Jeremy Spiegel M.D.

Mind Tapas

Confessions of a Maine Suboxone Doctor

A couple things I've learned treating opioid addiction.

Posted Jun 24, 2019

In this brief blog post I’d like to confess to you two things I have learned in years of practice treating people with opioid addiction.

Pixabay License
Calm Maine waters in Casco Bay
Source: Pixabay License

First, the medication buprenorphine (Suboxone, Subutex, Zubsolv) continues to prove extremely useful for so many people whose addictions ruined their lives.

Second, and just as important, is something which when combined with this medication-assisted-treatment has seemingly unlimited potential for restoring to equilibrium the sinking ship of a person drowning in the sea of addiction.

This second something is as intuitive as steamed lobster is red. Time.

When I say “time” what I’m talking about is, in part, the time it takes to be listened to by your doctor. Yes, to be heard in the physiological sense of hearing goes without saying. But to be listened to by your doctor, well, that’s what has the potential to propel someone to realizing their best life is what lies before them. This is especially true when your doctor is skilled at discriminative listening, when he is able to suss out what you may be having difficulty communicating directly. One example could be when you say, “I’m fine” when you actually mean or wish you could just plainly state, “I’m still struggling so much you have no idea, but I automatically put on a happy face as the saying goes…”

I do a lot of intentional wondering when I sit with my patients. “What does this person want for themselves?” I wonder to myself each time my patient sits in my office’s comfy leather chair once the squall has calmed. That is, once buprenorphine brings withdrawal symptoms to a halt, eliminates craving for opioids, and diminishes drug dreams.

“Now that you have time, time enough to breathe freely between office visits--to borrow a phrase from the legendary physician and healer Bernie Siegel, MD--what will you do with your time?”

The beauty of office-based treatment is that someone is free to explore what life could be without so much time wasted. Wasted time. What I’m told repeatedly from week to week and from year to year is the worst part of all in the struggle with addiction is time gone to waste.

Indeed it takes time to seek out drugs on the street; it takes time to plan to seek out drugs on the street; it takes time to plan having excuses on the ready for why they’re not participating fully in the lives of those around them; it takes time to recover from the previous day’s “going hard”; it takes time to suppress deep regret and self-hatred often accompanying a vicious, tempestuous cycle of chemical dependence.

Each patient’s own newfound freedom regularly brings to my mind that classic Twilight Zone episode when Henry Bemis, “a bookish little man with thick horn-rimmed glasses [who] wants only one thing out of life: the time to read,” finds himself on book-strewn steps of the public library with “time enough at last”.

Slightly down the road when the patient is beginning to get somewhere in their treatment, when the moment feels right I ask again, “What will you do with your time?”

And so they tell me.

And so they show me.

And I believe with all the strength of the winter winds of Casco Bay now giving way to calmer seas on a tranquil summer’s evening that it is here where real recovery begins. Here in the stiller waters of time. In the time between office visits.

With time enough at last, to make right what was once heeling to port and to starboard and then back again, and again, and again.

In the right hands, and with the time it takes to deeply listen, medication-assisted-treatment provides time enough at last.