Just One More Refill…

A couple weeks back the New York Times Magazine featured a laudatory article on the miracle of the opioid addiction medication Suboxone (buprenorphine and naloxone), itself an opioid), hailed first as an “orphan” drug initially unattractive to Big Pharma due to its presumed low earnings potential, all the way to its blockbuster embrace by same as a huge cash cow as the aggressively marketed new drug became the latest, newest thing for kicking an opioid addiction.

The dangers of treating a bunch of addicts with another addictive drug were barely mentioned in the article, which was based on the soon-to-be-released book, “Rehab: An American Scandal,” by Simon & Schuster (NYT attribution). In response to the question, “Is Suboxone addictive?” addictioncenter.com offered the less-than-rousing testimonial that “…the risk of becoming addicted to Suboxone is less than the risk of becoming addicted to other opioids.”

What a deal.

Take the case of my younger brother, referred to here as “Bro.” My parents were gone to their rewards by the time my only sib began his latest rehab (Suboxone-based) experience, so I was the one tasked with helping him (to the dubious extent that anyone can “help” a drug addict). This would have been sometime in the early 2000s. At that point Suboxone was becoming available as a one-stop, one-step addiction treatment, prescribed without other supportive resources (unlike Methadone, where patients had to show up every day for their doses). When Bro attended his mandatory “training” class to get the drug initially, the class facilitator called Suboxone “the Cadillac of addiction treatment.”

Get the pills, go home, take them, and Voilá! You’re cured, by the kindly good graces of Big Pharma! No sweat!

At first everything was fine and dandy. Bro took the pills, refilled his scripts (with many extensions), and things seemed suspiciously right in his addiction world. But he had, after all, been a drug addict and occasional dealer for nearly half a century: Could it really be this easy to quit?

And it seemed to be, until the inevitable day when even his “addiction doc” on Shattuck (many regular PCP doctors had off-loaded their “addiction services” to satellite offices in Berkeley so non-addict patients could be spared the sight of a roomful of addicts angling for their meds) began to question whether contributing to the making of a life-long Suboxone addict was really in the best interests of either Bro himself or the rest of the world.

Thus began the final chapter of Bro’s Suboxone story.

First there were attempts to cut back, a milligram at a time ─ which wasn’t great but still bearable. Then it became impossible to get off the final milligram. Tears ran down his face as he described his torments during this time: nausea, fevers, depression, and other horrors of opioid withdrawal.

He heard about a treatment clinic in Southern California that specialized in Suboxone withdrawal; for (as I recall) around $20-grand at the time, the clinic would manually “cleanse” your blood and return it to your body “Suboxone-free.” He even explored assisted suicide in Switzerland, but found that, like in California, the practice was restricted to patients with diagnosed terminal illnesses (advanced cancers and the like).

Psych problems and addicts need not apply.

In between all of this I drove Bro to various pharmacies along both Shattuck and Telegraph Ave where he tearfully pled his case that his life depended on just one more refill. All to no avail, pharmacists in Berkeley are a tough bunch. As I recall he finally white-knuckled it in a haze of unfettered cannabis oblivion, some of it in the form of high-dose liquid THC.

Suboxone is still available today (though it’s described now as part of a comprehensive treatment process rather than a stand-alone miracle) and I’m sure there are addicts who credit Suboxone with ending their addictions, addicts who took it responsibly for a short period then quit.

But my brother’s story is a cautionary tale and an important one since you’ll never hear it from the über-rich drug companies eager for addiction docs to sign you up. Treating addictions of any kind with another addictive drug can be a crapshoot, though it’s understandably popular with addicts looking for the elusive quick fix. I can just take another drug? Easy peasy.

We see this trend everywhere in our hurry-up culture, especially with the outsized influence of Big Pharma. Overweight? An Ozempic-type drug might be just the thing: one jab a day and you can eat whatever you want! Anxious? Forget that your life sucks, let me get out my prescription pad…

Drug addictions are physical, and withdrawal from them may require medical support. But they’re also psychological and demand the hard work of self-reflection that may in turn require counseling, peer feedback, and other ways to both illuminate what got you there in the first place and to create the lifelong resolve and structure essential for keeping your addictions at bay – neither of which is found solely in either a bottle or a syringe.