Methadone

Should I Tell A Prospective Employer About My Addiction And Recovery?

This really comes down to a personal decision.  Our program is intended to develop “a manner of living that demands rigorous honesty,” but it is also an anonymous program.  The “rigorous honesty” demanded is self-honesty.  There are, without question, situations where being too open about our past can destroy careers and create chaos in other ways.  Those situations are not beneficial to our recovery either.  In some circumstances, it may be best to keep things to ourselves.  Some employers simply won’t hire people in recovery — especially in early recovery.  A newcomer of my acquaintance ran into that just a couple of days ago.  With the job market being what it is, possible employment opportunities can be few and far between.

Perhaps the best way to address this is simply to not offer information.  If it is a drug-free workplace and they want us to take a drug test, that shouldn’t pose a problem (assuming that we’re clean and not on methadone or other drug maintenance).  Direct questions about health issues are not permitted, but we need to be careful.  If we lie and are found out, we will almost certainly be fired.  That would eliminate any chance of good references from that employer, and could impact our employability in other ways.

The Internet is a major issue.  If we’re determined to remain anonymous, we need to avoid recovery-related Facebook groups, and all references to our issues in all social media.  If we participate in online recovery forums, we must be extremely careful to use pseudonyms and avoid photographs and other identifying data.  It may be difficult or impossible to keep the secret regardless of our preferences, if we have been careless in the past.

My policy over the years has always been complete honesty.  If someone can’t handle who I am, I want to know it immediately, not months or years down the road.  I make part of my living writing about alcoholism, addiction and recovery.  In that context my history is clearly a plus, not a disadvantage.  However, my other job is in the security industry.  From my beginnings with the company, my employers have known about my past as an alcoholic and addict.  On occasion, I have been able to use my knowledge to help out with the issues of other employees.  But what if I had lied, early on?  What changes would I have had to make in my life, over the years, to keep the secret?  Would I be a senior manager in an industry that requires trust?  Would I have been able to take part in the recovery community as I have?  Would I be the same person?  Would I even be sober?

There’s no cut-and-dried answer to this question, but honesty has one big thing going for it.  It’s less likely to come back, months or years later, to smack you upside the head.

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.
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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.

I’ve heard that opiate overdoses often occur when users relapse. Is this true? What’s the deal?

It is true, but in order to give you a good overview, let's talk about overdoses (ODs) in general.

Most overdoses are caused by people mixing drugs such as heroin, alcohol, methadone and benzodiazepines (Valium, Xanax, Ativan and similar “tranquilizers”). These drugs are all central nervous system (CNS) depressants. When used together, there can be a synergistic effect, where the presence of both drugs creates more CNS depression than either could alone — sort of a 1+1=3 effect.

In an OD, they cause unconsciousness, slow the heartbeat and depress breathing. In lethal doses (LD), the user dies from suffocation when breathing ceases entirely. However, a lethal dose of a drug or drugs is not necessary in order for you to die. If you are lying on your back and unable to swallow because of CNS depression, a small quantity of liquid, such as vomit, can cause suffocation. This has killed many people who would probably have survived the OD otherwise.

There is also the matter of misjudging the amount of drugs in your system. Most drugs taken by mouth reach their highest levels in the body quite some time after they begin to have a noticeable effect — as long as 30 minutes to as much as 4 hours. You can easily become dissatisfied with the effects and continue to swallow more, then down the line the blood levels continue to rise and give you more than you bargained for. It is not uncommon for this to happen when mixing oral and injected drugs. The pills aren't getting the job done, so you crush and inject and — whammo!

Finally, we get to the issue you asked about. Opiate tolerance drops rapidly when you're not using. People who have abstained from drugs during detox and treatment, or while in jail or prison, end up with a very low tolerance in comparison to what they had when they stopped using.

If a person who has been abstinent for several weeks relapses, they will require much smaller doses in order to get high. This kills thousands of addicts every year, because the lethal dose (LD) drops as well. If they go back to using anything close to what they used previously, an OD is not only possible, but likely. People most at risk are those getting out of detox and treatment, or out of prison.

