Anxiety, step-work, and gratitude

I wish you all a very special Holiday season.

Getting Off Alprazolam (Xanax): The need for Recovery




My Response:





Getting off Suboxone, Continued…

Thanks BC for this post and discussion point:
thanks, bc of Diary of a Quitter
My Response:
Hi BC,

Methadone, Suboxone, Sweden.

What follows is an edited message from a reader in Sweden, and my response.  The original message can be found as a comment to my ‘methadone revisited’ post.  I removed a bit of the writer’s sarcasm and corrected a couple typos; as always nothing was added.
Comment:  Yes, methadone is a ‘pure’ agonist, but to claim no difference between it and morphine and other short acting agonists is really naive. The sole reason methadone is used is because of it’s different pharmacological profile. You claim that tolerance is as much an issue with methadone as with morphine/heroin, how is it then that patients stay on the same dose for decades?
Response:  There are several reasons that methadone is used for maintenance, not one sole reason.  First, it is easy to manufacture and so is dirt cheap.  Methadone clinics typically mark it up to $10-$15 per day, but when prescribed for pain treatment it is pennies per dose.  It does have some unique properties, and yes, those unique properties make it a good maintenance drug; for example it binds extensively to proteins and so has a long half-life when used for long-term maintenance treatment of addiction.  Interestingly though, when used for pain treatment it has a shorter ‘effective half-life’ and generally must be given every six hours or so.  In other words the half-life of the drug changes with chronic administration.  This somewhat unique property is one reason that SOME patients can be maintained on a stable dose for long periods of time.  A short exercise will help to understand this point:  Google ‘opiate conversion calculator’ and use it to find the dose of oxycodone that is equi-potent to 40 mg of methadone.  A good conversion program will ask you to differentiate between acute and chronic methadone.  You will see that with chronic use, methadone becomes more potent by a factor of 10 or more.  I see this as the main reason for the APPEARANCE of stability of dose with methadone maintenance.  Yes, some patients stay on the same dose for years.  But that same dose changes potency over time in ways unique to methadone, so that the patient is actually getting a constantly-increasing opiate potency at the receptor level—even as the oral dosage stays the same.   This does not occur with other agonists, and certainly does not occur with buprenorphine. 
Comment:  To claim that a methadone patient is still an active, using addict but someone on Suboxone is in recovery, that’s the biggest load of BS that I’ve seen in a long time. Sure, buprenorphine is only a partial agonist, but there’s still stimulation of opiate receptors going on. People without tolerance get just as high on buprenorphine as they do methadone, and tolerant users don’t get high with neither buprenorphine nor methadone.
Response:  People without tolerance are not the issue here, but for the record you are wrong—patients cannot get ‘just as high’ on buprenorphine as with methadone.  As an anesthesiologist I used buprenorphine for just that reason—for example, on the labor floor buprenorphine is a safer narcotic because medications given to the mother can cross the placenta and accumulate in the fetus, causing respiratory depression (and arrest) after the birth—a partial agonist like buprenorphine has a maximum effect that preserves respiration, at least as long as no other CNS depressants are present. Similarly a patient without tolerance will not be able to kill himself using only buprenorphine, as the effect will ‘max out’.  With methadone, on the other hand, it is quite easy to OD and die, simply from taking a few too many tablets.  In fact, a teenager experimenting with methadone for the first time can die from just two or three 10 mg tablets. 
As far as whether methadone users are ‘in recovery’ or are in ‘active addiction’, that is a matter of opinion.  I see a clear difference between taking methadone, a drug that causes progressive tolerance, and buprenorphine, a drug which allows tolerance to remain static.  The ‘shift of tolerance’ is at the heart of addiction—as it shifts upward the addict is high, and as it shifts downward the addict is in withdrawal.  Buprenorphine allows tolerance to increase to a level that eliminates the high, sedation, and other drug effects, but then the tolerance becomes fixed.  And for reasons not understood, doses higher than the ‘ceiling dose’ eliminate subjective cravings.  For people who consider being on methadone to be ‘in recovery’ I would just ask… why?  What is the difference between being on methadone and being on oxycodone, other than the dosing frequency?  I didn’t intend to take on the entire methadone system, but there are some very intrusive methadone ‘advocates’ out there—they pop into buprenorphine forums and spout opinions, using pseudo-scientific arguments and misquoting articles, causing nothing but confusion and ill will.  I suggest they get a blog of their own—maybe then they would feel less need to flame others.
Comment:  Having been on both substances myself, I can testify that the only difference I find between the two is that methadone has (for me) the ability to take away my cravings completely whereas buprenorphine didn’t quite do so.
Response:  Medication is only part of any recovery program.  In my opinion 16 mg of buprenorphine suppresses cravings sufficiently to allow any patient to remain clean.  Until a few years ago every single opiate addict in recovery (and not on methadone) was doing it without the help of a medication.  The real situation is that a person who uses from ‘cravings while on Suboxone’ is not ready to quit, and (sorry) in my opinion is looking for an excuse to use.  Nothing is perfect in life—people with opiate addiction must realize they have a fatal illness, for Pete’s sake!!  Cancer patients have to put up with the pain of surgery, severe nausea, hair loss, severe fatigue…  if an addict whines over a few ‘cravings’, I suggest they get real and take a good look at where they are at in life, and start being grateful for being alive. 
