Worrying Over A Wonder Drug

Deborah Sontag reports (NYT) that a relatively new maintenance drug for opiate addicts has made its way to the streets:

Buprenorphine has become both medication and dope: a treatment with considerable successes and also failures, as well as a street and prison drug bedeviling local authorities. It has attracted unscrupulous doctors and caused more health complications and deaths than its advocates acknowledge. It has also become a lucrative commodity, creating moneymaking opportunities – for manufacturers, doctors, drug dealers and even patients – that have undermined a public health innovation meant for social good. And the drug’s problems have emboldened some insurers to limit coverage of the medication, which cost state Medicaid agencies at least $857 million over a three-year period through 2012, a New York Times survey found.

Alec MacGillis defends the treatment and slams its media coverage:

Buprenorphine – bupe for short – has proven so successful at allowing opiate addicts to feel normal and go about their lives that advocates hail it as something of a wonder drug.

And the benefits multiply – less painkiller and heroin abuse means less HIV transmission, less hepatitis C, and, yes, fewer fatal overdoses. Check out the recent trends in buprenorphine use and heroin overdoses in Baltimore, which has embraced bupe as a weapon against its deeply entrenched heroin problem. No, correlation does not equal causation—for one thing, Baltimore was over the same period also expanding the use of naloxone, medication used by drug users and EMTs to reverse overdoses as they’re occurring. Still, it’s hard not to draw certain conclusions from these lines displayed in a recent article in the American Journal of Public Health, which echo the plunge in overdoses in France, an early adopter of buprenorphine.

overdose-chart

So what’s not to like? Why are we not shipping as much buprenorphine as possible into small towns in Maine and eastern Oregon and eastern Kentucky and all the other places reporting surges in abuse of painkillers and now, increasingly, heroin? Well, partly because bupe has gotten stuck with its own stigma—not as strong as methadone’s, but damaging nonetheless. … The Times cites data showing 402 fatal overdoses linked to buprenorphine in the United States reported to the F.D.A. from spring 2003 through September. As the article notes, this pales in comparison with the 2,826 attributed to methadone over roughly the same period and the more than 19,000 fatal overdoses from opioids overall in 2010 alone.

The fact is, there is no silver bullet for the country’s growing opiate addiction problem. And any approach is going to seem tainted, to bourgeois eyes, by the inherently chaotic and desperate nature of the milieu in which opiate addiction is rooted (though not confined to – painkiller abuse has been on the rise in tony suburbs, too). It would be deeply unfortunate if fraught portrayals in the media with decidedly oversimplified, alarmist headlines had the side effect of dulling one of the best tools we have in this fight.