Detox

If I’m On A Suboxone Or Methadone Program, Am I Clean?

justice.gov

Q. Is being prescribed methadone or suboxone considered being clean, even though they are addictive, abusable substances?

You’ll get different answers to this question from different people.  Generally the division lies between those who are on maintenance drugs and those who are not.  Both sides of the discussion have their valid points.  However, I believe you answered your own question when you used the expression “addictive, abusable substances.”

The consensus among most professionals and recovering addicts is that “clean”, when used in the context of recovery, means drug-free.  Having all mood-altering substances out of our systems is necessary before the changes that addiction creates in our brains can be repaired.  As long as drugs that modify the reward system (which includes all recreational drugs) are in our bodies, repair and normalization cannot begin.  When we are on Suboxone or methadone maintenance, we are still addicted¹, and our brains are essentially in the same condition as when we were actively using other opioid drugs.  It would seem to be pushing things to call us clean.

That is not to say that there are no benefits to drug maintenance programs.  To the extent that they allow people to cease other drug use and begin to take care of themselves and fulfill their responsibilities, they have some validity.  The problem is that the addiction remains in full force, and relapse — whether to other drugs or simply recreational doses of the maintenance drugs — is only a hair’s breadth away.  Adherence to maintenance programs rests squarely on our willingness to continue to follow them.  That is an extremely dangerous place for an addict to be.

Here at Sunrise, we believe that the proper uses of these drugs are as short-term substitutes for the drugs being abused, with a relatively rapid taper to a completely drug-free condition.  If we wanted, we could easily become licensed to provide maintenance services.  However, we do not believe that is in the best interest of our patients, their families, and the other people in their lives.
_____________
¹If you don’t think we remain addicted on maintenance doses of opioid substitutes, just try quitting.  Both Suboxone (when used for long periods) and methadone have withdrawal syndromes that are worse than the drugs for which they’re being substituted.  Truth.

Tellin’ It Like It Is

From a reader on another site (used with permission).  No comment required.

I was addicted to Crystal Meth for a solid six months – That may not sound like much, but it only takes a little to hurt you. At the time it seemed like fun and just something to do but it was so much more then that. It consumed my entire life and turned me into someone/something I didn't want to be. I would look at myself in the mirror and just hate the person looking back at me with every fiber of my being. I knew I needed to quit but I just couldn't deal with the withdrawals.

justice.gov

I reached my peak of use on October 27th of this year. I was celebrating my birthday with a few buddies and what went from a round of use turned into a 13 hour binge. It ended with me lying on the couch for the next 48 hours writhing in pain. I felt like my body was contorted; my heart was racing, everything looked off-balance, I couldn't eat, I couldn't sleep, and I literally felt like I was dying. And that was the last time I used.

I've been clean ever since and it has been rough. A couple weeks after that PAWS [Post-acute Withdrawal Syndrome] started setting in and it has been hellish to say the least. I have my good days and my miserable ones, but I just keep looking at the future and remembering it will get better. And to top this all off… I'm only 19.

Questions From Newcomers: Is it possible to have a healthy life right after detox?

The smart-aleck answer to the question “Is it possible to have a healthy life right after detox” is “What…are you kidding?”  However, the straight answer is “What do you mean by ‘healthy?’”

When it comes to recovery, we speak of at least two kinds of health: physical, and emotional.  Some folks would add spiritual health (which has nothing to do with religion) to that list.  We need to remember that our bodies and minds were subject to the effects of chemicals more-or-less continuously for months — in most cases, for years.  Major changes took place due to the effects of drugs on our brains, as well as their effects on other body systems, especially in the case of alcohol.  It would be unreasonable to expect these changes to reverse and return to normal overnight.  Just as it took years to create the problems, so may it take months to recover from them.  The good news is that it rarely takes anywhere near as long for repairs as it took to do the damage, and improvements begin to show up relatively soon if we’re patient.

Our physical health depends on what condition we were when we came to detox (young, older, fit, couch potato, etc.), what residual effects we may experience from the drugs (post-acute withdrawal), and what other health problems we brought with us.  Many, if not most, addicts suffer from a variety of problems that can range from cirrhosis of the liver and/or viral hepatitis to diabetes, malnutrition, or general poor physical conditioning — often several issues of varying severity that need to be addressed.  Even those of us who styled ourselves athletes during our addiction may find that the reorganization of our internal chemistry leaves us with less get up and go than we figured, or that the drugs were covering up some condition that is revealed by a physical exam when we’re sober.  These things aren’t inevitable, but the possibility of some problems should be anticipated.