In my prison work I frequently come across patients who are intent on fine-tuning their subjective experience using every med they can get.  They think that medication should make them happy, relaxed, content, and filled with self esteem… but in reality medication will do none of those things.  Their expectations are completely out of line.  I get the same impression from patients who always need a bit more of this or that for cravings.  The whole process of that type of ‘treatment’—the focus on symptoms, the need to medicate one’s self, the self-centered demand to feel perfect–  is more consistent with addiction than with recovery!
Comment:  I got annoyed when you’ve written stuff that is twisting the truth, if not lying, about the treatment that has quite literally saved my life. And calling methadone patients active, using addicts (also something many many doctors would disagree with you on).
Response:  There are the ‘many doctors’ again… but seriously, if it works for you, that’s great.
Comment:  Why can’t you accept that our treatments are very similar to each other? I know that you in the US can perceive them to be oh so different, since one can be prescribed in an office-setting and the other can’t. I can see that it can lead to a them-and-us-thing, where suboxone can appear “better” or “more refined” or “less dirty” or whatever.
Response:  The treatments have similarities and differences.  I don’t think one is ‘less dirty’ or ‘more refined’.  But the molecular actions of the drugs differ from each other, and so the subjective effects differ.  Sorry—that is just a fact.
Comment:  I live in Sweden and here we don’t have ‘clinics’ per se, here both buprenorphine and methadone is prescribed in the hospital, and we have to go there to get our meds daily, for the first 6 months and then we get take homes at certain intervals (if we’re clean that is).
Response:  That stinks. You are missing out on one of the biggest advantages of Suboxone. 
Comment:  Here buprenorphine and methadone alike is looked upon with judgment by many many people, since the treatments are so misunderstood. Here buprenorphine (and methadone) patients are called addicts by people who don’t know better.
Response:  They ARE addicts– myself included– And will always be addicts.  Opiate addiction is not ‘curable’—it can only be managed.  I am an addict.  But I am not ashamed of that—although I am ashamed of some of my actions during active addiction.  It bothers me that the whole concept of ‘recovery’ is absent from methadone programs.  A methadone ‘advocate’ made silly remarks a few days ago that showed a complete absence of knowledge of 12 step groups— something that has been an incredible movement throughout the entire world, for almost 100 years! 
Comment:   You seem to have a little of the mentality that if I can do it, so can you. And I find that a bit strange since then you could easily have become sober without medication at all, since other people have been able to do so. Do you see what I mean? I’m just saying that while suboxone works for a lot of people, it doesn’t work for all, and it’s just naive to think so.
Response:  You know what?  A common thing said at NA meetings is that ‘if I can do it, so can you’.   Yes, I do have ‘that mentality’ as you put it… and I don’t get your objection to that mentality.  I don’t understand the rest of that paragraph either—I think we come from totally different perspectives.  I believe that EVERYBODY is capable of getting clean without the use of medication.  Unfortunately, many addicts will not choose to give up their addictions until they have lost everything.  I had to lose a career and a great deal of money before I ‘got it’.  I didn’t ‘get it’ with Suboxone; I went away to residential treatment for over three months.  I didn’t want to do that, but my back was against the wall and finally there was no other place to hide.  Suboxone was not available at that time—at least not in my area, and I had never heard of it (this was in 2001).  I had the ‘typical miracle’ of AA, NA, etc… I realized I was powerless, and the urge to use went away.  It really is that simple.  Unfortunately, addicts will not usually recognize their powerlessness until they have lost everything—buprenorphine allows people to find some peace without having to go that far.  But I do worry that their ‘recovery’ does not run as ‘deep’—see my articles on the topic here: .
The issue isn’t over who is ‘better’; the issue is whether the recovery will last, and whether the person ends up having a rewarding life.  Opiate addiction is a horrible, fatal illness—I have lost friends and patients to it and so the bottom line is that any way that a person keeps clean is OK with me.  And so I usually present the options to the patient and let him/her decide which path they will take.  Yes I have opinions about methadone—just as others have opinions about Suboxone.  From my perspective, it seems that there are ‘methadone people’ who can’t tolerate the opinions of others.  And I wonder… is that a ‘recovery’ issue?  Part of recovery is learning to accept things we cannot change… like the opinions held by others.  Part of recovery is acceptance—the idea of ‘living life on life’s terms’— including the fact that people are going to disagree on some issues.  And part of recovery is learning to know one’s self, and to know that one is OK regardless of how other people think… like not getting all flustered if some stranger in another state– who doesn’t even know the person– holds the opinion that his choice of medication isn’t the best.  These parts of recovery are what make many people grateful for being an addict.  If things are as I suspect, and methadone maintenance patients are not taught how to find these things… that would be a shame.

