MONTPELIER — What happens when the very prescription drug meant to treat addiction becomes another means for addiction, and the accompanying problems, itself?
This is what’s happening with the opiate maintenance drug Suboxone, according to Vermont police and shelter directors. St. Albans City Police Chief Gary Taylor, Barre Police Chief Timothy Bombardier, Samaritan House executive director Linda Ryan, and Committee on Temporary Shelter executive director Rita Markley, as well as representatives for Gov. Peter Shumlin and U.S. Sen. Bernie Sanders, all met with Sen. Dick Sears (D-Bennington) and Health Commissioner Harry Chen on Wednesday to discuss the issue.
The drug issue
Suboxone, or buprenorphine and naloxone, is a prescription drug meant to provide maintenance treatment for opiate addicts. It comes in both tablet and sublingual film form, the latter created after an increasing number of child accidentally ingested the drug. It is manufactured by Reckitt Benckiser, also the producer of Lysol, Woolite, and other big-name products.
Unlike the six Vermont clinics approved to dispense methadone, another addiction maintenance drug, in a daily, supervised setting, doctors are able to prescribe Suboxone in larger amounts for people to take home, where it can then be used, abused, or sold.
In Franklin County, where 13 doctors are approved to prescribe Suboxone, the maintenance drug is being increasingly diverted and abused according to Ryan.
“I don’t know if the health department and legislature realizes how big this problem has become,” Ryan said. “[Nationwide], it has become a drug of choice in the streets. It’s making new addicts everyday and is therefore raising the demand for heroin everyday.”
According to Ryan, because Suboxone is an addictive narcotic, it is not providing treatment for many addicts, and it is also acting as a gateway drug for new ones. “Kids don’t start with heroin, they start with pills,” she said.
Suboxone is also easier to obtain, she said. The methadone clinics in Vermont also have limited space and are too far to travel daily for many people, but Suboxone is prescribed by doctors and sold by those who receive it.
Markley, who works with multiple homeless shelters in Chittenden County, echoed Ryan, and she added that giving Suboxone with little regulation to very low-income, vulnerable shelter residents likely to sell it is a mistake. “For the population we serve, it doesn’t work,” she said.
Ryan added, “You give a poor person the means to make that much money a month, they’re going to do it,” she said.
In addition, homeless shelters like Ryan’s and Markley’s don’t allow residents to keep drugs on them, so they must store the Suboxone for maintenance patients, which is a safety concern. “We don’t have the safety set up,” Markely said. “We don’t have the capacity to manage this. It’s a real challenge.”
She added, “We are at our wits’ end and we are looking to you for help.”
Public safety concerns
St. Albans City Police Chief Taylor said that in addition to Suboxone safety problems in shelters, the maintenance drug is also creating safety issues in cities like St. Albans. Because Suboxone is considered a medical treatment for addicts, police often can’t prosecute those they find with the drug, even if they are treating Suboxone like any other illegal drug and are part of the same cycle of low-level crime associated with drugs, such as mugging, robbery or assault.
“I can tell you we’re not chasing Suboxone,” Taylor said. “Those people are not going to be criminally charged and held accountable.”
Without much regulation of Suboxone, Taylor said there isn’t much police can do without some sort of change. “This is a struggle that has no end for us,” he said.
Taylor added, “We need to outline some parameters. There have to be better controls.”
Sen. Sears told those at the meeting Wednesday that he agreed Suboxone was a problem in Vermont. Health Commissioner Harry Chen said he could also see the issue at hand, though he added that a solution wouldn’t be easy.
“There is no one size fits all,” Chen said. “Part of the problem is patient selection.”
Chen said that while there were clearly issues with Suboxone, the drug was working as maintenance treatment for some people. “It’s important that we understand the different kinds of patients with different kinds of prescriptions,” he added. “Creating systems that can do all these things is important to me.”
But for Ryan, Markley and the attending police chiefs at the meeting, the problem with Suboxone is immediate. Chen said he would need some data before making any decisions, and Ryan agreed. “I would like some data,” she said.
Whatever the solution may be, Ryan, Markley and Taylor suggested that better regulation of Suboxone and more treatment options be provided. Sen. Sears added that he hoped a methadone clinic would come to St. Albans. “So that we have all options available,” he said.
Ryan also emphasized that long-term residential treatment could and should be pursued for many addicts, since it not only handles the present addiction issue, but why an individual starts using drugs in the first place.
“Most people use drugs to numb out, to not feel, to not deal,” she said.