Mentally and emotionally, most of us addicts (alcohol is a drug, and alcoholics are addicts) find that for the first few weeks and months we run the gamut of emotions, from manic highs — where we believe recovery is the most wonderful thing that could happen to anyone — to bouts of depression and the thought “If this is all there is, I might as well use.”

But there is good news!  For one thing, though we may feel lousy, physically and emotionally, these things slowly improve if we stay clean and sober and work on a program of recovery.  Furthermore, we have the assurance that, even though it may seem as though it’s happening at a snail’s pace, people who remain abstinent and take care of themselves otherwise always improve eventually.  For us addicts, accustomed to feeling good in a matter of minutes whenever we feel like it, these periods may seem endless.  But they are not, and periods of feeling good eventually occur, increasing in frequency and quality as the repairs take place and we get back into the swing of living.

As time passes, we begin not only to feel better, but to think about getting back to what we perceive as our normal lives.  We want to clean up some of the messes we made, right some of the wrongs, find jobs, begin to save a little money, and try to earn the respect and trust of others.  These improvements are immensely aided by the support and help of other recovering people.  Put succinctly, people who go to meetings and develop a support system, learning to follow directions and do the next healthy thing, tend to recover if they persevere.  Those who don’t rarely remain clean and sober for long.

So the answer is that it is possible to live a healthier life immediately after detox.  A healthy life may be further down the road, but it is attainable.  Millions of people have gotten through the first weeks and months of abstinence, and achieved lasting sobriety.  The secrets are, first, to want it more than anything else, and second to stick with it and — as they say — wait for the miracle.

Is Medical Detox Really Necessary?

I received an email from a hard-nosed recovering addict/alcoholic who stated, in essence, that inpatient detox isn’t necessary, that he did it on his own, and that all anyone needs is a (little of this, little of that) to get through it just fine, and he knows a bunch of folks who did it that way, and…blah, blah, blah.

I replied, politely, that everyone is different, and that just because it worked for some does not mean that it will work for everyone, and that detox is too important to take a chance on getting it wrong (or killing someone).  I refrained from asking how many of his acquaintances had a successful detox, culminating in long-term happy sobriety with no relapse.

In my years around the 12-step rooms I’ve heard similar comments every now and then.  Some guy (it’s nearly always a guy) makes some remark to the effect that if it was good enough for him and Christopher Columbus, it ought to be good enough for all these young whippersnappers.  Somehow I don’t see how surviving the threat of seizures, heart attack, stroke, DTs, profound depression and a variety of other jackpots (depending on the drug or mixture of drugs) proves anything, except that you were one of the lucky ones, but maybe that’s just me.

Just about any drug that will alter your mood noticeably can be addictive, including weed.  Getting off any of them can create enough withdrawal symptoms that it can be really difficult to make it through a self-detox, although not all are physically dangerous.  (Of course you could argue that things like possible psychotic episodes and profound depression are physically dangerous, but we'll let that go for another time.)

The bottom line, though, is this: Under the supervision of medical personnel who are trained to administer the proper medication and equipped to handle any problems, detox can be surprisingly comfortable.  Lacking that, there can be some nasty surprises.  Not everyone has complications, which explains the position of the scoffers, but enough folks do that it’s not worth taking a chance if you don't have to.

Inpatient or Outpatient Detox — What’s Best?

In order to understand why outpatient detox for drug addicts and alcoholics rarely gives satisfactory results, we have to review a couple of things about addiction.

Addiction is a compulsion to use a substance or behavior to alter the way we feel. However, it is more than that: it is a physical and emotional way of living our lives that, over time, becomes ingrained and seems to be the normal way to live. Addiction makes changes in our brains that cause us to believe that we need the drug or mood-altering experience — be it a prescription medication like Xanax, an illegal drug such as heroin, multiple sex partners, alcohol (the most commonly-abused drug of all), or something else. We believe that we need it to feel normal, to be comfortable — to live — and every time we try to get the monkey off our backs we have those beliefs reinforced by the discomfort of withdrawal.

