Stop Buying and Selling Suboxone!

 It’s been longer than usual since my last post. That’s because I spent the last five days in Boca Raton, Florida, at the annual meeting of the American Academy of Addiction Psychiatry. I usually go to meetings of the American Society of Addiction Medicine, since I’ve been a member of that organization for seven or eight years. I’ve always thought of ASAM as more “medically -oriented” and AAAP as more “mentally-oriented” but this week I found that they’re similar. 

Anyway, I went to some great meetings and lectures.

 The most intriguing was “Buprenorphine 201.” In this meeting, we had a lecturer, but she functioned more as a moderator for many of the physicians as we exchanged ideas about how we prescribe buprenorphine for our addicted patients.

 One of the more interesting topics was if, when, and how to taper buprenorphine. Should physicians encourage patients who are doing well on buprenorphine to taper off of it at some point? All the research data shows high relapse rates for patients who taper off of it. But many patients insist on tapering, due to the stigma, cost, and inconvenience of being on this medication, so what’s the best way to do this?

 I heard several new ideas, like doing dose plateaus. This means that once you taper 25% of the total dose, stay on the new dose for a few months to make sure the patient has completely stabilized before pushing the dose down again. Then stay at that dose for months, and so on. Another doctor said to use clonidine to treat early withdrawal symptoms. Another doctor suggested using benztropine (Cogentin) to manage some of the symptoms of opioid withdrawal. This medication is usually given to help symptoms of Parkinson’s patients, and to help manage the side effects of anti-psychotic drugs.

 The two best ideas I heard were: 1-Taper the dose down to as low as possible, in the range of 2mg, and stay at that dose for a prolonged time, maybe months. The doctor and patient can decide to taper further after a very prolonged time. 2-Use the 2mg Suboxone film, and cut it to gradually lower the dose. 

We all agreed there is little research to guide us to decide when taper is appropriate, and how to do the taper. Much of what we decide depends on the characteristics of the patient and their desires.

 Several other things came out of this meeting. The most worrisome is the degree to which buprenorphine, brand name Suboxone, is being diverted to the black market. This is making the DEA rather cranky, and other law enforcement types are beginning to make noises, saying that Suboxone should be re-classified as a Schedule II controlled substance because of the frequency it’s seen on the black market. If that happens, it would be the end of the Suboxone program. The DATA 2000 law that made it permissible to treat opioid addiction in a doctor’s office says the drug must be scheduled III or IV. A schedule II drug wouldn’t be covered by DATA 2000.

 So let me say loud and clear: If you are buying Suboxone, selling Suboxone, or giving Suboxone to someone other than the person to whom it was prescribed… KNOCK IT OFF!!!

You could ruin a good program that offers opioid addicts an option that was illegal in this country until 2002.

 Let’s do all we can to keep this medication available for the addicts who want recovery.

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20 responses to this post.

  1. Isn’t it always the few that ruin it for the many? In terms of law and legal status, I don’t think that creating a black market for Suboxone is going to change abuse. In fact, it will simply make the sale of the narcotic much more dangerous. Thanks for keeping us posted.

    Reply

    • I agree. As far as safety, the more Suboxone on the street, the better. People are much less likely to overdose with it. From a harm reduction point of view, we probably ought to give it to opioid addicts, free of charge. But the law enforcement types don’t look at addiction treatment that way. From their point of view, illicit opioid use is a crime and addicts should be punished. It’s a whole different mindset.

      Reply

      • Posted by nonya_biz on June 19, 2011 at 6:42 am

        i dont think i could agree with having suboxone more available than it currently is. i also dont think that its as ‘safe’ as you think it is. while the potential for overdose is lower than a full agonist like heroin, abusing suboxone/subutex has its own dangers. you must also take the human factor into the equation… people will abuse whatever is available in every way possible. i turn your attention to the rest of the world…

        Singapore has had problems with suboxone/subutex diversion and its subsequent appearance on the black market as a drug of abuse. notice the drastic increase in bup related deaths over a 2 year period after the drug was introduced to the country. http://www.sma.org.sg/smj/4711/4711e1.pdf

        in eastern europe (russia, chek, poland and prague etc) suboxone/subutex is one of the most widely diverted drugs available. many people inject the tablets. because of this, there is an increased rate of cytolytic hepatitis and hepatitis with jaundice observed in these abusers. and in users that are hep C positive, there is an even bigger impact on liver function, or lack thereof.

