DEPENDENCY: Local pharmacists say Vermont risks turning heroin addicts into long-term Suboxone addicts.
By Bruce Parker | Vermont Watchdog
For Vermonters trapped in a vicious circle of heroin abuse and recovery, Suboxone is a wonder drug that promises freedom from addiction.
But pharmacists on the front lines of Vermont’s war on opioids say the state’s embrace of buprenorphine is setting people up for a lifetime of drug dependency.
“I’ve never seen anybody go off Suboxone,” Jack Ruggles, a Derby Line pharmacist, told Vermont Watchdog.
“I’ve had patients five, six, seven years still on Suboxone. So now we have them off heroin and on Suboxone.”
Ruggles, who works at an independent pharmacy after years of working for Rite Aid in St. Johnsbury, said physicians who prescribe buprenorphine in Vermont’s treatment centers are substituting one drug habit for another — and asking taxpayers to foot the bill.
“(Users) are on Vermont Medicaid, so they don’t pay. It’s taxpayer money. They have a perfectly great drug to abuse on the streets and get some money for it, too,” he said.
According to Ruggles, 95 percent of Suboxone customers, most of whom are in their 20s and 30s, obtain perennial two-week refills through Medicaid.
Suboxone, a popular brand of buprenorphine, helps opioid addicts quit without experiencing painful withdrawal. Because the drug has a 16-milligram “ceiling” and unique blockers, addicts can’t overdose on Suboxone, nor can they get high on other drugs while taking the medication.
But while “bupe” is effective at getting addicts off heroin, the drug has its own addictive qualities that patients can’t overcome without professional help.
Addicts in Vermont aren’t getting that help.
“It’s not uncommon for them not to get patients off of it,” Lynne Vezina, a pharmacist at Burlington’s Vermont Family Pharmacy, told Vermont Watchdog.
According to Vezina, while Suboxone enables addicts to live functional lives, getting people off it is complicated.
“(For) a lot of the doctors, it’s a way for them to make a lot of money, and so they don’t look to get patients off of it.”
Even so, Vezina said the drug is highly useful if managed properly. “It has helped a lot of people. I see people who are leading an everyday normal life, working and doing well. So I do see benefits out of it.”
Opioid use has reached epidemic levels in Vermont. According to the Department of Health’s most recent drug-abuse data, 3,898 people received treatment for opioid addiction in 2013 — a tenfold increase from 399 in 2000. Of the nearly 50 state treatment centers designated to tackle drug abuse, three specialize in buprenorphine treatment — West Ridge Center for Addiction Recovery in Rutland, Community Health Center in Burlington and the Brattleboro Retreat Center in Brattleboro. The centers are hubs in the state’s “hub and spoke” model, a treatment system in which patients get emergency rehab at central locations before getting sent to individual physician care.
While financial incentives may be partially to blame for bupe dependency, a Vermont substance abuse counselor, who asked to remain anonymous, told Vermont Watchdog that physicians have multiple reasons for prescribing the drug indefinitely.
“This is an emerging field. There’s not enough research yet out there as to how to transition off it. Some clients report some difficulty with that.”
The substance-abuse counselor said some physicians view opiate dependency as a chronic illness, where patients take medication for life.
“Dependencies like alcohol and opiates are generally regarded as chronic conditions. Physicians will say it’s just like with diabetes — it’s a chronic condition and you continue taking meds indefinitely.”
Vezina said she only recently heard of people getting off Suboxone after it was discussed during a pharmacist association meeting.
“That was the first time I ever heard anyone ever talk about getting off of Suboxone. I always thought it was just replacing one thing with another, and that really bothered me.”
Taxpayer-funded dependency could become a permanent fixture in Vermont. This year the Legislature granted Gov. Peter Shumlin’s request for additional money for treatment centers, which, the governor says, is necessary to reduce long wait times for treatment.
But Ruggles said Vermont’s treatment centers are full because addicts aren’t getting off drugs and exiting the system.
“When I hear the news that our opiate clinics are full and no patients can get into them anymore, it’s because nobody is leaving them. We’ve created another monster,” he said.
Ruggles proposes a mandatory time limit for Suboxone treatment.
“People should be timed out in their rehabbing. Physicians need to be more apt in what they’re doing and in counseling, and say, ‘OK, you have six months or three months. We want you weaned off Suboxone in that time.’”
He said lawmakers must take action because “manufacturers have all the reasons in the world to leave them on it, because it’s drug company money.”
Vezina agrees something should be done.
“The goal from the start should be to get people off (Suboxone). There may be some people where it doesn’t work for them to get off it, but I don’t really see them trying. It’s very rare that they try to get somebody off of it.”
Contact Bruce Parker at firstname.lastname@example.org