His Rehab Didn’t Allow Suboxone
hayleskp shares the story of her Loved One’s addiction and his struggles to find help. It seems he has hit so many roadblocks on this journey. He’s closed off communications at the moment, and she doesn’t want him to give up.
I thought it best to answer questions with the telling of his story. These are the highlights but still I apologize for the length.
My son went through cancer treatment at the age of 12. He incurred many traumatic events during those years and was freely prescribed opioids for pain. We did not realize he was addicted until he graduated high school He went to rehab and was successfully sober for 7 years. He learned of kratom in a smoke shop. He was told it was “natural” and not addictive. Over the next couple of years he increased usage. As his usage increased he began to drink heavily and was “given” illegal drugs of all sorts when out with friends. Kratom was his mainstay. Read hakyeskp’s full comment here.
Your son has tried repeatedly to stop using drugs. He has been to a number of detoxes, rehabs, and sober living houses only to find himself once again at the same crossroads. What is the next move?
I see that you are not in Massachusetts but I want everyone to know that Sober Houses in Massachusetts cannot deny someone admission because of medication assisted treatment (Suboxone in your case) IF the house runs AT ALL on state funding.
The first thing to do is to help your son get back on Suboxone when he leaves rehab. Despite your son’s best intentions, he may use again and the drugs he takes are very dangerous. The Suboxone will reduce his cravings. It will also put him in front of someone, on a regular basis, who is drug testing and managing the opiates, regardless of where he is living. There is now a monthly implant of Suboxone called Sublocade. This can be considered support on a few levels. We know he needs all the support he can get.
I realize he is not talking to you, but I suspect he will do so shortly. He has reached out in the past. When he does reach out, focus on the Suboxone/ Sublocade. Get him another appointment with the psychiatrist and help him to get there. Watch Learning Module 8 for pointers on how to present this to him. Try to be mindful of the language you choose. You want him to know that your goal is to work in partnership with him, and that you believe in him. Try to steer away from language that puts him on the defensive. Be as open and empathetic as you can.
A sober house could be the best answer for your son, though it needs to allow the Suboxone. Many sober houses run on the AA/NA model. Some sober houses use the model as the reason to deny “substitute medications”, a term used by those who argue against drugs like Suboxone.
Yet, a recently published NA pamphlet states “As outlined in In Times of Illness, the choice to take prescribed medication is a personal decision between a member, his or her sponsor, physician, and a higher power.”
Houses fear that allowing drugs with the potential for abuse can divide residents. The drug can be stolen or shared. This is why some houses deny such medications.
If AA/NA is the way your son has stayed sober in the past (7 years at one point!) then he may more easily return to that. Notions around medications will vary by group and between members. There are people in AA and NA all over this country who are taking medications and staying abstinent through the 12 steps.
What about the church you mentioned where he found support in the past? That sounds like another promising community for him to lean on now. Is this near you? It’s encouraging that this provided such strength on many levels for him in the past. This is significant.
You are in a difficult position since the rehab had him come off the Suboxone and is more likely to refer to a sober house that also prohibits Suboxone. I would say that the Suboxone is more important, at this point, than this kind of sober house. It is just too dangerous out there.
Can you talk to the rehab? Can you insist that they find a sober house that will really support by monitoring his dosing of the medications, both the Suboxone and antidepressant? The monthly implant of Sublocade would make dosing unnecessary to monitor or to worry about.
If this cannot happen can you search for a room in a regular group house that expressly discourages drug or alcohol use? The roommates don’t necessarily need to be people in recovery but just those who prefer to not have it in the house. If this doesn’t exist, an apartment may be isolating by itself, but what if it is close to the church?
In terms of the church, is there anyone there that can help locate safe housing? Your son did well for 7 years. He asks for help. He sought out the church when he was in trouble. These are very hopeful signs. The problem with today’s drugs of abuse is the sheer danger of overdose. A person can be completely inexperienced, just recreating, or a chronic user – it makes little difference. Any drug purchase can be laced with fentanyl, a drug that is many times more potent than heroin.
If none of these housing ideas pan out, you may feel it necessary to have him home. You’re familiar with the daybed and locker idea. Use this idea to help ground you in your approach if he ends up coming home next. If the church is too far away, is there another church in the area that caters to young people in trouble with drugs? This is definitely worth looking into.
