Can Suboxone Help Stop the Opiate Epidemic?
The number of drug overdose deaths, particularly those related to opiate drugs, is growing at an alarming rate in the United States. Since 1999, drug overdose deaths have grown by over 300%, prompting the healthcare and addiction treatment industries to look to new solutions for an epidemic that currently shows no signs of slowing down.
The severity of the current problem cannot be overstated. While the population of the U.S. has only grown by about 16% since 1999, the number of fatal drug overdoses has more than tripled. This implies that the problem of substance abuse across the country increasing drastically.
The area of drug addiction that is receiving the most attention right now is that of opiate addiction, which causes a majority of the drug overdose deaths in the U.S. According to the Centers for Disease Control the percentage of total drug overdose deaths which are caused by opiate overdoses is also increasing, rising from 56.2% in 2010 to 73.7% in 2015.
This data suggests that the epidemic of opiate addiction in this country is the major contributor to the marked increase in total overdose deaths. This is why doctors, lawmakers, and addiction treatment professionals have been scrambling to find more effective ways to confront the problem and slow down the increase in fatal overdoses.
Medication Assisted Treatment
One of the types of treatment for opiate addiction and abuse which has gained significant traction in the past decade is medication-assisted treatment (MAT), which utilizes certain prescription medications in addition to more traditional forms of substance abuse treatment such as counseling and behavioral treatment.
The most popular medication currently available for the treatment of opiate addiction is buprenorphine, which is sold under brand names like Subutex as well as Suboxone, which combines buprenorphine and naloxone. Buprenorphine is typically used in two ways. First, it is widely used as the most preferred medication in medically supervised opiate detoxes which usually consists of a patient taking the medication for between 3 and 10 days.
More recently, however, doctors and addiction treatment professionals have been utilizing it as a part of a maintenance program which calls for patients to take the medication over longer periods of time which can last for many years.
Chad Sabora, an attorney in Missouri who has advocated for legislation to make MAT more accessible to people across the country, says “You’re removing the risk by putting them on Suboxone. You’re not completely removing it but you are reducing the risk that they will have an overdose by putting them on Suboxone.”
This is the philosophy behind most MAT programs, which are based on the fact that drugs like Suboxone act as a partial agonist, activating opioid receptors but also producing a diminished response from these receptors. This creates a situation where someone who is on Suboxone maintenance will not feel the same euphoric effects of other opiates like heroin while they are also on Suboxone. This is intended to drastically reduce the drive and motivation for an opiate addict to seek these drugs out.
While medications like Suboxone are not a magic pill which are able to completely solve the problem of opiate addiction in the country, there is evidence that they could provide the basis for treatment that could turn the tides on the opiate epidemic we are currently experiencing.
“These medications are crucial, especially right now. We are losing 190 people a day and the number keeps getting higher,” said Sabora.
Restrictions Making Treatment Difficult for Patients and Doctors
While many in the medical and recovery communities feel that medications like Suboxone have the potential to act as useful tools in the fight against the pervasive issue of opiate addiction, utilizing it and other similar medications to help the large number of Americans who are currently struggling with opiate abuse is being hampered by legal restrictions.
According to the FDA guidelines on Suboxone, there is currently a long list of restrictions which must first be met before any physician is able to prescribe medications like Suboxone to those who are trying to recover from opiate addiction. Those restrictions include needing to have a board certified subspecialty in addiction treatment, 8 or more hours of specialty training on the treatment of opioid-dependent patients and the ability to offer or provide referrals for psychosocial therapy. Even once a physician has attained the special licensing to be able to prescribe Suboxone, they are not allowed to treat more than 30 patients at a time.
This collection of restrictions has created a situation in which there is a severe lack of medication assisted treatment options for the millions of Americans who struggle with opiate addiction. In fact, according to the National Institute on Drug Abuse of the 872,615 potential providers registered with the Drug Enforcement Administration only 25,021 registered physicians are legally able to prescribe Suboxone.
“We need looser restrictions and more people to prescribe [Suboxone]…” said Sabora. “We have made some progress but we have to continue to look at data. Let’s look at what has worked in other countries. For example, France removed all of the restrictions on the prescribing of Suboxone and they saw something like a 42% reduction in overdose deaths.”
Arguments Against MAT
While many people who work in the addiction treatment field believe that medication assisted treatment is a useful tool which can help in the recovery of many with an addiction to opiates, there is still a section of the community which believes that it is not the answer to the opiate epidemic.
Arguments against MAT can vary widely, however, the most common include the idea that utilizing medications like Suboxone are simply replacing one opiate with another. While most concede that Suboxone is certainly a safer, less risky and more manageable opiate to be addicted to, those who rely on it to maintain their stability and to stay away from other opiates are still in a precarious situation.
The problem most of those who disagree with the idea of MAT cite is that any type of treatment which involves maintaining a patient on some sort of narcotic is simply a method of harm reduction as opposed to treatment which can provide a true chance at life-long sobriety. Continuing to take a narcotic, such as Suboxone, does not allow a person to put their disease into complete remission and leaves them in a situation where they either need to continue to take the medication for the remainder of their life or at some point face a situation where they are eventually going to come off of the medication and attempt abstinence based recovery.
Because of this, many of the traditionalists within the addiction recovery field believe that beginning with abstinence-based treatment is the most logical option. Nonetheless, given the massive scale of the opiate problem we currently face in this country and the almost countless different individual situations that those who are addicted to opiates may find themselves, drugs like Suboxone offer an option which in some cases may be the most appropriate.