Why Sen. Ed Markey’s Plan to Help Heroin Addicts Might Actually Hurt Them Instead

Recovering addicts say prescribing patients opiate treatments like Suboxone isn’t a cure-all when it comes to staying clean.

Photo via Sen Ed Markey on facebook

Photo via Sen Ed Markey on facebook

In the fight to combat the scourge of heroin in Massachusetts and across the country, Senator Ed Markey introduced new legislation last week—piling it onto existing state and federal efforts—that would increase access to drugs like Suboxone to help addicts kick their dependence on opiates.

But those in recovery and with experience using Suboxone say that Markey’s proposal, which would expand the amount of patients health officials could prescribe the drug to, and allow more certified health experts to dole out the medication, isn’t necessarily the right approach to solving the heroin epidemic.

“At the end of the day, you’re going to have to get off the drug Suboxone just like you had to get off of heroin to begin with. It prolongs the inevitable,” said Mike Duggan, a recovering opiate addict who runs a service in Arlington called Wicked Sober. Duggan’s organization provides patients and families with addiction resources, and helps addicts and alcoholics find available beds at detox facilities.

Duggan said Suboxone, a synthetic opiate substitute taken daily that helps heroin users to function normally and prevents them from feeling the effects of getting high, comes with bad withdrawal symptoms once a patient decreases dosage of the medication, or tries to wean off of it.

Suboxone and other buprenorphine-based medications like it are considered Schedule III narcotics under the Controlled Substances Act. Schedule III drugs are described by federal officials as substances or chemicals with a moderate to low potential for physical and psychological dependence.

“I get so many phone calls from patients that contact me to try and get help because they are on Suboxone and the detox lasts longer than it does with heroin, and it’s miserable,” he said. “Not to mention, say something happens and you can’t get your prescription for some reason—you’re going to be dope sick, and the solution is going to be taking a drug like heroin just to feel better. That right there tells you what a big problem it is.”

Last week, Markey announced new legislation that would expand resources for heroin users called The Recovery Enhancement for Addiction Treatment Act, or TREAT.

Markey’s proposal, backed by the American Society of Addiction Medicine and the Massachusetts Medical Society, would increase access to Suboxone treatment by lifting the federal cap on the number of patients doctors can prescribe it to, and, for the first time, allow certified nurse practitioners and physician’s assistants to help addicts by also providing access to these treatments.

Under current federal law, passed as part of the Drug Addiction Treatment Act of 2000, only a select number of certified physicians are authorized to prescribe FDA-approved opioid addiction remedies like Suboxone and Subutex to up to 30 patients at a time from their offices. To take on additional clients for a treatment program, a medical professional has to apply for a special waiver, and even then, they’re limited to 100 patients in all.

Markey argues that these limitations contribute to long waitlists for addicts seeking treatment to get off of heroin and other opiates, leading to more overdose deaths.

Markey’s plan, combined with social and behavioral supports, would increase the patient cap to 100 people per each qualified physician, and remove the limitation in its entirety after one year, provided a specialist completes approved training in a “qualified practice setting.”

Further, certain nurse practitioners and physician’s assistants could treat up to 100 patients per year as well, as long as they’re licensed in a state that allows them to prescribe controlled substances, they complete approved training on opioid addiction treatment, and they’re supervised by a physician who can prescribe opioid addiction medicine.

“Thoughtfully expanding existing federal restrictions, with a focus on expertise and quality, will help increase the number of patients who have access to life-saving treatment,” according to a description of Markey’s bill, posted to his website.

Duggan, who used Suboxone when he first got sober five years ago, said he can’t judge the success rate of the drug for everyone, but in his own experience it didn’t work out. “I got mixed feelings on it. Just because it didn’t work for me doesn’t mean it doesn’t work for someone else, but more or less, people that I know haven’t been successful on it,” he said. “The problem I see is simply this: when you have a drug problem and you’re substituting it with another substance, people think it’s a miracle-pill cure. There is no miracle-pill cure.”

Another addict who went through the Suboxone treatment program, who asked not to be identified, said for two years he took the medication before finally relapsing and turning back to heroin and other drugs.

Now sober once again, through alternative methods, he said doctors that he dealt with in the Boston area that prescribed Suboxone didn’t properly detail how addictive the drug can be, or how difficult it is to taper off of.

“It sounds like a good idea, but the thing that pisses me off is when the doctors take these [certification] tests, they are told [Suboxone is] not meant for long-term sobriety. I had two doctors, and when I wanted to taper off of it, they didn’t recommend it,” he said. “They want to keep you on it. People can go back to work and this and that, and feel normal, but they don’t tell you how hard it is to get off of it. It’s not good for your body for long-term use. And they will prescribe it forever.”

Other problems have included a rise in the drug’s street value, as well as corruption within the treatment programs that prescribe the medication.

In 2013, prosecutors charged a physician from Boston for over-prescribing Suboxone to more patients than is allowed under federal law. Dr. Richard Ng, 54, of Milton, was charged by Attorney General Martha Coakley’s office for prescribing opiates to patients that were not using the drug, and instead were still actively using heroin. Ng also collected fees from patients trying to get clean on top of receiving money from their health insurance companies.

Duggan and the recovering addict who asked to remain anonymous said Suboxone has its benefits, and is a great solution to helping addicts get sober and get their lives on track without feeling the painful effects of withdrawal from opiates, but the drug has setbacks, and users should seek additional counseling when trying to get sober.

“It’s good because the minute you get out of detox, you can resume your life without being sick,” the anonymous source said. “But it would be better if they educated people more about coming off it.”

Markey’s plan marks the third time that he’s put together a proposal to help combat the surge in opiate overdoses both in his district, and elsewhere. In August, Markey will come to Boston and hold a roundtable discussion with state and local officials about his comprehensive strategy to address the ongoing epidemic.

  • http://www.drugpossessionlaws.com/ Drug Possession Laws

    Hmm, check out the ASAM page, and tell me what side they are on.
    They oppose marijuana legalization as advocated recently by the NY Times, and support the policies of the ONDCP.
    But they support expanded access to drugs like Suboxone, which may or may not be helpful, but certainly provides them with more clients.

    • stevensousa

      What we need to do is make it easier to get real treatment (not just detox).. For the life of me I don’t understand why treatment is a four letter word with the insurance companies in Mass. If its the least bit difficult to get into a treatment center when the user decides to try then they will give up and turn back. Harvard Pilgrim should be a shame..

  • mattcurtisnyc

    What we need in the response to increasing opioid and heroin use – and increasing overdose deaths – are evidence-based public health strategies. I’m not discounting the experience of the two people critical of buprenorphine in the article, but they are a pair of anecdotes, not data. Buprenorphine, along with methadone, are parts of the gold standard for treatment of opioid dependence. Both medications greatly reduce overdose risk, allow people to reduce or eliminate injection drug use and all the potential negatives that come with it, and to stabilize, improve their health, work, and more. Buprenorphine is a wonderfully useful medication that’s been tragically underutilized, in part because too few doctors want to be involved in drug treatment and partly because of stigma around drug use and addiction. Like any medication it has downsides, but part of the conversation needs to be “Compared to what?” Detox isn’t even considered drug treatment by most public health and medical professionals, and people entering abstinence-only 12 step and rehab programs have incredibly high relapse rates. Removing barriers to buprenorphine access that are not based on clinical evidence — which is what the Markey bill aims to do — will be lifesaving.