If a sober home can’t be found that allows the Suboxone, then you may need to help him financially with one of these alternatives. Explain that you can help for a few months, and then will revisit monthly, if he is making progress. Define progress: sticking to the Suboxone, his antidepressant, and his recovery work… finding and holding some kind of job (any kind will do for now).
What a road you’ve been on. Thank you for sharing more of your story with us. Thank you for being on this site and for not giving up. After all that you’ve been through, all of the hard feelings you have – the doubts, the fears and the frustrations – are valid. Take your time to accept all that you are feeling. Write in a journal – use the one we have on our site to help keep track of changes. Make it a point to practice self-care in new and meaningful ways. Let these practices help you find your way to a centered, grounded place.
Each moment is new. We always have new opportunities to practice and learn. There is hope for your son. Your son knows what recovery looks like. He has had incredible struggles, but he has sought help for himself, repeatedly. It’s hard to imagine how challenging it has been for him to find the help he needs. His mental health is especially important, as is protection from relapse through Suboxone, and finding a safe recovery place to live. If you can keep your focus on helping him with these needs right now, it will help you to keep moving forward. This will do you both good.
Your son is lucky to have a parent like you. Please take good care of yourself and know we are here to help.
Maybe this is a good opportunity to address the “myths” and facts surrounding Suboxone.
Clearly it seems you endorse its use Dominique.
Honestly I am ambivalent (reasonable since I know very little).
Do you consider Suboxone a path to recovery? Is the LO then going to need Suboxone the rest of his/her life? Are the side effects of Suboxone simply another problem?
Maybe we should make some evidence based opinions available here by discussing them.
Quite frankly this has been on my mind.
Thank you. And I am surely sorry for hayleskp’s problems yet equally sure that the best change is spending time with AlliesInRecovery. People recover all the time hayleskp, and my wish is this for you and your son.
Thank you
228: I manage two sober houses and am studying to be a Licensed Drug and Alcohol Counselor.
Suboxone has a high success rate when taken as directed, but is often abused or sold, as a dose of Suboxone goes for as high as $30 dollars on the street and much higher in prisons.
It is illegal to dispense schedule drugs such as Suboxone without a specific license, and incredibly foolhardy to do so without malpractice insurance, which no insurer would ever give to a sober house.
We have had about a 70% success rate with Suboxone in our houses when taken as directed.
With dual-diagnosis clients, insurance will often pay for a visiting nurse to make sure the client is taking their meds as directed.
There is also the option of having the client get his daily Suboxone at at methadone clinic, which has been a successful strategy.
And by the way, the houses I run are in Massachusetts. No sober houses in Massachusetts receive any funding at all from the Commonwealth. I’ve never heard of such a thing, other than corporations or nonprofits who also run treatment centers.
And there is no law on the books at the state or federal level granting any rights or special status to any persons whatsoever based on any medication they take.
The houses I manage are owned by real estate lawyers, and I’m pretty sure they know what they’re talking about.
The question that remains unanswered:
“Is the LO then going to be addicted to suboxone for the rest of his/her life?”
If that is so, then isn’t this merely substituting one substance for another? For me at this point in my education, that answer is, yes.
If so, then is being addicted to suboxone that much better? In terms of side effects, etc.? Better than other narcotics?
OK. So dissecting the meaning of “70% success rate”… of what? Getting them off opioids, opiates? OK, fair enough. Yet then what percentage is then addicted to Suboxone for the rest of their life? Do these doctors giving prescriptions for Suboxone have any expertise? Do they have evidence based strategies and a plan to taper them off suboxone? Are there studies on the long term effects of Suboxone? I am not naive to percentages since there is evidence that percentages can be “pick and choose” in regards to exactly what they refer to; even if that isn’t what people are interested in.
I am only interested in: what are the suboxone side effects? How is the LO with SUD “tapered off” the use of suboxone or are they just substituting one substance for another?
The general discussion is what I’ve already become familiar with. What I find lacking, are the details spelled out above. These questions, with difficult answers, remain under discussed while this culture turns abruptly to easy answers, to a completely different question.
