Vote No on Laws That Prescribe

Regardless of why and how people develop substance use disorders, a.k.a.  addictions, 20 million Americans have them now, 1 in 7 is expected to get them, a person dies of a drug overdose every 19 minutes in the U.S., and only a fraction of those who need help are receiving it. Whether we approve of it or not, addiction is a national crisis. Not doing something effective about it strains our system and our people.

The two top treatments for opioid use disorder are the medications methadone and buprenorphine. Burpenorphine is dispensed primarily in two formulations, buprenorphine alone, brand name Subutex, and buprenorphine with naloxone, brand name Suboxone.

The purpose of adding naloxone to buprenorphine is political, not medical. Law makers have required pharmaceutical companies to include naloxone in the formulation of Suboxone in an attempt to prevent misuse of buprenorphine. Neither data about opioid use and misuse, nor the biochemistry of the metabolism of buprenorphine or naloxone, support including naloxone with buprenorphine as an effective method for preventing opioid misuse. Illogically, however, this requirement exists.

Each human’s physiology is unique and, therefore, each person’s response to medications is unique. Some people with opioid use disorder are able to tolerate Suboxone, i.e. buprenorphine with naloxone. Some people cannot. They have allergic reactions to naloxone, naloxone sensitivity, or pre-existing medical conditions for which the presence of naloxone creates complications. The expertise of medical professionals is required to determine what medications are suitable for each patient on an individual, case-by-case basis.

Virginia General Assembly House Bill 2163 entitled “Buprenorphine without naloxone; prescription limitation,” states “products containing buprenorphine without naloxone shall be issued only for a patient who is pregnant.” HB 2163 has passed the House of Delegates and is currently being discussed in the Senate Education and Health Committee. A similarly worded bill, Senate Bill 1178 has passed the Virginia Senate and is currently being discussed in the House Health, Welfare and Institutions Committee.

Virginia HB 2163 and SB 1178 mean that all men and non-pregnant women currently stable on Subutex must stop taking it and switch to taking Suboxone instead. HB 2163 and SB 1178 mean that all new cases of opioid use disorder in men and non-pregnant women in Virginia must be treated with Suboxone even if Subutex is the medically prudent, even medically imperative option.

Virginia HB 2163 and SB 1178 legislate medical malpractice.

In addition, the proposed bills mean that those taking Subutex who cannot take Suboxone will be forced to find another option. Access to the alternative top treatment, methadone, is virtually non-existent in our locale.* Treatment with naltrexone, while helpful to some, does not directly affect the areas of the brain most specific to opioid use (those treated by methadone and buprenorphine).

Those without buprenorphine in a form they can take, without access to methadone, and who find naltrexone ineffective, will have to do without treatment for opioid use disorder.

Of people with opioid use disorder who abstain from opioids without maintenance therapy, also termed medication-assisted treatment (MAT), 50-90% are likely to return to use. And, as reported by Maia Szalavitz, “[M]aintenance is the only treatment known to reduce drug-related mortality, which it cuts by more than 70 percent.”

Those desperate not to return to use do what people desperate for opioid use disorder treatment who languish on wait lists do as well: find friends or family members who are on buprenorphine and ask to share their doses. And those friends and family members risk and sacrifice to share their prescriptions in an attempt to save loved ones stricken by life-threatening opioid use disorder. Or, less often, they buy it from strangers, a.k.a. “dealers,” to self-treat opioid addiction.

Virginia HB 2163 and SB 1178 cruelly back its citizens into a corner, offering no healthful choices to benefit individuals with opioid use disorder or the Commonwealth as a whole.

I called my Virginia State Senator today. This is what I said:

“My name is Anne Giles and I am a constituent in Blacksburg, Virginia. I am calling to urge Senator Edwards to vote no on House Bill 2163. While I appreciate the attempt of public officials to address the opioid crisis in Virginia, HB 2163 would endanger those with opioid use disorder and further strain our systems providing them care. Health care professionals have determined that some people with opioid use disorder must take buprenorphine alone as Subutex and cannot take Suboxone for medical reasons. The law will require men and non-pregnant women on Subutex to switch to Suboxone, which may be medically contraindicated. HB 2163 legislates potential malpractice and must be opposed. I so hope Senator Edwards will take my views into consideration.”

State Senator: John S. Edwards (Democratic)
Capitol phone: (804) 698-7521
District phone: (540) 985-8690

. . . . .

*We were unable to find verifiable sources for the number of methadone clinics in the Commonwealth of Virginia. This source lists 3 methadone clinics in Western Virginia and this source lists 5 in Southwest Virginia. We verified that a clinic is operational in Pulaski, Virginia and is listed in the second source but not the first. Many people, particularly in rural areas, will be unable to make daily commutes to a distant methadone clinic, whether due to conflicting responsibilities (i.e., dependent care, work) or due to a lack of or limited transportation.

A version of this post first appeared in The Roanoke Times.

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.

Last updated 4/13/17

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  1. I have been on Subutex for 6 years. I also was forced to switch to Suboxin which I can not take. My hands and feet have swollen so bad from the Naloxone which I am highly allergic to that I can hardly walk and I can’t even make a fist my hands are so swollen. I’m at a complete loss. I feel they are forcing me back on Oxycodone which I never wanted to take again but I’m left without any opinion being those who abuse are more important than those of us who chose to stay off the stuff. So glad our State knows what’s best for us more so than our doctors. They are forcing their hands and this is wrong on so many levels. If I’m retaining fluid in my hands and feet from Naloxone I’m sure it’s probably around my heart also as this is one of the serious side effects of Naloxone. SMH.

  2. On May 15th, 9am in Henrico, the board will be meeting, possibly to re-asses this. I encourage all who can make it, to do so & be heard.

  3. This new law is crazy. My boyfriend has been on subutex for 5 years and is also documented that he is allergic to naloxone and is now being forced to take something that gives him mouth ulcers and hives or will be completely cut off. Subutex worked well for him. How can the state do this? Its almost like they want to see people whom are doing well fail.

  4. Can you please contact me I have been in recovery for a year now on subutex due to an allergy to the naloxone and today without warning in Abington va my clinic cut me off tried to force me to switch to suboxone and gave me no medication to help me til I find a better option (another clinic or state with another clinic) all I wanted to do was beat my addiction and when I left my clinic today with $400 in my hand guess what I done?? I feel horrible but I went and relapsed I hate myself for it but I’m an addict and I had no medication and my anxiety was at an all time high!! I’ve not had a dose since yesterday morning and when they informed me I was being switch even with my allergy documents I just lost it they treated me as if I was in active addiction and turned me away I don’t think that people actually understand how much the subutex helps the ones that want the help. Yes I’m aware that people are abusing it but I also know hat that they are abusing the suboxone strips and tabs and whatever else pills that are out there just because they are putting regulations on subutex doesn’t mean it will stop them from using!! I know more people in active addiction who get strips and shoot them way more than subutex they refuse the subutex actually!! Anyway I hate the rant but I’m very upset about this and I wanna know if the bill is now a law and if not how can I help petition for it not to pass?? thanks so much Linda h

    • Anne Giles says:

      Please contact a health care professional in your area, Linda. I deleted your phone number to protect your privacy. I appreciate you reaching out to me. Please reach out now for help from a health care professional. Take care!