11:55 am Doctor, patients speak out on Suboxone controversy
Recent headlines concerning a federal raid at an area doctor’s office has prompted one area doctor and his patients to speak out in support of a controversial treatment option for people suffering from addiction to prescription pain medication. 
Last week, agents from the U.S. Department of Health and Human Services entered a doctor’s office in Gate City, Va., that prescribes Suboxone to treat patients who are addicted to opioid-based drugs, such as oxycodone and hydrocodone. The raid was part of a year-long investigation into the clinic.
Dr. Robert Reeves is a Johnson City physician who left his family practice in order to treat the growing number of persons in the area who are addicted to opiod-based drugs, such as hydrocodone, oxycodone and morphine. He said these types of events have painted a negative portrait of Suboxone, causing many people to have a biased opinion of addiction treatment. Reeves added Suboxone has provided a starting point to finding hope for thousands of people caught in the trap of narcotic addiction.
Suboxone is a FDA-approved prescription medication indicated for the treatment of opiod addiction. The active ingredients in the drug are buprenorphine and naloxone.
Buprenorphine is a partial-opioid agonist. Partial agonists are defined as types of opioids that attach to receptors in the brain and body, but unlike other opioids, the drug has a ceiling effect. After reaching a maximum dose of 32 milligrams, there is no added effect from the medication to the opiate receptors in the body. Addiction doctors note that this is a major benefit to prescribing the drug.
Naloxone is an opioid antagonist. In emergency department settings, this medication is given to patients who have overdosed on heroin or prescription narcotics. The drug is added to Suboxone to deter patients from melting the drug and injecting it intravenously.
Buprenorphine is available in a variety of formulations, including Subutex and Suboxone. Subutex is a sublingual pill with only buprenorphine. Most doctors, however, only prescribe it for a very limited number of patients.
Suboxone is the primary drug of choice for physicians. Last year, pharmaceutical company, Reckitt-Benckiser, began manufacturing Suboxone in a sublingual film strip. The primary purpose of the new formulation was to deter people from injecting the medication and to limit illicit diversion. Reeves said each film strip is put in a package with a tracking number that is linked to the prescribed patient.
Suboxone and Subutex were first approved in 2002 for use by physicians as a drug addiction treatment option. Prior to the Drug Abuse Treatment Act of 2000 (DATA 2000), individuals who sought medical help for addiction to narcotics were severely limited on their options. Reeves said Methadone, inpatient and outpatient drug rehabilitation were the only medical treatments available in the United States. He added Suboxone has given doctors and patients an additional weapon to combat opioid addiction.
Unlike Suboxone, Methadone is a full-opioid agonist. Since it was first approved for opioid addiction in the early-1970s, patients who choose Methadone treatment must travel to approved clinics, often on a daily basis, in order to obtain the medication. For individuals in Upper East Tennessee, the two closest methadone clinics are in Asheville, N.C., and Knoxville. “It’s just not convenient for someone to have to jump through the hoops created by Methadone treatment. About 90 percent of my clients work. They can’t take half of their day to drive to these places for treatment,” said Reeves.
Reeves recently invited the STAR to tour his office to see how a typical visit works. Three of his patients agreed to speak for this story. Due to patient confidentiality requirements, Reeves asked that only their first names be used for this article.
Greg has been on Suboxone for several years. He said he became addicted to OxyContin after a friend gave him one to treat a headache and the stress of working long hours. Greg noted that event led him to spend over $250,000 in buying the drug off the street. He later lost his business and was forced to declare bankruptcy.
Greg has been working on maintaining his sobriety through the use of Suboxone and by attending Narcotics Anonymous meetings. He commented that he does not obtain any euphoric effects from Suboxone. “With Suboxone, I’ve never gotten high. I just feel normal,” Greg said.
Greg also stated he is preparing to discontinue the Suboxone regimen. Currently, Greg said he is down to less than 20 percent of his original dosage. He is hopeful to complete it by the spring of 2012. Greg is now employed and said he has found a good job which he enjoys.