        now, in these countries, you see more of these problems because there are no stringent laws that determine who can and cant prescribe the drug, like here in the US. we see isolated incidents { http://www.ncbi.nlm.nih.gov/pubmed/11281569 } here and there, but for the most part they are few and far between. should suboxone/subutex become more available on the streets, you will begin to see the same issues occurring here in the states that other countries are having.

        here is what i would like to see more of… the time-release injections of buprenorphine. these injections contain microbeads of buprenorphine that break down slowly and release a steady stream of the drug into the patient over a 1 to 2 week period. i know the shot is available, but i dont think it was labeled for addiction treatment. instead, i think it was labeled for alcohol dependence.. you have to forgive me, im not a pharmacist or doctor.

        the shot would serve 3 purposes… first, it prevents the user from having to redose. redosing is a trigger and reminds people that they are junkies. the second purpose, once your injected there is no possibility of getting high on opiates till the shot wears off. being that it doesnt wear off for at least a week, that gives the user plenty of time to remove themselves from a bad situation. it also forces the user to be clean for as long as the shot is in them. and the last point the shot clears up, it prevents diversion of the drug period! it also separates the people that would like to use suboxone as a crutch from the people that want to use suboxne to get clean…

        and btw, i like your blog and site. im a somewhat recovered junkie that is still very interested in addiction and helping others with the same problems. i try to spread the word of suboxone as its the miracle drug that saved my life. im glad to see you put in so much effort into helping others with addiction issues.. thru your book, your site, your practice.. your doing good work and i hope things go well for you and your work.

        sincerely,
        James H.

      • Safe? Did I say diverted Suboxone was safe? No. I meant to say “safer.” No illicit use of opioids is safe. However, there are degrees of danger. It’s kind of like needle exchange. It reduces, but does not eliminate danger.

        You are thinking of Probuphine, the formulation of buprenorphine that’s undergoing testing now. It’s like Norplant in that there are several cylinders impregnated with buprenorphine that are implanted under the skin and release medication over time. Supposedly it will last for 6 months. Obviously diversion would be very very difficult, and take care of the problem we now have with Suboxone diversion. Thus far the only human trials showed it superior to placebo, but of course what we need to know is how it compares with currently available treatments.

        Opioid replacement treatment is still illegal in Russia. In France and Scotland, where only the mono product buprenorphine, equivalent to our name brand Subutex, drug diversion was much worse than it’s been in the U.S. The European experience is one reason why we largely prescribe Suboxone, because previous experience shows it’s diverted and injected less than Subutex. Less….but it still happens.

        Thank you for reading and commenting!

  2. Posted by cheri on December 30, 2010 at 4:12 am

    I agree. Please knock it off. Suboxone I feel is a medicine that I take for chronic neuropathy. With methadone and oxy’s I wasen’t functioning at all. In bed in pain and high for 3 years. Suboxone saved my life. Now I am functioning like a human should thanks to suboxone. Some people have to ruin everything

    Reply

  3. Posted by me on January 1, 2011 at 7:27 pm

    Does any body know how the film can be detected back to you, see what it was is my friend was out of his meds and i lend him two of my strips he got caught with them and im scared that im going to get in trouble.

    Reply

    • The strips do have a barcode that can be traced back to the pharmacy where they were obtained. This pharmacy will know who they dispensed them to. So yes, I would worry. If you were my patient, I think the best thing you could do would be to make an appointment, come in and describe the situation. Your doctor may not feel like she can continue to prescribe, and the only way to gain her trust is to let her know you get how serious this is, and agree never to do something like this again. In this country, addicts and non-addicts tend to share medication pretty freely, not realizing how doctors and law enforcement view such sharing.
      I know a patient who gave or sold medication to another person who subsequently died of an overdose, and this patient was convicted of manslaughter. She will be in jail for a very long time.

      Reply

  4. Posted by Dave H on January 12, 2011 at 7:11 am

    Yeah I bet the DEA would love to put Suboxone in SCH II

    Most of the suboxone on the blackmarket isn’t used like heroin or cocaine. Its used just like anyone else would medically. To stop WD and craving.

    The film was made for many reasons, one of the lesser ones is to track the packages if one ever needed. This will not do much to stop it, most intelligent people will realize this and still sell them by removing them and sealing them into another packaging.

    How putting Suboxone wouldn’t be the end of the program. It would be the end of the ease and discreet access to it. It will then be used like methadone.

    Honestly I wouldn’t be surprised to see that happen in the next few years. That will definitely slow down the diversion, but as we all know, it will not stop it.

    The DEA is a corrupt organization, lets never forget that. Look into its history when it was formulated if you want to know more…

    This country has got medicine and healthcare ASSBACKWARDS…
    Sorry another rant…

    Like Jana said, STOP SELLING IT AND BUYING IT. GO TO THE DOCTOR. It will be cheaper in the long run. You can also get patient assistance programs to help or completely pay for the medication.

