Does Buprenorphine Really ‘Save Lives’?

Legal disclaimer: Nothing in this post is meant to be construed as medical advice. I am not a physician or pharmacist. Discuss any medications, changes, or questions you might have with your medical provider. Do not suddenly stop any medication unless under the direct guidance of a medical provider.

Today was a weird day. What began with some light historic-ecclesiastical reading and plans to write a piece about a specific trend in feminism in antique literature, turned instead into a Twitter brawl in which I repeatedly questioned doctors and pharmacists on a certain status quo, and received 5th-grade-style memes of Homer Simpson in response. What was the cause? Buprenorphine.

More popularly known as Suboxone or Subutex, buprenorphine (“bupe” for short) has been touted in recent years as “the” drug of choice to treat opioid dependence disorders (formerly known plainly as “addiction,” for politically-incorrect and insensitive jerks like me, or so I was told).

Although my concerns about the safety and efficacy of buprenorphine became quickly misinterpreted as a war on drug addicts (or whatever the PC term is now), I ended up spending the day reading through study after study (see below for a list), but was hopelessly ganged up on by dozens of angry and less-than compassionate “professionals” who took the time to point out I must know nothing about the subject because I also “make jewelry.”

They insisted I could not read scientific or medical literature although such things are written in English and I am blessed to have access to ‘foreign’ objects like the internet and dictionaries to look up any unfamiliar terms, and in short, I had it all wrong, and my misinformation would inevitably lead to the untimely end of numerous, unnamed individuals. I just needed “to trust my doctors,” insisted one.

They had already read all the studies and charts I supplied, which is why they needn’t bother to look at the ones I provided and actually answer my questions. I hadn’t been privy to that much gas-lighting since the most recent family holiday.

I guess I touched a nerve.


What is Buprenorphine?

Buprenorphine is most commonly used in the US to treat opioid addiction. The idea is to transition people off heroin (and dirty needles, and other unhealthy practices associated with street drug addiction) and/or illicit painkillers. In much, much smaller doses (micrograms vs. milligrams), it is used to treat severe pain. Bupe is an opioid, and can cause addiction in and of itself.

all opioids are addictive

-Source*


Is Buprenorphine Safe?

This is the question that most concerns me, and I have legitimate reasons to wonder:

Although more people have access to bupe than ever before, OD rates are still rapidly climbing. Dr. Andrew Kolodny insists this is because “more people need more access to bupenorphine,” but haven’t we seen this doubling down of ineffectual policies before? Yes, except 5 years ago, the trend began with the false narrative that irresponsible doctors were getting people hooked on opioids. And who started that claim? Oh, yeah, that Dr. Kolodny guy.

drug overdoes chart for Mont. Co

My interview with a local substance abuse counselor from 5 years ago, indicated bupe was neither as safe nor as effective as touted. She told me then “substance abuse counselors hate it.”


Money, Money by the Pound!

There have been many back-end, sly marketing techniques, going on for at least a decade by the makers of bupe, Reckitt-Benckiser/Indivior, recently accused of attempting to artificially prolong the patent on Suboxone.

There is a ton of money to be made by doctors who prescribe it (average $300 for first appointments, $150 or more for subsequent/monthly appointments, and whatever can be earned in lab and pharmaceutical kickbacks).

Federal guidelines were recently widely expanded to allow those doctors to be able to treat hundreds of patients at one time, instead of the strictly limited 30 patients from 12+ years ago (the strict limit was put in place to prevent doctors from essentially dealing the drugs to patients.

Now that it has been eased, a number of questionable practices have been increasing). A push by none other than PROP board members, via an article in the New England Journal of Medicine, asserts than everyone from nurse practitioners to OB/GYNs can and should be able to dispense buprenorphine, not just addiction specialists.

Bupe, in the form of Suboxone, costs an average of $151-518 for just 30 days of sublingual filmstrips for the uninsured, depending on dosage, and about $180-720 for 30 days of sublingual tablets, depending on dosage, up to 3x/day, although an original study of the drug, paid for in part by Reckitt-Benckiser, show the drug can last up to 3 days before needing a new dose. This was, in fact, a huge selling point of bupe, that people would not need to come daily to Suboxone clinics for the medication.

Patients on bupe can successfully go for 2-3 days on just one dose, reducing the need for daily clinic visits, and/or “reducing the need for take-home medications [which] decreases the possibility of illicit diversion and abuse of opioid dependence pharmacotherapies (Section 6)”


No Such Thing as Chronic Pain?

Contrary to PROP’s claim they do not want to ban opioids (of course they don’t, buprenorphrine is an opioid) or that they want to stop “drug companies” from promoting long-term opioids for chronic, non-cancer pain, Dr. Kolodny, founder and director of PROP, frequently promotes his ideas that essentially, there is no such thing as chronic pain, just opioid addiction.

That being the case, both birds can be killed with one stone groups can be helped via long-term maintenance with the opioid buprenorphine (made by a “drug company”).

only addicts, says kolodny


There is an enormous body of evidence dating back literally millennia that points to the existence of chronic pain as a real and devastating illness if left untreated.

