Angry Doctor

Monday, July 10, 2006

Use and Abuse

There is almost always two sides to a story, and this letter from Dr Soo published in Today today tells 'the other side' of the Subutex story:

Drug for heroin dependence can turn lives around
Letter from Dr Soo Ing Choong

I am a general practitioner and have worked to improve the health of my patients for more than 18 years.

Heroin addiction is a national problem. In the same way that people with other mental disorders such as schizophrenia or depression need medication, so do those with heroin dependence.

The health authorities recognised the usefulness of Subutex in treating heroin dependent patients, and approved its use in 2002. Since then, several Ministry of Health guidelines have trained doctors like myself in the proper use of this medication, and effectively stopped doctor-hopping by registering patients under the Cards system (Central Addictions Registry for Drugs Singapore).

Over the year, there have been many reports of people abusing Subutex — the only approved and effective medication for the treatment of heroin dependence. And with every negative media article, dozens of success stories go untold.

For every case of abuse of this medication, there are numerous patients who can return to work and contribute to society, re-establish family relationships and raise their children with love, as they try to break free from their dependence.

I have treated a large number of patients who have turned their loves around to become contributing members of society with the help of this medication. The public needs to understand that heroin dependence is a disease that should be treated like every other.

We've discussed this problem previously, and the subject continues to make the news and medical literature (click here to see the scale of the problem, here to find out about an alternative to Subutex, and here to look at some gross pictures of limbs turned gangrenous from Subutex abuse).

My own suspicion is that even with tighter regulation or even total banning, Subutex-abuse will continue to be a problem as long as it is manufactured, whether legitimately or illegally, if it indeed gives 'even more high' than heroin.

The genie is, as it were, already out of the bottle.

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  • I know this may sound like a naive and impractical suggestion but how about changing the system of how often these patients get their dosage of Subutex and then making sure that they are the ones taking it rather than selling it to an abuser?

    A. Daily doses at the clinic and have a nurse ensure that they've consumed it and perhaps monitor some other physiological effects. So that they don't think that i'm coming here everyday just to take medication in front of you, then again it can work both ways.

    B. Have a device that measures the daily physiological effects it has on the body after taking it. Sorta like taking temperature daily?

    I'm not sure if this is effective at all but just throwing ideas around.

    By Blogger Unknown, At July 10, 2006 11:27 pm  

  • Sorry adding on to point B. Monitoring a physiological change so that they can't cheat. But i'm assuming that the imbibing of Subutex will change something e.g. (i know it most probably isn't it but to give a rough idea) blood sugar, the chemical level of Subutex in the body, etc. Device has to record time and day rather than allow user to program that.

    However, that can still be overcome by passing the device on to the abuser.

    By Blogger Unknown, At July 10, 2006 11:31 pm  

  • Another way of course is to have a Daily Observed Therapy system (DOTS) that was used previously for TB patients.

    In other words, the patients go to the clinic, get the single dose and the doctor witnesses them using it the right way.

    But really the issue here is that there will be trafficking of Subutex eventually. Whether the doctors are involved or not.

    Heroin, morphine, opium, cocaine, these were all drugs that were developed to help patients kick off the addictions to each of these drugs. Today the main problem is the drug traffickers supplying these "drugs" rather than doctors.

    I believe the same fate will befall Subutex eventually.

    By Blogger Dr Oz bloke, At July 11, 2006 9:41 am  

  • I guess one way to reduce abuse is to impose very strict regulations like DOTS and a registry to keep tab on all patients and doctors involved to make sure each patient is receiving drugs from only one doctor, and that every patient registered with a doctor are actually taking the drug (instead of 'ghost' patients, which allows the doctor to sell the 'consumed' drug to addicts). A lot of work, but if it really works, it might just be worth the effort.

    If we ban the drug totally, trafficking of the drug (genuine and imitation) will continue as long as the demand is there; and while the illegal trade will continue even when the drug is available legally, keeping the legal 'trade' legal will at least mean some genuine patients benefit from the drug.

    By Blogger angry doc, At July 11, 2006 8:32 pm  

  • angry dr: -nods-
    hopefully something like the DOTS program is implemented. But the sad part about all these is that the ones who use it will be inconvenienced because of the abusers. Like all other things in life, the people who do not inconvenience others always ends up getting penalized because of those who do.

    By Blogger Unknown, At July 12, 2006 12:09 am  

  • The other counter argument to DOTS I am sure is patients complaining that it is so troublesome....they don't want to do it anymore.

    That sort of thing.

    The point for me is this : MOTIVATION is key. If the person is motivated enough, he will kick the habit, Subutex or not.

    If the motivation is not there. Then all this is merely prolonging the inevitable return to status quo.

    A strong reason for quitting and a powerful motivation driving the person on is still the foundation for any successful drug rehab program.

    Let's kid ourselves no more.

    By Blogger Dr Oz bloke, At July 12, 2006 10:56 am  

  • The DOTS like program is actually the law in Australia and New Zealand where they noticed a similar but much smaller problem with Subutex than ours. The pharmacist has to see the ex-addict put the drug under the tongue which is the way it is supposed to be taken. There have been anecdotal reports of people leaving the pharmacy and spitting out the drug and then injecting but the consensus is that this has markedly reduced the morbidity and mortality associated with Subutex abuse.

    By Anonymous Anonymous, At July 14, 2006 10:33 pm  

  • Guns kill people or people kill people? Drugs kill people or people kill people? Are we no longer responsible for the choices that we make? Why do we punish everyone and not the irresponsible people? I am on subatex and thank god because I am pregnant. It actually is better than methadone for my baby since it will have no withdrawal symptoms as I taper off toward birthing. Plus I am a clean and sober mother thanks to it and my choices. But if you keep limiting my choices because of other peoples irresponsibilities, then in a sense you are screwing my child. I wouldn't have this opportunity. I am so sick of more stupid laws, thats all we need is more rules and regulations and if they actually worked people wouldn't still be selling drugs anyways. Obviously we haven't solved the problem and by taking everyone right's/choices away and making their choices for them is only making them want to rebel. Freedom is the answer, and making your own choices and actually taking responsiblity for your actions is rewarding. If you make the concequences far outweigh the choice no one will ever fess up.. which is why no one is now...

    By Anonymous Anonymous, At September 18, 2009 4:23 am  

  • bravo,above anonymous writer,all the laws in the world don't stop people who want to abuse.punishing and or restricting those trying to legally get help for themselves only makes the battle for our lives that much harder.I have been on subutex for over a year now and it has not only saved my life it has also given me the 2nd chance I so desperately wanted. not all users of this medication are abuser.restricting or punishing the responsible because of a few bad apples causes more harm than good.

    By Anonymous Anonymous, At August 27, 2010 7:14 am  

  • Dr Oz i was quite sad to read your comment re if one has the motivstin they will indeed kick the habit. I am seriously guessing that you indeed have never been an addict. Let me tell sucks. Withdrawal is pure hell and at least subutex slows that process ad makes it manageable. Wkae up too the real world. Text books and lifelong beliefs don't make a truth. I'm day 2 of my third attempt and it by no means has been fun. It's hurt, it's been horrible. But my beautiful children need me. They love me regardless and i them, i couldnt care for them and offer complete withdrawal, but i could offer doing my best and trying subutex. Thak God for peopel like Nagry Doctor.....the world needs people such as him as the world's people are just not perfect, we make mistakes and albeight you who judges how to fix those mistakes.

    By Anonymous Anonymous, At June 26, 2011 12:25 pm  

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