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Friday, September 26, 2014

Suboxone Abuse: Tales and Truths

Suboxone is a drug that was developed by Reckitt Benckiser, a British pharmaceutical company, for treatment of addiction to drugs like heroin, hydrocodone, OxyContin, morphine, codeine, fentanyl and others. It was approved by The Food and Drug Administration in 2002 for such use.

Suboxone prevents withdrawal when someone stops taking opioids by producing effects similar to those drugs. Therefore, it is considered a "partial agonist," binding to opioid receptors in the brain and producing endorphins, the so-called "happy hormones," but not as many as full agonists such as morphine or methadone. Doctors say this makes it more difficult to abuse.

Sadly, almost as soon as it was approved, Suboxone began to be abused by some individuals. Here is a report from the Louisville Courier-Journal about three people who did just that:

1. Kenny

Kenny Stearns III first took Suboxone to help him kick OxyContin after an overdose. At first, Stearns melted Suboxone tablets under his tongue. But it wasn't long before he began dissolving Suboxone strips in water and shooting the mixture into his veins.

His life spiraled so far out of control that he was kicked out of a homeless shelter for drug use. "The first few times I used it, I could get really high from it. Then I just felt normal ... I wasn't high, but I wasn't sick either," said the 25-year-old from New Castle, Indiana. "To me, it's just trading one addiction for another."

Looking back, Stearns said he went to the wrong doctor — one who did nothing but prescribe Suboxone, accepted only cash and never offered counseling.

Stearns said he stayed off other drugs for a little while but soon returned to meth, using Suboxone as a "backup."

2. Nicholas

Nicholas Merola, of southeastern Ohio, said he also first got Suboxone from a cash-only doctor. He recalled being prescribed a month's worth of tablets, taking half a tablet a day and selling the rest. Over the next four years, he said, he did the same with prescriptions from 10 other doctors.

"If I would've took it as prescribed, I'd probably be pretty doped up. Taking half a day, it made me feel not sick," Merola said. "There are two reasons people take it: to get off drugs, and as a crutch to keep from getting dope-sick."

3. Evan

Evan Blessett of Jeffersonville, Ind., said some Suboxone users simply use the drug to get high. That's why he tried it at 17, buying it from a friend with a prescription.

"I liked it," said Blessett, 27, who previously had abused alcohol, marijuana and pain pills. "It was very similar to OxyContin, a heavy, sedative feeling."

Like Stearns and Merola, Blessett got hooked. He began selling his Suboxone for $20 to $30 apiece, using the money to fuel his habit.

All three men are now in recovery, Stearns and Blessett at The Healing Place and Merola at Chad's Hope Teen Challenge in Manchester, Kentucky. None is a fan of Suboxone.

(Laura Ungar. "Addiction Medicine Suboxone Now Being Abused." The Louisville Courier-Journal. 5, 2014)

The drug Suboxone seem safe, since it comes from a doctor, and it might also be cheap to purchase. The problem is that no one can deny Suboxone is increasing being abused. It is sold on the streets and inappropriately prescribed.

In a recent report published in the Journal of Addictive Diseases, the Center for Substance Abuse Research at the University of Maryland warned “there may be an epidemic of buprenorphine misuse emerging across the U.S.” because Suboxone was being so widely prescribed to treat addicts.

Researchers said addicts were smuggling buprenorphine into jails and the drug’s street value was growing because it doesn’t show up in drug tests.

(Meredith Y. Smith PhD. "Abuse of Buprenorphine in the United States: 2003-2005." Journal of Addictive Diseases, Volume 26. 2007)

People who choose to abuse Suboxone are likely to have abused opiates over a long period of time. They may simply abuse Suboxone as a way of preventing withdrawal symptoms from heroin or other opiate addiction, or they may wish to get high or simply be curious about the effect of the drug.

Prescribers who choose to abuse Suboxone usually have a troubled past and questionable practices. They find the Suboxone trade lucrative. To effectively treat addicts with Suboxone, physicians need only eight hours of required training. Many Suboxone clinics are cash-only establishments. Unless they are caring professionals who closely monitor patients and ensure they receive counseling or similar support, their carelessness causes abuse.

The U.S. Drug Enforcement Administration reports that 9.3 million prescriptions for buprenorphine (the mixed agonist-antagonist opioid receptor modulator in Suboxone) were filled in the United States in 2012.

Laura Ungar reports that prescriptions for Suboxone and its generic equivalent rose 63 percent in Kentucky between the first quarter of 2012 and the first quarter of this year, to 113,713 from 69,640.

Statistics like this suggest that medications like Suboxone are just readily available, and it might be all too easy for curious people to seek out the drug as a reasonable substitute for heroin or prescription painkillers.

"Suboxone abuse is huge," says Karyn Hascal, president of The Healing Place, a Louisville recovery facility. "For some, it's their primary drug of addiction. They're choosing it over other drugs."

We all know drugs thrive in troubled regions. The markets for Suboxone --  legitimate and illegitimate -- reflect this activity in regions with rampant prescription abuse and heroin abuse. And, of course, such hotbeds of activity have limited drug-treatment options.

The Bottom Line

I agree with Kentucky Attorney General Jack Conway, who said. "Some people desperately need Suboxone. (But) I view it as a treatment of last resort ... not a magic pill for addiction." Suboxone can be a lifesaving treatment when prescribed correctly, monitored closely and coupled with therapy or a support group.

"This is a double-edged sword. We want as many people as possible to get help, but we don't want the abuse," says Van Ingram, executive director of the Kentucky Office of Drug Control Policy. He continued: "Here's the deal: If you take it as prescribed, it can help you."

A 2008 study in the Journal of the American Medical Association showed that addicted youths who took Suboxone for 12 weeks were less likely to use opioids, cocaine or marijuana, or to drop out of treatment, than those who received only short-term detox and counseling.

Officials agreed that Suboxone can help some addicts kick drugs. That is why they don't want to cut off access for legitimate patients.

But, to me, nothing is slimier than a treatment facility that abuses. The control of a substance like Suboxone is crucial. The old line against the use of the drug is "You're merely trading one addiction for another." And, even if that holds some truth, a person who needs Suboxone to survive is a most worthy candidate for receiving continued medication. Yet, a medical clinic dedicated to saving lives that, instead, breaks the law and contributes to abuse is evil. It is the worst of licensed killers.

Nothing will convince me that any minuscule illegal prescribing or any intentional misstep involving drug trafficking, money laundering, or insurance fraud by a treatment facility should be tolerated. If illegal activity in Suboxone clinics occurs, the people involved are operators of pill mills. They know better and still choose to get their greedy hands on the object of their supreme affection -- big money.

"Let me share my story a little with you. I was a heroin addict. 2 years ago I went on methadone until I thought I was ready to taper last summer. I went to a medical detox for a week and left with a script of suboxone. I came off 90 mgs of methadone and went on 2 mgs of subx. I stayed n subx for about 4 months until I ran out. I thought I was ready to do this on my own. It just seemed like the best choice. I stopped subx and within a week I was driving into the city to cop heroin just to ease the withdrawal of subx. Made sense at the time.

"Withing a month I had a dope habit. Then last December I went back to a good subx Dr and went back on about 2 mgs. It's been 7 months and i am in no hurry to get off. My life hasn't been this good since before I started using heroin.

"I'm not saying this will happen to you, just be very careful because the opiate, she works in mysterious ways."

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