Suboxone Assisted Treatment
1 (c) (3) Non-Profit Corporation

Merry Christmas

Greetings!  How are all of you?  Christmas can be a wonderful time of the year for us but it can be really devasting if we are all alone.  It can be an agonizing time if we are in bondage to our addiction and our addiction has alienated us from our families.  

I can understand the dilemma from both sides.  It is not easy for you with the addiction and it hurts those who love you as much as it does you.  Many can't understand why you just can't say,"No."  It is possible even you don't understand-but it is important to me both sides have understanding of Addiction. 

Christmas is the time of year when the use of drugs increases. It is a time when suicide happens more frequently. I really would like to key in on "Adolescent Addiction." I realize it can be very stressful and maybe we don't pay as much attention to our children as we should.

We need to know what  the early signs are.  How else will we be able to detect them? It is my hope all of you with children will commit them to memory and make them part of your New Year's Resolutions.  

Early Signs of Teenage Drug and Alcohol Use 

1. Evidence of drugs or alcohol. The most obvious indication of drug or alcohol use are signs of intoxication, smelling alcohol or drugs on the greath or clothing, or finding alcohol, drugs or drug paraphernalia, such as pipes or rolling papers, in your teenager's
room clothing or car.  Any on of these indicators is cause for a frank discussion.

2. Change in previous level of functioning. This can be somewhat less obvious but is often an earlier signal that there may be a problem. It's important that parents be alert to any significant changes or decline in the following areas: 

> Change in school performance, such as a decline in grades,decreased motivation to complete assignments or be involved in school activities, skipping classes/truancy.

>  Significant changes in sleep habits (sleeping much more or much less), level of activity, appetite (increased or decreased), or hygiene. 

>  Significant changes in behavior and/or mood, such as increased irritability, aggression, disregard for rules, mood swings, depression, expressing suicidal thoughts or behaviors.

>  Decreased involvement in social activities, such as team sports or school-related activities, loss of interest in a favorite hobby.

>  Association with a deviant peer group, gang involvement, legal problems. 

A significant change in mood, behavior, academic performance, or peer group does not neccesarily mean your teenager is involved with drugs or alcohol.  It does mean a heart-to-heart, parent-child talk about concerns and problems is in order.   

Don't feel like you have to handle everything alone.  There are a growing number of clinical professionals  with training and experience in evaluating and treating mental health  and substance abuse problems in adolescents. This is important, because adolescents with substance abuse have a higher risk of having co-occuring mental health problems such as depression or attention deficit-hyperactivity disorder (ADHD), compared with adolescents who are not using substances.  

Will they just "grow out of it?"  

Yes and no. While it is true that many teens simply grow out of problem behaviors that arise during the teenage years, many do not, and it's almost impossible to tell who will and who won't at the time the problem behavior begins. The important thing for parents to know is that they should take problems like adolescent drug use seriously and seek appropriate support and treatment as soon as a problem is identified. They can help to ensure their children will grow out of it, and flourish as happy and healthy individuals as they move into young adulthood.   

Reference: Paula D. Riggs MD
Associate Professor, Department of Psychiatry, University of Colorado

            The Cost of A Smile

I am a 58-year-old woman who was fortunate enough to have the world's greatest mom with me until a year and a half ago. There are no words to describe how much I miss her.

I know this may seem strange to tell and believe me, I am not looking for a substitute for my mom, but I have found myself looking at elderly ladies and thinking how nice it would be to adopt one.

At the grocery store just last week, I saw a dear person near me; we were both bagging some produce. I looked at her and politely said, "The produce here is always attractive isn't it?"

Why did I engage in a conversation?

Because I just needed a smile or a kind word from this lady.
What I got has had a profound effect on me. This sweet person looked at me as if I were an alien, did not speak and did not smile, but just looked at me dumbfounded. I moved away crushed and almost cried.

I NEEDED her to give me just a kind word or a smile, no more. I vowed then to always stop what I am doing no matter how much in a hurry I am or what the other person looks like, and give that kind word or smile. Give the kind word or a smile.

