The death of Oscar-winning actor Philip Seymour Hoffman from an apparent heroin overdose is adding to fears from some addiction experts that a drug often used to treat opioid addiction — buprenorphine – may be contributing to addiction problems, not solving them.
Some in the pain patient community also worry that news coverage about Hoffman’s death could lead to further restrictions on access to opioid painkillers because they are perceived as “gateway” drugs to heroin.
Hoffman was discovered dead in his New York City apartment Sunday with a syringe in his arm. According to NBC News, investigators also found dozens of bags of heroin and six bottles of prescription drugs, including the addiction treatment drug buprenorphine – which is more widely known under the brand name Suboxone.
Hoffman did not have a prescription for the buprenorphine, according to investigators.
Buprenorphine is widely used to treat opioid addiction, but it is also a narcotic — prized by heroin addicts for its ability to reduce their withdrawal symptoms between highs.
Buprenorphine is so popular with addicts that it has turned into a street drug to be bartered or exchanged for money, heroin or other illegal drugs. According to one estimate, about half of the buprenorphine obtained through legitimate prescriptions is either being diverted or used illicitly.
“He (Hoffman) bought it from the street to control his withdrawal symptoms. That’s what happens to the vast majority of patients. They use Suboxone to control their withdrawal symptoms, but continue to use heroin to maintain their addiction,” says Percy Menzies, who is president of Assisted Recovery Centers of America, which operates four addiction treatment centers in the St. Louis, Missouri area.
Menzies uses Suboxone as a detox agent for patients in his clinic, but does not recommend it as a long-term medication for addicts. He likens it to using beer as a treatment method for alcoholics.
“We do not use addicting drugs to treat any other addictive disorder, but we are stuck in this complete insanity of using buprenorphine and methadone as the only treatment for opioid addiction. Small wonder, both opioid addiction and the treatment remains so stigmatized. The only people who benefit are the drug companies and the methadone clinics,” Menzies told National Pain Report.
But other addiction experts praise the benefits of buprenorphine and Suboxone.
“Because patients on Suboxone don’t keep taking more and more, they stay on a fixed dosage and over time, can even decrease the dosage. Their cravings stop, they return to work and renew their relationships with friends and family. In short, they get their lives back,” said A. R. Mohammad, MD, an associate professor at the University of Southern California’s Keck School of Medicine.
“There is no cure for addiction, as is the case with all chronic diseases. But when their disease is managed with effective, evidence–based medications over a lifetime, drug addicts – like diabetics – can live a normal, productive life. If nothing less, Philip Seymour Hoffman showed us that a person with the chronic disease of drug addiction can achieve greatness.”
Hoffman had spoken openly about his past substance abuse problems, saying he quit using drugs and alcohol while in his early 20’s. But early last year, the 46-year old actor had a relapse and checked himself into rehab for 10 days. He told TMZ that he was taking prescription medication, and his use escalated to heroin.
“We can’t speak to the treatment that Hoffman received, but we do know that he was addicted to opiates, most commonly known as prescription painkillers and heroin. Hoffman was one of the 100 opiate deaths that occur every day, and what’s all the more devastating is that these deaths are preventable,” said Steve Pasierb, President and CEO of The Partnership at Drugfree.org.
“It’s important to note that we are seeing a migration to heroin from prescription painkillers. More and more, these prescription medicines are harder to access and more expensive than heroin. By starting with greater awareness and action – like safeguarding our medicines and talking with our kids about the dangers of abusing prescription drugs – we will prevent more people from becoming addicted to heroin.”
Some pain patients worry that publicity surrounding Hoffman’s death will lead to new efforts to restrict access to prescription painkillers.
“The public in general has been brainwashed into lumping all drugs into the same problem. There are millions of us who use prescription opioids and painkillers legally. Mr. Hoffman’s demise is a completely different problem and one that should be addressed more by the DEA, instead of going after the legitimate patients and doctors,” said Dennis Kinch, a patient advocate and chronic pain sufferer.
“No one will look into the details and find out this has nothing to do with us. It is another case of people taking drugs illegally which they get from street dealers, not doctors, and who use them for recreational purposes, not clinical.”
In addition to buprenorphine, investigators also found in Hoffman’s apartment the blood pressure medication clonidine hydrochloride, the attention-deficit disorder drug vyvanse, the anti-anxiety drug hydroxyzine, and the muscle relaxer methocarbamol. All are used in addiction treatment clinics to treat patients, according to Percy Menzies.