Polysubstance Abuse and Suboxone Treatment

David, a 45 year old man, presented after a one year history of illicit use of Percocet; up to 50 mg daily to treat his chronic back pain. He did not experience any other symptoms of mood or anxiety except those associated with his using. He had been sober for six years prior to this relapse which followed a back injury. His back symptoms were alleviated with injections by his back surgeon and he expected to one day require surgery (Percocet is an opiate that he was abusing, so this does not make sense). He had been unable to stop Percocet on his own or control his using. He had begun to obtain his opiates illegally to avoid going into withdrawal and to control his craving. He was experiencing feelings of guilt and shame because of his inability to stop using.

David reported he was always a “partier” in his teens and early adulthood. His drugs of choice were alcohol and cocaine. In 2008 David went to an inpatient 28 day program to stop using and continued his recovery process with a local 12 step group in which he was quite active with good support. After his relapse he had quit going to meetings out of embarrassment, thinking of himself as a failure. David reported he was always a “partier” in his teens and early adulthood. His drugs of choice were alcohol and cocaine. In 2008 David went to an inpatient 28 day program to stop using and continued his recovery process with a local 12 step group in which he was quite active with good support. After his relapse he had quit going to meetings out of embarrassment, thinking of himself as a failure.

 

David presented for treatment wanting to go on Suboxone, as he had read about it and heard of it from friends. We discussed its risks and benefits as well as its role in his recovery. We were able to discuss the process of stopping his illicit opioid use and initiating the Suboxone treament. He was able to make the switch with minimal discomfort. Since starting Suboxone treatment he has not used any illicit opioids and is working with his back surgeon and psychiatrist to coordinate the role of Suboxone treatment in his pain management as well as his sobriety. He has returned to his 12 step community and reconnected to his family supports as well.