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Replacement Therapy (last entry)

So lets summarize the junkies opinion. I love the Alcoholics Anonymous program and I love the Narcotics Anonymous program and many people enjoy a great recovery in these 12step programs. When Bill Wilson and Dr Bob got together I doubt they realized they were anointed by God and that as a result millions of alcoholics would go on to lead productive lives they never envisioned while drinking. If you think that because I believe methadone to be a great tool that I’m against AA or NA program then you’re missing my point completely. In fact it’s quite the contrary, I believe these programs to be great and that those in the rooms are awesome people, I just want folks to be more open mined .
For the person who has a few years of addiction or maybe they got addicted to pain medicine after a surgery , these are perfect candidates for a five day Suboxone assisted detox followed by a thirty to ninety day rehab stay then total abstinence and meetings are a great program and many have great success . The Suboxone isn’t necessary after the detox period. This individual usually hasn’t done enough damage to their brain to justify continued medication. Again , when dealing with individuals there’s many factors to be considered and I don’t think there should be a one size fits all but a tailored assessment of each person.
Replacement Therapy is a viable option and should be one of the weapons used to fight addiction. If a person has diabetes or a heart condition and needs medication , no one says anything, its acceptable to treat a condition with medication from the doctor for these problems. If your brain doesn’t secrete or produce certain chemicals its fine to take Paxil,Celebrex, Prozac, or some anti-depressant but as soon as you mention Methadone there’s someone in the room to tell you ” you’re not really clean”. This ,my friends, has to change! Stop looking down your nose at people because their program is a little different then yours . It really is important to walk a mile in some one else’s shoes before you go passing judgement.
For me personally the program has been wonderful. Methadone addressed my addiction, my depression and my pain. To go without it would mean to live in pain daily, over the years of addiction I battered my body and my brain pretty badly . Methadone doesn’t completely keep me out of pain but makes it bearable . I still go to meetings and have no desires for opiates, I live an altruistic lifestyle , I’m a father, husband , brother and friend to people who know they can call on me , that I’m dependable and will help in any way I can. Family members and friends call me for advice or support these days but back in 2006 I was sleeping in the park and smoking cigarette butts I found on the ground. People on methadone go on to live very productive lives and have lots to offer so please lets remove the stigma of using this medication.


