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Health commissioner promotes Suboxone treatment for opioid addicts

The Portsmouth Daily Times - 2/4/2019

Feb. 04--If you have a headache, would it seem at all abnormal to take a pain reliever? If you are diagnosed by a doctor with high blood pressure, would anyone question you being given a prescription to lower your blood pressure? Perhaps you might take a statin to control your high cholesterol as well.

While there is undoubtedly, perhaps very unfortunately, a stigma attached to mental illness, for most people, it would not seem all that unusual for someone to be taking a common antidepressant such as Prozac. For Dr. Michael Martin, Scioto County Health Commissioner, the question then becomes, why is there such a stigma in place and such resistance, even in the drug treatment community, to using prescribed medicine (medication assisted treatment or MAT) to overcome opiate addiction?

According to Martin, many drug treatment programs and professionals will tell addicts and others, a person is not clean unless they are not taking any drugs or medications, other than perhaps routine prescriptions. Martin argues strenuously that for some addicts MAT is exactly the tool needed to release them from their addictions, to allow them to live normally, productively.

Speaking in Martin's Southern Ohio Medical Center office, two of Martin's patients, both admittedly recovering addicts, said MAT, using Suboxone, which seems to be the most commonly prescribed MAT treatment, has proven to be a genuine lifesaver.

While both patients -- one man and one woman -- spoke candidly about their addictions and their current and former lives, both also spoke on the condition of anonymity.

The female patient, now 42, and working in a rehab center, said she first became addicted to Percocet. Unlike Martin's male patient, the woman said she started taking drugs for the fun of it, just to get high.

After several years, the woman said she tried numerous times and numerous means to stop taking the opiates which by then controlled her life. She stated at one point she was probably clean for approximately two years but backslid and found herself in what proved to be a very difficult position. The woman said she tried attending a 12-step program that ended up basically taking over her life instead of the drugs.

"I was working the program morning, noon and night, going to meetings, meeting with my sponsor, whatever," she said. "It was all I had time for." Following that relapse, the woman said she just "could not get it back together again."

"My mental health was just off the charts," she added. She ended up a few years ago trying methadone, another MAT drug. But she also talked about, as did Martin, how methadone only can be given in a clinical setting, one daily dose at a time. Obviously, that means making the time to visit a clinic each and every day for an indefinite period of time.

"It was never going to work for me," she added. "I was never going to have time to get a job, to support myself, to have a real life."

Eventually, the woman said she tried Suboxone but really didn't take it seriously at first. She said it finally came down to a question of "life or death." At that point, she began to take the Suboxone in the way it was intended and to follow a regular treatment program.

"This might come off sounding badly but I don't have to focus on my recovery morning, noon and night. I can just live my life," the woman concluded.

Martin's male patient, 30, who now works at a local restaurant, said he started out on pain pills following major back surgery when he was 17. Eventually, he made his way up the drug chain, all the way to shooting heroin. Like his female counterpart, he tried various means and ways to get off drugs, but nothing seemed to really take. He talked about losing his job, his family, ending up homeless and finally, about three years ago, overdosing.

In terms of the stigma and intolerance attached to Suboxone use even in the rehabilitation community, the man tells a seemingly extreme story but one all too common, in the opinion of Martin and both of his patients.

Like his female counterpart, the man started attending a 12-step program. He already was taking Suboxone at the time.

"They kept telling me I couldn't consider myself clean," because of the use of Suboxone.

"They seem to tell people unless you're not using anything, you're not clean," Martin said. He added the medical definition of addiction is someone pathologically seeking drugs.

"When people are in a treatment program and taking their medication as prescribed, they are not addicted," Martin argues. "They are only seeing the benefits of the medication."

His male patient continued his story regarding his involvement with a Narcotics Anonymous group. He said a key part of any 12-step program is honesty. He found himself in kind of a Catch-22, in that he did not want to stop using a doctor prescribed medication greatly helping him but didn't feel comfortable lying to the group about his continued use of Suboxone.

"People get clean in different ways," he said. "This is what worked for me... And I'm pretty much the happiest I've ever been."

Both of the reformed addicts and, perhaps most importantly Martin, stressed there is no euphoric component involved in taking Suboxone. In other words, you don't get high off Suboxone.

"This is how I explain it," Martin said. He stated when an addict is using opiates, heroin or whatever, as he put it, "the lights are on, the party's on."

"The light switch goes off, they're withdrawing, they feel terrible, there's nausea and vomiting," Martin continued. He said Suboxone is like a dimmer switch.

"It takes them (addicts) to normal," Martin said. "They're not high, they're not low, they're not craving." At one point, Martin noted Suboxone blocks the effects of opiates essentially making it impossible for a person to get high from opiates.

Martin's female patient said there is always room for some abuse of Suboxone, apparently especially in IV form.

"For people who are taking it properly, for people who are taking it as prescribed, it can be life-changing," she said.

Martin said persons taking Suboxone can continue to take it for as long as it benefits them, as is the case with any other medication prescribed for one disease, condition or another. He added you wouldn't expect a diabetic to suddenly stop taking insulin.

"There are some people who argue you should be weaned off of it (Suboxone.) My thought is, as long as the Suboxone is working, there's no reason to stop taking it."

In Martin's opinion, there seems to be no doubt the mainstream medical community plays a part in some of the negative thoughts regarding the use of Suboxone. For example, a medical doctor must have a special certificate in order to prescribe Suboxone. Even then, a physician can only prescribe the drug to so many patients at a time.

Martin was happy to note SOMC only very recently received grant money to conduct MAT training for the hospital's emergency room doctors, who soon could be prescribing Suboxone when appropriate, again thanks in part to grant money. Martin argued the system needs to make access to treatment more readily available. He even commented, right now, it might be easier for an addict to go out on the street and buy heroin than to legitimately obtain access to Suboxone treatment.

"It would be nice if people could come in and say,' I need treatment,' and get treatment," Martin said. "We have a lot of barriers to treatment in this country."

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