Suboxone: The New Drug Epidemic?

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.

suboxone-2m-8mThe 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.”

“We took an abused drug and we said let’s use it to treat addiction to heroin and opiates.”

Last year patients filled about 9 million prescriptions for Suboxone or buprenorphine products, many may not realizing they were taking another opioid to treat their opioid addiction.

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 will trigger sudden withdrawal symptoms when injected. It is added as deterrent to prevent addicts from injecting Suboxone. When taken as a pill, naloxone is not absorbed into the body.

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.

Suboxone tablets.

Suboxone tablets.

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

“Suboxone is a fantastic detox agent.  But you have to use it with great caution as a long term maintenance medication. In my clinic we use a lot of Suboxone, but only for detox,” says Menzies, who is president of Assisted Recovery Centers of America, which operates four addiction treatment centers in the St. Louis, Missouri area.

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.

“For a drug addict, the most uncomfortable, painful problem of their addiction is withdrawal. If I can somehow control my withdrawal, then I have complete freedom to use heroin,” Menzies told National Pain Report.

“It’s a perfect formula for drug addiction. They have very little interest in getting off the drug. Suboxone, in my estimation, has allowed a very significant number of people to maintain their addiction.”

“This was great drug for its intended use,” says Charlie Cichon, executive director of the National Association of Drug Diversion Investigators, a non-profit that educates health care providers about drug abuse and diversion.

“But the abusers found out that this was another drug that they liked. It’s not a drug that gets them on that high plain like the other drugs that they abuse. But if they can’t get that drug that they like, Suboxone is readily available and it keeps them at this mellow stage until they can get the next drug.”

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.

“We joke that there’s more Suboxone on the street than in pharmacies. Most of the heroin dealers are diversified now. They offer you a choice of Suboxone and heroin. And now with all these generic forms coming out, that is going to explode,” says Menzies.

“My concern is that, just as what happened with chronic pain, we had an explosion of generic oxycodone and hydrocodone being introduced. And look at the mess we had. We’re going to see the same thing happen with Suboxone and buprenorphine generic preparations.”

Drug makers are well aware of the potential for diversion and tampering. Orexo, the maker of menthol flavored Zubsolv, is selling the tablets in single dose “blister” packaging designed to reduce accidental ingestion by children.

suboxone-film1And Reckitt-Benckiser, which took its Suboxone tablets off the U.S. market last year, now only sells Suboxone in individually wrapped film strips.

But experts say no amount of preparation and packaging can outsmart a determined drug abuser.

“When they had the pills available, the abusers would crush the Suboxone pills and make a yellow paste out of it,” says Chicon, explaining that the “paste” was sometimes smuggled into prisons after it was smeared on the pages of children’s coloring books.

“They’d have their little kids color in Mickey Mouse with crayons and they’d send the coloring book to prison to daddy or mommy. Daddy or mommy would know the pages that the Suboxone paste is on and they’d suck it or they’d sell it into the prison system,” Chicon told National Pain Report.

“Now they’re taking the yellow strips and they’re just taping them onto the pages as yellow squares or rectangles and then coloring around it. I have a coloring book page that has these strips on it that they’re getting into the prison systems. The abusers are always another step ahead of law enforcement.”

But the potential for abuse and diversion is no reason to stop treating addicts with buprenorphine, according to a commentary published in the journal JAMA Internal Medicine that calls for a “balanced approach” to the drug.

“Buprenorphine can and does cause harm, but those harms are outweighed by the serious health consequences and fatalities associated with opioid addiction itself,” wrote Robin E. Clark, PhD, and Jeffrey D. Baxter, MD, of the University of Massachusetts Medical School.

“Rather than overreacting to reports of buprenorphine diversion, policymakers should consider the actual harms that diversion may cause. Placing buprenorphine in the same category with more addictive and risky opioids distorts public policy and impedes effective treatment. Better education of prescribers and patients about the dangers of accidental ingestion by children, continued improvements in packaging and formulation of buprenorphine, and careful monitoring by prescribers and policymakers are all essential.”

Over 20,000 physicians in the U.S. are certified to prescribe buprenorphine. Percy Menzies wonders how many really understand the risks posed by buprenorphine.

“The Suboxone doctors, many of them have been very irresponsible, because they have no training in addiction,” Menzies says, explaining that the training often only amounts to a few hours of online education.

“It is shocking in this day and age that physicians are so incredibly ignorant about the pharmacology of buprenorphine preparations.”

