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Months in prison did not rid Daryl of his opioid addiction. "Before I left the prison parking lot, I was shooting in the air, getting ready," he said.
Daryl has been using heroin and prescription pain medications for over ten years. Nearly four years ago, he became one of 200 HIV-positive people during an outbreak in Scott County, Indiana. After this diagnosis, he was a victim of a scar.
But about a year ago, Daryl had an experience that made him realize that he might be able to stay away from heroin and opioids. For several days, he says, he could not find any drugs. He spent that time behind.
"It hurts everywhere, you vomit, you have diarrhea," said Daryl.
His friend offered him a part of a band of Suboxone, a branded version of the drug addiction drug buprenorphine that is associated with naloxone. Buprenorphine is a long-acting opioid that is generally used to treat opioid dependence. It reduces the urge to take more potent opioids than it took, prevents the physical weaning of these drugs and carries a significantly lower risk of fatal overdose.
Daryl injected buprenorphine and her opioid withdrawal symptoms disappeared. (Daryl is his middle name that NPR uses to protect his identity because it is illegal to use buprenorphine without a prescription.)
"At first I felt like I was up," says Daryl. "But I think that's what normal feels like now, I have not been normal for a long time."
A few weeks later, the pursuit of heroin had prevailed. Buprenorphine has controlled its withdrawal symptoms longer and Daryl has decided to use it to stay away from other medications.
Buprenorphine is one of three drugs approved by the federal government to treat opioid addiction. It's an opioid in itself, so some people abuse it – they sniff or inject the drug to become high. And patients who have prescriptions for buprenorphine sometimes sell them or give them to them, which is known as diversion. Some policymakers and officials cite diversion as a reason for further regulation. Suppliers must already be certified to prescribe it, and the number of patients to whom they can give the drug is limited.
But drug treatment professionals argue that the problem of diverting buprenorphine is often misunderstood. A black market exists in part, they point out, because the treatment of drug addiction can be difficult to find. President Trump is expected to sign a bill that would increase access to the drug, but it is unclear how quickly this access will increase.
In the meantime, many addicts will turn to the black market to try to deal with their dependency themselves.
It's a weaker opioid
Dr. Kelly Clark, president of the American Society of Addiction Medicine, which supports the measure that would increase access to buprenorphine, believes that making the drug more widely available outweighs the risk. On the one hand, buprenorphine is not as dangerous as other opioids. "The risks of overdose with buprenorphine are minimal," she says.
he East fatal overdose of buprenorphine – especially if users are not opioid tolerant or mix with other substances. But it is rare.
The effects of buprenorphine are less potent than those of heroin and fentanyl, and the drug may block the effects of other opioids. It is also usually formulated with naloxone, which reverses opioid overdoses and reduces the potential for abuse.
Because of these attributes, few people use buprenorphine to make the top. More and more people are using it to prevent weaning and stay away from other illicit drugs such as heroin and fentanyl.
Some addiction experts argue that self-treatment with buprenorphine can save lives because it is used instead of more dangerous substances, causing the continuous increase in the number of overdose deaths.
"It's not the buprenorphine that's responsible for our current situation," said Dr. Zev Schuman-Olivier, an addiction specialist and instructor at Harvard Medical School. "The majority of people use it in a way that reduces their risk of overdose."
"It's definitely illegal," says Daryl. "But would they prefer me to drive to Louisville and get two heroin bullets?"
Limited access
Dr. Michelle Lofwall, addiction specialist and researcher at the University of Kentucky, explains that people often try to self-treat when they have trouble getting treatment.
"These people want help and have tried unsuccessfully, so now they will pick her up if she is available," she says.
Professional treatment with buprenorphine may be difficult for patients to obtain. Prescribers need a special waiver to prescribe the drug, and federal regulations limit the number of people they can treat, a specific cap to buprenorphine.
Under the Obama administration, federal guidelines have been changed to increase the number of prescribers and the number of patients they can treat. Nurse practitioners and medical assistants can now apply for a waiver to prescribe buprenorphine, and physicians who meet certain requirements can now treat up to 275 patients, up from the previous 100 limit.
A new Trump bill would allow more nurses to prescribe buprenorphine and some recently renounced doctors to treat more patients.
Among these efforts, some law enforcement officials and policy makers said that it was necessary to take more regulatory and enforcement action to stop diversions.
But Basia Andraka-Christou, assistant professor and policy researcher on drug abuse at the University of Central Florida, believes that tighter regulation or closure of prescriptions would limit treatment options for people who are addicted to drugs. opioids.
"I guarantee you," she says, "or they will buy heroin and get treatment – which is probably not a good solution here – or they will buy Suboxone on the street. ".
A step towards a more complete and safer treatment
This street treatment is not ideal. Patients need a treatment professional to help them determine the appropriate dose and to address other common mental health needs among addicts. But Lofwall says that heroin addicts or painkillers often realize that they want professional help to stop smoking after trying buprenorphine illegally.
"They've had it and they know it works for them and they want to get it legally," says Lofwall. "They want to recover their life."
Daryl had this kind of experience. Several weeks after starting taking buprenorphine on a regular basis, Daryl tried to buy insurance so that he could get help (drugs and advice) to avoid other opioids.
"I think that if I had never started [Suboxone] in the street, I would have no interest in just getting fucked, "he says.
Daryl still has not managed to get treatment. He has struggled to start insurance and the illicit buprenorphine market may be fragile. Daryl struggled to stay away from heroin when the person to whom he had bought buprenorphine had lost the prescription. Drug addiction can take years to overcome, and many attempts, but Daryl says his buprenorphine treatment has helped him get back to normal life.
"I am at a time in my life where I know I have to change something or I will go back to prison," he says. "I'm really ready to do something different."
This story was produced in partnership with NPR, Kaiser Health News and Public Media side effects. A longer version of the story appears in the Side Effects podcast The workaround.
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