Bitter taste, euphoria, dosing…

From a person new to suboxone:
This is my, well, second day off opiates seeing it is 12:05am where I am. I had a 11 year on and off love affair with opiates. It got worse in the last 6-12 months or so. That feeling of euphoria really gets you and when you don’t have your pills you feel like you are going to die, literally!! I woke up this morning with no more pills. OH BOY was I sick… I found a list of docs who detoxed using subutex and/or suboxone… He did a patient and family history on me… He wrote me a script for six 2mg/0.5 suboxone. His instructions were take two under my tongue immediately… The taste was disguisting. I just took my second 2 and am cringing because of the taste… After 30-60 minutes, I felt wonderful… I was surprised he started me off at 2 and not 8mgs. The 2mgs do just fine. What is funny is that the euphoria you get from opiates, I am getting from this drug. I read up everything possible on the internet about this drug and it is supposed to be the best drug for opiate users. I have been posting a lot and hope you do not mind. I understand addiction and how hard it is so I want to help people. I am just starting my recovery and have a long road ahead, I know this but if more people know about SUB, there would be less addicts. I am making it clear to everyone that you absolutely cannot take any op’s while on Sub. Apparently you will get the worse side effects imaginable…
I deleted the parts that are identifiable or more specific to the individual than necessary here.
Some comments: As for the taste, there are some little tricks that will make suboxone more palatable; try chewing an altoid or another strong mint right before taking the suboxone, you can also try holding an ice cube in your mouth for 5 minutes first, spitting that out, and then taking the suboxone. Just be sure to start the suboxone dose without saliva or water in your mouth– you will produce saliva while you are dosing, and you want a high concentration of buprenorphine in the saliva, which means you want a low volume of liquid. Other people have used listerine strips. Finally, subutex has a different taste– it is bitter, but not ‘fruity’, and some people like it better. It is, though, significantly more expensive. Contrary to misconception out there, you do NOT need the naloxone to get the ‘blockade’ effect at opiate receptors. Subutex has an identical action in almost all patients– the exception being perhaps people who have had a gastric bypass or who have a (very unusual) allergy to naloxone.
For best results start with a ‘dry’ mouth, bite the suboxone with your front teeth to crush it and dissolve it immediately upon putting it in your mouth, then use your tongue to spread the the concentrated, dissolved medication over all surface areas inside your mouth. A couple points: the intact tablet is not doing anything, so holding it under the tongue takes needless time– get it dissolved right away. Second, there is nothing special about the area under your tongue; the medication will get absorbed from all surfaces inside the mouth, so use as much surface area as possible to increase absorption and speed the process. Third, after dosing for 5-10 minutes you can either swallow the saliva or spit it out– if the bitter taste really bothers you, perhaps spitting it out is the better option (also a better option for the rare individual who seems to get headaches from the naloxone in suboxone). Finally, do not drink anything or rinse your mouth with liquid for at least 15 minutes after dosing, as that will remove some of the buprenorphine that you are trying to absorb.
Euphoria… the initial effect of taking buprenorphine will depend to an extent on the individual’s degree of tolerance. A person taking over 80-100 mg of oxycodone per day who waits 24 hours to have moderate withdrawal, and then takes suboxone, will probably feel relief from the withdrawal, but will not feel much of an ‘opiate’ effect. On the other hand a person taking 5 vicodin per day (which contains hydrocodone, a weaker opiate) who waits 24 hours and then takes suboxone will likely have euphoria and other opiate effects– because the ‘opiate agonist’ activity of buprenorphine is stronger than what the person is used to or ‘tolerant’ to. In either case, the person’s opiate receptors will adjust fairly quickly to the potency of buprenorphine, and after a few days both patients will feel ‘normal’ after taking buprenorphine– no withdrawal, no euphoria. That is what makes it such a popular treatment– patients who take it regularly feel ‘normal’. In fact, many people experience life without the constant craving for opiates for the first time in years, and for the first time in years feel like a person who is not an opiate addict.
