With approximately 150 people dying every day currently in the USA from an opioid overdose (CDC stats) – 60,000 a year – I want to share some basic information about Harm Reduction treatment options that my husband and I regret not choosing 6 months before our son died of a heroin overdose.
Buprenorphine (Subutex) is a narcotic that is an opiate agonist. Like heroin and other drugs derived from morphine, buprenorphine contains chemicals that link with opioid receptors in the brain to reduce pain and produce feelings of well-being. Buprenorphine was prescribed for many years as a pain reliever before it was approved for opioid addiction in 2000. It replicates the actions of opioid drugs — only to a much lower degree due to long-acting effects that can relieve cravings for opiates without giving the high and has a more mild withdrawal. But it can still be abused and overdoses do happen, especially when used with other drugs or alcohol.
Suboxone is a combination 4:1 of buprenorphine and naloxone, an opioid antagonist. Naloxone (Narcan) is used to quickly bring someone out of an opioid overdose. Suboxone was developed in response to a need to discourage users from abusing buprenorphine by injecting or snorting the drug to get high. Naloxone was added to the buprenorphine to keep the user from feeling the effects of the opioid. It was first released for use in 2003.
Our son’s addiction doctor prescribes Suboxone due to its proven ability to help addicts gradually and safely detox while they also participate in 12-step programs and counseling. It can take years of gradually decreasing doses to help and addict fully recover. Sadly, there is a federally imposed limit on how many patients a certified addiction doctor can treat each year with these drugs. Until 2017, the limit was 100 patients. It has now been raised to 275. This is woefully insufficient given the number of people addicted to opiates in our country.
In 2000, Congress passed the DATA-2000 Law limiting the number of patients a physician can treat annually for addiction. National Alliance of Advocates for Buprenorphine Treatment (https://www.naabt.org/reasons.cfm) has an excellent article on why we need to end the limit on care with these life-saving drugs. They give 20 reasons the law needs to be changed immediately. #20: “No other medications have such restrictions, including the prescription drugs people get addicted to and die from. Like many well-intentioned laws, the unintended consequences are significant.”
Suboxone is not a magic bullet, and we knew that when we rejected it for our son in 2014. He had been on Suboxone 5 years before and he was prescribed 32 mg a day – the starting dose now is 8 mg a day. Because of that high dose, the withdrawals were so much worse than those from heroin – and he was hesitant to go through that again at some future date. We thought he needed to ‘just try harder’ and be more committed to a recovery program. And it was expensive and not covered by our insurance. Sadly, we failed to realize that he needed both medication and a program. He went through withdrawals once again, entered a sober living home and did great for almost 6 months. But he needed oral surgery and was given Percocet and within 3 weeks he had relapsed and died of a heroin overdose. As it has been said, Harm Reduction methods may not be perfect, but you can’t recover if you are dead.