It may be really NEEDED.

 None of us knows what is going on in the life or thoughts of another. As my sister so wisely pointed out as I related this story to her, we are all God's children and He loves all of us no matter how we may look to each other.

A kind word or a smile can be just a brief encounter in our life but can last forever in the heart of another.

 Reference:  Pat Ferguson/ Mountain Wings Original

The "The Cost Of A Smile" was sent to me. I believe it was words we all need to hear.  It doesn't take much to give another person a "Smile."  How often is it we take the time to let those we appreciate know how much they mean to us?  How often do we tell our Mother and Father how much we appreciate them?  Parents, what about you?  Do you let your children know how much you love them? (I am not speaking by actions alone but by saying the words, "I love you.")

 It doesn't cost you any money...only time! I want  you today to take the time out of your busy schedule to stop and let someone know how much they mean to you because you never know if another chance will present itself . Sometimes, people, especially parents and husbands, assume you know they love you.  I am here to clarify the misconception.  

I can tell you as a child I did not hear, " I love you," from mine. I then married and we become one parent and marry the other,(it's true) therefore, I never heard, " I love you" from my husband. I  knew they loved me in some part of my being but I needed to hear the words.


As long as we look outside of Self - with a capital S - to find out who we are, to define ourselves and give us self-worth, we are setting ourselves up to be victims. We were taught to look outside of ourselves - to people, places, and things; to money, property, and prestige - for fulfillment and happiness. It does not work, it is dysfunctional. We cannot fill the hole within with anything outside of Self.

You can get all the money, property, and prestige in the world, have everyone in the world adore you, but if you are not at peace within, if you don't Love and accept yourself, none of it will work to make you Truly happy.

When we look outside for self-definition and self-worth, we are giving power away and setting ourselves up to be victims. We are trained to be victims. We are taught to give our power away. As just one small example of how pervasively we are trained to be victims, consider how often you have said, or heard someone say, "I have to go to work tomorrow." When we say "I have to" we are making a victim statement.

To say, "I have to get up, and I have to go to work," is a lie. No one forces an adult to get up and go to work. The Truth is "I choose to get up and I choose to go to work today, because I choose to not have the consequences of not working." To say, "I choose," is not only the Truth, it is empowering and acknowledges an act of self-Love.

 When we "have to" do something we feel like a victim. And because we feel victimized, we will then be angry, and want to punish, whomever we see as forcing us to do something we do not want to do such as our family, or our boss, or society."

Codependence: The Dance of Wounded Souls

Codependence and recovery are both multi-leveled, multi-dimensional phenomena. It is very easy for me to write hundreds of pages about any single aspect of codependence and recovery what is very difficult and painful is to write a short column. No facet of this topic is linear and one-dimensional, so there is no simple answer to any one question - rather there are a multitude of answers to the same question, all of which are True on some level.

So in order  to facilitate writing a short column on this month's topic, I am going to make a brief point about two dimensions of this phenomena in relationship to empowerment. These two dimensions are the horizontal and the vertical.

In this context the horizontal is about being human and relating to other humans and our environment. The vertical is Spiritual - about our relationship to the God-Force. Codependence is at it's core a Spiritual disease and the only way out of it is through a Spiritual cure - so any recovery, any empowerment, depends upon Spiritual awakening.

Now that said, I will write this column about the other dimension. On a horizontal level empowerment is about choices. Being victimized is about not having choices - about feeling trapped. In order to start becoming empowered in life it is absolutely vital to start owning our choices.

As children we were taught that it is shamefully bad to make mistakes - that we caused our parents great emotional pain if we were not perfect. So as adults most of us went to one extreme or the other - that is we tried to do it perfect according to the rules we were taught (get married, have a family and career, work hard and you will be rewarded, etc.) or we rebelled and broke the rules (and usually became conformists to the anti-establishment rules). Some of us tried going one way and then, when that didn't work, turned around and went the other.

