The Opioid Crisis

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Considering how serious the opioid epidemic has become, and how many people have needlessly died, wouldn’t it be nice if there was a medication that people could take that could control their addiction to the substances?

Funny, but there is. Federal law limits its availability.

The medication is Buprenorphine, which has been used to treat opioid dependence in the United States since 2000. Buprenorphine comes in various forms, of which Suboxone is the most common. It took a long time for the US to approve its use, and then it would only do so if it could allow only specially trained physicians to prescribe for a limited number of patients.

Any doctor can write all the prescriptions for OxyContin she wants without special training, but often cannot prescribe a medication that treats the drug addiction that results from the OxyContin. Consequently, many, many people who need it are unable to get the medication. Every doctor who will prescribe it has a very long waiting list. 

Oddly, Buprenorphine can be readily found on the street. Drug addicts who want to get off heroin can more easily get it from their drug dealer than any doctor.

There are two ways to solve this problem. One way would be for Congress to waive the special training. I’ve been to the version of the training for counselors. It’s unnecessary. Doctors already have the skills they need to prescribe Buprenorphine. If they need knowledge about side effects and counterindications of the medication, they can find out about it the same way they find out about any other pharmaceutical. They can look it up on the internet here.

The other way to solve this problem is for more doctors to be trained, so they can prescribe the medication. If you are a doctor who prescribes opioids, then you should also prescribe the medication that your patients often need to manage their addiction to opioids, even if you do have to take a silly training. If you don’t, then drug dealers who will sell both opioids and Buprenorphine are acting more responsibly than you. 

Do I think Buprenorphine is a good way to treat opioid addiction? There are better ways. Medication is never the best way to treat addiction, but it is the easiest. The best ways are harder, they all involve relating to real people in a real way, like in individual therapy or groups; impossible to do when a person has got a monkey on his back. I’m a pretty good therapist, but I can do nothing with someone who comes in high, or worse, in acute withdrawal. They need to get started somehow on their abstinence.

Yes, they can go off their drugs, cold turkey, and experience a few of the worse days of their lives; but I thought the whole point of being a medical professional was to relieve suffering and assist patients to achieve their goals.

I would like to be able to refer my clients who need it to a doctor who could get them started right away on Buprenorphine, but that’s not possible. What do you think I should do, instead?

Keep a list of drug dealers I can hook my clients up with? Imagine that.