Buprenorphine, Treatment for Opioid Addiction, is Also Abused

Buprenorphine, a drug used to treat opioid addiction, is increasingly being abused, The New York Times reports. Some for-profit buprenorphine clinics are run by doctors with troubled records, according to the newspaper.

The drug was developed as a safer alternative to methadone for treating addiction to heroin and painkillers. It can be prescribed by doctors in offices, rather than dispensed daily in a clinic. The newspaper tracked patients of two large buprenorphine programs. In one program in suburban Pittsburgh, requirements for obtaining the drug are minimal, and there is a high tolerance for patient missteps, the article notes. Another center at West Virginia University in Morgantown is located in a hospital complex, and run by an addiction medicine specialist.

The doctor who runs the Pittsburgh clinic, Allan W. Clark, is in recovery. He prescribed himself Adderall in the late 1990s, and found his mood improved and he focused better. He took more and more of the drug to get the same effect. In 1999, he checked himself into a rehabilitation program. He lost his Ohio medical license and was put on probation in Pennsylvania for eight years. He now runs a buprenorphine clinic with five doctors working for him, and treats 600 patients.

Dr. Carl R. Sullivan III, who runs the West Virginia University program, primarily treated alcoholism until he saw a “spectacular explosion of prescription opioid drugs” starting around 2000. He saw many patients leave rehab and relapse. Some died. When he started prescribing Suboxone, the brand-name drug whose main ingredient is buprenorphine, he saw a big change. He became a paid treatment advocate for the drug’s maker, Reckitt Benckiser. He noted, “If the company didn’t pay me a nickel, I’d still promote Suboxone because in 2013, it’s the best thing that’s happened for the opioid addict.”

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    November 24, 2013 at 2:34 PM

    I did buprenorphine and did real well. It took care of the pain I suffer from a motorcycle accident and worked much better for my addiction. When it was time to detcx I would cut the buprenorphine pill (didn’t have the strips yet in 8th. There were times that I forgot to take the dose in the morning. But when I finally ran out. I did not have any symptoms to speak of.

    Buprenorphine is a good medication. In fact I wouldn’t mind calling it a magic bullet. I have difficulty thinking how it gets abuse. They did not explain that in this article. I don’t remember ever being high on buprenorphine. Just made me feel comfortable with my pain and cravings. Abstinence based treatment is not so effective. And the data and statistics are quite fuzzy. Given that the facilities police themselves and provide the statistics. I wonder how honest are they.

    One needs to read the article in The New York Time.

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    November 24, 2013 at 2:09 PM

    I am just going to guess here. I bet you that if research is done. We will find out like with methadone. The problem is not the medication but the system or the clinic that runs them. Some clinics are going to be excellent, other (am guessing the large majority)are going to ignore the research and best practice. Why is it that when clinics or doctors screw up we blame it on the patients or the medication? Like Nora Volkow says when we do not understand the conditions we blame it on the patients.

    It is never that the clinician is misinformed or that they are acting incompetently. The problem is someone else.

    This article did not presented any argument or problem. All they did is to attach the “character” of the doctors. It just happened that I have been with two doctors who prescribed me buprenorphine. Both were “in recovery” neither of them as far as I can tell is having any problem with the protocol they follow.

    This article does not state how is buprenorphine being abused?

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    robert newman

    November 19, 2013 at 2:24 PM

    The two-part, front-page series on buprenorphine in the NY Times emphasizes the risks and adverse consequences of buprenorphine treatment. It highlights two “clinics” (sic!) that seem to be the very antithesis of what was implied and envisioned when “office-based opioid treatment” (OBOT) with buprenorphine was authorized by Congress in 2000. For instance, in 2002 the Times predicted, “In years to come, drug addiction will probably be treated like hypertension, diabetes and other chronic, relapsing diseases: with a variety of medications prescribed in the doctor’s office.” Likewise, in 2004 ASAM stated, “OBOT refers to models of opioid agonist treatment that seek to integrate the treatment of opioid addiction into the general medical and psychiatric care of the patient. … An important feature of OBOT is that it allows primary care physicians to provide addiction treatment services in their usual clinical settings, thus expanding the availability of care.”

    The two facilities described do not bear the slightest resemblance to the “usual clinical settings” in which primary care – or most specialty care, for that matter – is delivered. Furthermore, it is likely that the articles will subvert the intent of those who championed OBOT by creating demands for precisely the same unique constraints and conditions to be imposed on buprenorphine providers as those that for decades have hampered methadone “programs,” thereby making office-based treatment impossible. In addition, it seems inevitable that the Times series will lead zoning commissions and other authorities that have implemented stringent and for the most part insurmountable obstacles to establishment of methadone clinics to promptly seek to extend NIMBY ordinances to cover buprenorphine providers as well.

    In short, these articles will increase tremendously the stigma associated with all forms of medication-based treatment of opioid dependence, and deter physicians from beginning or continuing to offer treatment of addiction. And this at a time when everyone agrees opioid dependence in the US is a greater problem than ever. For supporters of both buprenorphine and methadone treatment, especially in primary care, office-based settings, as well as for the general public, this is tremendously distressing!

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    November 19, 2013 at 1:19 PM

    I have viewed this abuse of suboxone more frequently lately and find it very upsetting. I have maintained successful recovery for a little over two years and most of the credit is given to the use of suboxone. I am fully aware that this type of therapy is only used as one of the tools needed to assist individuals with finding and maintaining sobriety; however, I struggled with opiate addiction for about four years (trying methadone maintenance, etc.)and from the time I was introduced to this therapy (suboxone) I have been able to focus on other aspects of my disease and remain abstinent from any other substances. I have viewed individuals that become part of treatment programs that offer suboxone maintenance, only to turn around and sell or trade it for other addictive substances. This is a behavior that influences society to view this type of therapy as negative and influences the thought that this therapy is only giving up one substance for another.
    I have experienced some obstacles within the last two years, but if I wasn’t dedicated to my recovery and utilizing suboxone I am confident that I would of experienced relapse. I am currently taking 2mg. every other day with my goal being to discontinue use by the first of the new year.
    I just wanted to share my thoughts and feelings, due to the negative feelings I have been feeling when see the abuse of such a positive therapy so frequently.

    Best Regards,

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    Skip Sviokla MD ABAM

    November 19, 2013 at 11:39 AM

    As a recovering physician addict, I take issue with the second part of the article on Suboxone. Although I have been clean and sober for 14 years, I realize that I might still be under scrutiny by any with whom I interact. I accept the fact that I am guilty until proven innocent and act accordingly. I also insist on running a clean professional clinic which runs on time and which is based upon a mutual respect for my patients. We are not friends. If they falter in their treatment, they either accept a higher level of care or are discharged. Substance Abuse medicine is not very lucrative if you run an ethical practice. The well deserved popularity of the drug might make it tempting for some to run patients through a course of it without regard to their overall recovery. I have never taken anything from the manufacturer of the drug and am an enthusiastic supporter of it’s use because I have seen it work well over the past seven years if prescribed within the right treatment setting.
    I do not doubt the accuracy of the description of the doctors given in the article. I would like to invite Ms. Sontag to visit my clinic in order to see another side of the story.
    Skip Sviokla MD ABAM
    author “From Harvard to Hell and Back”

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