Debate continues over role of Suboxone in primary care

Sublingual Suboxone(Buprenorphine/Naloxone 8mg/2mg) Tablets (Jr de Barbosa via Wikimedia Commons)

Buprenorphine is one of the medications used to treat opioid addictions. A speaker at a recent medical conference in Anchorage said getting the medication to heroin users through their primary care providers is an essential way to reduce overdose deaths. But some addiction treatment professionals in Alaska say not so fast.

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Buprenorphine is a synthetic opioid that’s often combined with another drug and sold as Suboxone. It’s usually a small film placed under the tongue. Like heroin, it stimulates receptors in the brain, but to a much lesser degree. Massachusetts family physician Steve Martin has prescribed the medication for years.

“The most common response we get from people (we prescribe it to) is ‘I feel normal now,'” Martin said. “Without any craving, without any feelings of withdrawal. Without feeling like they have to find something right away. Without feeling like they can’t go to work or take care of their family.”

Martin said buprenorphine doesn’t lead to addictions, and it’s the cause of fewer than one percent of overdose deaths. People need to be on it for at least year before they taper off, though some have been on it for much longer. The medication has been available since the early 2000s, and has been prescribed for long-term use in Europe.

Martin spoke to a group of primary care providers from around Alaska during a conference in late April. He said that drug dependence needs to be looked at and treated like any other chronic disease — as part of primary care. And, just like medical providers don’t require counseling for medications to treat depression or diabetes, they shouldn’t require it for buprenorphine, a medication to treat addiction.

“For a given person we can’t predict whether counseling will be helpful or not,” Martin said, citing studies in medical journals. “But in randomized trial after randomized trial, people randomized to counseling plus buprenorphine or buprenorphine or Suboxone by itself do equally as well in terms of their recovery.”

Martin said some people get support through church or family relationships instead of through formal counseling services.

Karl Soderstrom, who runs Fiend 2 Clean peer-to-peer addiction recovery support network in Wasilla, disagreed.

“I think it’s naive to think that counseling isn’t effective. I think that by just prescribing we’re addressing the biological effects of the individual and keeping them from suffering withdrawal symptoms,” Soderstrom said. “But we’re not addressing the root causes of the addiction and the underlying behavior that the individual is experiencing.”

According to Soderstrom, we can’t just rate the success of medications, like buprenorphine, based on overdose numbers because recovery is about more than just staying alive. It’s reconnecting with a healthier life and community.

Anchorage family health nurse practitioner Jyll Green provides addiction treatment services, primarily a long-acting form of naltrexone called Vivitrol. She said buprenorphine can easily be diverted and sold on the streets.

“People are getting one-month prescriptions for these medications, which is allowing them the opportunity to divert their medication on the street, which many patients tell me they have done, so they can still purchase street drugs,” Green said.

Green advocates for stronger regulations on the distribution of the drug.

Federal laws changed in 2016. Now doctors who prescribe buprenorphine products like Suboxone and Subutex to treat addiction can increase their patient limit from 100 to 275.

Martin said the treatment helps people get their lives back on track, and over regulating the medication means fewer people will have access to it.