Opiate Addiction Implant Receives Mixed Reactions In Vermont

By Kelly Burch 08/11/16
As the state prepares to roll out the first-of-its-kind implant, doctors and users are chiming in with their thoughts and concerns about the costly treatment.
Opiate Addiction Implant Receives Mixed Reactions In Vermont
Probuphine PhotoBraeburn

In May, the Food and Drug Administration approved the first implant for the treatment of opiate addiction. The implant, called Probuphine, is inserted into the upper arm and releases a continuous, low dose of buprenorphine (commonly marketed as Suboxone) for six months. 

Now, the implant is beginning to be used by patients, but both patients and doctors have mixed opinions on the new treatment method. 

On one hand, Probuphine cannot be lost, traded, or accidentally ingested by a child—all dangers that buprenorphine pills and dissolvable strips currently have. This solves the major problem of diverting drugs—selling or trading doses—that can undermine the efficacy of a medication-assisted treatment program. 

"Addicts will always find a way to alter whatever it is they have to get high," Dr. Patricia Fisher, the medical director for case management at the University of Vermont Medical Center told Seven Days Vermont. However, with the implant, "you can't do that unless you're going to take it out of your arm somehow.”

The issue of diverting drugs is particularly important in Vermont, where the prison system has seen an influx of buprenorphine smuggled into correctional facilities on stamps and letters. 

Although Probuphine can address the problem of diversion, the advantage comes at a cost: a sixth-month dose of Probuphine is $5,000, more than double the $1,800 cost of a sixth-month supply of buprenorphine pills or dissolvable strips. 

The FDA approval calls for Probuphine to be used as part of a treatment plan that includes counseling and psychosocial support. However, some people who work in the treatment industry worry that the sixth-month dose implanted in one session will remove the motivation for patients to attend counseling and other sessions if they do not need to come to clinics for pills or a prescription.  

"We don't want people to think that this is just a magic answer,” Barbara Cimaglio, Vermont deputy commissioner of health, told Seven Days. “We want to make sure that we're not giving people false security that this is something that, all by itself, is going to be a miracle.”

However, for people who are ready for a bit more independence in their recovery, Probuphine can be a good alternative. 

"I think it would be a game-changer, because people would be able to get help and be stable without having to spend days upon days going to clinics," Cimaglio said. "They could get on with their life.”

The FDA approved Probuphine specifically for patients who are already stable on low doses of buprenorphine, and in an established treatment program. 

In Vermont, the opiate crisis is so acute that Governor Peter Shumlin devoted his 2014 State of the State address to the issue. But in the two years since, there has been no deceleration in opioid-related deaths in the state. In 2015, 76 people died from opioid overdoses, and 24 died in just the first three months of 2016. 

The rollout of Probuphine in Vermont has happened in phases. Blue Cross Blue Shield of Vermont covers Probuphine, but the implant has not been approved by Vermont’s Medicaid, and the state’s opiate treatment centers don’t currently offer it. This means that few patients have had a chance to access the new implant.

The patients that spoke with Seven Days were hesitant to try the new treatment. 

“I'd have to talk to somebody that's done it," said Todd Wells, who takes buprenorphine to combat a Percocet addiction. "I would be like, 'How does it feel?’"

Another man, John Nolan, told the paper that while he only gets relief from methadone, not buprenorphine, he was happy to see advances being made and more options for medication-assisted treatment. 

"If you stay clean and sober, you can have somewhat of a life," Nolan said.

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Kelly Burch writes about addiction and mental health issues, particularly as they affect families. Follow her on TwitterFacebook, and LinkedIn.