Buprenorphine: The Drug Addicts Should have Seen Years Ago

Biology 103
2005 First Paper
On Serendip

Buprenorphine: The Drug Addicts Should have Seen Years Ago

Scott Sheppard

It is an understated fact that Biology is inherently a social science rather than a distanced, objective study of living things. This becomes quite apparent in medicine when the preconceived distinction between social and natural blurs—the disease and the person with a disease are not extricable—and people inhibit the progress of healthcare by ignoring the categorical conflation. Over the past ten years, one can follow the frustratingly slow developments to increase availability of the revolutionary drug, Buprenorphine. The addicts may finally be throwing around the term Bupe, and in the heroin addiction department, slang can be one of the most important indicators of progress—a social assumption. As America continues to throw money into the "noble" and "moral" campaign that is the War on drugs, drugs continue to kick America's ass. It has taken years to finally bring bupe to the people and the reasons for this are countless, but one thing is certain: when a problem is not observed from every possible point of view the solutions that humans come up with will always re-enforce biases, and constantly miss the mark.

In 2002 Buprenorphine finally was approved by the FDA after ten plus years of testing and analysis. Bupe is described as a partial agonist for mu receptors in the brain(receptors that mediate analgesia (relief from pain) typically induced by opiates), which basically means that in some ways it works as a pure agonist opiate such as methadone and heroin, but in other ways it is unique. Buprenorphine does not give users a sense of feeling high, it merely relieves withdraw symptoms, and it binds with the mu receptors for longer durations, keeping recovering heroin addicts stable and comfortable for up to 48 hours. Buprenorphine also can act as an antagonist when used at higher dosages which means that after a certain quantity, bupe will actually create withdraw symptoms such as nausea, sweating, and other flu-like symptoms. This effect makes it difficult to misuse bupe—an attractive quality for users who find themselves abusing methadone in their attempt to stay off heroin. Bupe's antagonist characteristics also make it difficult to get high with additional opiates, so even if an addict were to shoot up within two days of taking bupe, he would regret the nauseating experiment. Additionally, bupe is not nearly as addictive as methadone or heroin, giving heroin addicts the opportunity to effectively lower their tolerance to opiates and wean themselves entirely from a dependence on narcotics. 2.

All of these very attractive qualities might invite skepticism; it seems as though bupe is a dream drug that would have hit the streets with a bang. This drug has been tested next to methadone for the last ten years, and the results are mixed although methadone remains to be perceived as the more effective treatment overall. In most tests effectiveness is gauged by two factors: patient retention and suppression of heroin use. Heroin addicts are able to more likely to stay off of heroin for longer periods of time with high doses of methadone, and more patients stick with their methadone treatment plans than bupe treatment plans. What has been underestimated in these scientific studies is how different types of users require different types of treatment. It may be that bupe is more effective for the strong-willed user who wants to free himself from all opiates, but needs a way of alleviating the severe withdraw symptoms. Methadone is a stronger narcotic, it gives users a buzz, and as long as it is in strong supply, many recovering heroin users would be perfectly content trading their heroin addiction for a less incapacitating methadone addiction; this is not meant to be passive aggressive raillery that discreetly de-legitimates methadone, but this is how many people feel when they use methadone. Bupe gives addicts another option in dealing with their dependence.

Unlike methadone bupe can be distributed by primary care physicians rather than clinics, and because it is so difficult to abuse, users are freed from the social stigmas that daily visits to the methadone clinics incur. The conservative promotion of bupe along with its ambivalent status as a less potent, less effective but promising alternative to methadone has made it difficult for heroin addicts to realize bupe's potential. In Europe countries such as France use bupe more than methadone and the results seem to be positive. Sources claim "a drop of 80% in opiate overdoses in France as well as a four-fold drop in HIV reports since 1995. In addition, drug related crime has dropped by a factor of 3." 1. These studies claimed to be recent as of April, 2002. France has done other tests showing that methadone may still more effective in preventing recovering addicts but it admits that the social reality makes buprenorphine very attractive, because it is disseminated by general practitioners as a regular prescription drug would be.

In America bupe is finally exiting a gauntlet of bureaucratic regulations and close-mindedness. Even when an amendment to the Harrison Act (an act that carefully governs doctor's ability to prescribe opiates) was made in 2000 to allow prescriptions of bupe to be filled, the amendment was far from flawless. Initially this amendment prohibited methadone clinics from providing bupe, and although this prohibition was dropped a year later, it added to the unspoken sentiment that addicts did not need options, they needed methadone. The amendment gave private practices the right to prescribe it, but social apprehension and lack of motivation have quelled the initial revolutionary status that bupe entailed. Sources claim that "In New York City an estimated 200,000 heroin addicts and perhaps two to three times that many prescription opiate addicts, some 34,000 people were on methadone maintenance throughout 2004, while only about 1,000 people filled a bupe prescription." (7)

This amendment also screwed the pooch in defining its terms. It allowed "single providers" to fill only thirty bupe prescriptions at a time, and the category "single provider" ranged from single physician practices to huge HMO's and hospitals. An organization could include over fifty doctors, and it would still be limited to thirty bupe prescriptions. This restriction was just lifted in August 2005 so that now the ratio is more pragmatically determined by the number of doctors—for every doctor thirty prescriptions may be filled. 5. More and more people are beginning to realize that bupe works and it offers something different to heroin addicts who thought methadone was the only way out.

Bupe's frustrating progress can be explained in terms of its poorly regulated availability, questionable effectiveness, and practitioner apathy, but these stumbling blocks are actually symptoms of larger ideological problems. Heroin addiction is a problem that affects the quality of life throughout the entire country, for users and non-users alike. HIV, crime, unemployment, and the state of the economy are just a few things on a long list that are very closely related to heroin addiction. Bupe's social appeal has been neglected because of two shortsighted opinions about heroin addiction in this country: the first is that heroin users are basically irrecoverable social losses and the other, is that heroin addiction is merely a medical affliction that should be treated strictly by the drugs with the best records. Heroin addiction is a disease, but diseases are inextricable from social structures and perceptions. Heroin addicts undeniably have a certain perception of themselves whether they are being treated at methadone clinics, mainlining for the first time, or hiding their dope behind a white collar job. Bupe has made such slow progress because its social benefits have been underestimated, and addicts should be able to treat their disease in the most appropriate ways.

International Treatment Center for Advancement of Addiction
The Medical Letter: Bupronorphine: An Alternative to Methadone
The Bupronephrine FAQ
Join Together
Common Sense for Drug Policy
Medicine Australia