Should the cure for an illness be harder to get than the cause? Well, it is.
As you are probably tired of hearing, we are in the midst of an opioid addiction epidemic, sparked or exacerbated by the over-prescription of legal but highly addictive opioid prescription pills such as oxycodone and hydrocodone (OxyContin, Percocet, Vicodin). They are so addictive that when, belatedly, doctors began curtailing the prescriptions, the now dependent patients often switched to black market opioids.
Government crackdowns on the pharmaceutical companies who manufacture the drugs mean that they are hard to come by even on the black market and users have had to resort to more deadly and cheaper options such as heroin and fentanyl. Drug rehab, even when available, is far more costly and hard to find than black market drugs.
While there is no cure for addiction per se—an addict can relapse even after decades of sobriety—there are substitute drugs that can safely control the addiction without causing euphoria. There are three main drugs used for such medication-assisted treatment (MAT): naltrexone (Vivitrol), methadone and buprenorphine (Suboxone).
Of the three, naltrexone is the most popular among judges and politicians in part because it is an anti-euphoriant. It can’t get you high and, in fact, stops you from getting high even if you take an opioid. This also means if you still have the opioid in your system, if you haven’t already gone through the detox phase of recovery, naltrexone will put you into immediate and painful withdrawal, the same withdrawal that prevents many addicts from even seeking recovery.
(Another reason for naltrexone’s popularity is that it can be given as a monthly injection, Vivitrol. Buprenorphine, however, also is available as a six-month implant, Probuphine, although that hasn’t helped it take off as an alternative treatment.)
Methadone and buprenorphine, on the other hand, are opioids themselves, just weaker one. Taken as prescribed, they won’t get you high, just control your craving so you can function, hold down a job, get drug rehab treatment, and in general carry on with your life.
It is still possible to get high by taking a larger dose or by taking another opioid on top of it, but relapse is a possibility with all addicts. Politicians are fond of saying this means using buprenorphine and especially methadone is just exchanging one addiction for another. Scientists and doctors, however, say they work. According to a study in the American Journal of Public Health, “in places where methadone and buprenorphine were available, the number of fatal overdoses fell by 50%.”
Politicians are more worried that more people may take drugs than that fewer people will die from taking them. There are even segments of the population that object to the increasing availability of naloxone (Narcan), the anti-overdose drug because it reduces the risk of overdose and therefore encourages drug abuse.
In the case of methadone, abuse is usually prevented by making the patient report to the doctor or a methadone clinic every day for their daily dose. In the case of buprenorphine, policymakers seek to reduce the risk of abuse by limiting the number of people doctors can so treat. No other drug is so proscribed. In order to prescribe it at all, doctors need a special waiver.
President Trump is expected to sign legislation that will increase the number who can be prescribed, among other reforms. It may not be enough.
Experts have said that we can’t stop drug abuse until treatment is less expensive and easier to get than staying high. The same is true for buprenorphine and methadone.