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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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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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'Miracle drug' has high success rate for treating opiate addiction

From the Lancaster Eagle-Gazette:

Rampant opiate use in Fairfield County has local recovery officials wondering what they can do to help more addicted individuals.

Pressed with time and a growing number of patients, many doctors are forced to turn away people hooked on opiates such as heroin, OxyContin, Vicodin, morphine and other pain relievers.

Some even die on waiting lists for a widely used medication called Suboxone: A touted "miracle drug" that suppresses symptoms of withdrawal, reduces cravings, reduces drug use and helps patients stay in treatment.

"With all the deaths and what's happening because of opiates, I just feel like we need more programs in Ohio for that," said Dr. Robert C. Polite, medical director at the Recovery Center in Lancaster. "That's on my wish list to get an opilaoid-treatment license for the Recovery Center where we do specifically Suboxone."

Polite founded the Recovery Center's opiate-addiction recovery program that uses the drug Suboxone. His goal is to one day have a clinic devoted solely to helping those addicted to opiates.

The center chalks up much of its success to the drug, which is helping many Fairfield County residents kick their opiate dependency. The center boasts a success rate of more than 60 percent.

The medication blocks the ability for patients to get high off other drugs, but it still gives the patient a lower feeling of being high, said Recovery Center Clinical Director Sharon Shultz.

Patients typically stay on the medication 10 to 18 months, and more than half refrain from opiate use after treatment. That's a drastically higher success rate than any other type of addiction treatment, Shultz said.

The center has a 30- to 40-person waiting list for the Suboxone program, with more than 50 being treated right now. It's the fact others are waiting their turn - often in critical stages of dependency - that makes the Recovery Center strict on its Suboxone patients, Shultz said.

A lot of patients understand the severity of their situations and stick to the rules, she said.

The number of patients treated in the program has more than doubled in the past two years, since the Recovery Center started offering the treatment program.

But, Polite said the program still is fairly new and malleable.  He said one of the challenges with the program is getting more patients in the door for help.

The problem lies in the number of patients doctors are prohibited to see, Polite said. On top of that, only specially-licensed doctors may prescribe Suboxone.

Posted: 5/11/2009 3:30:00 PM

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