Living like this for long periods, we begin to view it as normal. No creature willingly goes from situations that seem normal into those that seem different [Read more…]

The “Bath Salts” Problem Is Rapidly Getting Worse

It's no news that people want to get high.  The urge to turn off our brains for a while, or do something that just feels good, goes back at least 8,000 years.  We know that because the ancient Sumerians wrote about beer on tablets that have lasted until the present day.  There is every reason to believe that our romance with intoxication goes much farther back than that — probably to the time when one of our hunter-gatherer ancestors first discovered that spoiled fruit could give a guy a buzz.

So it's no surprise that entrepreneurs keep trying to stay ahead of the law by developing and marketing drugs that start off more-or-less legal due to the inability of regulators to keep up with the changes.  The way laws are currently written, if a drug isn't specifically mentioned in a statute it's pretty hard to prosecute someone for possessing it, and even harder to charge anyone who sells it.

Thus, we have “bath salts,” the current entrepreneurial emesis.  Unconcerned with details like clinical trials and the variety of other checks and balances needed to gain approval for mainstream pharmaceuticals, the manufacturers of these designer drugs make them available to a public that is absolutely at their mercy.  At the same time, web sites like “bathsaltsdrug.com” and “bathsaltsreview.com” promote the alleged safety of the drugs as a “public service” (most of them actually designed to provide guidance to outlets that sell them online).

The active ingredients in most bath salts are the chemicals methylone, MDPV, mephedrone and flephedone.  Sometimes referred to as “copy-cat cocaine,” these drugs — all chemically-related — are central nervous system stimulants.  MDPV (Methylenedioxypyrovalerone), after which most of these drugs are modeled, is a modification of pyrovalerone, a drug that was investigated about 50 years ago for use as a weight control medication and to combat fatigue.  It never got to market because of its abuse and addiction potential.  MDPV is known to be several times as potent as methylphenidate (Ritalin), itself a drug with considerable potential for abuse.

Most of the drugs on the market today are analogues (slightly-changed chemical copies) of MDPV.  Thus they share its drawbacks, along with some of their own.  For example, the changes made in their structures to avoid legal issues are untested, and their effects largely unknown.  Furthermore, they are unstable when exposed to air, and often degrade into other compounds with unknown qualities.  Possible reaction with additives, packaging, or with compounds added by users, can create further complications — all problems unlikely to occur with regulated pharmaceuticals.  As a result, what you think you're seeing is not necessarily what you get.

We are beginning to see more and more headlines such as “Report: Bath salts killed Tampa man,” and “America's New Drug Problem: Snorting ‘Bath Salts'.”   We will see more, because problems with users of bath salts are becoming more common.  In one case, in Panama City, Fla., several officers were needed to subdue a man who tore a radar unit out of a police car with his teeth!

Bath salts are used because they promote euphoria, increased energy, sociability, wakefulness, and have some sexual stimulant effects.  On the other hand, adverse effects include (but are not limited to) rapid heartbeat, high blood pressure, insomnia, nausea, tooth grinding, headaches, kidney pain, dizziness, agitation, difficulty breathing, and increased body temperature, chills and perspiration.  At least one death was caused when the MDPV analogue methylone caused the brain of a 23-year-old man to swell due to lack of oxygen, and an accompanying high fever that shut down his kidneys and other organs.  The possibility of drug use triggering and exaggerating users' existing physical or mental problems is yet another risk.  Nor is it a small one, as those with such issues are far more likely to resort to self-medication than others.

The solution, if there is a good one, will most likely be found in education combined with laws that are written to close the  loopholes that enable sale and possession of these drugs without fear of prosecution.  The Federal government is investigating the possibility of a nationwide ban on unchecked use of the components involved, which may make pursuit and prosecution of the manufacturers and sellers more practical.  As it is, substance abuse treatment personnel report more mentions of bath salts during intake, indicating use is on the rise.  Actual treatment protocols have yet to be established, however, and there is some question whether users of these “unofficial” drugs will qualify for insurance coverage.

More, as they say, will be revealed.  In the meantime, parents and other interested parties need to be on the lookout for possible drug-related behavior in loved ones, friends, and others they care about.  Until we get some sort of handle on this problem, these drugs — sold in convenience stores, gas stations, head shops and similar outlets — will remain readily available to potential users of all ages.

 

SUNRISE TO OPEN DETOX FACILITY IN FT. LAUDERDALE

We are happy to announce that it is official! Sunrise Detox — Ft. Lauderdale will be opening Fall 2011! More information to follow as plans progress.