Replacement Therapy Pt5

So lets talk about withdrawal for just a moment, I can tell you from experience that it is by far one of the worst feelings in the world and not only because of the physical symptoms but the whole ride is pure hell. Lets start at 16 hours after your last shot of heroin, if it was of high quality you should be feeling the beginnings of withdrawal. At this point , the physical part is bearable but the mental part is severe. You know that sickness is coming and your brain is going crazy, your trying to think of every possible way to stop it. The impending pain is almost worse then the actual sickness and its really bad when you’re in a jail cell and you know you can’t get to an opiate! At 24 hours you’re in full withdrawal, you’re eyes water, your muscles cramp, nausea and diarrhea set in everything that can hurt does, you’re irritable , shaking and vomiting. There’s no sleep and no escape from it, I heard one girl say its like having a thousand bugs on me and a thousand snakes in me, and this is the beginning these feelings will intensify over the next 48 hours till you feel like you’re losing your mind. Depending on how much you use dictates how long this last but most improve in about five days with insomnia sticking around for a few weeks
Now the normal person may ask, why would you return to the drug after going through all that? The truth is, that’s addiction and it is a disease, an insidious disease where the addict, without treatment will return to over and over for reasons he doesn’t understand. For the sake of argument lets say he kicked cold turkey and did a thirty day inpatient program. Now they say ok go home , get a sponsor, make your meetings , work the steps and get better. He goes out the door with the best of intensions but his”friend”picks him up and and tells him, ” man you did great, just don’t do it everyday and by the way I have some really good shit” his addict brain goes right to work and he starts justifying his actions and diminishing his addiction. ” yes I let it get out of control but if I don’t use three days in a row ill be fine” or ” I’ve been good I deserve to get high” and my all time favorite ” well I’ll get high today but tomorrow I’m back on track” these are the lies we tell ourselves and this is how junkies overdose. They try to do the same amount they did before going to detox and their tolerance is down or they mix it with alcohol or benzos which is by far the quickest way to overdose.
So it’s not a bad idea to detox with Methadone or Suboxone for the opiate addicted even if he doesn’t have years of addiction in his background . It’s just safer and a more stable introduction to sobriety, to those who say that you are trading one addiction for another certainly have a point but don’t you think a slow taper from addiction is better then an overdose? Again this is just my opinion but the numbers are overwhelming but first we need to remove the stigma of methadone . Many who take methadone don’t go to meetings because the traditional 12 steppers are so quick to pass judgement on them. They will tell you in no uncertain terms ” you’re not really clean” but yet they are supposed to be there helping others and leading an altruistic lifestyle but I guess that only applies if your doing things the way they do them or the way they tell you to do them. Doesn’t sound altruistic or spiritual when you look at it on paper now does it?
Please don’t hit me with ” this is a program of abstinence ” or that the literature says this or that. I’ve read the literature and worked the steps and they are both guides to lead an alcoholic/addict to a spiritual awakening by altruistic living coupled with continued self evaluation. The program is the addicted helping the addicted and that’s the key, that’s the magic and that’s God at work. If we continue to ostracize those who recover using medicine we do a great injustice to them and stifle our spiritual growth in the process. We must do more then admit we are powerless over our addiction and that our lives are unmanageable. We must admit that there’s more then one way to recover and that there’s no one answer to dealing with the addict. Our stories are similar and yes that’s the common ground we all stand on and the ties that bind should be greater then those that would tear us apart but tolerance ,understanding and acceptance shouldn’t be words reserved for those who agree with us it should be across the board for all!
I’m not looking to reinvent the wheel or rewrite the big book of Alcoholics Anonymous or the basic text of narcotics anonymous , I just want the people in those great organizations to be a little more open-minded. While I recognize that we all got to the rooms because of our common problem our roads there are vastly different. Lets stay there with a continued goal to lead a productive life helping one another and searching our soul to reach out to others even if someone doesnt recover the same way you do. We can choose our own God but not our own method of recovery, that seems ridiculous to me but that’s my opinion. I guess you have to look inside yourself, you have read the research you have read my opinion but ultimately it comes down to you, will you open your mind and agree there’s more then one way to recover or is total abstinence the only way? Are you standing on spiritual principles with that mindset? Search yourself because I’m sure you’ll agree that continued evaluation is crucial to recovery.

Replacement Therapy pt4

Is anyone reading this or am i talking to myself? ill press on in hopes that one person hears me.Ok, this is the part where I throw lots of fact, figures, studies and such at you, but please stay with me , I want you to see I didn’t arrive at my opinion on a whim. I know what my personal experience was and is like but I was astounded by the numbers that support my opinion. Studies have shown that methadone is an effective treatment for heroin and prescription narcotic addiction when measured by:
* Reduction in the use of illicit drugs
* Reduction in criminal activity
* Reduction in needle sharing
* Reduction in HIV infection rates and transmission
* Cost effectiveness
* Reduction in sex work (prostitution)
* Improvements in social health and productivity
* Improvements in health condition
* Retention in addictions treatment
* Reduction in suicide
* Reduction in overdose

This is taken directly from the NIDA National Institute on Drug Abuse as is the following :
Research Highlights

