Where Addiction Meets Your Brain

The Neurobiology of Addiction

Buprenorphine, Methadone and Opiate Replacement Therapy - 2

After The Harrison Act was ratified, it was the beginning of the DEA and the “Controlled Substances” legislations. Again, although well meaning, this effectively drove addicted patients underground, and the black market for opiates began. Read More


Thanks for speaking on the unspeakable. The government agencies have failed miserably but I think its the responsibility of the specialist in the medical field to begin looking at innovative ways to prevent the growing opiate dependent culture. I think pain pills as a long-term plan is unethical and a very lazy way to care for a patient's chronic pain


Thanks for responding. Ethics in the treatment of people with addiction gets a lot more lip-service than action. Let us continue to speak at every opportunity.

Doctors aren't making any effort to be clairvoyant or even astute

Doctors are busy people earning a buck. As much as patients would like to think their family doctor is trying to be clairvoyant or astute, and attempting to determine when a patient is drug seeking or in legitimate pain, that's not the case.

Doctors are trying to see as many patients as they can within a day. They are billing billing billing. To them, it doesn't really matter whether a patient is drug seeking. What does matter to doctors is whether their practice is operating within federal, state and local guidelines and laws, and in compliance.

If a rich elderly white male who has private insurance wants pain pills he's going to get pain pills out of just about any doctor. A poor black person with Medicaid who has the same request will have a harder time because most doctors will fear that minorities and the impoverished will resell the drugs and spend more time doctor shopping which could trigger state oversight or audit of a medical practice.

Not only is the illegal and legal drug trade corrupt, so is the treatment industry. Doctors, pharmacists, drug dealers, LEOs, Corrections Officers and the courts have all figured out how to turn a profit on the backs of addicts. The treatment industry is no different, everybody has their hand in the pie. Few opiate addicts recover because there is no incentive to effectively and positively deal with drug addiction. More drug addicts means more money for everybody involved.

Thanks for sharing your

Thanks for sharing your thoughts. Over-prescribing doctors tend to be either duped, greedy, codependent or drug-users themselves. Couple that with JCAHO declaring pain to be the "fifth vital sign" and you have a pipeline of opiates that is legit. Please continue to speak out when you are able.

opiate addiction

I have been on prescription opiates since 1989. I have seen it from where in the beginning doctors would see you from beginning to end - in other words help you taper down.
I have seen the time when oxycontin came into use and it was pushed with abandon from broken arms to cancer. I have seen where the company that made oxycontin (and also oxymorphine), both time release painkillers. oxycontin was designed as an opiate to be used illegally. First the oxy was added to increase euphoria. Then, even though the same company made other time release painkillers, like their morphine, with silicone - which made it impossible to inject - changed their oxycontin to be mixed with wax for time release. No reason other than one only had to heat it in a spoon of water and the drug was released leaving only the wax. It was very obvious.
I have seen rehab centers that catered to the well off but in trouble with the law due to heroin possession and sentenced to rehab give their patients as many shot glasses of codine and valium as they could handle.
I have been in, and seen all over the country, this new drug pushed onto rehabs called suboxen. These poor kids come in with a small hydrocodone addiction or usage being prescribed this drug. It is an extremely strong drug that one cannot taper off of. It is made that way.
Now that I am retired (I owned a labor intensive business)and on disability for my injury (after working 20 years with it on pain killers)I have yet been to a pain doctor, which is very difficult to get now, that will take you on with the attempt to taper you off the drugs they got you on. It has been 9 years now and I still cannot get off the drugs. I was on extremely high dosages during my last years of business. I had 170 employees, grossed 10 million a year in business, but completely shut myself down when the county, and then the city, shut down my business after 24 years. I have finally reduced my addiction from 480mg oxycontin a day and 10 10mg methadone a day to 2 10mg methadone and 1 4mg dilidud. I don't know if I can get totally free or not. Very unhappy without the 1 dilidud. It changes your brain chemistry. Oxy is the worst,then dilidud,suboxone, then morphine, then methadone.

Your comments are well taken,

Your comments are well taken, and I am sorry for your pain and suffering. I am not sure if you can get off pain-killers either, but I can tell you that the higher the dose you are on, the lower your pain threshold. I admire your attempts to wean yourself down.
The only thing I would disagree with you about is the use of buprenorphine (Subutex). It is a worthwhile drug if it is used correctly. Unfortunately, it is prescribed without enough follow-up by some doctors and it is not used as it was intended to be prescribed.

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Joseph Troncale, M.D. FASAM, has been working in addiction medicine for 20 years. He is the Medical Director of the Retreat.

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