Gov. Gavin Newsom’s administration is at serious risk of exacerbating the opioid crisis by rapidly scaling distribution of the anti-addiction drug buprenorphine without needed controls and medical supervision.
Unfortunately, Newsom appointees and municipal allies are treating buprenorphine as a panacea—in fact, it is an addictive and euphoria-inducing narcotic that must be prescribed with ongoing oversight and therapeutic support to be effective. Furthermore, buprenorphine does nothing to address other dangerous substances fueling the national addiction crisis, such as methamphetamine and cocaine.
Medication assisted treatment (MAT) for opioid use disorder (OUD) is a recovery tool which changes millions of lives for the better. California and cities like San Francisco plan to spend millions of dollars out of legal settlements with pharmaceutical companies to finance distributions of MAT drugs like buprenorphine that help patients curb cravings and lead stable lives. However, people who are living on the streets need more than yet another pill to find salvation.
The city’s overdose prevention plan is thick with improper applications of buprenorphine.
For example, the plan calls for non-medical personnel such as firefighters to dispense buprenorphine on any emergency call related to opioid withdrawal. Firefighters are heroes, but they lack the medical expertise necessary for this intervention. The plan likewise provides that doctors should start OUD patients on buprenorphine any time they turn up at a medical facility, regardless of the reason for their visit.
The plan further courts catastrophe by encouraging distribution in settings such as prisons and “high-risk housing sites,” where the possibility of diversion from legitimate medical uses is elevated. This repeats a regulatory mistake that fueled the opioid crisis in the first instance. As West Virginia attorney general Patrick Morrisey (R.) explained in a 2020 report, federal authorities failed to account for diversion—use of opioids for reasons other than medical care—in authorizing higher and higher opioid manufacturing quotas.
Bear in mind, San Francisco will flood the streets with buprenorphine even as the city makes way for private safe-injection sites and tolerates open-air drug use. Indeed, the Bay Area saw a 4600 percent increase in fentanyl-related overdose deaths between 2015 and 2020. San Francisco is rightly concerned with the growing rate of drug overdose deaths plaguing minority communities. I applaud their intentions, but it is self-defeating to promote drug use while trying to curtail drug use.
The California Department of Health Care Services issued a memo on preapproved spending out of settlements with drug manufacturers and distributors related to the opioid crisis. To its credit, the memo talks generally about the importance of outpatient therapy and counseling during MAT regimens. But on closer examination, there is ample cause for concern. The plan replicates San Francisco’s errors in at least two respects.
First, the memo approves spending for “MAT education and awareness training” for law enforcement and non-healthcare first responders. To the extent these programs are a prelude to widespread distribution of buprenorphine via non-medical personnel, it is an alarming development.
Second, the state pre-approved spending to dispense buprenorphine in carceral settings. I know from my experience as a drug court judge that it is risky to bring addictive narcotics into prisons. Nevertheless, the memo makes no mention of controls to ensure MAT drugs are used properly among inmates.
Importantly, the memo seeks to expand oversight over opioid treatment centers, while treating telehealth as an important distribution vector for buprenorphine. While telehealth is a useful and necessary recovery tool, prescribing MATs remotely seems fraught. These providers must adhere to the same standards as treatment centers.
Just two years ago, attorney general Rob Bonta reached a $300 million settlement with drugmaker Indivior related to its Suboxone (buprenorphine) product. The settlement provides that Indivior “promoted the sale and use of Suboxone to physicians who were writing prescriptions that lacked a legitimate medical purpose; were issued without any counseling or psychosocial support; and were for unsafe, ineffective, and medically unnecessary purposes.”
Knowing that buprenorphine is a diversion risk that requires “psychosocial support,” why hasn’t the state outlined a detailed anti-diversion strategy or stepped in to discourage San Francisco’s reckless distribution plan?
There is still time to make needed corrections to MAT policies in California. Policymakers can head off catastrophe by encouraging proven and prudent procedures for MAT use that help patients find the miracle of recovery.