Recent meta-analyses have supported the efficacy of methadone for the treatment of opioid dependence. These studies have demonstrated across countries and populations that methadone can be effective in improving treatment retention, criminal activity, and heroin use (Marsch, 1998).
An overview of 5 meta-analyses and systematic reviews, summarizing results from 52 studies and 12,075 opioid-dependent participants, found that when methadone maintenance treatment was compared with methadone detoxification treatment, no treatment, different dosages of methadone, buprenorphine maintenance treatment, heroin maintenance treatment, and L-a-acetylmethadol (LAAM) maintenance treatment, methadone maintenance treatment was more effective than detoxification, no treatment, buprenorphine, LAAM, and heroin plus methadone. High doses of methadone are more effective than medium and low doses (Amato, Davoli, Perucci, et al., 2005).
Patients receiving methadone maintenance treatment exhibit reductions in illicit opioid use that are directly related to methadone dose, the amount of psychosocial counseling, and the period of time that patients stay in treatment. Patients receiving methadone doses of 80 to 100 mg have improved treatment retention and decreased illicit drug use compared with patients receiving 50 mg of methadone (Simpson, 1993).
A systematic review conducted on 28 studies involving 7,900 patients has demonstrated significant reductions in HIV risk behaviors in patients receiving methadone maintenance (Metzger, Woody, McLellan, et al., 1993).
A randomized clinical trial in Bangkok, Thailand, included 240 heroin-dependent patients, all of whom had previously undergone at least 6 detoxification episodes. The patients were randomly assigned to methadone maintenance versus 45-day methadone detoxification. The study found that the methadone maintenance patients were more likely to complete 45 days of treatment, less likely to have used heroin during treatment, and less likely to have used heroin on the 45th day of treatment (Vanichseni, Wongsuwan, Choopanya, et al., 1991).
In the Treatment Outcome Prospective Study (TOPS), methadone maintenance patients who remained in treatment for at least 3 months experienced dramatic improvements during treatment with regard to daily illicit opioid use, cocaine use, and predatory crime. These improvements persisted for 3 to 5 years following treatment, but at reduced levels (Hubbard, Marsden, Rachal, et al., 1989).
In a study of 933 heroin-dependent patients in methadone maintenance treatment programs, during episodes of methadone maintenance, there were (1) decreases in narcotic use, arrests, criminality, and drug dealing; (2) increases employment and marriage; and (3) diminished improvements in areas such as narcotic use, arrest, criminality, drug dealing, and employment for patients who relapsed (Powers and Anglin, 1993).
In a 2.5-year followup study of 150 opioid-dependent patients, participation in methadone maintenance treatment resulted in a substantial improvement along several relatively independent dimensions, including medical, social, psychological, legal, and employment problems (Kosten, Rounsaville, and Kleber, 1987).
A study that compared ongoing methadone maintenance with 6 months of methadone maintenance followed by detoxification demonstrated that methadone maintenance resulted in greater treatment retention (median, 438.5 vs. 174.0 days) and lower heroin use rates than did detoxification. Methadone maintenance therapy resulted in a lower rate of drug-related (mean [SD] at 12 months, 2.17 [3.88] vs. 3.73 [6.86]) but not sex-related HIV risk behaviors and a lower score in legal status (mean [SD] at 12 months, 0.05 [0.13] vs. 0.13 [0.19]) (Sees, Delucchi, Masson, et al., 2000).

Ok I hope all the numbers and research don’t put you off. I also don’t want to give the idea that I think it’s right for everyone, but i am of the opinion that the stigma should be lifted for those who choose to do maintenance along with a 12 step program. That when dealing with addiction that we are dealing with many factors and the cookie cutter must be eliminated . No one approach is all right or wrong, but it seems to me that people have very strong feelings about this and if I’m able to show someone that open-mindedness is more important then method then my job is done.
Just recently one of the stars of the show Glee overdosed and died after an attempt at unassisted sobriety. The actor Cory Monteith had long struggled with opiate abuse and had recently did a stint in one of these rehabs that insist the only way to be clean is total abstinence . I site this case because you may have heard about this fellow because he’s on television but trust me many addicts die in their first year of sobriety because they relapse and try to do as much as they were doing before they cleaned up. The lower tolerance sets them up to overdose. If you’re asking yourself if I hold these rehabs responsible for these deaths I say emphatically , yes I do! The research is in, there’s no excuse to not give people more options then the one approach these places have used for years with a less then 10%success rate!
Many of these rehabs have this bootcamp style of conditioning the addict, using a method referred to as ” breaking you down to build you up”,where the addict is berated and intimidated to “break down” the ego. Some even go as far as re-enacting past trauma to make one confront the past. In my opinion these rehabs are flawed in a big way and a kid forced into one comes out more rebellious then ever. You can tell me that junkies need a firm hand and that many of them got in their current position because no one has told them no or dealt with them harshly . I’d say no two people are the same and while that approach may be a much needed therapy we need psychiatric background to see who needs what!
While NIDA has been in favor of maintenance or assisted detox for quite some time, many rehabs continue to push these one size fits all therapies. Some have incorporated Methadone and Suboxone into there programs and many have opted for a different approach , such as Community Reinforcement and Family Therapy (CRAFT), which focuses on building a social environment including family and friends that reinforces sobriety and discourages drug use by providing addicts with coping mechanisms as well as support networks to build and maintain recovery. There’s the key. I just think the therapy needs to be tailored to the addict and not the other way around.

