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Months in prison did not rid Daryl of opioid addiction. "Before leaving the prison car park, I was shooting in the air and getting ready," he said.
Daryl had used heroin and prescription pain medications for over a decade. Nearly four years ago, he became one of 200 HIV-positive people during an outbreak in Scott County, Indiana. After this diagnosis, he said, he began.
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 said, he could not find drugs. He spent this time feeling bad because of the weaning illness.
His friend offered him a portion of a band of Suboxone Film, a branded version of the buprenorphine drug addiction drug associated with naloxone.
"At first I felt like I was up," said Daryl. "But I think that's what normal feels like now. I have not been normal for a long time.
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, which NPR and Kaiser Health News use to protect his identity because it is illegal to use buprenorphine without a prescription.)
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.
"I do not need anything. I was not sick. My belly did not hurt. I did not hurt my joints, "he said.
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. 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. Providers must already be certified to prescribe it, and the number of patients they can treat with this 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 Donald Trump is expected to sign a bill that would increase access to the drug, but it is unclear how quickly access will increase.
In the meantime, many people with addictions will turn to the buprenorphine black market – sometimes using it to increase the rate of use, sometimes using it to prevent withdrawal until they can get it. something more powerful and use it sometimes exactly as it is intended to be: treat addiction.
[khn—slabs slabs=”790331″ view=”inline”]It is a weaker opioid
Dr. Kelly Clark, president of the American Society of Addiction Medicine, which supports the measure that would increase access to buprenorphine, says 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 said.
A fatal overdose of buprenorphine can be fatal, especially if users are not opioid tolerant or associate 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. 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 buprenorphine that's responsible for our current situation," said Dr. Zev Schuman-Olivier, 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," said Daryl. "But would they prefer me to drive to Louisville and get two heroin bullets?"
[khn—two—photos photo-first=”879249″ photo-second=”879250″]Limited access
People often try to treat themselves when they have trouble getting treatment, said Dr. Michelle Lofwall, addiction specialist and researcher at the University of Kentucky.
"These people want help, they tried and they did not succeed. So now they will pick him up when he is available, "she said.
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 a limit of 100 previously.
The new bill en route to the Trump office would allow more nurses to prescribe buprenorphine and some recently dispensed physicians 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, said that stricter regulation or closure of prescriptions would limit treatment options for dependent people opioids.
"I guarantee you," she said, "or else they will buy heroin and get high – which is probably not a good solution here – or they will buy Suboxone in the street".
A step towards safer treatment
Getting Suboxone on the black market is obviously not ideal. Addiction is a complex and chronic disorder and patients need comprehensive care. This means that a treatment professional will help them determine the appropriate dose and provide them with advice to address the other mental health needs common to people with addictions. But Lofwall said that heroin addicts or pain relievers often realize that they want professional help to stop smoking after trying buprenorphine illegally.
"They got it and they know it works for them and they want it legally," said 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 to do nothing but to get high, "he said.
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 may take years to overcome, and many attempts, but Daryl said that his move to buprenorphine had allowed him to return to normal life.
"I am now in a phase of my life where I know I have to change something or go back to prison," he said. "I'm really ready to do something different."
This story was produced in partnership with NPR, Side Effects Public Media and Kaiser Health News. A longer version of the story appears in The Sidewound podcast of Side Effects.
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