For some patients looking to break their addiction to heroin or prescription painkillers, there's a drug out there that works. It’s calledSuboxone, but government regulations and individual doctors have made it difficult to get, which is leading many to buy it illegally.
A lot of people usingSuboxonefor the first time don’t get it at a doctor’s office.
"I took it when I couldn’t find drugs," said a 32-year-old personal caregiver from Danbury who didn't want WNPR to use her name. "I was, actually, buying it off the street -- and I did that for, God, almost a year."
Following a knee surgery, she started using, and eventually abusing, prescription opiates likePercocet. She boughtSuboxoneillegally for months before getting it legally at her doctor’s office in New Haven.
She credited Suboxone and her doctor for helping her successfully treat her opioid dependency.
"You can’t just say, 'I can’t do this anymore. It’s ruining my life.' You really have to dedicate yourself to this," she said. "Because even a drug likeSuboxoneisn’t going to fix you. It’s you."
JeanetteTetrault, a doctor at the Yale University School of Medicine who prescribesSuboxone, said this woman’s story isn’t unique.
Lots of patients who come toTetraultseekingSuboxonetreatment have heard about the drug, and many have used it illegally.
"It’s not to get high," Tetrault said. "It’s really to ward off withdrawal symptoms -- that is what fuels opioid addiction in a lot of cases. There’s the initial seeking of the euphoria from usingopioids, but for most patients who develop true opioid addiction and opioid use disorder, they tell me they continue to useopioidsto maintain."
Suboxoneis a partial opioid, a combination of two drugs: buprenorphineandnaloxone. When used in the absence of other drugs, its chemistry makes it a hard drug to overdose.
In medicine,Suboxoneis used to mitigate opioid withdrawal symptoms. The drug allows some patients day-to-day functionality, which lets them build family members or a job back into their life.
"You can do all those things now, which is what makesSuboxoneso attractive on the street," said Stephen Holt, co-director of the Addiction Recovery Clinic at Yale-New Haven Hospital. "But it's just a Band-Aid."
Holt said that as far as street drugs go, it’s “extremely common” for his patients to have usedSuboxoneillegally before coming to him to get a prescription.
"It’s helping the chemical issue," he said. "But you’re in no way engaging the behavioral issue -- the psychological issues that led you to start using these medications in the first place."
As to that part about behavioral issues, addiction doctors say that’s the most important thing aboutSuboxonetreatment. Holt said it’s also part of the reason why it’s so hard to getSuboxone legally in a place like New Haven.
For starters, to prescribeSuboxone, JeanetteTetraultsaid doctors must complete an eight-hour training program. They then need to get a federal waiver.
"Initially, a physician can only prescribe to 30 patients through that DEA waiver," she said. "After a year of experience prescribing to patients, one can then apply to increase their waiver numbers to be able to prescribe to 100 patients at a time."
President Barack Obama has proposed raising that prescriber cap to 200 patients, but some doctors have said they’re stretched thin as it is -- that it’s a lot of work to manage and care for 30Suboxonepatients, let alone 100 or 200.
That work includes urine toxicology tests to make sureSuboxonepatients are using the drug correctly and not selling it on the street. They also require regular follow-up visits and therapy. Time-consuming stuff for doctors and their staff, which means not everyone who has a prescriber waiver fully uses it, and that many patients who wantSuboxonesimply can’t get it.
"You’re going to have this sort of tiered system where many of the private providers within greater New Haven, or in Connecticut, are selectively taking on patients who are the most straightforward to care for," Holt said. "The least complex."
Like patients without other psychiatric illnesses, or patients with more money. Holt said it’s common for many private psychiatrists and physicians who are licensed to dispenseSuboxoneto charge a cash-only fee up front that isn’t covered by private insurance. JeanetteTetraultsaid that’s problematic.
"There’s very few other chronic diseases that you would say, 'Oh well, you know what -- let’s just bypass insurance and pay me $500 to treat your hypertension or diabetes,'" Tetrault said.
And as some clinics turn away patients who might benefit fromSuboxone, but can't foot those up-front costs,TetraultsaidSuboxoneprescribers need to be more critical of their own ethics and prescribing practices -- as the public health issue of opioid abuse continues.
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