Legislators attack treatment for opioid use disorder

WW commentary

Buprenorphine, the main active ingredient in the products Suboxone, Subutex, Sublocade, Zubsolv and Bunavail, is considered one of the gold-standard methods of treatment of opioid-use disorder, commonly referred to as opioid addiction. Yet the Pennsylvania Senate is considering two bills that would act as barriers to that treatment.

Bill SB 675 would establish state-level certification for buprenorphine maintenance therapy providers, requiring fees of up to $500 per provider and between 8 and 24 hours of training on the medication and on opioid use disorder. 

The fee would be paid for each provider that prescribes the medication. Because many clinics have multiple prescribers, these fees would stack up to create an insurmountable barrier for smaller clinics, especially those serving rural areas in the state where the opioid epidemic has largely burned communities in silence. 

The proposed requirements are also redundant, as the Drug Addiction Treatment Act of 2000 already requires special registration and training for prescribers of buprenorphine products. DATA 2000 itself already creates barriers to care, as it limits the number of patients who providers are able to treat.

The second bill, still in committee in the House, would require 2.5 hours of therapy at a state-licensed treatment facility for a year. It would also require the prescribers and clinics to eventually wean people off the medication, with some patients being permitted to stay on longer if they obtain a waiver.

Using diversion — the illicit trade, sale or gifting to other people — of buprenorphine was their reasoning for the two bills. Meanwhile politicians have decided to ignore the overwhelming evidence that comes from the medical and scientific community. They argue that while they understand buprenorphine has positive medical uses and has positive use in addiction/substance use disorder treatment, this diversion is so severe that they must put up these barriers. 

‘Buprenorphine saved my life’

We have to examine why people divert buprenorphine to others because it isn’t a drug that can actually get an opioid-tolerant person high. As a partial opioid agonist, it imperfectly fits the opioid receptors in the brain and therefore does not provide the traditional opioid effects of euphoria. 

Instead, it’s a drug that staves off the withdrawal and the cravings associated with long-term opioid use disorder. People are using it to keep themselves from having to go back to heroin, which has largely become tainted with the synthetic opioids fentanyl and carfentanil. 

On this basis alone, diversion of buprenorphine serves a positive purpose. Even non-opioids now contain fentanyl and the highly deadly carfentanil, leading to more people becoming dependent on opioids than ever before. 

We’re at a moment when so many die of overdoses every single day, yet the state wishes to make it harder for people to get on life-saving medications. We need more buprenorphine in the hands of people who need it. 

In a worker’s world, buprenorphine (and methadone!) would be treated as another tool in the anti-addiction toolbox. It would be pushed as hard or harder than Vivitrol and ReVia (generic name: naltrexone); it would be seen as a life-saving medication like Narcan (generic name: naloxone); and, most importantly, its use would snowball and greatly undercut the opioid epidemic.

Some argue that buprenorphine maintenance treatment is an addiction in itself, despite all the evidence that shows otherwise. House Representative Kerry Benninghoff said, “All you’re doing is trading one drug for another.” This is a pervasive myth that has only served to scare people away from getting treatment that could very well save their lives.

Being dependent on a medication and being addicted to a drug are two very different things. We don’t say that a diabetic who needs insulin is “addicted” to insulin. Patients in buprenorphine maintenance therapy are kept on a stable dose that does not impair them or get them high; they aren’t engaging in the behaviors typically associated with “addiction.” 

The opposite is true. In many cases, patients on buprenorphine are not only recovering from opioid use disorder, but are leaving the addiction lifestyle behind as well. No longer do they engage in the destructive behaviors associated with opioid use disorder. Multiple studies have shown that the quality of life of patients improved on buprenorphine and that the treatment helped subjects decrease all drug use, except for tobacco.

As socialists, as people looking to create a better world, we must be on the lookout for things which harm the most marginalized. And make no mistake, people with opioid use disorder are among the most marginalized, experiencing alienation, isolation and poverty.

I’m a person who struggles with addiction, and I’m on buprenorphine and I know it saved my life. I know that the hundreds of thousands of others who use or have used it probably don’t wish to be forced off of it by paternalistic, so-called public servants who have outdated ideas on substance abuse and recovery. 

So what can we do? We can call attention to the issue by sharing stories and elevating the voices of people in recovery on this subject. We can also sign onto Pennsylvania Harm Reduction Coalition’s letter to the Senate against SB 675, at paharmreduction.org/oppose_sb675. Lives depend on it.

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