Lack Of Suboxone Access Leads Users In Need To The Black Market

By Paul Gaita 10/09/18

President Trump is expected to sign a bill to expand medication-assisted treatment but it remains unclear as to how soon that will take place.

hand offering prescription through laptop screen

A new feature by NPR underscores a potentially dangerous conundrum for health care professionals and individuals seeking treatment for opioid use disorder: while buprenorphine (also known as Suboxone, Subutex and Zubsolv) has proven effective in blocking the effects of opioids, it's also difficult to find and a challenge to obtain due to federal limits on prescribers.

As a result, many prospective patients have turned to the illicit market, where Suboxone can be obtained via diversion, or from patients who sell or give away their own prescriptions.

President Donald Trump is expected to sign a bill to expand medication-assisted treatment (MAT), but as NPR noted, it remains unclear as to how much access will be granted and how soon that will take place.

Along with methadone and naltrexone (Vivitrol), buprenorphine is one of three federally-approved drugs to treat opioid dependency.

As the NPR feature stated, while it is less potent than heroin or prescription opioids, including fentanyl, it is possible to overdose on buprenorphine if mixed with other substances.

But such instances are rare, especially when the drug is formatted with the overdose reversal drug naloxone. As Dr. Zev Schuman-Olivier, an addiction specialist and instructor at Harvard Medical School, said, "The majority of people are using it in a way that reduces their risk of overdose."

Despite its effectiveness and relative lack of harmful side effects, obtaining buprenorphine is subject to federal regulations in regard to who can prescribe it—medical professionals need a special waiver to do so—and how much can be obtained. Currently, those doctors that meet the federal requirements to prescribe buprenorphine are limited to treating 275 patients.

Nurse practitioners and physician assistants may apply for a waiver to administer the medication as well. Under the SUPPORT for Patients and Communities Act, the number of such health professionals and the length of prescription may be increased.

Until that bill is signed, buprenorphine remains both difficult to obtain and expensive. According to 2016 estimates provided by the U.S. Department of Defense, medication and twice-weekly visits to a certified opioid treatment program are $115 per week or nearly $6,000 per year. That puts the medication out of range for many in need, forcing them to turn to diversion situations for assistance.

But as NPR noted, that scenario can be dangerous: patients need assistance from a treatment professional for proper dosage and treatment for mental health issues that may come as a part of addiction.

Diversion has become prevalent enough to warrant calls for more regulations regarding buprenorphine and stronger enforcement against those that break the law. But the NPR story quoted Basia Andraka-Christou, an assistant professor and addiction policy researcher at the University of Central Florida, who said that stricter rules are not what's needed for patients.

"I guarantee you, they're either going to go and buy heroin and get high, which surely is not a great policy solution here," she said. "Or they're going to go buy Suboxone on the street."

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Paul Gaita lives in Los Angeles. He has contributed to the Los Angeles Times, Variety, LA Weekly, and The Los Angeles Beat, among many other publications and websites.