A commonly-used medication that is being used more and more often in the treatment of opioid addiction may be triggering a brand new epidemic of addiction, recreation, overdose and death throughout the United States. Enter Suboxone.
This medication is called buprenorphine. Buprenorphine is far more widely known as Suboxone, its brand name. For many years, Suboxone was marketed only by the pharmaceutical company Reckitt Benckiser. Their patent expired in late 2012, and since then other drug manufacturing companies began rushing to develop their own formulations in the hopes to snag some market share of Suboxone’s $1.5 billion American reach.
There were two generic alternatives to Suboxone introduced to the US market earlier in 2013. Recently, a drug manufacturer in Sweden has begun sale of a menthol-flavored tablet called Zubsolv. Zubsolv is intended to hide the sour, bitter taste of buprenorphine. Other formulas and variations of Suboxone include a film-like strip like a Listerine strip, and a buprenorphine patch, like a nicotine patch. One company has even developed a buprenorphine implantation that is surgically placed under the skin.
In 2014, pharmacists filled over ten million Suboxone prescriptions and buprenorphine alternatives for patients. Many may not have realized that they were actually carrying yet another opioid in the treatment of dependence. Buprenorphine has always been a narcotic, a highly strong and highly addictive pain killer approved as an opioid addiction treatment in 2002 in the US. In combination with naloxone, Suboxone is created. Both drugs are used to help addicts wean themselves off opioids such as Oxyxontin, heroin, hydrocodone, or Vicodin.
Naloxone blocks receptors for opioids in the brain. It triggers abrupt withdrawal symptoms once injected. This drug is an added deterrent to stop injection of Suboxone in addicts. When injested as a pill, naloxone is not absorbed in the body. While praised by experts on dependence as a treatment tool, some are worried the drug is abused and overprescribed.
Reports from SAMHSA (the Substance Abuse Mental Health Service Administration) discovered a tenfold gain in the number of ER visits from users of buprenorphine. Over half of these 30 thousand hospitalizations in 2012 were for non-medical usage of the drug.
The number of deaths from buprenorphine overdose is not known, as medical examiners and coroners do not routinely perform tests for buprenorphine. In many clinics, including Detox of South Florida, Suboxone is used for detox. The issue with Suboxone, though, is that many adducts have discovered that they can use the medication on its own versus using it to assist with addiction recovery.
Suboxone does not get users high, but instead assists with smoothing out symptoms of withdrawal between those highs. It’s a wonderful drug when used as intended. But if users can’t get a drug they are looking for, Suboxone is available at the ready and maintains the mellow, calm stages until they are able to get their next fix.
Suboxone has become so popular amongst addicts that it has morphed into a street drug. One estimate states that almost half of the buprenorphine pushed via legitimate prescriptions is instead diverted to the street or used illicitly. Pharmacist Percy Menzies states:
We joke that there’s more Suboxone on the street than in pharmacies. Most of the heroin dealers are diversified now. They offer you a choice of Suboxone and heroin. And now with all these generic forms coming out, that is going to explode.
My concern is that, just as what happened with chronic pain, we had an explosion of generic oxycodone and hydrocodone being introduced. And look at the mess we had. We’re going to see the same thing happen with Suboxone and buprenorphine generic preparations.
Drug manufacturers are very much aware of the possibilities of tampering and diversions. The manufacturer of Zubsolv, Orezo, has been promoting their tablet in individual-dose blister packs, designed to reduce the accidental digestion by kids. Additionally, Reckitt-Benckiser currently only sells their Suboxone substances in single-serve film strips. They ordered all tablets off the American market recently.
However, experts say that there is no amount of preparations and packaging that can outsmart a determined and desperate drug abuser. Charlie Chicon states:
When they had the pills available, the abusers would crush the Suboxone pills and make a yellow paste out of it. This “paste” was sometimes smuggled into prisons after it had been smeared on the pages of children’s coloring books.
They’d have their little kids color in Mickey Mouse with crayons and they’d send the coloring book to prison to daddy or mommy. Daddy or mommy would know the pages that the Suboxone paste is on and they’d suck it or they’d sell it into the prison system.
Now they’re taking the yellow strips and they’re just taping them onto the pages as yellow squares or rectangles and then coloring around it. I have a coloring book page that has these strips on it that they’re getting into the prison systems. The abusers are always another step ahead of law enforcement.
But the potential for diversion and abuse isn’t a reason to stop treating addicts with buprenorphine, according to a commentary published in the journal JAMA Internal Medicine that calls for a “balanced approach” to the medication.
Over 20,000 doctors in the U.S. are certified to prescribe buprenorphine. Menzies wonders how many really understand the dangers posed by buprenorphine. “The Suboxone doctors, many of them have been very irresponsible, because they have no training in addiction,” Menzies says, explaining that the training frequently only amounts to a few hours of online instruction.
“It is shocking in this day and age that physicians are so incredibly ignorant about the pharmacology of buprenorphine preparations.”
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