Have you ever been prescribed a medication that didn’t work for you? I have. One formulation of birth control pills made my hair fall out and, ultimately, feel suicidal. When I was quaking with anxiety after the end of my first marriage and was prescribed Xanax, I fell to the floor in a near blackout from the very first dose. In both cases, my physicians expressed compassion and concern, prescribed different medications for the same purposes, the medications worked, I returned to stability, and continued to live my life.
If laws had mandated that my physicians were limited to prescribing me only the medications that made me suicidal or caused me to lose consciousness, well, I doubt I’d be here today. It’s a ridiculous concept, isn’t it? Laws mandating what physicians can prescribe for their individual patients with unique needs, case-by-case?
Yet, that is exactly the case. States are passing laws that limit how physicians can prescribe opioid medication for pain patients and for patients with opioid use disorder. In Virginia, bills passed both houses of the General Assembly prohibiting physicians from prescribing buprenorphine (Subutex) to men and non-pregnant women. Physicians must now prescribe buprenorphine with the additive naloxone (Subuxone) instead. As an additive, naloxone has no medical value; its sole purpose is to discourage misuse by injection.
The Virginia bills mean that patients stable on buprenorphine alone in Virginia must now take buprenorphine plus naloxone. Physicians have prescribed buprenorphine alone (Subutex) based on their expertise and their consideration of the patient’s unique needs. Some people can’t take naloxone, whether because of allergy, sensitivity, or other metabolic contraindications unique to that person.
But the bills say that all men and all non-pregnant women, regardless of their unique medical needs, most take buprenorphine with naloxone (Suboxone).
Let’s think this through a minute. Sure, the bills infringe on the individual rights of physicians and patients, and on the physician-patient relationship. Sure, lawmakers are engaging in malpractice by legislating medical treatment. Sure, it’s inhumane to make people take medications that make them ill. Sure, the overt intent of the bills is to discourage buprenorphine misuse by injection, ostensibly to take action against the opioid addiction crisis that Virginia Governor Terry McAuliffe has declared a public health emergency. Aside from all that, isn’t the primary, unstated intention of the bills to curb health care and criminal justice costs related to opioid misuse? How likely is a buprenorphine control law to do that?
Let’s take a walk in the shoes of someone with opioid use disorder. I’ll go first.
If I were being successfully treated for opioid use disorder, had adverse reactions to the naloxone in Suboxone, and were now stable on Subutex, I would know that science says I may need to take either methadone or buprenorphine indefinitely, perhaps my entire life, to treat my illness. If I learned from my physician that the laws have changed and I now have to switch from Subutex to Suboxone, or to try methadone, let’s check out my options.
Buprenorphine alone is out because of the laws. Methadone is out because, while it’s cheaper than buprenorphine, it’s so highly federally regulated that it must be obtained at a clinic and I don’t live near one in my rural area. Taking buprenorphine with naloxone, Suboxone, makes me ill. Even if I were willing to suffer the additive’s side effects on my own behalf, I’m the primary caregiver for my elderly father and I can’t afford to be sick. I could start to Google for ways others in this situation have tried to solve the problem and would find zero help from credible sources, but some highly suspect ways on message boards for how to hold the Suboxone pill in my mouth to separate out the buprenorphine from the naloxone, then spit out the naloxone… Huh?
I’m backed into a corner. I am no longer allowed to have the medication, Subutex, that kept me well. If I take what makes me ill, Suboxone, I won’t be well enough to care for myself and my father. If I don’t take what makes me ill, Suboxone, and I go off medication-assisted treatment entirely, with relapse rates between 50% and 90% after cessation of buprenorphine, I have a huge chance of that old illness – opioid use disorder – coming back. Counseling won’t make a difference; opioid use disorder could kill me this time. Marijuana might have helped, but it’s not legal in my state.
I’m stable and I’m no more a burden to the health care and criminal justice systems than any other citizen. These new laws now destabilize me and increase the likelihood that I might become very costly indeed.
Which would you choose?
What if we simply stride out of the buprenorphine control, no-win corner and straight out the door into the vista of financial data from the National Institute on Drug Abuse, NIDA: “According to several conservative estimates, every dollar invested in addiction treatment programs yields a return of between $4 and $7 in reduced drug-related crime, criminal justice costs, and theft. When savings related to healthcare are included, total savings can exceed costs by a ratio of 12 to 1.”
Laws controlling buprenorphine limit addictions treatment. Limiting addictions treatment increases costs. Therefore, laws controlling buprenorphine increase costs.
Are lawmakers thinking citizens would rather pay $12 in health care and criminal justice system costs rather than $1 for treatment?
And citizens can certainly read the data on how other countries have solved their overdose crises. They loosen, not tighten, access to addictions treatment medications.
If not for humanitarian reasons, then for fiscally sound ones, lawmakers, please, legislate the end of restrictions on addictions treatment and let the people with opioid use disorder have the medications they need and let their physicians prescribe them.
Disclosure and disclaimer: The opinions expressed here are mine alone and do not necessarily reflect the positions of my employers, co-workers, family members or friends. This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.
- Say No to Laws That Prescribe
- Why Opioid Maintenance Does Not Replace One Addiction with Another
- Addiction or Dependence: A Life and Death Difference
- Understanding Why We Have Wait Lists for Opioid Addictions Treatment
- What the Opioid Epidemic Means in Virginia
Last revised 3/1/17