Copies of medical texts from Ancient Egypt and Greece to modern times describe hundreds at least, of debilitatingly painful conditions with no cure from back injuries to rheumatoid arthritis and damaged nerves, that impact the lives of an estimated 50 million chronic pain patients in the United States alone.

It is, at minimum, grossly irresponsible to claim these people and their well-documented diseases and the expertise of thousands of doctors don’t exist!

There is a form of bupe called the “Butrans patch,” made for chronic pain (the chronic pain that “doesn’t exist”). Many insurance companies are forcing patients and/or their doctors to try it or the fentanyl patch, although there are also extended-release (ER) pill formulas for Vicodin/norco at far lesser dosages that suffice most chronic pain patients just fine. Ironically, many of these companies have new “addiction reduction” policies that refuse to take chronic pain patients and their medical histories into account.

So why are these insurance companies pushing so hard for medications that are far stronger than what doctors want patients on? I called one popular insurance company, Anthem/Blue Cross-Blue Shield, who told me the Butrans patch was “not any stronger,” than other ER medications, contrary to what my own doctor and these charts show.

According to Drugs.com, the Butrans patch for chronic pain is known to actually cause pain and severe illness, withdrawal syndrome, and a host of psychological effects associated with drug abuse including anxiety and depression, agitation, hostility, and paranoia. It is not safe around children, pets, pregnant or nursing mothers, and must be dispensed in micrograms not milligrams like most pain medications.

butrans patch dosing


That Old-Time Naloxone is Good Enough for Me

In an odd twist, Dr. Kolodny and his group, PROP, also push for buprenorphine to replace other long-acting, lower-strength opioid medications, insisting the abuse potential is much lower because of the Naloxone (Narcan) element in Suboxone.

However, “The Clinical Pharmacology of Buprenorphine: Extrapolating from the Laboratory to the Clinic,” by Sharon L. Walsh and Thomas Eissenberg, received on Dec. 19, 2002, and published by Elsevier and Drug and Alcohol Dependence on Feb. 4, 2003, and funded in part by Reckitt-Benckiser, the very makers of Suboxone, Subutex, and other very popular forms of buprenorphine, to introduce buprenorphine to clinicians, describing its safety and efficacy findings and how it appears to work, reveals:

“The doses of naloxone that precipitated withdrawal [in patients given 8mg of sublingual and 3 and 10mg doses of BPN/day]…were approx. 10 times greater than those that precipitated withdrawal in patients maintained with 30mg oral methadone” (Section 3.2.3).

Most patients are maintained on far higher doses, and the study’s authors also found other studies reported no withdrawal effects in patients given 8mg/day of bupe and challenged with 4mg of naloxone. The amount of naloxone in 8mg of Suboxone preparations is only 2mg.


The One “Good” Opioid in the Epidemic?

Current stats show the increasing rates of bupe abuse, and the original studies of bupe emphasize it, “does posses abuse potential.” Furthermore, the study describes bupe as producing “paradoxical” effects, “the same dose of buprenorphine can produce no detectable effects or it can produce prototypic opioid agonist effects and intoxication” (Section 3.2, emphasis added by blog author).

“Buprenorphine is not being monitored systematically enough to gauge the full scope of its misuse, some experts say. The Centers for Disease Control and Prevention does not track buprenorphine deaths, most medical examiners do not routinely test for it, and neither do most emergency rooms, prisons, jails and drug courts (emphasis added).

“I’ve been studying the emergence of potential drug problems in this country for over 30 years,” said Eric Wish, the director of the Center for Substance Abuse Research at the University of Maryland. “This is the first drug that nobody seems to want to know about as a potential problem.” –Source


Why Aren’t People Getting Clean with Bupe?

The study’s authors’ appeared to assume that patients on bupe could and would be easily transitioned (weaned) off with minimal withdrawal side effects. A relatively fast period of only 5 days claimed patients went from 8mg to 1mg with no withdrawal signs observed or symptoms reported (Section 3.2.3), but more and more patients are being maintained on moderate doses of 8-20mg of bupe indefinitely.

The study even states that patients on bupe can successfully go for 2-3 days on just one dose, reducing the need for daily clinic visits, and/or “reducing the need for take-home medications decreases the possibility of illicit diversion and abuse of opioid dependence pharmacotherapies” (Section 6, emphasis added by Rambling Soapbox).

suboxone od and abuse-is it safe-Source

Buprenorphine is an unusual drug by all accounts, which has been the cause of much misinformation, however it works just like any other opioid. According to multiple studies, it causes the exact same effects as other opioids, including intoxication, sedation, euphoria, respiratory depression, constipation, behavioral impairment, and urinary retention.

suxone od rises

Source

What sets bupe apart, is how it binds with opiate receptors in the brain. Many people think it blocks the effects of other opioids, but bupe binds faster and longer than more traditional opioids, including heroin and OxyContin.