By going to either extreme we were giving power away. We were not choosing our own path we were reacting to their path. Integrating the Spiritual Truth (the vertical) of an unconditionally Loving God-Force into our process is vital in order to take the crippling toxic shame about being imperfect humans out of the equation. That toxic shame is what makes it so hard for us to own our right to make choices instead of just reacting to someone else set of rules.

Recovery from codependence is about balance and integration. Finding the balance of taking responsibility for our part in things while also holding others responsible for their part. The black and white perspective is never the truth. The truth in human interactions (the horizontal) is always somewhere in the gray area.

And we always have a choice. If someone sticks a gun in my face and says, "Your money or your life!" I have a choice. I may not like my choice but I have one. In life we often don't like our choices because we don't know what the outcome is going to be and we are terrified of doing it 'wrong.'

Even with life  events that occur in a way that we seemingly don't have a choice over (being laid off work, the car breaking down, a flood, etc.) we still have a choice over how we respond to those events. We can choose to see things that feel like, and seem to be, tragic as opportunities for growth.

We can choose to focus on the half of the glass that is full and be grateful for it or to focus on the half that is empty and be the victim of it. We have a choice about where we focus our minds.

In order to become empowered, to become the co-creator in our lives, and to stop giving power to the belief that we are the victim, it is absolutely necessary to own that we have choices.

As in the quotation above: if we believe that we "have" to do something then we are buying into the belief that we are the victim and don't have the power to make choices. To say "I have to go to work" is a lie. "I have to go to work if I want to eat" may be the truth but then you are making a choice to eat. The more conscious we get about our choices, the more empowered we become.

We need to take the "have to"s out of our vocabulary. As long as we are reacting to life unconsciously we do not have choices. In consciousness we always have a choice. We do not "have to" do anything.

Until we own that we have a choice, we haven't made one. In other words, if you do not believe that you have a choice to leave your job, or relationship, then you have not made a choice to stay in it. You can only Truly commit yourself to something if you are consciously choosing to do it.

This includes the area that is probably the single hardest job in our society today, the area that it is almost impossible not to feel trapped in some of the time - being a single parent. A single parent has the choice of giving their children up for adoption, or abandoning them. That is a choice! If a single parent believes that he/she has no choice, then they will feel trapped and resentful and will end up taking it out on their children!

Empowerment is seeing reality as it really is, owning the choices you have, and making the best of it with the support of a Loving God-Force.

There is incredible power in the simple words "I choose." ¤

Reference: Robert Burney M.A.   Heroin Times July 2007

  Treatment of Acute Pain In Patients Receiving Suboxone

Buprenorphine is a partial agonist at the mu opioid receptor. As such, buprenorphine can provide analgesia, although the doses used generally for analgesia in other countries ranges from 0.2 to 0.6 mg., sublingually  and  the  duration of  effect is  limited to 68
hours. No peer-reviewed published data is available to advise the appropriate dose of bup/nx for the management of acute or chronic pain.

As a mu agonist, buprenorphine effectively blocks the analgesic properties of other opioids that could be use to treat acute pain. In addition, providing buprenorphine after a full mu agonist can result in precipitated withdrawal in a patient who has already taken an agonist opioid medication to treat acute pain.

General Principles:

Inform patient of your awareness of their addiction and provide
reassurance that their addiction will not be an obstacle to pain management.  Include the patient in the decision-making process to allay anxiety about relapse.  Offer addiction-counseling as needed.

Patients who are opioid dependent should not be denied pain treatment with opioids when indicated. Maintenance opioids should  not  be  expected  to adequately treat new onset acute pain. Patient controlled anesthesia (PCA) can be used in opioid dependent patients with acute pain.


Level of evidence: Very low – expert opinion/clinical experience For patients receiving bup/nx who develop or are anticipated to have acute and limited (e.g. 2 hours to 2 weeks) pain that will not be adequately treated with nonopioid analgesia, the following steps are recommended:

1.   Anticipated pain (e.g. elective surgery, tooth extraction)

> Temporarily discontinue bup/nx 24-36 hours prior to anticipated need for analgesia ·

> Provide adequate opioid analgesia, titrate to effect. It is good practice to know the usual doses needed for patients undergoing the planned procedure. Discuss with your colleagues and remember that patients who are opioid dependent and who have recently received bup/nx will likely need higher than usual doses of opioid analgesics due to their physical tolerance and/or narcotic blockade from recent doses of bup/nx.

