"ADDICTION'S MAGIC PILL"
A Crain's NY Business article reporting on buprenorphine appeared on 16 April, headlined "Addiction's magic pill." Those of us who are old enough may recall another headline that appeared in a weekly magazine called The Mirror which also referred to a magic potion - in that case methadone, which it described as a "Cinderella medication."
Any and all medications or other treatment interventions that offer the promise of helping those with drug dependence are welcome, and that definitely applies to buprenorphine. But raising expectations that are clearly not realistic - i.e., the prospect of "curing" addiction - will in the long run be strongly counter-productive. In addition, there are references to buprenorphine leaving patients more "level-headed" and less "befuddled" than methadone - a claim that is often heard but as far as we know absolutely without scientific support.
Finally, there is out-and-out misinformation, such as the statement that methadone must be "dispensed in controlled settings in daily doses." For many years now it has been perfectly legal to provide stable, long-term patients with up to a full month supply of methadone for unsupervised consumption.
posted by RGNewman, MD @ 1:33 PM
5 comments
5 Comments:
Bupe is not available in my area unless you have exhorbitant amount of cash..no insurances accepted. I could not take Bupe due to the co-existing Xanax issue, but my son could and would greatly benefit IF he could afford it.
I am someone who is always in pain and is now physically addicted to both Oxycontin (8 years) and Xanax (21 years.) IN addition I have numerous chronic health problems ~ such as pulmonary fibrosis (thought to be MAC related although I am HIV -), Hep C , prior TIA, prior hypertension, depression, etc.
I also KNOW I am dying. I am now 106 lbs and 5'9. (I weighed 243 lbs for about 8 yrs or so prior to Jan. 06.) I am in my early 50's.
I have horrid insurance (Med. & Medicaid) and no car, nor do I know anyone with a car.
I have only been outside 5 times since Jan 06 as well...one of those trips to my PCP who in hindsight "dumped me" by telling me he was afraid I was dying and told me to go find a big hospital in the city who took NIH funding. He then added that his pratice and all of his referall specialists loathed and did not take my "new" secondary insurance due to the Medicare Advantage fiasco that occured abruptly for dual-eligibles in my state in Jan. O6.
I told him our car was dying as well and he reminded me there was no public or medical transportation anyway. [I had moved in Sept. 05 from a quiet middle-class county to the nearby "budget busted" big city.] He was correct as I called every specialist and none took my secondary and confirmed by phone that the trans. was in-city only.
In July of 06 ,I know..(the worst time possible) I did go to "supposedly" one of the TOP 10 hospitals in my state that got a LOT of NIH funding as my PCP suggested. I was admitted but they were at 110% capacity. I was only kept 2.5 days (1.5 of it in the ER) and the care was ~to be kind ~ "frenetic." I rarely saw a nurse and if I did..I was spoken at, not to. I was healthier then and 167 lbs. (Although I had lost over 70 lbs. in 7 months.) My addiction(s) were not as bad as they are now. Then I was only taking 5 Xanax daily. They discovered the pulmonary nodules.
I actually ended up begging the brand new attending (who always appeared very frustrated and overworked)to be allowed to stay but was abruptly discharged at 4 PM on a Friday anyway..never seeing their "promised" social worker or recieving any coherent follow-up care. I had wrote up a list of questions but the "team" was always in a hurry and rushing in and out. I never could get any of them to answer or even look at my papers.
My PCP's office staff messed up the OP referrals 3 times and then refused to try again. TO be fair.the OP ref.'s were done by a brand new resident and were not done correctly.
She set me up with clinic appointments with "more brand new residents" (instead of putting down an actual hospital doctor) so the coding was somehow meaningless or non-existant. Neither the hospital nor my old PCP would call each other and I got lost in the middle.
After 10 months or so of trying to get some type of home care, psych care, transportation or to find a new PCP who would accept both my insurances (which I never could), I gave up. Even attempting to just get basic correct information from this "new wretchedly thrown together" MedAdv. Plan was so ludicrous..I stopped calling out of frustration. They "outsource" their MH/D&A to a state 15 hours away who have no knowledge of this area. Temps constantly would answer the phones at the new MedAv and make things up. Supervisors were always too busy to come to the phone,etc. As for my secondary insurance..the welfare office knew nothing as far as docs who accepted it. The state said to call my local welfare office...they knew everything. The welfare office said to call the state back. I could go on and on. It was and still is disheartening and unorganized!
Now 9 months later,I can barely stand more than 2 minutes at a time , nor can I perform any ADL's. Sadly, I also have no family or friends except my grown son who is also an addict. Chronic constipation is so bad, I literally have to bite on a washcloth to prevent screaming from URQ back pain attempting to defecate, so I rarely eat and a decubitus ulcer is surely next as I am skin and bones. All my hair has fallen out and I have no one to bathe me. (My son does not know how to care take at all.) Always alone and never able to sleep or lie in any position for too long w/o pressure from being so frail -my Xanax use has spun wildly out of control. For 20 years I had always taken it as directed.