According to Emergency Medical News, bupe, methadone, fentanyl, and often even oxycodone CANNOT BE DETECTED IN URINARY ANALYSES, and while chronic pain patients have been legally limited, force-tapered, dropped from practices, abused, forced to endure routine UAs although physically disabled, and stigmatized to taking 90MME (morphine milligram equivalence) or less (or none) for their safety, addicts are recommended to take many times that amount!

how much bupe vs pain pills

 


99 Problems, and the Studies are 1, 2, 3…

Concerning trends arise upon review of certain buprenorphine-related clinical studies, including the Walsh and Eissenberg study. Extremely small numbers of subjects were tested, for example, 7, 5, 10, 8, and 8, throughout the 1990s (Walsh and Eissenberg, Section 3.2.1). Other “larger” studies had only 99 subjects.

More recent studies include odd comparisons of numbers that effectually obscure real conclusions like this one from Spain, which looked at 19 other studies published between 1974-2016 (an odd range with no explanation given) from several high-income countries, more than 70% of whom were males with mean ages of 23-39.6, and featuring around 100K patients in 13 different groups on methadone for 1-13 years, but only around 15K patients in 3 groups on buprenorphine for just 1-4 years, to show how patients remained alive while on MAT treatment.

The doctors I “spoke” with on Twitter claimed that patients were more likely to die once off bupe, citing studies in European countries like this one, but a quick review reveals the key seemed to be patients who were both on a medication-assisted treatment (MAT) like bupe AND in a supervised, residential treatment center. Much like the ones the substance abuse counselor I interviewed 5 years ago lamented the loss of…


This is Not Treatment

Unlike the assumptions in the original study that patients on bupe will either receive treatment in-office, or be prescribed a single dose to last up to 3 days, there has been a strong push to allow addicts to be prescribed bupe for take-home use, such as this message, brought to you by the curious National Alliance of Advocates for Buprenorphine Treatment.

In other words, people with addiction issues to narcotics are being given powerful narcotic prescriptions a month at a time to take home, a scenario the study’s authors never imagined or recommended!

take bupe home with you

Let me restate: people with self-control issues around opioids are sent home with bottles of opioids and expected not to overdose? No wonder the relapse rate is so high. That is devastating.

recidvism rate for OD

Stats prove that drug abusers often mix different classes of drugs (known as a “cocktail) resulting in overdoses, so why should buprenorphine be pushed as the only cure-all when, not only are there two more established addiction treatment drugs, namely Methadone and Naltroxene (Naltroxone, in particular, is a non-opioid that also works to reduce cravings for alcoholism), but Narcan and bupe will not work to reduce cravings for the other types of drugs many users abuse, including antidepressants, anti-anxiety meds, stimulants, and hallucinogenics. This might be why:

-Source

Does Buprenorphine Really Save Lives?

“Buprenorphine is now more popular than cocaine, ecstasy, and heroin in some European countries. It is easy to obtain, currently quite fashionable, popular with opioid aficionados, and apparently associated with a quite pleasurable high when injected or snorted.

I would not be surprised to see more BPN issues in the ED, given the rise in its popularity, its increasing availability, and its perceived wide margin of safety. One might be confused by an opioid toxidrome with a negative drug screen unless the drug has been identified by history.” –Source


Sources Cited


More Sources:

Williamson, West Virginia and the Opioid Crisis (Fake News Alert!)

Headline: 20.8 Million Pain Pills Flood Tiny Town in WV

Let’s talk about Williamson, West Virginia, the little town in Mingo County that has been featured in the news for the past several years as a sort of starting point for the opioid epidemic.

IMG_2123_watermark
Downtown Williamson, WV, named for my grandfather’s side of the family!

According to sources, 20 million (give or take about 1 million) pain pills were sent to Williamson, WV, pop. 2900-3200 (depending on your source) over a 10 year period, and that those numbers are insanely high for such a little town. Sources imply the doctors there must be corrupt pill-pushers, with their pockets deep in Big Pharma, and/or Big Pharma picked on this unsuspecting underdog town for the purposes of corporate greed. 

This story is also meant to imply doctors cannot be trusted to prescribe pain pills appropriately, and therefore need major government oversight. Doctors are meant to be seen as directly responsible (along with Big Pharma) for “passing out pain pills like candy” and getting the population hooked on opioids.

The headline’s numbers look insane (which is the point), but NOT ONE article takes demographics into account. That little town’s elderly population consists of 22% elderly (65+), and 56% adults 18-64. Those working adults overwhelmingly hold/held manual labor jobs, which tend to lead to more serious and long-term, even lifelong injuries.


Break It Down:

  • 20 million pills divided by 10 years = 2 million pills per year.
  • To keep things simple, assume ONLY the elderly 65+ gets pain pills. That’s 22% (elderly pop.) x 3,000 (total pop. of town) = 660 elderly people.

  • 2 million pills per year divided by 660 (est. elderly pop.) = 3030 pills/year/elderly person.
  • 3030 pills per year divided by 365 days per year = roughly 8 pills/day.

  • 1 pill lasts 4-6 hours, so 24 hours/4 hours coverage = 6 pills per day*.

