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Bar News - February 17, 2016

Opinion: We Need More Suboxone to Fight the War on Opioid Addiction


Today’s heroin addiction crisis crosses all socioeconomic lines. It does not care about race or age, sex, or status. In my practice, I see patients of all ages – young, middle-aged, in their sixties. They come from all walks of life. I continually ask my patients for advice on how we might address the heroin crisis and its alarming death rate. Most have personally known people who have died from overdoses. Their responses have influenced my thoughts on this crisis and convinced me that having a more comprehensive plan to address the withdrawal issue is a key part of fighting the epidemic.

A major tool in coping with addict withdrawal is Buprenorphine. Suboxone is the most commonly known brand name for this particular drug. The generic name is buprenorphine/naloxone. Naloxone is an opioid antagonist which is added to the buprenorphine to reduce the risk of abuse. Suboxone eases, then eliminates, withdrawal symptoms and allows patients to get through this critical period without relapsing. Patients are then better equipped to pursue rehab and therapy for their addiction.

It is important to note that Suboxone is not a substitute for therapy; therapy can still be helpful to get at the emotional and mental issues which may be behind addiction. However, it can help a patient get through those first critical days and weeks of withdrawal, and then allow them to maintain abstinence from opiates long term. Often addicts relapse because they cannot get through those initial critical weeks of withdrawal. Suboxone can aid them during this vital transition time and allow them to pursue a full course of psychotherapy. I have found Suboxone and other buprenorphine-containing medications to be a highly effective treatment for opioid withdrawal and addiction.

Many addicts do not seek treatment for their addiction because they are terrified of going through withdrawal. This is what often leads those addicted to prescription painkillers to buy heroin in the first place. When they can no longer play the prescription angle and get painkillers through their doctor (or through doctor shopping), they go to the street – and thus begins the agonizing downslide into heroin addiction. Now, we are also seeing opioid addicts buying a new scourge called Fentanyl, an opioid that’s 100 times more potent than morphine and is the direct cause of many opioid overdoses. Desperate addicts will inject themselves (knowingly or unknowingly) with pure Fentanyl, which is even more lethal than heroin.

One way to stop this overdose cycle is to make Suboxone treatment more available to those seeking help with addiction. If they know that there is a way to ease withdrawal, they are more likely to seek help. Suboxone humanely aids chemically-dependent patients in detoxification. Currently, many detox and voluntary residential drug treatment facilities do not use withdrawal-easing drugs of any kind. There has been a long-held belief that abstinence without Medication Assisted Therapy is best, but in fact, many addicts avoid treatment because of the fear of withdrawal, and forced withdrawal has its own risks. Abstinence withdrawal is more tolerable and reasonable for alcohol, marijuana and some less lethal drugs, but it is no match for heroin and Fentanyl. The risk of relapse and a lethal overdose occurring is too great.

Those at the highest risk for overdose death are addicts who have experienced a forced withdrawal (incarceration is a common example of this). For more than a decade, it has been known that this group is extremely vulnerable. Why? Because when they resume use – as they frequently do – their drug tolerance is reduced. They are unaware of the change and inject or ingest the same quantities of opioid that they were taking before, thus making them susceptible to overdose. With opioid drugs (and particularly the heroin/fentanyl combination), the risk of relapse and a lethal overdose occurring is too great to not offer greater access to withdrawal-easing drug therapy.

Inmates are especially vulnerable to overdose death because they are forced into withdrawal while incarcerated. Jailhouse withdrawal, and the associated risks, is a well-known problem, but one that has been tough to address. One way to reduce the risk of overdose deaths in jails and following release is to provide Suboxone (buprenorphine and naloxone) or Subutex (pure buprenorphine and much less expensive that suboxone or other brand names) treatment to inmates. The misuse of this life-saving drug would be impossible if administered by medical staff under supervision. Every inmate in withdrawal would eagerly agree to take the medication. (A patient recently told me that he witnessed 50 inmates undergoing withdrawal at a local county jail.)

When going through withdrawal, all an addict thinks about is the craving for the drug. Getting treatment is not even on their radar. Addicts who benefit from withdrawal-easing drugs are more receptive to treatment programs and are better able to focus on the benefits of being clean. Once they get a taste of what life can be like without drug dependency, they are more apt to follow-through and get long-term help when they are released from jail. Yes, there will be those who receive buprenorphine treatment and do not seek further therapy once out of jail, but at least their chances of dying from an overdose have been greatly reduced. They will not have experienced forced withdrawal with subsequent lowered tolerance to street drugs, which would raise the risk of overdose.

Without question, there are issues with this recommendation to have jails provide Subutex. It would add cost to county budgets ($3 per pill). However, if overdose deaths are reduced and more addicts are restored to healthy, productive lives, the cost savings incurred by other parts of local and state budgets will be enormous. Trickle down benefits would extend to cities and towns who would see less involvement by police and first responders to overdose situations; crime – which goes hand in hand with addiction in many cases – could also decline as fewer addicts need to feed their habits. Even more important, the pain and suffering of family members will be greatly reduced as fewer addicts die. And, we would all agree that lowered use of the medical examiner’s office would be a great accomplishment.

Dr. David Schopick

Dr. David Schopick is a board-certified psychiatrist in private practice in Portsmouth who has been serving patients in the Greater Seacoast area for more than 25 years.

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