A heroin addict — we’ll borrow NPR’s nomenclature and call him “John” — needs help. Maybe he can’t afford the price of a hit. Maybe he’s unable to work when he’s focused on getting high instead of getting paid. Or maybe he had an overdose scare — in 2013 alone, more than 8,000 people in the U.S. died due to a heroin overdose. He learns about a drug called buprenorphine or Suboxone (the latter is the brand name) which, according to the New York State Department of Health, “helps people to stop using heroin or other opioid drugs.” The NY Department of Health makesbuprenorphine seem like a great choice for John:
Buprenorphine may be an appropriate treatment for people who are dependent on opioids, such as heroin and prescription drugs. Buprenorphine stops cravings, blocks withdrawal symptoms to prevent “dope sickness” and blocks the “high” from heroin and other opioids. Because buprenorphine helps with withdrawal and cravings, it can help to protect people from risky behaviors and can lower the chance of someone having an overdose. Additionally, people who are dependent on opioids and living with a chronic disease (e.g., HIV) are more likely to adhere to their chronic disease treatment and have better health outcomes if they are on buprenorphine treatment.
And to make matters even better, it’s perfectly legal and available with a prescription. So where does John get his buprenorphine?
From his drug dealer.
Every morning, guys like John visit people like “Mystery Man,” an Albuquerque-area scofflaw who trades in illegal narcotics, drugs, and probably anything else with a large enough black market markup. Mystery Man, per NPR, finds junkies with buprenorphine prescriptions, reimburses them their $50 co-pay (and probably a bit more to sweeten the deal), and then sells the buprenorphine for $5 a pill to guys like John. Buprenorphine won’t help you break the heroin habit, but it will make it easier to get through the day without a needing to take heroin. As Mystery Man told NPR, his customers are better off for it: “People don’t overdose no more. They’re just mellow. If you take [buprenorphine instead of heroin] you won’t be stealing, you won’t be robbing, and you won’t be prostituting.” In another NPR report, one which opens with John’s story, another heroin addict called buprenorphine a “miracle pill.”
Oh, and unlike methadone, the other major treatment for heroin abuse, buprenorphine is not addictive. Further, buprenorphine is very hard to overdose on. Buprenorphine is relatively safe, effective, and not heroin — so why do some addict have to get it from their drug dealers?
First, there’s the general costs and inconveniences of going to a doctor. As the Washington Post notes, “some insurance companies strictly limit the drug. Medicaid isn’t ideal for providers either. It covers the drug but pays only a tiny fraction of the office visit, making it far easier for the well-insured to obtain than the poor.” Many buprenorphine seekers, therefore, find a cheaper alternative, such as your source for the heroin which causes the need for buprenorphine in the first place.
But more importantly, buprenorphine, like heroin, it a type of drug called an opiate — and you can get high off of it. For that reason, it’s typically illegal for a doctor to prescribe an opiate to treat opiate addiction, as the doctors would simply be moving the patients from one opiate to another. Because buprenorphine is so effective at stemming the cravings for heroin, though, Congress made an exception in the case of buprenorphine, passing the Drug Addiction Treatment Act of 2000. Doctors, with some limitations, can now prescribe the drug.
Because Congress doesn’t want opiates flowing freely, the limitations are still very significant. Doctors need a special license to prescribe buprenorphine. To obtain that license, a doctor needs to take an eight-hour certification course and have a certification in addiction or something similar. Even licensed doctors were originally only allowed to prescribe buprenorphine to thirty patients; that limit has since revised upward to 100. These restrictions limit an already small number of doctors who would be interested in helping heroin addicts — those patients aren’t the best customers. If you’re a heroin addict, there simply aren’t enough legal ways to get buprenorphine. By some estimates, as of 2012, fewer than 20% of heroin addicts could be legally treated by the number of doctors authorized to treat them.
The good news is that these numbers are improving — methadone clinics can now often provide buprenorphine to heroin addicts. But there’s still a sizable gap, and we therefore still end up with the ridiculous situation where drug addicts get their anti-addiction treatments from their dealers.
From the Archives: Aspirin (TM): The bonus fact talks about why heroin was invented in the first place — and helps explain why some are concerned that buprenorphine could be a wolf in sheep’s clothing.
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Related: “Beautiful Boy: A Father’s Journey Through His Son’s Addiction” by David Sheff. 4.5 stars on 752 reviews.