Suboxone: The New Drug Epidemic?

From the National Pain Report:

A drug increasingly being used to treat opioid addiction may be fueling a new epidemic of diversion, overdose, addiction and death in the United States.

The drug’s name is buprenorphine, but it is more widely known by its brand name – Suboxone – which for many years was sold exclusively by Reckitt-Benckiser, a British pharmaceutical company. Since Reckitt’s patent on Suboxone expired in 2012, several other drug makers have rushed to introduce their own formulations – hoping to grab a share of the $1.5 billion market for Suboxone in the U.S.

Two generic versions of buprenorphine were introduced earlier this year. And this month a Swedish drug maker began selling a menthol flavored tablet – called Zubsolv – that is designed to mask the bitter taste of buprenorphine. Other formulations of the drug include a film strip that dissolves under the tongue and a buprenorphine skin patch. One company is even developing a buprenorphine implant to be inserted under the skin.

“This is insanity,” says Percy Menzies, a pharmacist and addiction expert. “Buprenorphine is one of the most abused pharmaceuticals in the world.”

Buprenorphine is a narcotic, a powerful and potentially addicting painkiller that was first approved as a treatment for opioid addiction in the U.S. in 2002. When combined with naloxone to make Suboxone, the two drugs can be used to help wean addicts off opioids such as heroin, Vicodin, OxyContin, and hydrocodone. Naloxone blocks opioid receptors in the brain and central nervous system.

Over three million Americans with opioid dependence have been treated with Suboxone. Although praised by addiction experts as a tool to wean addicts off opioids, some are fearful the drug is overprescribed and misused.

A report by the Substance Abuse and Mental Health Services Administration (SAMHSA) found a ten-fold increase in the number of emergency room visits involving buprenorphine. Over half of the 30,000 hospitalizations in 2010 were for non-medical use of buprenorphine.

How many died from buprenorphine overdoses is unknown, because medical examiners and coroners do not routinely test for the drug.

The problem with Suboxone, according to Menzies, is that many addicts have learned they can use the medication, not to treat their addiction, but to maintain it. Suboxone won’t get them “high” but it will help them smooth out withdrawal symptoms between highs.

Suboxone is so popular with addicts that it has turned into a street drug – to be bartered or exchanged for money, heroin or other illegal drugs. According to one estimate, about half of the buprenorphine obtained through legitimate prescriptions is either being diverted or used illicitly.

Posted: 9/24/2013 10:22:00 AM

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For Many, a Life-Saving Drug Out of Reach

From The New York Times:

Overdose now kills more people in the United States than car accidents, making it the leading cause of injury-related mortality according to the latest statistics from the Centers for Disease Control and Prevention. The number of deaths — 37,485 in 2009 — could be cut dramatically if Naloxone were available over-the-counter and placed in every first aid kit.

But that’s not likely to happen until the Food and Drug Administration takes some action. Naloxone is currently available only by prescription. Although dozens of needle exchange programs, rehab centers and pain specialists in at least 16 states distribute it, the prescription requirement severely limits its availability to those organizations that can afford to have doctors on staff.

Naloxone (its brand name is Narcan) can be administered either nasally or by injection. It can rapidly reverse the potentially deadly effects of opioid drugs, which include heroin and prescription pain relievers like OxyContin and Vicodin. It does not produce a high — quite the opposite, in fact, because it blocks the effects of opioids.

Naloxone is much safer than some drugs currently available without a prescription. Both insulin and Tylenol (acetaminophen) can be deadly if misused, but it is impossible to overdose on Naloxone and it has few side effects.

Overdose deaths linked to prescription opioids more than tripled between 1999 and 2006. The majority of fatal overdoses involve either prescription opioids or heroin in combination with alcohol and/or another depressant drug, such as Valium or Xanax.

Some cases do occur when pain patients mistakenly take too much or drink alcohol with their medications, however, most seem to involve people with histories of addiction who get the drugs from non-medical sources. For example, a study of prescription-drug-related deaths in one heavily affected state found that fewer than half of overdose victims had been prescribed the drug(s) that killed them and that 95 percent showed signs of addiction, such as injecting drugs meant for oral use.

But while people with addiction seem to have little trouble getting unprescribed opioids, Naloxone is tougher to get because there is no black market for it and few people even know that they should seek a prescription for it. And many pharmacies do not even carry it, as it is typically only used by ambulance crews and in hospitals.

Naloxone is highly effective because it displaces opioids from the receptors in the brain that depress breathing. Slowed and eventually stopped respiration is what causes opioid overdose death — because this happens over the course of an hour or more, there is often time to intervene.

Unfortunately, many family members and friends of drug users are unaware of the signs of overdose and believe that, as with drunkenness, the best thing to do is let the person “sleep it off.” Such ignorance can be fatal.

The rare cases that have been reported where Naloxone didn’t help have overwhelmingly been either overdoses of other drugs, like cocaine, or situations where the person was dead before the Naloxone was administered.

Posted: 9/26/2011 9:46:00 AM

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When Children’s Scribbles Hide a Prison Drug

From The New York Times:

Mike Barrett, a corrections officer, ripped open an envelope in the mail room at the Maine Correctional Center here and eyed something suspicious: a Father’s Day card, sent a month early. He carefully felt the card and slit it open, looking for a substance that has made mail call here a different experience of late.

Mr. Barrett and other prison officials nationwide are searching their facilities, mail and visitors for Suboxone, a drug used as a treatment for opiate addiction that has become coveted as contraband. Innovative smugglers have turned crushed Suboxone pills into a paste and spread it under stamps or over children’s artwork, including pages from a princess coloring book found in a New Jersey jail.

The drug also comes in thin strips, which dissolve under the tongue, that smugglers have tucked behind envelope seams and stamps.

Law enforcement officials say that Suboxone, which is prescribed to treat addiction to heroin and powerful painkillers like oxycodone, has become a drug of abuse in its own right, resulting in prison smuggling efforts from New Mexico to Maine. Addicts buy it on the street when they cannot find or afford their drug of choice, to stave off the sickness that comes with withdrawal. But some people are also taking it for the high they say it provides.

The Food and Drug Administration approved Suboxone in 2002 as the first narcotic that doctors could prescribe for addiction to opiates. Seen as a more convenient alternative to methadone, which can be dispensed only at federally licensed clinics, it blocks the effects of opiates while reducing cravings and easing withdrawal symptoms.

A spokeswoman for Reckitt Benckiser, the drug’s manufacturer, said in an e-mail that the company was “aware that a certain level of Suboxone diversion and abuse exists,” and that it had taken steps to counter it.

To deter abuse, Suboxone contains naloxone, a substance that precipitates withdrawal symptoms when the drug is injected. Suboxone also has a ceiling effect, with the effect leveling off after a certain dosage.

But users can experience euphoria, especially if they do not take it regularly, and Suboxone, whose main ingredient is buprenorphine, is increasingly sold on the street in New England and other regions where it is commonly prescribed.

Posted: 5/27/2011 9:09:00 AM

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