  • Before this opioid crisis started, 4-6 pills/day wasn’t an unusual amount, and patients could even sometimes take (gasp) 2 pills at a time, depending on the dosage and their situation.
And those figures are crunched just based on the elderly population alone. If you figure in other older adults like those in the 50-64 age range, that number of pills per day goes down even further.

There is a heroin epidemic, and there is an economic crisis, but as far as Williamson, WV and little towns like it being “flooded” with unnecessary pain pills, I call FAKE NEWS!

An Open Letter to Dr. Andrew Kolodny

Update 6/27/18: I am overwhelmed by the positive responses I have received for this letter. I would ask that readers also take a look at all the articles and references cited in this piece, and share those as well. Those references go into much, much more detail and research than I have had space or time for here. Thank you all so much for reading and sharing, I believe we will make a difference and win this fight for our lives! #wearehere

See also: A Rock and a Hard Place, The Truth About the Opioid Crisis, and Strangulation on Medicine

Dear Dr. Kolodny,

I am one of millions of chronic pain patients in the United States who has been continually and increasingly oppressed over the past few years by progressively invasive and prohibitive laws at the state and federal levels concerning the delicate relationship between doctors and patients, particularly when it comes to a certain class of drugs, i.e. opiates.

Ever since my very real, physical condition began about 4 years ago, my family and I have been disoriented again and again by a lack of what might be termed, “help,” from doctors. We have discovered a very confused medical community, corruption, and a growing collection of laws being passed so fast and furiously hardly anyone seems to know just what is going on.

This has resulted in doctors leaving my city, doctors outright refusing to accept chronic pain patients (or, if they do accept these patients, refusing to treat them with medications that suit the patient best) or new patients, and unprecedented referrals to pain management clinics and psychiatrists. I have a detailed post planned addressing the pain management clinics, but the psychiatrist referrals were more baffling to me. My local psychiatrists even refused me as a patient about a year ago because, “we don’t see chronic pain patients.” That made sense to me as I don’t suffer from mental illness, still my providers insisted I must be mistaken.


Down the Rabbit Hole

I began researching you and your career last night out of curiosity. I wanted to answer the question, “Who is this Dr. A. Kolodny, that everyone from journalists to policy makers and bloggers keep quoting as an “expert on opiates”?” And I found out. You, sir, are a psychiatrist and board-certified addiction specialist-turned policy maker (1) and buprenorphine (Suboxone) “evangelist” (2).

Your first private clinic was a Suboxone clinic in New York City, established sometime around 2003-2005, and it appears you (and/or other health officials) felt stymied by the federal limit at the time of just 30 patients for such clinics (put in place to stem corruption), because said health officials have been in the background, quietly working away at this very limit which was amended in 2006 (called DATA), to allow 100* patients after 1 year, and is now up in the House for being overturned altogether, along with expanding legal prescribers to nurses and other non-doctor medical staff. And look what has happened as a result:

Health officials, concerned about restricted access, lobbied alongside Reckitt Benckiser for the patient cap to be raised. “Why should we bind a healer’s hands from helping as many as he or she could?” Senator Hatch said, getting an amendment passed in 2006 that allowed doctors, on request, to go from 30 to 100 patients after a year.

The stage was set for more patients, prescriptions and problems. “It’s when the limit was raised from 30 that doctors started to get commercial about it,” said Dr. Art Van Zee, whose buprenorphine program at a federally funded community health center in rural Virginia is surrounded by for-profit clinics where doctors charge $100 for weekly visits, pulling in, he estimated, about $500,000 a year.

“They are not savvy about addiction medicine, don’t follow patients very closely, don’t do urine testing and overprescribe,” he said. “That’s how buprenorphine became a street drug in our area.” https://www.nytimes.com/2013/11/17/health/in-demand-in-clinics-and-on-the-street-bupe-can-be-savior-or-menace.html (4)

“In the early days of Suboxone, with Reckitt Benckiser barely marketing its own drug, Dr. Kolodny, then a New York City health official, crisscrossed the city with colleagues to spread the word about the new medication, entice public hospitals to try it with $10,000 rewards and urge doctors to get certified.”

https://www.nytimes.com/2013/11/17/health/in-demand-in-clinics-and-on-the-street-bupe-can-be-savior-or-menace.html (4)

Since at least 2005, you have been marketing buprenorphine as if you had a personal stake in the drug, to government institutions and agencies including prisons, public hospitals, and rehabilitation facilities (2). In the fall of 2013, you were appointed Chief Medical Officer (5), of the largest chain of non-profit detox/rehab facilities in the USA (cited for questionable practices and abuse from at least 2012-2015) (6) called Phoenix House, which received $131 million in June 2013 (7), championing the use of MAT, or “Medication Assisted Treatment,” and which now funds your non-profit, policy-influencing group, PROP, or Physicians for Responsible Prescribing. I wonder which drug Phoenix House used?


Hang ‘Em High?

salem witch hanging.PNG
An innocent “witch” (woman) is hanged at the Salem Witch Trials, much like other innocent pain patients are persecuted.