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23 Responses

  1. Jay says:

    I read a lot of these forums and I finally had to speak out. Suboxone saved my life period! For all you haters on the drug please answer me this what should people with addiction do? You got a better idea? Cause I would love to hear it!! Unfortunately there are bad cases but the good far out weigh the bad so anyone reading this that are not sure if they should go on a sub program feel more then welcome to lie, steal and do whatever else you gotta do to make sure you don’t withdraw every four hours. I will continue to see my sub dr once a month and live a normal life. I hope this post makes your choice a little easier.

  2. joe says:

    I would agree provided there are no negatives from suboxone use.People should however be informed of the many possible side effects of sub. use,and of how long withdrawal from sub.takes(just in case they decide to discontinue.As i was on suboxone for ten years(14 mg daily) due to 2 year lortab addiction.Suboxone surely changed my life(it almost killed me three times.Undiagnosed physical lung,joint,and countless other ailments.Three instances of unexplained undiagnosed convulsions,not to even mention what it does to you mentally.I am,or was perfectly healthy 49 year old man.Was okay on subs for 5 years,after that started to have problems.However ,as the physical,or mental changes can not be proven to be caused by subs i will not comment further on same.What can be proven is that after 5 months after discontinuing this drug i am getting back to my normal self,mentally,and physically.My most significant comment would be to speak of how long withdrawal from suboxone takes after ten years use.I was told countless times that withdrawl from subs.last 7 to 10 days.I knew that this was completely untrue as withen the ten year span i had stopped subs for ten days(only starting to feel uncomfortable on eleventh day).Now as to the taper schedule,i went down from 14 mg to one half mg over 3 months finally jumping totally off subs 8-31-13.For the next two months i was in full withdrawal,completely useless.Finally had to take one half mg subs on 10 -05 -13. Fell on the floor right after that as if brain caving in,started shaking uncontrollably( again convulsions).Taken to er,admitted to hosp.,all tests negative,cannot find cause.Released after 3 daysCould not think straight for 8 days.Apologies folks, i was on subject of withdrwal .As stated took last half mg of sub10-05-13,as of today 2-12-14 still in mild withdrawal.It is unknown to me how long it might continue,but that said i now am now feeling my normal happy self,and all physical symptoms have disapeared,or greatly subsided.No matter what withdrawal symptoms,severity or length of time they last,i will suck it up and take them as i am back to my normal self after ten years.The point i would try to make is that we were lied to concerning side effects,and true withdrawal time from subs.I do realize that some people do need to be on subs. for life,and if they can do so without any problems that would be fine.Just be informed before begin this drug.

  3. donna wagoner says:

    Am sooo sick and tired (frustrated to tears) of either reading or hearing both the media and medical professionals report only negative effects of suboxone. I’m a success story. Been taking it for 5 yrs and finding it harder and harder to get the legal way. I have insurance but have to pay out of pocket. (DRS DONT TAKE INSURANCE CASH ONLY $250/MTH NOT INCLUDING MEDS) THE MAJORITY OF DEATHS U READ ABT CITING SUBOXONE THE CULPRIT FAIL TO SAY IT WAS BEING ABUSED. ANYBODY PRESRIBED SUBOXONE WOULD HAVE MORE THAN AN ADDICTION PROBLEM IF THEY DONT SEE ALL THE WARNING LABELS WARNING AGAINST THE DANGERS OF DEATH WHEN MIXING SUBS WITH BENZOS) CASE AND POINT PHILLIP SEYMOUR HUFFMAN. GOD BLESS HIS SOUL. I THOUGHT HE WAS A GREAT ACTOR BUT. DID ANYONE NOTICE THE SHMORGASHBOARD OF NARCOTICS HE WAS CAUGHT WITH? PLEASE SOMEBODY HELP THOSE OF US STRUGGLE TO TO MAINTAIN OUR SOBRIETY. IT WAS PAIN MANAGEMENT DOCTORS WHO PRESRIBED OXYCONTIN AND OTHER STRONG NARCOTICS FOR YEARS. I CAN EASILY GO BACK TO THOSE DRUGS AND LIVE LIFE LATHARGIC ALMOST CATATONIC. WHY IS IT SO DIFFICULT FINDING A DOCTOR WHO PRESCRIBES/WHOS ACCEPTING PATIENTS? SOMEONE NEEDS TO HELP THOSE OF US BEGGING AND PLEADING. CAN I GET AN AMEN?

