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Magic Little Pill: Attitudes Regarding the Use of Buprenorphine in Opioid Treatment Aarik J. Kimberlin Siena Heights University

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Abstract Opioid dependence is a major problem in our society. Buprenorphine purports to help treat opioid dependence. It has met with fierce resistance especially from 12-Step programs and abstinence based programs. Despite their arguments, many which are valid. I found that Buprenorphine saves lives. Therefore I find that it is a useful treatment for opioid dependence.

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Magic Little Pill Anything that is strong enough to overpower a Mothers instinct is evil. There is nothing as pure, as fierce, or as primal as a Mothers love. A Mothers love is so ingrained that it has to be a part of our DNA, how else would we have survived as a species? Fathers can come and go but a Mother is always there. Yet, drugs can annihilate Motherly instincts. Its not even a contest, the drugs win every time. The drugs cause Moms to neglect their children, abuse their children, and even sell them. Opiates such as heroin and oxycontin are especially nefarious. Despite these opiates power, there have been successful treatments for it. One of the more well-known treatments is in 12-Step recovery such as Alcoholics Anonymous and Narcotics Anonymous. Methadone is also a treatment option. More recently, a drug called Buprenorphine has been used to treat opiate addiction. Pharmacological Solution Buprenorphine was introduced with the Data 2000 act. It is similar to methadone in the fact that it a medication that is taken to combat heroin. However Buprenorphine is different than Methadone because it is only a partial opiate agonist which is important because the user does not get high and its not as addictive a methadone (Horyniak, Armstrong, Higgs, Wain, Aitken, 2007, para. 1). Methadone is dispensed within specialty clinics. However, buprenorphine is prescribed as Buprenorphine and is available in Doctor's offices (White, 2011, p. 7). This makes the drug more widely available and takes away from the stigma of having to go to a Methadone clinic.

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Despite its benefits, Buprenorphine has met with fierce resistance within recovering communities; especially Narcotics Anonymous and abstinence based treatment programs. Bill White describes the tact taken by 12 step programs thusly, " All 12-Step programs are distinguished by the belief that the central mechanism of addiction recovery is a process of spiritual awakening, and that this awakening can occur as an experience of sudden transformational change or (more commonly) unfold over an extended period of time" (2011, p. 12). So there is a feeling that the medication somehow blunts this opportunity to have a spiritual awakening. While Narcotics Anonymous officially has no opinion on outside issues, its members certainly do. White illustrates the NA members opinion using their own words. One member states: [Buprenorphine] is a dangerously addictive drug and is in no way a cure for opiate addiction. It is a fresh equivalent to methadone, which was first presented as a cure for heroin addiction. Heroin in its early days was presented as a cure for morphine addiction (2011, p. 15). While this does not represent every member's view it does give us insight into the attitude that medically managed patients face. Another reason for opposition to Buprenorphine treatment is that many feel it robs the addict of hope. Balmer, Gerke, Gleespen, and Schwartz in their position paper against Buprenorphine maintenance use this quote: If you want to treat an illness that has no easy cure, first of all, treat them with hope (2011, p. 1). Buprenorphine use according to Balmer, et al., does not allow for neurobiological healing, i.e. increasing production of the bodys own opioids and replenishing opioid receptors (2011 p. 3). This is a corollary to the argument of NA members; the medication gets in the way of the natural recovery process. 12-Step recovery insists a person hits bottom, gets some willingness, and then has a spiritual awakening as a result of the recovery process.

