|A medication increasingly being used to treat addiction to opioid drugs – both legal and illegal – is sending ten times as many people to hospital emergency rooms as it did a few years ago.
Buprenorphine, which is more widely known under the brand name Suboxone, was involved in 30,135 emergency room visits in 2010, up from 3,161 visits in 2005, according to a report by the Substance Abuse and Mental Health Services Administration (SAMHSA). Over half of the hospitalizations were for non-medical use of buprenorphine – with some users taking the drug to get high.
“The buprenorphine in these visits may have been misused or abused, either for psychoactive effects or in an attempt to self-treat for opioid dependence,” the SAMHSA report said.
Buprenophine is an opioid that was approved as a treatment for opioid addiction in the U.S. in 2002. The use of the drug has grown significantly since its introduction. In 2005, over 5,000 physicians prescribed buprenorphine to 100,000 patients. By 2010, over 18,000 doctors were prescribing the drug to more than 800,000 patients.
Most of the buprenophine used to treat opioid addiction is made by Reckitt Benckiser, a British pharmaceutical company that combines buprenorphine with naloxone to make Suboxone. The two drugs are combined to help wean addicts not only off of illegal drugs like heroin and cocaine, but prescription opioid medicines such as Vicodin, OxyContin, oxycodone, and hydrocodone. Naloxone is added to Suboxone to block opioid receptors in the brain and central nervous system.
Reckitt recently started taking its tablet versions of Suboxone off the U.S. market, replacing them with a film version that dissolves under the tongue. The company says the film is less likely to be swallowed accidentally by children.
According to Drugs.com, Suboxone is the 28th top selling drug in the U.S. with nearly $1.4 billion in sales annually. Over three million Americans with opioid dependence have been treated with Suboxone.
Although it was developed as a “safe” way to wean addicts off opioids, some health officials are worried about the growing use and misuse of buprenorphine.
“Buprenorphine use can be risky for individuals who are not opioid dependent because its effects are similar to other opioids (although usually more mild), leading to injuries and other health consequences,” the SAMHSA report says.
“I’m not at all surprised to see that non-medical users are winding up in emergency rooms,” says Andrew Kolodny, MD, chairman of the Department of Psychiatry at Maimonides Medical Center and president of Physicians for Responsible Opioid Prescribing (PROP). Kolodny has been a leading advocate of Suboxone to treat addicts.
“Buprenorphine works differently from other opioids, so the risk of an overdose death is much lower. But if used improperly, by someone who has other opioids in their blood stream, it’s use can precipitate a powerful withdrawal reaction that makes someone feel like they’re going to die,” Kolodny wrote in an email to National Pain Report.
“Although these reports concern me, I would be much more concerned if black-market buprenorphine use was leading to new cases of opioid addiction and if its use was causing a rise in overdose deaths, but fortunately this does not seem to be the case,” Kolodny said. “We need to do a much better job of expanding access to treatment. If there was better access to doctors who know how to prescribe it responsibly, I think we’d see less people buying it on the street.”
In a recent report published in the Journal of Addictive Diseases, the Center for Substance Abuse Research (CESAR) at the University of Maryland warned “there may be an epidemic of buprenorphine misuse emerging across the U.S.” Researchers said addicts were smuggling buprenorphine into jails and the drug’s street value was growing because it doesn’t show up in drug tests.
“The true magnitude and scope of buprenorphine diversion, misuse, and adverse consequences is unknown because current epidemiologic measures do not systematically monitor buprenorphine,” CESAR warned in a December, 2012 newsletter. “Similarly, buprenorphine-related deaths are not accurately tracked because medical examiners and coroners do not routinely test for the drug.”