All Hail the New Prozac

“ALL HAIL THE NEW PROZAC!
SUBUTEX™ (Buprenorphine) FEELING BETTER THAN WELL?”

I remember the hyperbole back in the mid 1990’s when Peter D Kramer published his best selling book “Listening to Prozac” and hailed the new era of ‘psychopharmacology” Prozac and its SSRI cousins were hailed as the cure all maladies and a general panacea for the ills of modern times. Thousands of middle class wannabe neurotics and gullible GP’s prescribed the drug by the millions, spawning the culture of Elizabeth Wurtzel's “Prozac Nation” and earning the share holders of Elly Lilly a few more billion dollars in the bank. If any one followed Miss Wurtzel and her later books (More, Now, Again: a Memoir of Addiction) she rather unsurprisingly she turned away from Prozac and discovered the best immediate ‘anti-depressants’ since time immemorial – Opiates. Simply, what you or me would call good old time junk.

Whilst this may seem like a pointless aside in terms of the drug using fraternity and in terms of the treatment methods on offer to day to ‘Addicts’, I can’t but help see an underlying parable to the latest wonder drug our medical practitioners have seen fit to prescribe as a treatment for Opiate addiction - SUBUTEX™. I remember when SUBUTEX first came to prominence in the UK I was told by my well meaning key-worker that Buprenorphine was indeed this cure all; withdrawal from Heroin was to be a thing of the past with this painless option for detox and maintenance. What was offered on the table was the long awaited safe and reliable alternative to the evils of Methadone or Benzodiazepine/DF118 related detoxs.

My own personal experiences with the drug have been a mixed bag and I am certainly not one to condemn it or dissuade anyone from choosing it as either a method for detox or maintenance. The advent of Buprenorphine for the treatment of addiction as undoubtedly has been a blessing. However, I do feel that certain dangers have been overlooked and much in the same way as Valium and Librium were proclaimed as non addictive replacements for the barbiturates medical history has an uncanny knack of repeating itself over and over again. It was perhaps the 6 weeks stint of sleepless nights and protracted withdrawal that perhaps inclined me to review my position on the drug. I had been on maintenance at a lowly 4mg for about 18months and so fell the need to perhaps heed warning to those conned into the idea of an easy ride when finally deciding to taper off.

Another major concern and far more worrying than my personal angst, is the growing use and abuse of Buprenorphine worldwide. If reports are to be believed it’s becoming the no.1 drug of choice for those who may not have access to Heroin.

This worrying statistic from the “International Herald Tribune” in reference to the drugs illicit use and popularity in Georgia is proof enough of the massive global proliferation of the drug.

“Consumption of Buprenorphine nearly tripled globally from 2000 to 2004, according to the UN's International Narcotics Control Board, increasing to 1.7 billion DDD, or defined daily doses, a World Health Organization statistical measure of drug consumption.”

Nepal, Bangladesh, Sri Lanka and Finland are all noted as problem areas where the same article allegedly professes that Bupe is being used by up to 90% of IDU’s!

Aside from this worldwide phenomenon closer to home there are various reports from both inmates and prison staff (who shall not be named here) that SUBUTEX is becoming the most popular drug now in HMP UK. Many prisoners choose to snort the drug as it does not appear in most standard drug tests. After periods of abstinence from other Opiates I’m reliably informed it will get you ‘battered’ or extremely intoxicated if we’re using more appropriate terms.

How many of those users that pick up there doses from pharmacies that inject their SUBUTEX we do not know. However it is extremely inadvisable as it’s known to cause serious damage to veins, abscesses and other serious complications. Due to the drugs solubility in water since the days of Temgesic it has always been a prime candidate for injection and combined with Benzo’s can lead to overdose and death.

Whilst personally I would not like to see us go down the Suboxone (Buprenorphine mixed with Naltrexone) route that our American cousins employ – perhaps we could consider prescribing Ampoules for those that are not ready to give up injection quite yet. For many drug users ritual is a massive part of the habit and it is not always as simple as going from IV use to dissolving tablets under your tongue.
Overall and put in context the introduction of Buprenorphine as a treatment for Opiate users has been a beneficial and productive step forward. The rapid 13 day detox has helped out many friends I have known and given many thousands of people the change to tackle their habit, especially if they have been wary or unwilling to go down the Methadone route. Long term maintenance on SUBUTEX is perhaps more controversial and I know many people struggling with even the smallest drops in their prescribed amount. It was my own protracted withdrawal that prompted me to perhaps review what information I’d be given about SUBUTEX myself and friends who have had serious consequences from the injection of their tablets (which I’d never advise.)

To finish off – I’d like to return to where I started though and to return to the subject of antidepressants. There are various sources on the web and medical tracts that have looked at the benefits of using Buprenorphine for the treatment of depression that have had seemingly productive results. While I do not profess to be a medical or pharmaceutical expert, it’s a shame that in the climate of Opiate phobia that much of the medical profession are constrained by that research and development of drugs like SUBUTEX for the treatment of mental illness. The mood stabilising effects of such drugs could have a wide benefit for all kinds of mood disorders and not just those deemed as addicts. Whilst GP’s and Psychiatrists are happy to hand out hand out highly toxic anti-depressants, anti-psychotics with dubious efficacy and highly addictive Benzodiazepines, it is a shame that further research isn’t done into true ‘mood brighteners’, which drugs like Bupe could well be…………………..