Replacement Therapy PT3

Lets take a brief look at Methadone, Dolophine,Physeptone,Heptadon and Methadose are just a few names for the same drug that is methadone . It’s a synthetic opioid created in 1937 in Germany,it’s along the lines of morphine and effects the brains opioid receptors in similar fashion as Heroin. It was introduced in the United States in 1947 by Eli Lily but it wasn’t until the 1960s in New York that researchers Dole &Nyswander found methadone as suitable treatment for heroin dependent people. The drug has and is used for chronic pain but most often it’s used to treat opioid dependent individuals with great success.
Studies have found that methadone in adequate doses (20mg-100mg) prevents or reverses withdrawal symptoms and last for twenty-four hours. Further it was discovered that methadone can block the euphoric effects of of illicit drugs (heroin) thereby reducing the disire for the drug. All these things along with the fact that methadone is cheap has made it the option most states make available to the opiate dependent . Distribution varies by country and state.
In the small state of Delaware they have one state clinic that is funded by the state with the patients there paying with Medicaid . There’s two more private clinics where the patients pay out of pocket or copay with insurance carrying the rest. The private sector cost about 90 dollars per week and I think your treated with a bit more courtesy then the state run place. This has been this writers experience and I think many would agree with me. The private sector also gives the patient the choice between Methadone and the latest ‘wonder drug’ suboxone . This book about replacement therapy wouldn’t be complete if I didn’t mention Buprenorphine . It’s the latest weapon to fight the opioid addiction that is sweeping the country. Buprenorphine is most commonly marketed as suboxone and recently a generic version was approved by the FDA called Subutex and is used in the detox to bring people off of heroin , OxyContin ,Percocet and the like without the severe withdrawal . It also has a blocking effect to illicit drugs. It was approved in 2002 and claims to have many advantages over methadone. Success rates vary but it has reported a 40% to 60%effective in certain studies.
In my humble opinion, Suboxone is effective in the short term to abate withdrawal but as a maintenance tool, I can’t see any advantages to it over methadone . I guess it could be a better tool for the person who doesn’t want the stigma of reporting to a clinic and would rather go to the doctor and get a prescription for Suboxone but there’s some things to consider. First off its pretty expensive, especially if you haven’t any insurance. If you don’t mind paying extra not to report to the clinic or so you can see yourself as a better class of junkie I want to think about what got you in this position, if it was prescription drugs you may want to think about trusting yourself to take this as directed. Studies have shown its abuse to be lower then methadone when people are left to their own dosage but I have to be honest if it can be abused , it will . Later in the book we will look at different maintenance programsthat is based on my experience but first lets talk about traditional cold turkey attempts at sobriety.
I have kicked heroin cold turkey in jail on many occasions and it is one of the worst experiences of my life. I’d get locked up for shoplifting or possession and sit in the city jail for 90 or 120 days waiting to go to court. For the first week I’d be in so much pain that no one wanted to be around me. Puking and shitting every ten minutes doesn’t make you popular but the other inmates did like that I wouldn’t eat anything for 5-7 days. I would trade my tray off for fruit because it was the only thing I could keep down. On one occasion I went 17 days without sleep, well that’s not exactly true. The human body can only go so long without sleep so every once in awhile my body would shut down for twenty minutes or so but then it was right back awake. After 17 days of cat naps I finally slept for four hours and I felt wonderful after sleeping for them few hours, insomnia is one of the worst parts of withdrawal because there’s just no escaping your need for the drug. After thirty days I would be sleeping and working out, eatting and healthy, by the time my court date would roll around I’d look like a different person.
I’d tell myself I was going to stay clean this time but as soon as I would be released I’d return to using . I did this over and over and over, and that my friends ,is the insanity of addiction, doing the same thing and expecting different results! A person who kicks without a detox, rehab and after-care program set up is lying to themselves. Drugs are the symptoms of a much bigger problem and if I don’t work a 12 step program or address that bigger problem then I’m destined for failure over and over! This has been my experience and if you’re reading this then you have too or someone very close has experienced the same. I finally found that the bigger problem was me and my thinking , my character defects were staring me in the face but until I was prepared to deal with them I would continue on a pattern of self destructive behavior that plagued me for most of my life. The day I hit my knees and cried out to a God I claimed didn’t exist and ask Him to kill me or cure me was the turning point in my life. Once I became willing to admit that I didn’t have all the answers and that I needed something bigger then myself to battle the demons that raged within me, then changes could come but surrender was necessary .