  4. James says:

    I like all started out on perk 10′s to 15′s to then 30′s and oxycotins. Eventually prices sky rocketed and I graduated to Herion. Fortuantley I’ve found I can pretty much safely detox myself alone with just 2 8mg suboxone films. I first wait till I have the runs and cold chills running down my spine . day one i’ll start off with like just over half of the first sub. maybe 3/4. day 2 I take the second half of it. and the following 3 to 4 days i’ll cut up the second sub into 3 or 4 strips and ween off that way. it’s worked very effective so far, but I wouldn’t suggest tampering with this way all the time, or it will sooner or later stop working for you i’m sure .

  5. Nancy Cook says:

    My comment is to number 10, Nancy on this website. Where do you live or have you found a doctor yet? There may not be one in your city but check your surrounding cities. I am in Louisiana, live on the northshore and I travel 72 miles for my doctor and have to make 4 meetings a month. But one is a church service which counts as a meeting. My Doctor is also a pastor and the meds and God help me but I am chronic pain and I pray that one day soon all my pain will be gone and I no longer need the medicine.

  6. Serena Hodge says:

    I started taking pain pills for back pain, over the next 7 years I got addicted. It was the worst 7 years ever!! I tried everything , to get off the pills, nothing worked until suboxone!I have been on suboxone for 3 years now and my dose remains the same I have not had to increase my dose!! It helps with my back pain and I finally have a normal life!!

  7. john says:

    Suboxone should never be used for more more than a week or guess what? You are now addicted to Subs. Start out with 2mg and ween yourself down to a tiny spec after a week. You should now be able to function without anything. You won’t feel perfect but you wont be disabled like going cold turkey either.Like any drug, it’s not good to stop suddenly. It helped me get of oxys and im clean now. Yes I still crave it now and again, but quit smoking after 20 years and you will still crave a cig the rest of your life.

  8. Tammy Robinette says:

    My question is to Ben? Are u still on subutex? If so do u worry as far as something happening to u. And u would need pain medicine for a real reason? Also I have read so many threads, where ppl are having a hard time getting off this drug. How did u do it? Or are u still on it? From my experience with my son, who is 20. I feel he’s getting something off of it. If it can make a day at work go faster, without anxiety, and being pissed off at the world. It’s manipulating something in the brain! I’ve read more bad than good. Or is it how it’s being used at the facilities. Some seem professional, (Ins. always out of network), to the facilities that are making $$$$ off young kids! You tell me?

  9. Ben says:

    Yes that was a ridiculous article. Suboxone and Subutex saved my life about 5 years ago. I was using 6 grams of strong heroin daily! Had to sell it to to do it and that comes with people wanting to rob or kill you for your drugs. I got on the Suboxone program in another state because it wasn’t available in my state. Since then i have lived a great life finally. Work a good job, live a normal life and can finally enjoy life without worrying how i was going to get “well” daily. It is a great drug that gets people off methadone, heroin, oxy and much more. Also i have never been high from subutex.

  10. N. Rodriguez says:

    I’m an old lady with an addiction that has lasted my entire adult life (except for a ten year abstinance when I had my youngest child). Its not the drug that makes u pick up its the personal problems that do. Heroin makes u think that u r without problems, but the problems r still there when u get up the next day & ur sick as a dog & have to get the $ 2 get another fix. I’ve been lucky enough in not have to put a mattress on my back (as many do; women as well a men) cos I was smart enough to get myself an education & many times I had 2 & 3 jobs (thank the Lord for grandmothers 2 babysit) I’ve been a legal secretary, a bartender & a waitress In a high class restaurant. The secretarial job was so that my parents wouldn’t find out about me. The other jobs were great cos it got me $ every day (& u no u need it). I’ve been lucky (or maybe not) in as much a I didn’t get busted ’till I was 50 yrs old & thats cos I took a rap 4 my youngin. even then It was o.k. cos I put up a store in prison & was the cottage representative & met some nice women there. So u future addicts be smart don’t become a street whore get AIDS & STDs have some self respect & live a semi normal life. Or better yet stay away from people that do drugs especially boyfriends that u think u love that will put u on the street & beat u daily 4 not making enough $ 4 the drugs u & he need 4 the day. Get an education, find yourself a good man (or woman) & with all the $ u would spend on drugs u can buy a home or take cruises or whatever. Believe me drugs are not the answer.