> Do not provide bup/nx while patient is receiving opioid analgesia. Discontinue opioid analgesia once pain has remitted or can be managed with nonopioid analgesia.

> Allow patient to experience mild to moderate opioid

> Re-induce patient onto bup/nx as per usual.

 > Note: single doses of opioid analgesics (e.g. post dental extraction) may be effective even if bup/nx has not been discontinued. However, patients should be cautioned to avoid bup/nx dosing during period that opioid analgesic is likely to be occupying receptors.

2. Unanticipated pain (e.g. major trauma, renal colic, acute fracture)

> Determine when the last dose of bup/nx was ingested and temporarily stop bup/nx.

> Options to consider: regional anesthesia, increased dose of buprenorphine, high potency opioid such as fentanyl, providing alternate opioid agonist treatment such as methadone during period of pain management.

> Provide adequate opioid analgesia, titrate to effect. It is good practice to know the usual doses needed for patients who experience this event. Discuss with your colleagues and remember that patients who are opioid dependent and who have recently received bup/nx will likely need higher than usual doses of opioid analgesics due to their physical tolerance and/or narcotic blockade from recent doses of bup/nx.

 Monitor/caution patients regarding the potential for oversedation during the first 72 hours after the last bup/nx dose. While the initial effect of a full agonist may be blocked by buprenorphine, as this blockade fades, the full agonist effect may become clinically evident.

> Do not provide bup/nx while patient is receiving opioid analgesia.

>  Discontinue opioid analgesia once pain has remitted or can be managed with non-opioid analgesia.

> Allow patient to experience mild to moderate opioid withdrawal.

>  Re-induce patient onto bup/nx as per usual.  

References:  European Journal of Pain: Ejp. 9(5):599611, Annals of Emergency Medicine.43(5):580-4, 2004 May

Kogel B. Christopher T. Strassburger W. Friderichs E. Interaction of mu-opioid receptor agonists and antagonists with the analgesic effect of buprenorphine in mice. [Journal Article] 2005 Oct.

Sporer KA. Buprenorphine: a primer for emergency physicians. [Review] [46 refs] [Journal Article. Review. Review, Tutorial]

Savage, S. R. (1998). Principles of Pain Treatment in the Addicted Patient. Principles of Addiction Medicine, SecondEdition.A. W. Graham and T. K. Schultz. Chevy Chase, MD, American Society of Addiction Medicine: 919-944

Medication-Assisted Treatment for Opioid Addiction in Opioid  Treatment Programs. CSAT-SAMHSA, DHHS, Rockville, MD. Treatment Improvement Protocol (TIP) Series 43.

 It's about the time for Santa to arrive. I am truly hoping your Christmas Holidays will be all you expect them to be.  It is very difficult to cope even if you are not disabled with pain and /or if you are dealing with addiction issues. We are not here to judge you, nor condemn you, only to help you find your way out of the wilderness.  

I speak to you as one having dealt with many of the issues affecting most of you.  I do understand and I am here for you. We stay open twenty-four hours every day of the year and we hope if you need help and /or just someone to listen to you that you will not hesitate to give us a call.  If you can just call our number and let it ring once then we will call you back at our expense. We have Caller Identification.  

If you can't afford to call but you have access to the Internet, I will be checking to see if there are any of you requesting for us to give you a call. Please send your requests
Please do not forget to leave the number I can reach you at and when you would like me to give you a call.  It would be my pleasure to be available to meet new friends Christmas and I welcome you to reach out to us. 

We can be reached at:  770.428.0871 Office
                                   770.527.9119 Cellular
                                   770.428.8769  Help-Line

From All The Staff at Suboxone Assisted Treatment.

Writtten:  Deborah Shrira     Dated: 8 December 2007