The best defense, of course, is to hit meetings, use your supports and stay clean. But if you think you need another run, be really careful or it may be your last.

Drug abuse costs rival those of chronic diseases

Drug abuse in the US (not including alcohol) costs the economy $193 billion a year, according to a new report.  That figure equals or exceeds the cost of chronic diseases such as diabetes.

Read about it…

Study Shows Buprenorphine Beats Methadone For Pregnancy Maintenance Treatment

An article in the December 9th issue of the New England Journal of Medicine (not available online) refers to a Johns Hopkins study regarding maintenance treatment for opiate addiction in pregnant women.

photo: Martin LaBar/Flickr

First, we need to mention that, when a woman who is currently addicted to opiates gives birth, the baby is addicted as well. The child's detox symptoms are known as neonatal abstinence syndrome (NAS).

The Johns Hopkins study revealed that babies born to women who were maintained on buprenorphine (Subutex) during pregnancy, rather than methadone, required 89% less morphine to relieve the symptoms of NAS than those whose mothers had methadone. Furthermore, hospital stays for the babies were reduced by an average of 43% (10 days versus 17.5 days).  The reason for this is not clear, but it is likely related to the long life of methadone metabolites, some of which are also opioids.

The study's authors reported that “Although there were no significant differences in overall rates [of NAS] … the benefits of buprenorphine in reducing the severity of neonatal abstinence syndrome … suggest that it should be considered a first-line treatment option in pregnancy.”

It is important to note that the study involved buprenorphine in the form of Subutex rather than Suboxone which, in addition to buprenophine, contains the narcotic antagonist naloxone.  Unborn babies should not be exposed to naloxone. Any mothers or doctors considering this form of maintenance should be very clear on this point.

Opiate Overdose Due To Reduced Tolerance

In practically all cases, opiates kill by respiratory depression: when we OD, the part of the brain that controls breathing shuts down, and we “forget” to breathe.  This causes death by hypoxia — suffocation. I was reading again today about another addict who overdosed and died because she misjudged her tolerance for Oxycontin after leaving detox and relapsing.

Our tolerance to the respiratory depression of opiates rises rapidly.  It doesn't take long before a frequent user can tolerate doses as much as 10 times higher than those that would kill a non-tolerant person.  This is true of all opioid drugs: heroin, methadone, hydrocodone, oxycodone, and so forth.  When we detox completely or partially, through maintenance use, cold turkey, or in a clinical setting, our tolerance drops rapidly.  We become far less tolerant to the fatal effects of the drug than we were while using regularly. If we manage to stay clean for a while our tolerance drops even more.

I leave detox or treatment, I hit some meetings, I do the right things for a while. Then I start to slide back into my old ways, hanging with the wrong people, around the wrong places, and doing the wrong things.  Since I don't have any real support staying clean, I'm a sitting duck when post-acute withdrawal hits, and I start jonesing for my drugs.  So I go out and score. Maybe I know a little about reduced tolerance, so I decide to start slow…but not slowly enough.  Or maybe a buddy decides to give me a little extra taste.  Or maybe I get a hot shot.  Or maybe I just go nuts.

Maybe I nod off, stop breathing, and don't wake up.

This could literally be the most valuable information of your life.  Remember it.  Reduced tolerance is the number-one cause of overdoses.

Binge Use of Alcohol and Drugs

Getting drunk or high on an intermittent basis — perhaps every weekend —  is known as binge using. There is are indications that people who binge drink stand a considerably greater chance of becoming alcoholics, especially young people, who are still forming neural connections in their brains.  Many authorities believe that this applies to certain drugs as well, especially “uppers” and opiates.  The human brain is not fully mature until about age 22.

Binge use does not mean that we are addicted but, if consistent, it is a danger signal both immediate and for the future.

The big question is whether we need to use during the week in order to be comfortable.  This is known as maintenance use, and it enables alcoholics and other addicts to get through the week while functioning normally, “busting loose” on the weekends.

Only you can decide if you are an addict, but if alcohol or other drugs are causing problems in your life and you still feel that you have to find excuses to use them, or that you “deserve” to, then you definitely have cause for concern.