Replacement Therapy pt 2

I’ve found that the best place to start is with the beginning, I mean, I love those movies that start with the ending and then go back to show how they ended up there, but we’re not going to do that with this book. I hope to entertain you along the way but the reality is that this book is intended for informational purposes more so then for a long leisurely read. Lets start by telling you who I am, as you can see I’m Freddie Jay or at least that’s the name I write under, the real one is too long and we in the rooms cherish our anonymity . I had a twenty five year addiction to heroin and an even longer relationship with lots of other drugs. My first drunk was somewhere around 9or 10 years old and while it was completely unintentional , I seemed to like the effects more then I should have. My parents had left me at home by myself, they weren’t great parents to say the least but they really dropped the ball on that day. I had a cold and had stayed home from school, my parents didn’t go to their jobs , my dad was a dope dealer so he worked from home,in a manner of speaking, but they went somewhere. Anyway , being the great parents they were they gave me some NyQuil before leaving to alleviate my cold symptoms . They left and the NyQuil had an immediate effect, I don’t know if you have ever read the back label of NyQuil but that stuff is like 40proof or something. To a kid who already had the disease lying dormant inside of him, I loved the feeling the alcohol gave me. My young addict logic went to work immediately, if one capful made me feel better, well then , certainly five capfuls would make me completely better or atleast I’d feel five times better! So when my parents found me crashed out on the floor a couple of hours later, my father realized I was drunk on NyQuil and had a great laugh.
That didn’t start me on the real thing, that would come when I was like 13 but I will call it my first drunk just because I can clearly see that even then I had an addicted way of thinking. My complete story will be out later this year with my book called ” A Junkie’s Nightmare, Coming Clean”,Look for it in December . However I will tell you some more just to qualify myself. My first joint of marijuana was at 13 years old, I went to see a Ted Nugent concert at the Baltimore Civic Center as it was known back then in 1981, with two older guys from my neighborhood. I smoked weed and drank whiskey for the first time that night, I also met a little rock and roll chick who gave me head while The Motor City Madman belted out Wango Tango. I fell in love that night, not with the rock and roll chick and not even with the weed or whiskey but with the whole lifestyle! Sex,Drugs,Rock&Roll was all I wanted , all I needed and all I would pursue! I took to wearing more black that Johnny Cash and my uniform became jeans and a concert tshirt.
My mother had cancer and my father sold her pain pills, they were powerful pills called dilaudid a brand name of hydromorphone a narcotic of the opioid family. These little pills went for as much as sixty dollars each back in the eighties. The pills could be crushed up and broke down in water making them a favorite for heroin addicts who liked to inject them to get the immediate effect. I found out about the pills and used them with my older brother, again that’s another story but it was my first time injecting drugs and I loved it. I would shoot Dilaudid ,cocaine , methamphetamine (crank) and Heroin before I was twenty years old. Heroin &cocaine commonly called speedballs was my favorite. It would take a few overdoses, five major incarcerations and twenty five years of pure hell before I would finally check into detox in 2007 then go to rehab for six months to start on my road to recovery.
My first year of recovery was glorious but as my second year of being clean got under way I got hit with medical problems as well as bouts of depression. In pain both physically and mentally I would start taking prescription pills at about the time I was celebrating two years I would run out of my pain pills and fully relapse by injecting heroin. For three months I straddled the fence between making meetings and shooting dope! I finally came clean with my sponsor and friends and family. It was then that I’d be introduced to two little words that would cause me to question all I thought I knew about recovery, those two words were Replacement Therapy. This book isn’t a doctors view or anyones opinion other then my own. This is my opinion about the pros and cons of methadone maintenance and my thoughts about replacement therapy and its effects on a person who has dealt with addiction for most of his life. Come along as I share my experience , strength and hope.