  11. Tammy Robinette says:

    So it’s a good drug, to help you get off another drug. Statement: I’ve read so many can’t get off this one! I’ve seen clinic’s that look like a crack house, with EO coming in and out with their Lock Box? Not once was someone told or demanded you wear a Bracelet, recognizing your med. Blocks pain! Accident unconscious, go to hospital. They don’t know. What happens when they IV with a pain medicine? No professionalism in this clinic. There’s a sign on wall, they want help for a counselor. I’d venture to say all that are there are on Sub! (Opinion). You tell the counselor your doing 2mg a day. They start you out on 8mg? And if your not there at 8am in morning you won’t get your full dose. Your gonna tell me, There’s Not Something Wrong With This Picture! This person getting it from the street. Yea seems somewhat normal. Not pissed off at the world. But steady playing with their hair, like a child when sleepy. I guess that’s Normal. Go to another more professional clinic. Evaluation: Person, I want to stop it all. In the end the counselor, feels they can do this on their own with counseling No Drugs! I’ve been told and read. Withdraws are bad! But, YOU WON’T DIE! Using a recipe, forget the name. Using vitamins, Epson salt baths, herbal teas, staying away from processed food, and power drinks. Can help with withdrawals. Oh yea and exercise. God knows you want work, be independent? Or for the most Not! Tolerance, is the biggest part of all! And it all starts with your mind, heart, and soul.

  12. JeffZ says:

    It amazes me this clown got ANY press time. Bupenorphine saaved my life, excuse me it helped me treat the viscious physical cravings my addiction/disease imposed upon me following losing my leg below the knee & traumatic brain injury age 8 from a motorcycle accident which had me taking Oxycodone (Percodan & Percocet) which I was aggressively encouraged by my drs to take for my chronic pain from muscle, joint & nerve damage on an almost daily basis by the age of 14, snorting then injecting heroin when my tolerances naturally

  13. Steve, unfortunately, you don’t seem to understand the nature of addiction. Look at your last sentence. Let me ask you, would you give a gun to someone with depression? That is the whole point – you don’t give narcotics to a narcotic addict – prescribed or otherwise… Just like you wouldn’t give an alcoholic a prescription for alcohol…

  14. Steve says:

    Still blaming the drug, instead of the addict. My friend overdosed our senior year, but I know that the drugs aren’t to blame, his friends and family failed him and he made the decision to take what he did. He’s at fault, his parents are also at fault, and so are his friends. Not the opioids (prescription for chronic pain, taken as prescribed), not the benzodiazepines (abused), not the zolpidem, not the cannabis, and definitely not the doctors who treated his intractable pain.

    When someone commits suicide, do you blame the gun, or the depression?

  15. Nancy says:

    I have a bad problem an can’t find any help I tried to find a suboxone doc but can’t find one anywhere around where I live it sucks we should have more docs treating this problem I would have such a good life an so would my children if I could just find a suboxone doc

  16. James Bosco says:

    I think, when used properly, suboxone can help opiate/heroin addicts live and maintain a normal life for a while. The problem starts when you realize you no longer want to be a slave to another drug, but from my own experience I cant tell you that being on suboxone maintenance is the lesser of two evils. One thing I don’t understand though is the misconception that you can’t shoot suboxone up. If the company that sells these pills actually say that you cannot shoot suboxone that is a terrible lie. The only time you shouldn’t shoot suboxone is when you have just taken opiates/heroin because then it will send you into precipitated withdrawal, but that goes for any way you ingest it. I shot suboxone for a year the pill form as well as the strips, I just traded one for the other. Bottom line in addiction is that when you’re ready to stop, then you’re ready.

  17. My son died of acute narcotic toxicity one year ago. Since then, I have been researching the drug which he was on for nearly 3 years. I have taken everything I have learned about this drug and made it into a blog. It seems that everything you read about Suboxone is positive. If you do a google search on Suboxone or buprenorphine, you have to get past pages and pages of paid advertising and pro-Suboxone information to find any negative information about Suboxone at all. This is not fair to addicts who should be given all the information out there that is necessary to make an informed decision. What I have found out is scandalous. There are an increasing number of media accounts and studies concerning crime, overdoses, death, diversion and addiction problems associated with Suboxone (Buprenorphine). I present this information as a public service to those that are only told one side of the Suboxone story…

    http://www.SuboxoneAbuse.Wordpress.com

    Also, if you want to read about it from those that are addicted to Suboxone, go here:

    http://www.Subsux.com .

  18. marcy says:

    Menzie is quite misinformed

  19. marcy says:

    Exactly. Blame the addict not the pill. Ok, so u have a disease and u take a pill to maintain it right? Ok, addiction is a disease. Perion point blank!!!