This leads to a much broader issue that I have talked about before– an issue that is more controversial: what other things should be required of patients taking suboxone? I have heard ‘second hand’ that Dr Miller, the President of ASAM, the American Society for Addiction Medicine, takes the approach that patients on Suboxone should be sober from all other intoxicants and attending group treatment and 12 step programs. I am in agreement on the ‘total sobriety’ issue but not with the second part, for a couple of reasons. Elsewhere in this blog I theorize a bit on the issue of Suboxone and 12-step attendance (I also discuss the issue here: but I have some practical concerns as well. First, ‘recovery’ is all about ‘rigorous honesty’, and yet if a person is honest about taking suboxone at an NA meeting he/she will end up being confronted and harassed– so patients are told to be honest about everything except suboxone use– and that is a problem because we are then reinforcing one of the things the addict has been doing for years– hiding the use of an opiate. Second, people on suboxone are different from people who are not on suboxone– they don’t have the constant awareness of the desire for opiates (or the unconscious drive for opiates manifest as irritability), and have an entirely different subjective experience. They don’t ‘feel’ like opiate addicts. Yes, they are still opiate addicts– don’t get me wrong on that. But they don’t feel the same way. And so I don’t know if a 12 step meeting will do anything for them. I know that to buy into recovery a person has to be desperate; not because there is anything wrong with the 12 step message as I think it is a great, universal approach to life that benefits everyone lucky enough to ‘get it’. But to adopt the 12-step way of living, of seeing the world, a person has to change. And change is very, very hard, and very rare. I remember my own first experience with the twelve steps: sick with withdrawal I wandered into a mall bookstore, found a book about AA, and read through the 12 steps. I concentrated for a few minutes, and considered what they said. Later that day, after using, I thought… ‘that didn’t work’. I’m trying to be a bit funny, but my point is that many people think that ‘recovery’ consists of intense education. Those people are eventually frustrated in treatment, as they think they are ‘getting it’ and yet their counselors and peers keep telling them that they are not getting it. In reality, treatment through a 12 step approach requires a deep change of attitude that is very difficult to come by. I like the saying ‘insight maketh a bloody entrance’. True change usually requires a significant period of distress– a rock bottom, a depression, a great deal of personal turmoil… another comment frequently heard in treatment is ‘crisis equals opportunity’, or ‘the Chinese symbol for crisis is the same as for opportunity’– something that I suspect is not actually true, but I could be wrong.
Wow. I talk too much. OK… practical problems to requiring 12 step attendance… My point (in case you zoned out) was that sitting through 12 step meetings, while not in the middle of a personal crisis at least at the start of 12 step exposure, may be a total waste of time. Ditto for attending ‘recovery group therapy’. Those things work for one type of treatment, and I see little reason why they would be helpful for people on Suboxone. An analogy… (wish me luck)… people with hyperthyroidism sometimes have the thyroid gland surgically removed; other times the thyroid is destroyed by taking radioactive iodine. If a person has had the entire thyroid removed, it makes little sense to then make them take radioactive iodine. Wow… that isn’t bad…
On the other hand… people with thyroid cancer have their thyroid surgically removed and then take radioactive iodine just in case some thyroid tumor cells were left behind. Given that opiate addiction is a fatal illness– at least as fatal as any cancer– maybe the more done, the better. I will say that anyone who is on Suboxone who is attending NA or AA or who wants to attend, and who can deal with the privacy issue of taking Suboxone, GREAT! If you can ‘get it’– if you can truly understand your powerlessness over substances and turn your life over to your ‘Higher Power’– you will be better off for doing so. You will also be in the position to get off of suboxone at some point.
I had better close, but will add one last thing. I will save the ‘dosing’ issue for another post, but please stay tuned because it comes up very often and there are some important concerns. But my last point today is that Suboxone does NOT cure opiate addiction, just as atenolol does NOT cure high blood pressure. To be honest, ‘cures’ are rare in medicine– we usually help the body heal itself or provide medication that ‘maintains’ a reduction in symptoms. We don’t fix the faulty blood pressure set point that is the core problem with hypertension– we give meds that artificially force the heart to pump with less force or at a lower rate, or that make the blood vessels open up wider, and that drops the blood pressure. Stop the medication and there often is a situation like ‘withdrawal’ where the blood pressure rebounds higher. Suboxone is an incredible medication– I know what it is like to be trapped by addiction before the days of Suboxone, and I understand why suicide is such a common outcome with addiction– if taken properly Suboxone will put addiction into complete remission, and that is a wonderful advance of science that saves many lives. BUT…. a person who becomes addicted to opiates has only three options: Buprenorphine maintenance for life, 12-step meetings for life, or prison and death.
In my next post I will try to talk about what a person on Suboxone CAN do to eventually stop taking the medication. I will also discuss the ever-important dosing question. The ‘sneak preview’ nutshell version is to follow the instructions of your prescribing doctor. Addicts take what they think they need to take– patients take what they are prescribed. You are not an addict anymore– are you?

