Suboxone® (buprenorphine) therapy is one of the most promising treatments for opiate addiction. Buprenorphine is the first addiction drug that can be doctor-prescribed in the office, much like medications for the treatment of “common” conditions such as diabetes and hypertension. Until buprenorphine was approved for the treatment of opioid dependency, methadone was the best option for treatment. However, methadone is highly regulated, and requires the patient to receive treatment in a structured clinical environment. With approval of buprenorphine for the treatment of opioid addiction, treatment has entered the mainstream. It couldn’t have happened at a better time. The abuse of prescription drugs and pain pills cuts across socioeconomic lines. Abusers can be found in every economic, age, and race classification. Addiction experts hope that the accessibility to Suboxone therapy will draw more of the nation’s 1.1 million opioid addicts into treatment.
But ironically, this accessibility presents challenges of its own. I recently attended an international addiction conference that included several presentations on the abuse of Suboxone itself. If a current trend continues, my fear is that buprenorphine will follow the same highly-regulated path of methadone treatment, and will become increasingly difficult to obtain.
Currently, physicians desiring to prescribe buprenorphine for treatment of opioid dependency need only take eight hours of training and apply for a waiver to prescribe it. Then, once they begin treatment of a patient with buprenorphine, they are supposed to administer periodic urine tests and encourage participation in therapy or 12-step programs. As a physician who works in an addiction practice, I can tell you the second part – the treatment protocol – is “easier said than done.” Further, despite the handful of mavericks who will prescribe buprenorphine with little understanding of how it is abused, it’s my opinion that the addicted community itself will put the accessibility to Suboxone at risk for everyone.
Not surprisingly, many web sources describe in detail how a person can use Suboxone (or Subutex) to “get high.” In fact, I believe the recent uptick in abuse is in part because addicts are ingenious. If there is a potential to abuse a mood altering substance, they will find a way. I recently read a blog detailing how to use micron filters to “bang that s___” or snort it.
More doctors are prescribing buprenorphine, but it’s the street abuse of this medication that demands the attention of the DEA and medical boards across the country. This problem will get worse since buprenorphine is available in generic form – in addition to the treatment of opioid addiction and withdrawal symptoms, it is being prescribed for other afflictions, including (but not limited to) pain.
What does all this mean? As buprenorphine therapy increases, it has the potential to become a drug that is increasingly abused. We are drifting toward this extreme. There will always be a few that turn what’s meant for good into wrong, but surely we have grown enough as a society to know you can’t punish the many for the actions of a few. My hope is that those who have benefited from this drug will do their best to ensure that it remains available to others by using it appropriately.