    R and B offers this for 1 year, no cost, no strings. Ask you doctor next time you see them. Its a great program. However, the number of patients allowed is 2-3 per doctor. Somehow, by GOD, I got lucky this year. Right now is the best time to try too since its the beginning of the year..
    Okay I really got stop posting here for a day or so…..

    DRH

    Reply

  5. Posted by Mark on February 3, 2011 at 12:44 am

    Unfortunately, buying Suboxone illegally is my only option right now. Not only do I not have medical insurance, but my family would disown me if they found out. I was a drug addict for many years and stopped taking Oxys and doing heroin on November 18th, 2008. At the same time, I have an undiagnosed back problem (I believe it’s a slipped or herniated disk, can’t be pulled muscle and I doubt it’s a pinched nerve), and I don’t want to take any risks with opiates like oxycodone and hydrocodone. Another popular pill around nowadays is Opana, and they’re going for more than a dollar a mg. The 40s go for $45. I can usually get Suboxone for $5-$15 a piece, which I am glad to pay since I can make two 8 mg pills last a little over a week. If I went to a doctor, my family would find out, my girlfriend would break up with me, and my life as I know it would be over. I’d love to go somewhere to get them prescribed, but one doctor around here charges $300 per month, not covered by insurance and not including the price of the prescription. The other charges $60 every two weeks, and tried to taper me off them from 16 mgs a day to 2 mgs a day in just under 2 months. I was sick as a dog every day, she never did anything to help me, and she would talk to me with disgust every time I told her of the issues she was putting me through. I really don’t know what else I can do…

    Reply

  6. Posted by ben on February 18, 2011 at 1:19 pm

    i can attest to that story^. my suboxone doctor charged $300 up front and $40 every two weeks, and he doesn’t accept insurance. i was, of course, glad to pay it, as i was spending sooo much more on pills. pills are getting ridiculously expensive on the street. opana 40s go for $45 around here as well. oxy 80s used to go for like $65 each, but since they changed from OC to OP, the price has dropped considerably. i can get oxy OP80s for $25 now. low strength pills such as norco, lortab, and percocet 10mgs go for $6 a piece now, which is completely ridiculous. so, it definitely makes more sense to buy suboxone on the street anytime you can, it’s way more bang for your buck.

    i found this site they way you complaining about, “snorting suboxone film”. the reason i was searched it is because i heard from a friend that you could dissolve them in water, and snort the resulting concoction, because supposedly the bioavailability increases with that method. so i was like, hell, i will try it. it burns worse than anything i’ve ever snorted, but it does act MUCH stronger this way. so, i’ve been doing that for about 5 days. today, i went to snort up my dissolved strip, did so, and blood immediately started trickling out of my nose. scared the hell out of me, needless to say i will not be snorting suboxone film anymore, i’m just going to take it as directed. it definitely feels corrosive whenever you snort it, and the blood coming out of my nose proved that it actually IS corrosive.

    moral of the story:

    DO NOT SNORT SUBOXONE FILM STRIPS. IT WILL MELT YOUR BRAINS.

    ok, that’s all of my input.

    thanks for reading.

    Reply

  7. Posted by Lawrence on July 12, 2011 at 4:10 am

    There is a company making an device/implant of buprenorphine that lasts 6 months.
    It is a tiny rod that is implanted in the arm,procedure done right at a doctor’s office.
    Buprenorphine is slowly,steadily released into your system.
    If this implant is FDA Approved,the black market for other forms of this drug, Suboxone,Subutex) would decrease.Black market sales would drop and abuse of drug wouldnt exist with this implant.
    Company is called Titan Pharmaceuticals and name of this Buprenorphine implant is Pubrophine.Sounds like a great idea’
    Anyone heard of this procedure or were implanted in this Clinical study?

    Reply

    • Yes, I mentioned it in one of my earlier blog entries. It has been found to be effective compared to placebo, but to my knowledge, it hasn’t yet been compared to sublingual buprenorphine. This, of course, is the real question: how does the implant compare to the sublingual form?

      Reply

  8. Posted by mikle on August 3, 2011 at 8:39 pm

    i know some one selling suboxn who do i call to turn them in

    Reply

    • Of course you can call the police if you wish. Selling suboxone is a felony, I believe, and risks the whole suboxone program.

      From a medical point of view, please let the person’s doctor know he/she is selling pills/films. Doctors can’t give out any information and won’t talk to you about anyone, but you can send them message either through a nurse or in a letter. Be specific in what you see or know, because most docs won’t stop treatment unless there’s evidence of diversion.

