Suboxone can have dangerous, deadly downsides
Franklin County Sheriff Christopher Donelan in his office. Recorder/Paul Franz Purchase photo reprints »
Buprenorphine — Suboxone or Subutex — may be as widely diverted and abused as any prescription opioid on the market, although the reasons may be more complicated.
Introduced in 2003 as a less dangerous, less abusable alternative to methadone, Suboxone is a compound of the opioid buprenorphine and the overdose antidote naloxone.
Last summer, Suboxone was the overwhelming drug of choice smuggled into the Franklin County House of Correction, according to the sheriff and superintendent.
Sheriff Christopher Donelan said an investigation by the state police narcotics unit failed to identify the source, although the problem has since slowed.
Suboxone comes in thin films that can be slipped into book bindings or otherwise easily concealed, which Donelan said may account for its popularity in smuggling.
Suboxone can be abused to get high by opiate-naive users whose tolerance has not been raised by harder drugs, and withdrawal is another motive for the trade.
Bought or traded Suboxone may be used illicitly by heroin or pain pill addicts in jail looking to fight off withdrawal when their drug of choice is temporarily unavailable, or by recovering addicts whose prescribed Suboxone regimen is abruptly interrupted.
Abrupt buprenorphine withdrawal is, by most accounts, worse than heroin withdrawal. Patients participating in a therapy regimen are weaned off the drug to some extent if their insurance is canceled or interrupted, or weaned off over what may be a period of years if they and their provider believe they are ready.
An abrupt end to therapy at a high dose doesn’t go well for the patient. Two inmates of the House of Correction interviewed last year described buprenorphine withdrawal lasting for two to three sleepless weeks after they were arrested.
Whatever the reason for taking it, Donelan’s view — supported by doctors — is that Suboxone calls for care.
“Like any prescription medication it needs to be prescribed, it needs to be supervised by a medical professional,” he said.
Risks include damage to a weakened liver and complications through mixing with other drugs.
The New York Times last fall reported that Suboxone was listed as a “primary suspect” in 420 deaths reported to the Food and Drug Administration since 2003. In contrast, the Centers for Disease Control found methadone — also a prescription painkiller — to be involved in nearly a third of all prescription opioid deaths in 2010.
Buprenorphine was listed on at least one death certificate locally.
In 2012, a 33-year-old Greenfield man died of an overdose. Following an autopsy, the medical examiner ruled his cause of death to be “acute intoxication by the combined effects of cocaine and buprenorphine,” listing severe and chronic substance abuse as the underlying condition.