  20. wayne c says:

    I struggled with addiction to opiate painkillers for 11 years. I tried rehab several times, that never worked. I tried a methadone clinic for two years and all that was a easy high given to me for free, the doctor allowed you to increase your dose any time you wanted, and by combining any type of other opiates, or benzodiazepines just made for a fun day. I then tried a pain management doctor to which to me was the biggest scam I have ever seen as long as you had insurance and kissed the doc’s butt you got what you wanted. I did this for two years again being on methadone, of course I abused it, sold, traded. and so on. I was miserable for about 10 days each month before my appointment, but all you had to was make sure your drug test was clean (all I did was use some else urine, if your an addict you know the deal) and you got your script. I believe most pain management doctors don’t care and are highly paid legal drug dealers. I also suffered from extreme depression the whole time I was abusing. I was actually to the point of suicide! One day I decided if I didn’t make a change if I didn’t do it, the drugs were gonna kill me. I saw a suboxone website and decided to make an appointment with a local clinic. The screening was intense you had to be interviewed by two counsellors, and a nurse, and they decided if were a good candidate for suboxone. I met the doctor and he was great! he explained to me how I had damaged the chemical balance in my brain and possibly might not ever be the same. I was started on suboxone and it made feel normal, like I felt before my addiction started. I use the drug properly. My clinic has a zero tolerance policy if you are positive on a drug screen or any opiates, benzos, etc. no faking these test they come in the bathroom with you! I go to group 4 to 5 times a week my depression is all but gone, it is the best decision I have ever made. Of course it can be abused, but for people who really want to be sober it is great, I can turn down a pain pill with blink an eye, I have no desire to get high any more. I hope if you’re serious about your recovery and you do the really take it seriously this will help you.

    One more quick observation how come a monthly supply of suboxone (a helpful drug) cost on average about $700 a month, when I used to pay $45 for 240 methadone? Tell me who wants to keep the public hooked??

  21. Sebastian says:

    This article is so absurd in so many ways, I don’t even know where to start.

    First, Percy Menzies’ views on Suboxone are about what one would expect from the president of a for-profit “addiction recovery” center that counts on a revolving door of patients in order to maintain its business. The scientific research on Suboxone has established that when the drug is only used as a short-term detox treatment (such as it’s used at Assisted Recovery Centers of America), the patient relapse rate is between 90-100%.

    Ask Percy Menzie what the relapse rate is for patients who are treated with Suboxone at Assisted Recovery Centers of America, and you’ll probably be conveniently told “We don’t keep track of that information”, or “We cannot give out that information.” Or if you’re lucky, Percy might be honest and acknowledge that the relapse rate is very, very high…which should make any sane person question just how effective short-term treatment is. Heck, even the manufacturer of Suboxone acknowledges that in the absence of a compelling need to get a patient completely off Suboxone, much better treatment outcomes are realized when a patient is maintained on the drug for a longer period of time.

    Yes, maintaining a patient on Suboxone has to be done correctly by a competent physician, but assuming that’s done then Suboxone can be a very effective treatment aid.

    “News” articles like this do a great disservice to people who might benefit from proper buprenorphine treatment. Anyone reading this article should be advised that there is a lot of information in it that is pure bunk.

  22. Jacob Landis says:

    This is pure idiocy. People who take suboxone are 99% of the time trying to get off a dangerous or addictive opiate like heroin or oxy. The pharmacist who said, “We took an abused drug and we said let’s use it to treat addiction to heroin and opiates,” is just wrong. Bupe was developed as a drug to treat opiate addiction, which — surprise! — for which people have the highest rates of recovery when they use (gasp!) variants on opioid medications to wean from heroin or painkillers. Have you heard of methadone? Prisoners should get suboxone in prison so they can get treated for their fricking heroin addictions instead of having to sneak it in.

  23. Connie says:

    If the addict was serious about their recovery, Then blaming Suboxone from allowing them not to feel their withdrawal is just silly. They don’t have to pick up that needle, it’s their choice. The addicts that Suboxone has helped get clean and stay clean weighs out the number of those people. I stand up and salute those addicts who can come off drugs and not use anything for the rest of their life, but to some addicts they need a crutch, they just are not going to stay clean unless they have something in their system that will numb that craving for that once desirable drug of their choice. To me Suboxone has been great at helping those addicts to get clean and stay clean. If the addict is using Suboxone as a stabilizer until they get their next fix, then blame the addict and not the Suboxone drug because the addict isn’t serious about their recovery.

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