Induction, Relapse, Benzo Questions

Some questions about the induction process and my answers:

If I try to just take the oxycodone for a period of time prior to meeting with you would that eliminate some of the problems and complications associated with the transition from methadone to suboxone? If I took only oxycodone for 4 days or 6 days might I be able to go directly to suboxone without that withdrawal period?

Yes, it is helpful to change from methadone to oxycodone for a stretch of time. Methadone is highly protein-bound, and takes forever to leave the body– I like people to be off methadone for at least 4 days, whereas 24 hours off oxycodone is usually sufficient to avoid precipitating withdrawal with suboxone. There is no way to avoid withdrawal completely, however, as a person must be in a bit of withdrawal at the time of suboxone induction. Otherwise the person will get very sick.

Would I be feeling well enough by (specific date) to be physically comfortable enough to be a joy to be around or will I still be suffering? I believe I will need some help just with the driving alone…

Some people start suboxone and go to work later the same day– it depends on the person’s individual ability to handle the withdrawal, and on their tolerance to opiates. A person who takes less than 40 mg of methadone per day (or the equivalent dose of oxycodone) will generally have no problem adjusting to suboxone. I have done inductions on people taking well over 100 mg of methadone per day, and they do OK as long as they have gone without methadone for a few days. If you can change completely to oxycodone and avoid methadone for a few weeks before suboxone, you will do better.

In addition to the methadone I have also been prescribed Clonazopam (a benzodiazepine) that I take with the methadone. I take 3 to 4 mg a day. Can Dr. Junig prescribe me that or a different one and get me tapered off the benzo’s? I really want to be clean and sober as I once was… I stopped going to meetings and I had gone to over a thousand during that time and was pretty darn healthy in all ways; but after I stopped I picked up a drink and eventually narcotics again.

Clonazepam is a dangerous med for anyone with a history of addiction. The tolerance that develops makes the drug helpful only for short-term use, for the most part. I will prescribe it sometimes for a person who is taking the proper medication for anxiety (like prozac or effexor) but who still has breakthrough anxiety, as long as the dose remains stable. 3-4 mg is a high dose, and I would want to try to taper that down a bit if possible.

The part about the meetings is typical. Opiate dependence is a long-term affliction—life-long for most people. People contemplating suboxone have two choices: life-long medication, or life-long meeting attendance. At this point there is no cure. Addicts who stop going to meetings eventually go back to opiates, for the most part. Likewise, it is important for people who stay sober through the 12-steps to avoid all intoxicants. Use of a different drug often results in ‘cross-addiction’ to the different substance, which then often leads back to using the drug of choice.

More Suboxone Information at



Is Suboxone At Odds With Traditional Recovery?

