Last month, The Forum chronicled one borough native’s descent into opioid addiction; how in the matter of a couple of years a dentist’s prescription for a painkiller rapidly plunged into full-blown dependence on heroin.
This week this space spotlights what many opiate addicts have characterized as a wonder drug, one of the crucial tools in managing addiction to narcotic painkillers or heroin: buprenorphine and naloxone, better known as Suboxone.
Approved in 2002 for office use by physicians by the Food and Drug Administration, Suboxone “is intended to be the formulation used in maintenance treatment of opiate addiction,” according to the FDA’s Talk Paper on the drug. Naloxone was added to Suboxone to guard against intravenous abuse of buprenorphine by individuals physically dependent on opiates. While at one point Suboxone was available in both pill- and film-form, the pills have slowly been phased out in favor of the film. Both are supplied in 2 mg and 8 mg strengths, and both are placed under the tongue and must be allowed to dissolve.
Suboxone revolutionized how addiction specialists treated opioid-dependent patients because it has less potential for abuse “than methadone, and therefore can be prescribed by physicians from their offices,” according to PsychCentral.
However, based on the potential for abuse of Suboxone, the FDA and Department of Health and Human Services recommended that the Drug Enforcement Administration place the active ingredient, buprenorphine, in Schedule III under the Controlled Substances Act. Buprenorphine is considered to have less risk for causing psychological and or physical dependence than the drugs in Schedule II such as morphine, oxycodone, fentanyl or methadone.
The PsychCentral paper also posited, “compared with methadone, Suboxone’s most obvious advantage is that it allows office-based maintenance treatment of opioid dependence. The difference in quality of life between patients on Suboxone versus methadone maintenance can be tremendous.”
Additionally, one of the myriad products of the state opioid epidemic is the nascent Suboxone street market. Known as “oranges,” one tablet or film can cost as much as $25. Because of this, PsychCentral reported, “the DEA tightly regulates its use. Physicians must complete an eight-hour continuing medical education course in order to obtain a special DEA number before they can prescribe Suboxone. Even with the waiver, the DEA limits the number of patients on [a doctor’s] Suboxone ‘panel’ to a maximum of 30 during their first year of prescribing and a maximum of 100 patients thereafter.”
By Michael V. Cusenza
