Tuesday, July 19, 2011

Chris Newcomb, M.Div. 
I remember hearing the song “Human” by the British electronic New Wave group called The Human League on the radio as a young lad in the early 1980’s.  It was a unique song and had a catchy lyric to it.  The song is about cheating in a relationship, unfortunately, which my young mind did not understand at the time.  However, I think the chorus of the song is a great illustration for our discussion of Step 7. 
The writer* sings these words in the chorus of the song:
“I’m only human,
of flesh and blood, I’m made,
I’m only human, Born to make mistakes”
*(Human League, “Human”)

Have you ever felt that way?  Ever made so many mistakes that it feels like you’re some kind of human that is worse than a ‘normal’ human?   Ever felt like your mistakes were better known than the rest of mankind’s? 
To be certain, I am exaggerating just a little bit.  The point is this:  all humans make mistakes.  We all stumble.  We all fall.  It is a fact.  So, we can all step back and breathe a collective sigh of relief.  However, there is more we can do to deal with this conundrum of our broken human condition.  The name of the game is adopting humility. 
If we adopt humility, a few wonderful things happen.  First, we realize that we are not the ruler of the universe.  This removes a lot of pressure and strain on us and others.  Second, in our new found status as creature and not creator, we are free to receive help from the Higher Power of our own understanding.  Last, receiving help from a Higher Power is really great for removing character defects!
Character defects are what led us into addiction in the beginning and will lead us back if we hold on to them.  The problem is so many of us want to fix ourselves. We want to banish our character defects by ourselves but are surprised when we realize we can’t.  However, this realization often swells our pride even more to hold tighter to the very defects we want to eliminate from our lives!
Do you have character defects?  Better yet, do you admit that you have character defects?  If so, what are you doing to deal with them?  Are you asking your Higher Power to remove your character defects or are you fruitlessly trying to remove them yourself?  As we say in the recovery community, "How’s that working for you?"
In closing, character is forged in the fire of adversity.  Character is forged from the purging of character defects.  Character is important, necessary and valuable.  Character is not built by individuals alone.  We all need outside help to develop helpful character traits through our Higher Power and a community in which we can live out these new traits before others. 

Buprenorpine Implants

Peter R. Coleman, M.D.

The Buprenorphine Implants are made by a small pharmaceutical company called Titan Pharmaceuticals, and Titan supplied funding for the study. The implants last over 6 months. The usual dose is 4 or 5 implants and this dose delivers steady, but quite low levels of buprenorphine – about the equivalent of 1 mg daily of the oral, sublingual dose.  The trial was conducted in 2007 and 2008 and involved 168 adults. Patients received either 4 active implants or 4 placebo implants. They were allowed to take extra sublingual Buprenorphine (Suboxone) if they felt bad or had cravings, and if they kept using the extra Suboxone they were able to get a fifth implant, if they wanted it. The whole trial was double blind, so neither the patients nor the staff studying them knew who got the real implants.

The two main study outcomes they were looking at were to see if patients with the real implants stayed in treatment longer and whether they had less urine drug screens that were positive for opiates.

The results did show that the active Buprenorphine Implants worked better than the placebo ones. As far as staying in the study goes, 66% of the patients with the real implants completed the study, but only 31% of the patients with the fake implants completed the study. Also the patients with the real implants had less positive urine drug tests – 60% versus 72% of the patients who had the placebo implants. The patients with the real implants also reported fewer cravings and they had fewer withdrawal symptoms.

Over all, the drug company was happy with the results and felt that the study showed that the new implants can be helpful to patients trying to deal with their opiate addiction. In fact, the number of patients staying in treatment with these Buprenorphine implants is considerably better than patients who take regular sublingual Suboxone. Results from previous studies of patients who take regular Suboxone show that only about 35 - 50% of them stay in treatment for the whole 6 months. And, the implants do eliminate the problem of patients skipping their dose so they can get high or selling their Suboxone on the street.

Of course, one thing the study didn’t address is the difficulty patients have when it is time to get off their Buprenorphine  – either in the Implant or in regular Suboxone. As mentioned earlier, we are seeing more and more patients who just can’t stand the long and intense withdrawal symptoms coming off Suboxone. Fortunately our Accelerated Opiate Detox (AOD) program works very well for these patients.

Here at TCI we use Naltrexone implants, to help patients stay off opiates, and I have to say that when I look at a study like this I am more and more delighted with the treatment we offer. In this study, the patients who got the real implants still had drug tests that were positive for opiates 60% of the time. This means that over half the time these patients were still using drugs! This is hardly what we want from a treatment program. I guess it not surprising that 65% of the patients dropped out and didn’t complete the study – presumably because they were back using drugs.

In contrast, Naltrexone implants work much better. We do not have the resources to do long term studies on our implants, but a number of other groups have done these types of long term outcome studies. In general, the studies using Naltrexone Implants show that about 60% of patients are completely off opiates at 12 months. Their drug screens are all negative because while patients have Naltrexone implants in place they are unable to get any benefit from using opiate drugs.

In fact, I met the staff from Titan pharmaceuticals a few years ago at a conference and I asked them why they were working on a 6 month Buprenorphine implant and not working on a 6 month Naltrexone implant. I was told that the company had decided there was a better market for the Buprenorphine implant. I wish they would re-consider and develop a reliable 6 month Naltrexone implant that really would help patients stay clean.