There’s a new obstacle to ending the opioid addiction epidemic. Many pharmacies won’t carry the most effective medication-assisted treatment (MAT) for people with an opioid use disorder (OUD).
The drug is buprenorphine, better-known by the Suboxone brand name, a formulation that includes naloxone to make abuse less likely. It is available as a pill and a sublingual film.
Buprenorphine is an opioid, but it is a less potent opioid. If you are addicted to heroin, oxycodone (OxyContin) or hydrocodone (Vicodin), buprenorphine will not get you high, only prevent withdrawal.
The result is that you can function, go to work or school, seem human around your family and friends, and remain a productive member of society instead of a junkie spending every waking hour plotting how to get more opioids.
However, if you are new to opioids, buprenorphine can get you high. There is a black market for the drug. This leads some to conclude that buprenorphine is as bad as these more potent opioids, that using buprenorphine to get off of heroin or OxyContin is just trading one addiction for another.
So, some physicians, judges, law enforcement, and lawmakers oppose its prescription and some pharmacists refuse to stock it. Methadone got a similar bad rap, which is why now it is usually only prescribed one daily dose at a time in a licensed healthcare setting.
Some authorities would prefer if the only MAT available for prescription was naltrexone, not an opioid, a drug that prevents the high from opioids if anyone uses opioids anyway. It is available in a once-monthly injectable form, Vivitrol, to ensure that it is taken every day.
The problem is that Vivitrol has a poorer sobriety rate than buprenorphine because the craving is still there and other drugs will get you high, including stimulants (cocaine), benzodiazepines (Xanax, Klonopin), and good old alcohol.
If only there was a long-term form of buprenorphine to prevent diversion and ensure daily use.
There is. Actually, there are two.
Probuphine was the first buprenorphine implant. Placed in the arm, it provides a steady, non-divertable dose of buprenorphine for three months. However, it takes special training to insert and implants have a bad name ever since the Norplant birth control device.
There is a new version of bupe: Sublocade, once a month injectable form of buprenorphine. It’s been available for less than two years and has not been much publicized (except by a competitor who has its own injectable bupe that is being kept off the market because Sublocade is considered an orphan drug by the Food and Drug Administration). I couldn’t find any information about how many people have chosen this form of MAT or how those who use it feel about its effectiveness.
Still, addiction treatment science marches forward, blocked only by the people, courts, healthcare, and legislators who are supposed to be helping us.
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