By now almost every opiate addict has heard of Suboxone, a medication for opiate dependence that has been around for about ten years. I admit to mixed feelings about Suboxone based on what I have seen and heard while treating well over 100 patients over the past two years. I also acknowledge that my opinions are likely influenced by my own experiences as an addict in traditional recovery.While Suboxone has opened a new frontier of treatment for opiate addiction, it also threatens to split the recovering and treatment communities along opposing battle lines.Such and outcome would be a huge missed opportunity to improve the lives of opiate addicts.
An amazing medication
For clarification, the active ingredient in Suboxone is buprenorphine, a partial agonist at the mu opiate receptor. Suboxone contains naloxone to prevent intravenous use; another form of the medication, Subutex, consists of buprenorphine without naloxone.In this article I will use the name ‘Suboxone’ because of the common reference to the drug, but in all cases I am referring to the use and actions of buprenorphine in either form.The unique effects of buprenorphine can be attributed to the drug’s unique molecular properties.First, the partial agonist effect at the receptor level results in a ‘ceiling effect’ to dosing after about 4 mg, so that increased dosing does not result in increased opiate effect beyond that dose.Second, the high binding affinity and partial agonist effect cause the elimination of drug cravings, dispelling the destructive obsession with use that destroys the personality of the user.Third, the high protein binding and long half-life of buprenorphine allows once per day dosing, allowing the addict to break the conditioned pattern of withdrawal (stimulus)-use (response)- relief (reward) which is the backbone of addictive behavior.Fourth, the partial agonist effect and long half life cause rapid tolerance to the drug, allowing the patient to feel ‘normal’ within a few days of starting treatment.Finally, the withdrawal from buprenorphine provides a disincentive to stop taking the drug, and so the drug is always there to assure the person that any attempt to get high would be futile, dispelling any lingering thoughts about using an opiate.
Different treatment approaches
An ideal program will combine the benefits of 12-step programs with the benefits of the use of Suboxone.The time for such an approach is at hand, as it is likely that more and more medications will be brought forward for treatment of addiction now that Suboxone has proved profitable. If we already had excellent treatments for opiate addiction there would be less need for the two treatment approaches to learn to live with each other.But the sad fact is that opiate addiction remains stubbornly difficult to treat by traditional methods.Success rates for long-term sobriety are lower for opiates than for other substances. This may be because the ‘high’ from opiate use is different from the effects of other substances—users of cocaine, methamphetamine, and alcohol take the substances to feel up, loose, or energetic—ready to go out and take on the town. The ‘high’ of opiate use feels content and ‘normal’— users feel at home, as if they are getting back a part of themselves that was always missing. The experience of using rapidly becomes a part of who the person IS, rather than something the patient DOES.The term ‘denial’ fits nobody better than the active opiate user, particularly when seen as the mnemonic:Don’t Even Notice I Am Lying.
Drug obsession and character defects
The dynamic nature of personality
Combining suboxone treatment and traditional recovery
Other Questions (and answers):
-Should Suboxone patients be in a recovery group?
I have similar reservations about forced attendance, but there is something to be gained from the sense of support that a good group can provide.
These steps are necessary for addicts in ‘sober recovery’, as the obsession to use will come and go to varying degrees over time depending on the individual and his/her stress level.But for a person taking Suboxone I see the steps as valuable, but not essential.
-Where does methadone fit in?
Methadone is an opiate agonist. A newly-raised dosage will prevent cravings temporarily, but as tolerance inevitably rises, cravings will return.With cravings comes the obsession to use and the associated character defects.This explains the profound difference in the subjective experiences of addicts maintained on Suboxone versus methadone, and explains why in my practice I have many patients who have switched to Suboxone, but none in the other direction.
The downside of Suboxone
The beginning of the future
Time will tell whether or not Suboxone will work with traditional recovery, or whether there will continue to be two distinct options that are in some ways at odds with each other. The good news is that treatment of opiate addiction has proven to be profitable for at least one pharmaceutical company, and such success will surely invite a great deal of research into addiction treatment.At one time we had two or three treatment options for hypertension, including a drug called reserpine that would never be used for similar indications today.Some day we will likely look back on Suboxone as the beginning of new age of addiction treatment.But for now, the treatment community would be best served by recognizing each others’ strengths, rather than pointing out weaknesses.
This article can be reproduced freely as long as the following attribution is included:
The author, Jeffrey T. Junig MD PhD is a psychiatrist in solo practice in Wisconsin, and is Asst Clinical Professor of Psychiatry at the Medical College of Wisconsin.  Read more about suboxone at, AddictionRemission, or at Suboxone Talk Zone. He can be contacted at Fond du Lac Psychiatry.