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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 andits 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 NAmembers 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 studypersons

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 flip-

flop. 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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