Suboxone and Opioids: Creating a Problem to Solve a Problem?
The opioid epidemic, which has swept much of the country since the turn of the 21st century, has brought tragedy to millions, cost the country enormously, and spawned a huge new industry in opioid treatment.
As former Surgeon General Vivek H. Murthy said last year: “Substance use disorders represent one of the most pressing public health crises of our time.”
Yet, in an attempt to alleviate this crisis, a derivative crisis has emerged with the principal drug used to treat opioid and heroin addiction.
In 2015, more than 52,000 Americans died from drug overdoses in 2015. Two-thirds are from prescription pain relievers and their now-cheaper cousin, heroin—nearly 100 deaths each day. During the last 15 years, as many Americans have died from overdoses than the total death toll in all of America’s wars put together, excluding the Civil War.
Suboxone, a drug combining the treatment medications buprenorphine and naloxone that was introduced in 2002, has generated $1-2 billion a year in revenues, first for its initial British manufacturer, Reckitt Benckiser, and the company that it spun off two years ago, Indivior. Many doctors and patients swear by the drug, but its maker has fought vigorously to keep generics or alternative drugs off the market, leading to an antitrust suit initiated last fall by 42 state attorneys general.
At the same time, Indivior’s latest version of the drug is dispensed as a film placed under one’s tongue. This version has become a street drug and smuggled into prisons, endangering inmates and correctional officers. Finally, it can be addictive, causing considerable suffering.
After several wrenching years of trying to fight her son’s addiction to Oxycontin and heroin, several suicide attempts, psychiatric wards, detox programs, and a parade of therapists, Laurie Kaye Schwartz of Kensington, Md., took her son to a highly regarded drug-treatment clinic.
“They put him on 16 mg. of Suboxone, which was mandatory in that program,” she said. “Doctors don’t take insurance and it was $600 for the intake and $250 for each visit for a prescription.” Suboxone is typically used for three to four weeks, reducing and usually eliminating cravings for opioids or heroin.
However, over the months, Ms. Schwartz’s son became dependent on the drug because it essentially replaces dopamine, one of the brain’s chemicals that influence happiness. Told that her son was “better off keeping him on because there’s no protocol to get him off,” they went to another psychiatrist. Since physicians must be certified to prescribe Suboxone, the doctor got the certification and tried to taper down her son’s dose. When he tried to go off, he would get the shakes and vomit.
Seeming to be a little better, thanks to antidepressants, Ms. Schwartz’s son, now 31, moved to California last September. That quickly crashed, as he became manic, ending up on the streets and in homeless shelters. Today, Ms. Schwartz doesn’t know where her son is and whether he has gone back to opioids or found someone to prescribe Suboxone.
Last year, Maryland became the first state to try to make other treatment drugs more available and reduce the illicit use of Suboxone by dropping the drug from its preferred status for Medicaid coverage. The state replaced it with a newer treatment drug that is absorbed and processed by the body at lower doses, producing less harsh withdrawal symptoms than Suboxone. Already, prison smuggling is down sharply.
However, as other states consider following Maryland’s lead, Indivior has recently more than doubled its lobbying presence in the state capital. In late January, it registered two more Maryland lobbyists and hired an in-house lobbyist for Maryland in October, bringing its Annapolis lobbying presence to five. The company has a highly paid nationwide network of lobbyists from Alaska and Wisconsin to West Virginia and Kentucky, and nearly tripled its spending on federal lobbying last year.
With its market share falling and the antitrust suit looming over it, Indivior certainly has an interest in keeping other states from adopting Maryland-like policies and perhaps in weakening or reversing Maryland’s law.
The company has only said that it “intends to defend” against the suit and “related actions.”
But as the experience of Ms. Schwartz’s son illustrates, treatments for individuals suffering from opioid addiction should be dictated by science, not by one company’s attempt to make enormous profits with a drug that carries its own hazards.
Andrew L. Yarrow, a former New York Times reporter affiliated with several Washington think tanks, writes frequently on health and other public-policy issues and is working on his fifth and sixth books. See: www.andrewlyarrow.com and www.manout.us.