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Buprenorphine faces opposition on more fronts than just recovery philosophy. Its pharmacological efficacy has also been disputed. According to a 2010 study persons dependent on prescription opioids, tapering with buprenorphine during a 9-month period, whether initially or after a period of substantial improvement, led to nearly universal relapse (Helwick, 2010, para 1.). This study's intent was to see what happened when clients were tapered on a stringent basis. Experiential Knowledge In his paper regarding Medical Managed Treatment Bill White uses what he calls experiential knowledge along with scientific knowledge. Scientific knowledge, he explains, seeks to understand from objectivity and distance it uses exact data and measurements to draw conclusions. Experiential truth comes from having been in a situation and survived it. This truth also comes from the inherited knowledge of a group. White states Science stands and demands, Where is your proof? Experience stands in response and proclaims, I am the proof! and offers its biographical evidence (2011, p. 2). It is within this framework that I will describe my position on Buprenorphine use. My position on Buprenorphine sounds like a seasoned politicians; I was against it, before I was for it. However, unlike a politician, my position is not a calculated flipflop. Let me explain, as an addict in recovery, I was always suspicious of people taking the easy way out. So when I thought about Psychotropics in general and Buprenorphine in particular, I thought they were just a way to cop out. I felt that people were not willing to put in the hard work that it takes to be sober and they were cheating themselves in doing so. I felt that the only way to get and say sober was through the 12 steps of AA or NA. This was because it worked for me and it worked for countless others.

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However my experience with addiction and its treatment started to broaden once I decided to make a career in addiction counseling. My first job was at a psychiatrists office as a counselor for patients on Buprenorphine. I definitely had a bias against the medication and the clients. In time I started to learn that there were other models of recovery and not everyone recovered in 12 step programs. The moment that really changed my mind was when I was at dinner where a Doctor was presenting a case study of a woman I'll call Carol. Carol to put it bluntly was a mess. She was opiate addicted, unemployed, and unemployable when she first started getting treated by the Doctor. Carol refused to go to 12-Step meetings or counseling but would talk the Doctor and take her Buprenorphine as prescribed. Even with the Buprenorphine Carol was still having a tough time in life. She suffered from depression and was generally unhappy. However, Carol was able graduate from college and apply for Grad school while on Buprenorphine. I am convinced that Carol would have a better outcome if she would attend meetings, but some people just aren't willing to go meetings. The fact is that without the Buprenorphine Carol would have not been able to graduate from college and may have well died from her disease. That is why I think Buprenorphine is helpful it keeps people who may have otherwise died alive. In a study it was found that the odds of death were 75 percent higher for among patients treated with out Buprenorphine than those treated with Buprenorphine (Clark, Samnaliev, Baxter, & Leung, 2011, para. 23). To me, it really just boils down to a life or death matter. Buprenorphine saves lives. Diet and exercise can treat some forms of diabetes, but we would not deny diabetic insulin and say that they had to suffer more and hit bottom to start exercising and dieting. No, we meet the diabetic where they are at and treat them appropriately. Therefore, despite my research

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my mind remains unchanged. Death is the least common denominator and Buprenorphine prevents deaths.

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References

Clark, R., Samnaliev, M., Baxter, J., & Leung, G. (2011). The Evidence Doesn't Justify Steps By State Medicaid Programs To Restrict Opioid Addiction Treatment With Buprenorphine. Health Affairs, 30(8), 1425-1433. Retrieved November 22, 2011, from ABI/INFORM Global. (Document ID: 2442187331). Balmer, J., Gerke, C., Gleespen, M., & Schwartz, J. (2011, November 14). Dawn Farm's Position on Buprenorphine Maintenance. Retrieved November 18, 2011, from Addiction and Recovery News: http://addictionandrecoverynews.wordpress.com/ Horyniak, D., Armstrong, S., Higgs, P., Wain, D., & Aitken, C. (2007). Poor Man's Smack: A qualitative study of buprenorphine injecting in Melbourne, Australia. Contemporary Drug Problems, 34(3), 525-548,382. Retrieved November 19, 2011, from ProQuest Criminal Justice. (Document ID: 1533151351) Helwick, C. (2010, May 24). For Prescription Opioid Dependence, Relapses Associated With Shorter Treatment Course. Retrieved November 18, 2011, from Medscape: http://www.medscape.com/viewarticle/722342 White, W. (2011). Narcotics Anonymous and the pharmacotherapuetic treament of opiod addiction. Philadelphia: Great Lakes Addcition Technology Transfer Center.

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