Since you often cite the United States vs. Purdue Pharma (2007) settlement in your interviews and writings, perhaps you saw an opportunity to expand the use of buprenorphine by targeting and demeaning chronic pain patients as mere “addicts”.
It was odd to me in researching that incident, in the official “Purdue Guilty Plea” document (8), the very words they were condemned for, claiming OxyContin to be “less addictive” and “less subject to abuse and diversion” (8), appear to be the exact words you use time and again when describing the benefits of buprenorphine (2).

Kolodny reminds his colleagues of the drug’s advantages. He stresses that bupe in the form of Suboxone is safe and almost impossible to abuse, a huge selling point at many of the clinics they will visit. Suboxone has a second active ingredient in the mix, he explains, an anti-overdose drug called naloxone.

It does nothing if you take bupe as directed. But if you sniff bupe or inject it or otherwise try to pack enough into your bloodstream to get high, the naloxone acts like a chemical booby trap, erasing the effects of any opiate, bupe included, and bringing on sweaty, nauseating withdrawal. “That’s the last time you’ll do it,” Kolodny says dryly. https://www.wired.com/2005/04/bupe/

In 2016, your organization, PROP (Physicians for Responsible Opiate Prescribing), got the ear of the CDC and helped to write the now-infamous, misinformed, and rushed guidelines for prescribing opiates. While these guidelines were fairly general in nature, they have been used as a springboard for countless pieces of state legislation and DEA investigations, which has, in turn, led to the above-mentioned abuse and abandonment of chronic pain patients and doctors, as well as opiate shortages in hospitals and ERs (The DEA, in an attempt to prevent diversion of opiates to the black market, has cut production by an incredible 45% in the past 2 years). I imagine that suits you just fine, since you have publicly stated you believe opiates should be discontinued for all but the dying and post-major surgery “for a few days” (https://www.ket.org/opioids/inside-opioid-addiction-10-questions-with-dr-andrew-kolodny/), and that “more treatment” is needed (https://www.vox.com/science-and-health/2017/8/3/16079772/opioid-epidemic-drug-overdoses), i.e. MAT/Suboxone clinics like Phoenix House.

'The National Gesture' 1926
“The National Gesture” 1926

You have hailed local municipalities and states in their further pursuit of legal action against American Big Pharma, the companies who make such things as Vicodin and Percocet, but not Suboxone/buprenorphine (which is also an opiate), which is made by an overseas company, Reckitt Benckiser, or Naloxone (Narcan), which is produced in a nasal spray exclusively by Amphastar Pharmaceuticals (10), a relatively new company founded in California in 1996 (11),  whose stock (and Narcan prices) have been rising quite a bit, lately (12, 13). Are you truly against the use of opioids, or just the ones that help pain?


The Opioid Epidemic!

mccarthyism
McCarthyism Propaganda

Although your policies, based on inaccurate data (14-15) https://www.acsh.org/news/2017/10/12/opioid-epidemic-6-charts-designed-deceive-you-11935 (15), and http://www.mdmag.com/journals/pain-management/2012/october-november-2012/just-how-responsible-is-prop, have been wildly ineffective at stopping heroin/fentanyl overdoses; although you are not a pharmacologist, opiate researcher, pain doctor, pain patient, surgeon, or even general practitioner; although you ran a private clinic for a short time in 2005 (as far as I’ve been able to learn) that dispensed buprenorphine/Suboxone, you have, for the majority of your career as far as I can tell, been a policy-maker and not directly involved with addiction patients or chronic pain patients whom you recently claimed were simply addicts who needed compassion and “treatment” (and, presumably, Suboxone).

“Many Americans are truly convinced that opioids are helping them. They can’t get out of the bed without them.”

“Policy makers were told by industry-funded pain organizations not to penalize pain patients because of drug abusers. We realized that this wasn’t true. We don’t have these two distinct groups, one for pain patients and the other for drug abusers.” https://www.kolmac.com/2015/12/qa-dr-andrew-kolodny-chief-medical-officer-phoenix-house/ (15a)


If You’re Not For Us, You’re Against Us

sen. joe mccarthy demonstrates the communist threat
Senator Joe McCarthy Demonstrates the Communist Threat in America

You are cited and quoted in an impressive number of articles and interviews as a compassionate person who wants to see people and their families heal from the devastation of addiction, which is why it surprised me to find quotes from you that didn’t seem, well, “nice.”

It is the FDA’s role to vigilantly regulate the approval, labeling, and promotion of  pharmaceutical products, not that of counties or municipalities. County and municipal lawyers are inadequately qualified to make or enforce federal drug policy, and these lawsuits serve as a vehicle for local governments to seek revenue  through ill-informed measures under the guise of drug abuse prevention. In a May 30,2014, interview with   FDA Week, a CLAAD spokesman voiced these positions and expressed concern that these lawsuits are part of “a trend that will distract us from the real meaningful approaches to reducing prescription drug abuse.”

