because they can't turn the A/C on. The drug addicts and their enablers are turning this country into a slum and the most innocent, the elderly and the infants, are their true victims. As long as the state babysits them and pays them to go get their meds for the day you can pretty well count on nothing changing for the better.
I'm done ranting.....for now.
Sue White
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Such hypocrisy. This great and wonderful God-created planet we get to live on has provided us with natural herbs that can benefit a person's quality of life in the event of falling ill.
The biggest problem in regards to all this is, we are evil people. We can take anything that is good and misuse it. It's a heart thing.
"Krylon" , great product for spray painting. What do some people use it for ? Inhale it into their beautiful pink lungs of soft tissue, of course. You see, spray paint has no medicinal value. Instead it causes irreversible damage to a person's lungs and brain.
This sounds familiar to me. Oh yes, cigarettes. Tobacco is another useful plant but evil man has added toxins that are a proven carcinogen that makes a person addicted to their product so they will buy more, all for a buck. These nasty things stink and even the smoke they emit is cancerous. The manufacturer even has to put on the package that the product causes cancer. Users even throw their cancer sticks all over the ground as if they think littering is legal for them. But I digress.
What was I talking about, oh yeah , Opioids. The natural herb that makes a person living with daily pain or nausea and panic attacks manageable. Life is tough. It can sucker punch you without warning. Mentally as well as physically.
So what am I saying? Despite many many cancers and heart disease that are brought by cigarettes to their users and those around them, the demonization of the word "Opioids" is misguided. Jesus made a really good analogy that I think fits here "We swallow a camel but choke on a gnat."
Money provides cigarette dealers to be deemed as legal in the world. So as the cancer patient spends the day vomiting from their "Cemo" it's illegal to give then a natural herb that greatly reduces their nausea. The patient living with daily constant pain from arthritis can't take perhaps what's really needed because, Lord forbid they get addicted - despite it's a long-term condition. This is a cruel society.
The adage "Don't punish all for the sins of the few" has no place in the medical field. It's a fact. We have those that ingest bath salts, paint, brake cleaner etc....
El Chapo has nothing on our tobacco dealers. You can't fix stupid.
Michael Burns
Opioid User