Thank you in advance of considering the complex questions in order to address the answers.
Thanks so much for writing in and expanding on this important topic. I misspoke about sober houses. I meant to say it is residential programs in the state of Mass that cannot deny admission to someone taking prescribed medication for opioid addiction.
70% success is a very good outcome. The key is taking the Suboxone as directed, as you say. I have just started crunching the numbers for one of my jail grants, and “success,” defined as 4 weeks of urine tests that are negative for illicit opiates, is just under 30%. Out of 125 inmates who leave jail, and who are either started on MAT while in jail and/or case managed to a community MAT program, 91 go to their first MAT appointment, and 27 are clear of opiates in month 2 (so just under 30% of the 91). This is with ongoing case management and bus tokens for transport. They are not clear of other drugs necessarily. In comparing our outcomes, one could argue that sober housing is boosting outcomes by 40%!!! Folks in your sober housing program may not be so different than inmates leaving a county jail. In Springfield,1 in 7 pass through the local jail every year.
Neither the sober house nor the jail grant is a rigorously designed randomized clinical study but the differences are suggestive of how important safe structured housing may be to addressing opioid addiction.
The position of the Department of Public Health in Massachusetts is that Medication Assisted Treatment (MAT: Methadone, Buprenorphine, Naltrexone), is not Harm Reduction (eg. safe injection equipment, condoms for HIV). While its benefits may indeed not be limited to harm reduction, it is undeniable that MAT clearly reduces many potential risks associated with opioid addiction. It does so in 4 ways:
1) It immediately eliminates any withdrawal from opioids. This point cannot be overstated. When addicted to opioids, the individual is in a constant race against time. If the person doesn’t find and take in more opioids, within 24 hours or so he will start a slide into incredibly painful and uncomfortable withdrawals that can last many days. As the quantity of opioids increases – which it necessarily does due to tolerance and the strength of the opioids on the streets (especially fentanyl) – so does the agony of the withdrawals. This makes it very hard to successfully wean oneself off the opioids. The brain is constantly screaming for some opioids to end the pain of withdrawal.
Read Dominique Simon-Levine’s full response to 228 here: https://alliesinrecovery.net/discussion_blog-the-argument-for-mat
Thank you Emily and everyone that coordinates and operates on this site.
It is refreshing to witness the level of respect here. I am not sure that some people here won’t go down in history as saints on par with the likes of Gandhi, Albert Schweitzer, Mother Teresa etc. It’s an inspiration to see the value of human life in spirit and action. We need NO MORE MARTYRS attesting to the pain of living in a culture oblivious to the spiritual value of every human being.
I am much obliged. Keep up the morale and its good deeds! I am possibly speaking for more than myself when I implore you to ask the people on this site for help when necessary in your work to make this world a better place Dominique. Thank you.
228, your kind and heartfelt words mean so much to me and to all of us. it is an honor to do this work. thank you for your openness and your participation, and for expressing this appreciation. being able to share in the conversations on this website is truly a gift.
this is what we all can do: keep being here for one another. keep being honest. keep being present. keep finding ways to be compassionate and non-judgmental, to respect and value one another…. and keep it up.
in gratitude, emily
Thank you so much for the loving advice. My son left rehab after spending a week more than his insurance would pay for. He learned that the rehab center allowed him to stay without insurance approval. I am so grateful because without that week I fear he would not be in a good place. He agreed to go into a fairly strict sober home where he knew others from rehab and he can have sober support of others working the program. He was not on Suboxone but another support drug when he left the center. He mentioned that he ran out and needed to see the center’s addictionologist. They had talked with him about a 30 day injection of the drug but he wanted to try the pills first. I do not know what he has done on that front but he is now 5 days in sober living attending PHP. He is saying all the right things but we all know how sneaky addiction is.
I am working my own recovery having recognized that my codependency is not so much around his addiction but his health in general. He currently has health challenges with heart, kidneys, blood pressure and a broken foot. I am trying to be respectful knowing he is an adult now and can maneuver these thing without me. Because of his codependency on me for his health I did not allow him to grow up. I believe it is on my side of the road to force that now so that he can gain confidence that he does not need me.
Likely we may encounter many more challenges as time goes on but for today I have some measure of hope.