After reading the interview, Dr. Andrew Kolodny, president of Physicians for Responsible Opioid Prescribing (PROP)and Chief Medical Officer of Phoenix House,  contacted CLAAD via telephone to condemn its comments. During this conversation, Kolodny threatened that the Internal Revenue Service would revoke CLAAD’s tax-exempt status when alerted to the comments, which he believes conflict with CLAAD’s charitable mission.  CLAAD takes these false allegations and threats very seriously, and  responded in a letter which is publicly available for view on our website.

Critics who categorically dispute the motives of organizations like CLAAD and its diverse coalition members are, at best, narrowly focused. Their zealotry reveals their otherwise undisclosed health insurance industry bias.  At worst, they endanger the lives of people who live with pain and other conditions that can require controlled substances by stifling access to quality care. http://paindr.com/claad-and-phoenix-house-square-off/ (16)

Anyone who questions your authority, expertise, policies, or the efficacy of your pet drug, buprenorphine, is loudly dismissed by you as uneducated (17), addicted (15a), or corrupt (15a, 18), regardless of how closely they actually work with addicts and pain patients (17).

But Dr. Kolodny, I have nothing left to lose — your policies and attitudes have directly impacted my health, my freedom, my ability to be a parent, my work, my hobbies, my family, my finances, my friends, and my personhood. I have no problem announcing to the public, as loudly as I can, “The Emperor is not wearing any clothes!”

emporer has no clothes


Citations

(1) http://www.cecentral.com/search/faculty/136145

(2) https://www.wired.com/2005/04/bupe/

(5) https://www.phoenixhouse.org/news-and-views/news-and-events/phoenix-house-appoints-dr-andrew-kolodny-as-chief-medical-officer/

(4) https://www.nytimes.com/2013/11/17/health/in-demand-in-clinics-and-on-the-street-bupe-can-be-savior-or-menace.html

(6) https://www.reuters.com/investigates/special-report/usa-rehab-phoenixhouse/

(7) http://www.phoenixhouse.org/wp-content/uploads/2014/06/2013-Financial-Report.pdf

(8) https://assets.documentcloud.org/documents/4378824/Purdue-Guilty-Plea-Copy.pdf

(9)

(10) https://www.npr.org/sections/health-shots/2015/09/10/439219409/naloxone-price-soars-key-weapon-against-heroin-overdoses

(11) http://www.amphastar.com/about-us.html

(12) https://www.equities.com/news/naloxone-stocks-who-s-really-winning-the-battle-against-the-opioid-epidemic

(13) https://thinkprogress.org/pharmaceutical-company-with-monopoly-on-lifesaving-treatment-jacks-up-prices-3883e95f88c7/

(14) https://medium.com/@stmartin/neat-plausible-and-generally-wrong-a-response-to-the-cdc-recommendations-for-chronic-opioid-use-5c9d9d319f71

https://www.ket.org/opioids/inside-opioid-addiction-10-questions-with-dr-andrew-kolodny/

(15) https://www.acsh.org/news/2017/10/12/opioid-epidemic-6-charts-designed-deceive-you-11935

(15a) https://www.kolmac.com/2015/12/qa-dr-andrew-kolodny-chief-medical-officer-phoenix-house/

https://abcnews.go.com/Health/deaths-drug-overdoses-continue-rise-us-blacks-hispanics/story?id=54094943

(16) http://paindr.com/claad-and-phoenix-house-square-off/

(17) https://www.nytimes.com/2016/05/29/opinion/sunday/addicted-to-a-treatment-for-addiction.html

(18) https://www.kolmac.com/2015/12/qa-dr-andrew-kolodny-chief-medical-officer-phoenix-house/

https://www.vox.com/science-and-health/2017/8/3/16079772/opioid-epidemic-drug-overdoses

https://www.cdc.gov/drugoverdose/prescribing/guideline.html


Further Resources

https://www.cdc.gov/drugoverdose/prescribing/guideline.html

https://www.bendbulletin.com/topics/5342867-151/opioid-crisis-pain-patients-pushed-to-the-brink

http://www.mdmag.com/journals/pain-management/2012/october-november-2012/just-how-responsible-is-prop

http://nationalpainreport.com/cdc-does-not-comply-with-federal-law-8828305.html

https://www.chronicle.com/article/To-Counter-Opioid-Crisis-NIH/240219

https://www.painnewsnetwork.org/stories/2016/8/11/prop-ends-affiliation-with-phoenix-house

https://www.drugabuse.gov/publications/research-reports/relationship-between-prescription-drug-abuse-heroin-use/introduction

The Truth About the Opioid Crisis

*This article was originally written in 2015. It has since been updated with new, groundbreaking information and facts.

Previously titled, “On Opioids: America’s Drug Addictions and the Wacky Laws that Perpetuate Them.” See also: PROPaganda: Part 1 and Part 2; An Open Letter to Dr. Kolodny; A Rock and a Hard Place; and Strangulation on Medicine vintage heroinTwo years ago, a little silver car sat parked outside our home. As the sun was going down an ambulance, police cruiser, and firetruck suddenly arrived to pull an unconscious young woman with a bobbing blonde ponytail out from the driver side of the car, a bottle of heroin found next to her. We didn’t even know anyone was inside the vehicle. I never saw that young woman again, and the police came to impound her car a few days later.