I am dehydrated and void about 2 ounces a day if I am lucky. I never did have good veins from previous hospitalizations..so I have daily nightmares of having to go to an ER that is probably already short staffed and having to beg to be throughly washed first. ( I know I would most likely need a central line and ding ding.instant infection.)
I KNOW I WOULD BE ANY ER DOC's WORST NIGHTMARE.
I read these blogs and all the doctors and nurses write about these days is money. [Or your dislike of Medicare/Medicaid/problematic patients.] I read too much..to the point that I suffer daily rather than even attempt to go to an ER again.
The thought that I would not be believed or either just detoxed way too quickly or just right off of 20 Xanax 0.5 a day [and around 80 mg. of Oxycontin] is worse than dying this way. Or how do you do a colonoscopy or bronchoscopy on someone so addicted? Why is everything pushed toward outpatient when I have no one to help me at home? Would I be rushed out the door of any hospital or dumped to some horrendous nursing home in a ghetto (my insurance IS that bad) with roaches and most certainly undertrained, understaffed and most likely uncaring staff?
I called the three lone drug detox's in my area that even take my insurance and as expected, they are located in the worst neighborhoods imaginable. You get 3 to a maximum 7 days if you are lucky. Their protocols are "horrendous" according to guidelines supported by the better tx centers, 300 page addiction treatment protocol commission reports I have read or the recent HBO's "Addiction Series" board's guides and choices information [geared obviously for people who can afford to choose.]
I am way too sick now to even walk..let alone attend groups or be in a facility with no truama hospital staff. My seizure risk would be so high even 30-90 days out if I did not go totally insane from "reverse anxiety" first from the Xanax WD alone. Also, having read extensively on addiction I know that a 3 or 7 day program in my condition would or could not work...esp. with no family, friends or transportation for aftercare. I can not even walk more than 10 feet now without getting severely lightheaded.
I believe my abilty to even be this cognizant after 16 months of almost total isolation [except the 4 hours or so daily I see my son] speaks to the things I have not yet lost..my high level of intrinsic intelligence, acute awareness of the current state of mind of physicians and the grave disparities in medical care that sadly exist today and my own knowledge of my personally difficult medical and psychological condition(s).
I KNOW that you all appear to categorize everyone who uses drugs or deteriorates like I have as "non-entities" or not worth treating.
In reality I was and in many ways still am a warm and caring person. I am also very sensitive...which makes the thought of being "hated upon sight" or "judged harshly" even worse than suffering daily this way. I DO suffer.
SS for writing so much.. I just wanted to REMIND everyone here that not all people are drug seekers ( I have a safe full)..some of us are also very ill and have an ounce of pride left. That pride I retain inside somewhere (coupled with shame and guilt) keep some of us upon reading all of these blogs and articles from even attempting to seek care.
I don't know why I am still alive but I certainly hope it ends soon. I see no way with the way medicine is structured now how I could have ANY realistic chance [or even be alotted the necessary timeframe it would take] at this severe point in my med history to recover.
I am so sorry for the hell you are going through. We all have problems in life which sometimes seem insurmountable. I have only had a few short bouts with medical issues, but they were enough to see how vulnerable we are when our health is gone.
I like you, will only have Medicaid to rely on when the inevitable happens. I HAVE been an addict in my younger years, foolishly giving in to the instant gratification of drugs rather than build a life that will take care of me in times to come.
If you would like to read my blog it is junkieconfessional@blogspot.com
I also have a friend, who through her own hedonism - though she doesn't clearly admit it, is getting ready to do a stint in prison. Her blog is "prisonerofthewarondrugs@blogspot.com
I only mention myself and her because I think sometimes it helps to know other people are living in their own personal hell. You need friends and so do we although our situation are dramatically different. Denise
You are NOT alone.... I am going through hell JUST LIKE YOU! The medical systems in many countries.. SUCK... here in the UK or the USA... if you are in pain, or are depressed or suicidal.... GOOD LUCK... no one will really care... unless you are very fortunate to have a loving family member... i have no family.. Big Hug..... I understand.. but cannot offer you help from here.. bye bye my friend
Well I am anonymous who wrote the first comment above. I posted my story here and on two other medical blogs. Not one of the three doc's who blog I commented in even answered my comment . Did you even read what I wrote?
To me, that speaks volumes to how I am not a human being anymore but just a "thing."
Everything I wrote then was true then.it still is.
Now I am 98 lbs. and even less cognizant than before. I need help but truly do not know where to turn.
I just spent the last four days unable to sit up for long periods due to my feet sweeling or trying to lie down..which I can barely tolerate due to being virtually skin and bones.
Does ANYONE in the medical profession care at all?
Ty to the two other posters who at least offered comfort.
i am so sorry to hear anyone going through that i know what your going through. its bad enough all the hell you go through then when you try to get help drs treat you like you the lowest form of life along with people who never been there it makes it that much worse. i know it doesnt fix things but i do feel bad for you try to hang in there and dont let what people say get to you im sure your a good person that got dealt a bad hand but god knows if your good deep down and one day hopefully you wont suffer anymore and again sorry your going through this ill keep you in my prayers
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