Replacement Therapy

The following is chapter one of a short book on methadone maintenance your feedback ,pro and con, would be appreciated.This booklet is my opinion about replacement therapy, I called it The Junkie’s Opinion because I wanted to give people just that, a long term,chronic abuser and habitual relapsers view of methadone maintenance as a viable option. I will give you my research notes and quite a bit of facts and figures, however I want to make it perfectly clear that the thoughts and opinions expressed in this booklet are my own, I take no “donations” from drug companies and speak for no one other then Freddie Jay.
I will qualify myself further in the following pages but I want the reader to know that this writer has lived it. I have tried to quit cold turkey, I have done assisted withdrawal where they brought me down with Clonidine , that’s actually a blood pressure drug that they found helps with the symptoms of withdrawal , it don’t help much! I’ve kicked with the help of Suboxone and when given in the proper dosage is the best way to come off of opiates but Suboxone is an an opiate and you can become dependent on it. There’s many factors that go into treating the addicted and there really is no cookie cutter approach when dealing with any individual. Type of opiate , length of time using it, amount used and wether it was injected, snorted or smoked are just some of the factors that go into determining which approach is most conducive to successful detox and maintained abstinence .
The unfortunate truth is that 90 percent of heroin addicts will relapse in their first year after a stay at the local rehab. You have to tailor the recovery process to the person but another unfortunate truth is that some of these programs simply don’t understand the opiate addicted brain . If they do their indifference is tantamount of malpractice but what do I know they have the PHD I’ve only lived it. Now I don’t know the technical terms so I’m just going to explain the opiate brain in my own terms.
All people have naturally occurring opiates in their brain, the brain releases these opiates in response to working out , love, orgasm or in response to pain. When these naturally occurring endorphins are released in our brain we have over all good feelings , a state of well being. These endorphins are essential to a healthy functioning brain. When a person takes heroin or any opiate it floods the pleasure centers of the brain this outside stimuli is many times stronger then what your body produces. I’ve been asked by people who have never tried heroin what it feels like and it’s very hard to describe but I’ve used the following answer to give a normal person an idea of the sense of bliss heroin gives you. Imagine you were naked in the middle of a a huge ocean just moments before freezing to death and dropping to the bottom of the ocean. Suddenly you are scooped up and a warm fluffy blanket that smells as sweet as lilacs is wrapped around you as someone holds you an strokes your hair. If you take that visual and multiply it by ten, that’s how I felt seconds after taking the syringe out of my arm. Now I’m not trying to sound like I’m pro heroin but let’s be honest there’s not millions of addicts because it doesn’t feel good.
When you continually put this outside stimuli over days months and years into your brain , your brain stops making the naturally occurring endorphins and if you stop taking opiates your brain is completely without its essential chemicals and withdrawal begins. You’re looking at a week of pure hell followed by thereto six weeks of insomnia , it gets ugly! Ill tell you about withdrawal in more detail later on but for now let’s focus on the brain. Now that its completely without opiates it goes haywire and depending on factors mentioned above takes weeks or months to repair itself. Think of it like a computer trying to reboot to standard operating after a major system crash. Some brains are simply unable to recover or get back to anything like normal after extended periods of opiate abuse.
That said, it takes some addicts months to recover, if they can and its during that faze that you enter PAWS , no it’s not an animal shelter, it’s Post Acute Withdrawal Syndrome . This can last for months and has such symptoms as depression, insomnia , chronic fatigue and at times can make you feel like the first few days of withdrawal hell. PAWS can stick with the chronic user for years, the length and severity are directly related to length and amount of opiates used. To think that a person with twenty years of opiate addiction can go to detox for five days and then be all better is ludicrous ! I’m not saying that there aren’t people that have kicked on their first try but believe me they are few and far between. Methadone and Suboxone have been used with great success to introduce a long term user to sobriety , tapering them off in 18 to 24 months and ill gladly show you the data I’ve researched . We will also look at the stigma of methadone or Suboxone maintenance as well as the long term chronic abuser of opiate and the possibility he may need replacement therapy for life. The only question is where do I begin?


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