Last July, I sat in the small chapel at a local funeral home staring at the body of my husband’s cousin. Only 29 years old, living less than a mile from our house, married and a daddy-to-be, and there he lay in an open coffin looking sound asleep. After months of staying clean he had found a dealer in the apartment complex he and his wife had just moved in to. That night he took heroin, unknowingly laced with fentanyl, for the last time.


drug dog
McGruff the Crime Dog teaches kids to “Just Say No” to drugs. I remember this guy!

In 2013, Ohio Senator Mike DeWine decried heroin use as “a statewide epidemic.” (1) A rising tide of heroin-related deaths totaled over 900 for Ohio in 2013, a sharp increase from previous years that showed no signs of leveling off or decreasing (1). Heroin is cheap, easy to get, and often deadly (1). Heroin use is also linked to prescription narcotics, which studies (2) show has decreased in rates of abuse in my area (heroin and fentanyl have continued to rise), ostensibly due to tougher federal and state laws (3) implemented last year that limit their prescription by practitioners.

Many times a person will experience legitimate pain, be prescribed a narcotic, get hooked on the high, and then turn to heroin when their prescription is over and they can’t get a refill (2). (*New information and stats show this commonly held narrative is overwhelmingly false. The vast majority of those abusing prescription drugs ALREADY had a history of drug or alcohol abuse.) Heroin is essentially morphine, a drug (morphine, not heroin) commonly used in emergency rooms for severe pain (5). It is one of the strongest opioids available (5) and it is a major problem that people are taking the leap from prescriptions like Vicodin and Percocet (hydrocodone and oxycodone) to street heroin. (*It is actually not one of the strongest opioids available) While lawmakers are right to be concerned about prescription opioid abuse (*which has been decreasing since it peaked in 2012), they are not focusing efforts on the much larger problem of heroin abuse, and the sad results are astounding.

Last May 2014, The National Institute on Drug Abuse, a component of The National Institutes of Health, presented the following information at the Senate Caucus on International Narcotics Control (4).

“To illustrate this point, the total number of opioid pain relievers prescribed in the United States has skyrocketed in the past 25 years  (Fig. 1).[4]  The number of prescriptions for opioids (like hydrocodone and oxycodone products) have escalated from around 76 million in 1991 to nearly 207 million in 2013, with the United States their biggest consumer globally, accounting for almost 100 percent of the world total for hydrocodone (e.g., Vicodin) and 81 percent for oxycodone (e.g., Percocet).[5]

This greater availability of opioid (and other) prescribed drugs has been accompanied by alarming increases in the negative consequences related to their abuse.[6] For example, the estimated number of emergency department visits involving nonmedical use of opioid analgesics increased from 144,600 in 2004 to 305,900 in 2008;[7] treatment admissions for primary abuse of opiates other than heroin increased from one percent of all admissions in 1997 to five percent in 2007[8]; and overdose deaths due to prescription opioid pain relievers have more than tripled in the past 20 years, escalating to 16,651 deaths in the United States in 2010.[9]

Pretty scary-sounding stuff, but notice in the argument above words like “opiates other than heroin” which may or may not include prescription narcotics, and may in fact include Suboxone *also here (more on that in minute). Although the number of prescription opioids has increased over 10 years, the percentage of abuse represents only a fraction of the number of people taking these medicines, 305,900 to 207 million. Compare that to the numbers of heroin users which is double the amount of prescription narcotics abusers, “The number of past-year heroin users in the United States nearly doubled between 2005 and 2012, from 380,000 to 670,000” (4). Policymakers have put the emphasis on the wrong syllable and no one is being helped.

Indeed, the recent laws our country and states have implemented to purportedly alleviate the “problem” of prescription opioid abuse, have only exacerbated the very real problem of heroin abuse, which is reaching epic proportions around the nation (4). I recently spoke with a local 25-year veteran chemical dependency counselor that I’ll call “Glinda” (not her real name). Poor Glinda was very frustrated with the current system of treatment for drug abusers, telling me quite frankly, “People are dying because of this new policy!” What policy was she referring to?

drug overdoes chart for Mont. Co

Glinda informed me that up until 5-6 years ago, the standard form of treatment for heroin users who wanted to be free was a very selective residential treatment program. After being selected for treatment, the heroin addict was admitted to a local hospital that partnered with the chemical dependency clinic. The patient stayed in the hospital for 3-4 days, being observed and weaned off all drugs. By the end of those 3-4 days, the patient was completely drug-free and then sent to a residential treatment facility for another 28 days, at least. Although it was not 100% fool-proof, Glinda admitted, “We had a pretty high success rate.” This program had been in place since 1960 in Dayton, Ohio, until about 5 years ago when drug companies came out with Suboxone (also known as buprenorphine), a drug created to help users stop their opiate addictions. A slightly less intense form of synthesized heroin, *Suboxone/bupenorphine is actually stronger, and therefore more addictive than heroin. Heroin has a relative strength of 5x potency of oral morphine, bupenorphine has a relative strength of 40x, while hydrocodone (Vicodin) has a potency strength of -100x and oxycodone (the generic, short-acting version of Purdue Pharma’s oxycontin) has about 1x!). Although touted as “life-saving” for the Naloxone additive it contains, Suboxone is still a powerful narcotic/opioid with the same potential for addiction.