Unlike most doctors who prescribe Suboxone on an universal timetable for each patient, Reeves said he takes a different approach. While most of his patients stay on the medication for approximately 36 months, Reeves allows patients to reduce their dosage as time progresses. He does provide coaching and counseling to clients on methods to reduce the amount of Suboxone they take on a daily basis. “What I find is that my patients want to lower their dosage. They don’t need me to tie one arm behind their back in treatment. When they do it on their own, they take pride in being able to take that step,” Reeves argued. “My job is more to coach on the physical part of the treatment and how not to outdo your endorphin production.”
When a person takes medications such as OxyContin, Lortab and morphine, their natural endorphin production is greatly reduced. Reeves stated when a person discontinues long-term use or abuse of narcotics, they often feel bad because their body is not producing enough endorphins. Endorphins are naturally-occurring chemicals in the body to regulate pain and mood.
Although there has been no scientific research, Reeves said he believes patients who use Suboxone have less difficulty in restarting the endorphin process. “While everybody’s body chemistry is different, it can often take a year to get those normal endorphin levels again,” Reeves said.
Recent medical studies have noted that buprenorphine does have potential for use as an anti-depressant. Federal rules, however, discourage doctors from using opioids to treat ailments other than pain, severe diarrhea and detoxification.
Approximately 50 percent of the patients who seek help at Reeves’ office are people who suffer from addiction issues, but who also have legitimate chronic pain considerations. One of these clients is Bryon. After Bryon suffered severe leg and knee injuries in the United States Army, he was prescribed large amounts of pain medication by Veteran’s Administration doctors.
When surgery did not alleviate Bryon’s pain, he became more dependent on the narcotics for pain control. As is the case with many pain patients, however, the medications also numbed his emotional and mental pains caused by post-traumatic stress disorder.
“It’s a bit of a trap,” said Reeves. “These drugs don’t just ease physical pain. They ease pains of the heart, old hurts, social anxiety and depression. Not everyone who takes painkillers is going to get addicted. In fact, most people don’t like taking them. But for those few who have a natural inclination toward addiction, they often get caught in the trap.”
For pain patients who are addicted to opioids, Reeves said Suboxone can be successfully used on a long-term basis to treat chronic pain. Bryon said the medication helps him effectively manage the pain. “When I wake up in the morning, I am so stiff that even a hot shower doesn’t help much. Suboxone provides me with pain control, but it doesn’t have the same effect that the other drugs do,” Bryon stated.
Bryon is hopeful an upcoming surgery will eliminate a great deal of his pain issues. “My ultimate goal is to reach a point where I don’t have to take Suboxone or anything else for pain.” As part of their treatment, patients at Dr. Reeves’ clinic must also take a drug test when they come for their monthly visit. The drug testing allows him to determine if a patient has used any drugs, including alcohol. A test is also conducted to make sure the proper level of Suboxone is in their bloodstream. “We don’t use the tests to get rid of people. We use it as an opportunity to learn,” Reeves said.
Reeves also addressed the issue of illegal diversion of Suboxone in the area. “The people who are buying it on the street are often fence-straddlers. They want to get off drugs, but they’ve not yet made the jump to go to the doctor,” Reeves commented. He added that news stories of people who crush the drug in order to use it intranasally are not telling the whole story. Reeves said “some people do this as ‘leftover’ behavior from their earlier days of using. That’s just another reason for doctors to prescribe the film strips.”
Greg said he believes addicts who are still using the more potent drugs use Suboxone when they cannot obtain their drug of choice. “They use the Suboxone just to maintain until they can get what they really want. I don’t think they’re doing it to get high. They use it to avoid going into withdrawals.” said Greg.
Martin has been coming to Dr. Reeves for about four years. Like Greg and Byron, he is nearing the end of his treatment. “I started using drugs when I was 13 years old. The lifestyle of opiate addiction is really hard to get out of. It has been a rocky road to get here, but I’m learning to enjoy and love my life. I’ve been able to break the chain and learn a new way to live,” said Martin.
Reeves said Martin speaks for many of his other patients. “When you get free of the black hole of addiction, the holes in their lives start to close. I don’t have to get them well. They get well,” said Reeves.
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