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Months in prison did not rid Daryl of his addiction to opioids. "Before I left the parking lot of the prison, I was shooting up, getting high," he said.
Daryl had used heroin and prescription painkillers for more than a decade. Almost four years ago, he became one of more than 200 people who tested positive for HIV in Scott County, Ind. After that diagnosis, he said, he went on a bender.
But about a year ago, Daryl had an experience that made him realize he might be able to stay away from heroin and opioids. For several days, he said, he could not find drugs. He feels that time feeling terrible because of withdrawal sickness.
Suboxone Film, a brand-name version of the buprenorphine addiction medication that is combined with naloxone.
"At first it felt like I was high," Daryl said. "But I think that's what normal feels like now."
Buprenorphine is a long-acting opioid that is used to treat opioid addiction. It reduces the risk of death by a significant reduction in the risk of fatal overdose.
Daryl injected the buprenorphine, and his opioid withdrawal symptoms disappeared. (Daryl is his middle name, which NPR and Kaiser Health News is using to protect his identity because it is illegal to use buprenorphine without a prescription.)
Weeks later, the grind of chasing heroin had worn on him. Buprenorphine Controlled Drugs, and Daryl.
"I was not sick, I was not sick, my belly did not hurt, I was not hurting in my joints," he said.
Buprenorphine is one of just three federally approved medications to treat opioid addiction. It's an opioid itself, so some people misuse it they snort or inject the medication. And patients who have prescriptions for buprenorphine sometimes give away, which is known as diversion. Some policymakers and officials point to diversion as a reason to further increase regulations. Providers who need to be certified to prescribe it, and have a cap on the number of patients they can treat with the drug.
Aim addiction treatment professionals argue the problem of buprenorphine diversion is often misunderstood. A black market exists in part, they point out, because addiction treatment can be hard to find. President Donald Trump is expected to sign a bill that would increase access to medication, but it's unclear how quickly that access will grow.
In the meantime, many people dealing with addiction to the market for buprenorphine sometimes using it to get high, sometimes using it to prevent it treat addiction.
Dr. Kelly Clark, president of the American Society of Addiction Medicine, who supports the measure that would increase access to buprenorphine, contends that the drug is more widely available. For one thing, buprenorphine is not as dangerous as other opioids. "The risks of overdose with buprenorphine are minimal," she said.
It is possible to fatally overdose on buprenorphine especially if users do not have a tolerance to opioids or they mix it with other substances. But that is rare.
Buprenorphine's effects are those of heroin and fentanyl, and the medication can block other opioids' effects. Because of these attributes, few people use buprenorphine to get high. Instead, more people use it to prevent withdrawal and other illicit fentanyl.
Some leading addiction experts argue that self-treatment with buprenorphine can save lives because it is used in the most dangerous substances.
"It was not diverted to our responsibility for your current situation," said Dr. Zev Schuman-Olivier, an addiction specialist and instructor at Harvard Medical School. "The majority of people are using it in a way that reduces their risk of overdose."
"It's definitely illegal," Daryl said. "But would they be driving to Louisville and picking up two 8-balls of heroin?"
Dr. Michelle Lofwall, an addiction specialist and researcher at the University of Kentucky, said:
"These people want help, and they are trying to succeed, so they're going to get it if it's available," she said.
Professional treatment with buprenorphine can be difficult for patients to get. Prescribers need a special treatment, prescribers need to treat, a cap that is specific to buprenorphine.
Federal guidelines changed under the Obama administration to increase the number of prescribers and the number of patients they can treat. Nurse practitioners and physician assistants can now apply for a waiver to prescribe buprenorphine, and doctors who meet certain requirements can now treat up to 275 patients that's up from the previous limit of 100.
The new bill on its way to Trump's desk would have more nurses prescribe and more patients.
Amid these efforts, some law enforcement officials and policymakers have said that more regulation and enforcement are needed to stop diversion.
But Basia Andraka-Christou, an assistant professor and addiction policy researcher at the University of Central Florida, said increasing regulations or shutting down prescribers would limit treatment options for people addicted to opioids.
"I guarantee you," she said, "they're going to go and buy heroin and get high which is not a great policy solution here, they're going to buy Suboxone on the street."
Getting Suboxone on the black market is obviously not ideal. Addiction is a complex, chronic disorder and patients need comprehensive care. That means a treatment to help them figure out the proper dose and counseling to address other mental health issues that are common among people with addiction. Aim Lofwall said people addicted to heroin or painkillers often realize they want professional help in quitting after trying buprenorphine illegally.
"Lofwall said," They've had it and they know it. "They want to get their life back."
Daryl had that spell of experience. Several weeks after he began using buprenorphine on a regular basis, Daryl tried to get a handle on the situation.
"I think I had never started (Suboxone) on the street, I would not have done nothing but getting high," he said.
Daryl still has not made it into treatment. He had trouble starting his insurance, and the market for illicit buprenorphine can be fragile. Daryl struggled to stay away from heroin when he buprenorphine lost the prescription. Addiction can take years to conquer, and many attempts, but Daryl said his life on buprenorphine allowed him to see a way back to a normal life.
"I'm at a point in my life now, I know I've got to change something, or I'm going to go back to prison," he said. "I'm definitely ready to do something different."
Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation. This story was produced in partnership with NPR, Side Effects Public Media, and Kaiser Health News. A longer version of the story appears in Side Effects' podcast The Workaround.
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