Chemical dependency counselors hate it.”

Poppies
Dorothy Gale sleeps among the poppies in “The Wizard of Oz”.

What went on behind the scenes one can only guess at, but, Glinda told me, lawyers, policymakers, lobbyists, and state and city medical boards all  jumped on the Suboxone bandwagon (6) as a cheaper alternative to hospital detox programs. Laws were passed to ensure Medicaid would pay for new Suboxone and methadone clinics, which popped up over the city of Dayton and state of Ohio like daffodils in spring. According to Glinda, these clinics simply hand out free Suboxone or methadone (an opiate drug even stronger than heroin) to any user who comes in asking. They are limited to one round a day or week depending on the clinic. Users are supposed to go through counseling before they can have the drugs, but Glinda said, “Many times this ‘counseling’ is nothing more than an hour-long video.”

Glinda told me that Suboxone users sometimes take an additional anti-anxiety medicine with benzodiazepines like Xanax, Valium, or Ativan, to get back the extra high Suboxone purposely leaves out, often resulting in the user’s death. However, many other times users will take their free drugs and just sell them on the street for heroin. “It may be a cheaper ‘solution'”, Glinda said, “but no one is getting clean. Chemical dependency councilors hate it.” The article, The Misguided Obsession with Heroin / Opiate Maintenance Drugs (Suboxone, Subutex, Buprenorphine, Methadone) (7), from The Clean Slate Addiction Site, echoes Glinda’s concerns,

“Most of the research on drugs like Suboxone (a popular formulation of Buprenorphine and Naloxone) checks the effectiveness of the drug over a 12 week period. That’s it. And as stated above, long term results are essentially unknown. Also, most of the “success” that’s found with drugs like Bupe and Methadone is that people who take it stay engaged in treatment programs longer than those who just receive counseling (without drugs).  

If the NESARC results from heroin and prescription opiate users are to be factored into the equation, we might decide less treatment is better. After all, those opiate and heroin addicts who received treatment had MUCH longer periods of abuse and dependence before actually remitting. Which in itself means more occasions of use, which means more opportunity to overdose.”

At the same time safer (compared with street heroin) and documented prescription narcotics are being locked down, marijuana (8) is becoming legalized in various forms around the nation and addicts get their stronger-than-prescription-narcotics Suboxone or methadone free, allegedly to help them get off narcotics. By severely limiting the prescription of legitimate narcotics, not only have policymakers been contradictory, they have effectively tied the hands of America’s doctors and punished law-abiding citizens in real pain, in order to prevent them from potentially becoming law-breakers. But we also have laws in place that essentially reward law-breakers by giving them free drugs, as a way of trying to make them law-abiding citizens. We are making more heroin addicts with these policies, not fewer, and the numbers sadly corroborate.

After speaking with Glinda for over an hour, my final question was simply, “What can we do to change this?” Her response, “Activism is the key. Contacting policymakers including county commissioners and boards of health (these links are for Montgomery County and Ohio), and pointing out the facts that these [Suboxone and methadone] clinics just are not working. Then maybe we can help save some lives.” Or, in the words of one of my favorite films…”People are dying! Would you please shut down the system?”


Sources (in order of appearance)

https://www.mikedewine.com/dewine-heroin-epidemic/

http://mha.ohio.gov/Portals/0/assets/Research/OSAM-TRI/Dayton.pdf  (Pages 114-118)

http://www.usatoday.com/story/news/nation/2014/08/21/us-restricts-hydrocodone-painkillers/14387867/

http://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2014/americas-addiction-to-opioids-heroin-prescription-drug-abuse

http://mcintranet.musc.edu/agingq3/calculationswesbite/convchart.pdf (Pages 2-3)

http://www.thefix.com/content/best-kept-secret-addiction-treatment?

http://www.thecleanslate.org/the-misguided-obsession-with-heroin-opiate-maintenance-drugs-suboxone-subutex-buprenorphine-methadone/

http://www.governing.com/gov-data/state-marijuana-laws-map-medical-recreational.html

http://www.mcohio.org/government/bcc/index.html

https://odhgateway.odh.ohio.gov/lhdinformationsystem/Directory/GetMyLHD


Read More:

http://www.daytoncitypaper.com/a-light-at-the-end-of-the-tunnel/

http://novusdetox.com/heroin-effects-history.php

http://www.historytoday.com/ian-scott/heroin-hundred-year-habit

http://www.drugabuse.gov/publications/drugfacts/heroin

http://www.drugpolicy.org/new-solutions-drug-policy/brief-history-drug-war