      If I were the doctor, after getting a report of diversion, I’d immediately ask the patient to go for a pill count. If it’s OK, that calls into doubt the diversion. If the pill count is off, or if the patient just doesn’t go for the count (didn’t get your message, phone not working yada yada) you know diversion is likely. I’d stop prescribing, and I imagine most doctors would do the same.

      Some patients on medication-assisted treatments with methadone and buprenorphine have relatives who want them to stop. They mistakenly think these medications are bad or evil, and call to report all kinds of things. Some people are malicious, and attempt to discredit a patient to their doctor. That’s why I don’t assume every caller about diversion is legitimate either.

      If you care about this person and aren’t afraid of retribution, let them know you’re very worried they could get into terrible legal problems unless they stop selling drugs.

      Reply

  9. I recently was able to get into a suboxone doctor and have finally been able to get into a program and its been a lifesaver. I just wanted to say a few things about this topic:

    1. I purchased suboxone for months before finally getting into a suboxone doctor and getting on a legitimate program. Why? Because all of the doctors who could see patients for suboxone were capped out (I think the limit is 100?) in my area. I literally looked for two months before I was finally admitted. The fact that patients and doctors are are treating this drug as a VERY long term treatment makes it next to impossible for new arrivals. I don’t disagree with the long term treatment strategy but I do think this is a broken system.

    2. Although the drug is a bit less expensive at a pharmacy than it is on the street, when you add up the cost of mandatory therapy, doctors appointments, and the actual medicine itself it ends up costing more than just buying it off the street. And I have insurance! (which isnt the case for many suboxone patients).

    I realize the chance of a successful treatment is much higher when coupled with each of these items but in the eyes of the patients it really doesn’t give people much incentive to see a doctor for treatment when it’s cheaper and easier to buy off the streets.

    3. Almost everyone buying suboxone off the streets are buying it with the intent of getting OFF more harmful opiates and to become a more productive member of society. (Me included). People don’t buy suboxone to abuse when it’s cheaper and more euphoric to buy any number of other full on opiates.

    I guess my point here is that the people who are wanting to change the drug to a higher class because of the black market are grossly misinformed. On top of that there needs to be an easier, less expensive route to getting it legally otherwise it’s going to continue to be an issue.

    Changing the category of the drug is the wrong approach. It would be like changing the category of depression medicine because depressed people begin to buy the Zoloft off the black market. Who does that help? Not the patients, not the doctors, and especially not society

    Reply

    • Posted by Jennifer on October 10, 2013 at 7:43 pm

      I’m happy to hear you were able to get into a program. My husband and I have not been so lucky.

      Reply

      • Posted by Mitch maloney on May 31, 2014 at 4:55 pm

        Thank you. Thats the first comment that has any true insight of what the issue is with this medication. I agree 100% . Ive been on suboxone for 3 years and last year I lost my job and insurance so i couldnt pay for the medication legally anymore. I called every doctor on suboxone.com and the cheapest I could find that wasnt full including cost of meds was $1100 per month . Thats ridiculous when I could buy it on street for 1/3 of cost.

  10. Here in Finland (Turku) Suboxone sublingual pills (8mg bubrenorfine 2mg naloxone) cost on street in between 20€-30€, many people in the treatment program sells those pills and then buy SUBUTEX pills for 40€-70€, then injected it. I think that is the issue here

    Reply

  11. Posted by Mitch maloney on May 31, 2014 at 8:55 am

    I love your article it was very informing. Suboxone has been very good for me for a while but now it seems its just as bad if not worse than opiates. Ive tried 3 times to detox from subs and failed each time. I stayed off for 14 days and still couldnt function mainly because of depression , no energy, and scatter brain. I mean i literally felt retarted . I have 28 and really NEED to get off this. My doctor want even talk to me about it wout paying $200 and its 3 hours away. I just need a plan on how to taper correctly without losing job and family knowing im detoxing.please help

    Reply

    • Sorry but I can’t give specific medical advice in this forum.
      Getting off opioids is one thing – staying off is another. Are you ready to come off of it?
      I don’t know where you live, but $1100 is a whopping amount. I wonder what’s included in that amount – I’d hope that inculdes some mighty fine counseling! Even if that included medication, that’s out of reach for people with no insurance. Can you get coverage under the ACA?

      Yes, the drug may be cheaper on the street, but you don’t get medical services and counseling on the street, and specific instructions on how and when to taper off the medications, given by a doctor who is familiar with your history and medical status.

      Reply

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