On Overdose Day, during an overdose crisis, if we want to save lives, let’s talk about what it will take to tear down the barriers to buprenorphine access.
When you’re in recovery and running an addiction treatment company, it’s impossible not to be impacted by death on a daily basis. After losing a close friend to opioid overdose, Robin and Lisa, Workit Health’s founders, chose to provide recovery meds like buprenorphine for opioid addiction. The clinical research and meta-analyses were coming in strong. Those who used anti-addiction medications cut their death rates from overdose in half. So now, all of our patients get naloxone with their prescriptions, but they come to us for buprenorphine (Suboxone).
To say we weren’t prepared for the stigma against recovery meds is an understatement. Our founders come from a 12-step background, as do I, so of course we understood in an abstract way the general “concern” about buprenorphine use in the recovery world. But the level of institutionalized stigma against these life-saving medications has been shocking. Clients have to fight, and I mean fight, to find doctors who will prescribe buprenorphine, and by the time they reach us, many are utterly exhausted. I can’t tell you how many times I’ve listened to someone on the other end of the phone line, weeping out of pure frustration. As someone with nine years in recovery from opioid addiction, I’m not sure if I could have hopped through the hoops required to get buprenorphine in early recovery.
So on International Overdose Day, let me take this opportunity to pose a quick reminder: the evidence shows this is a medication that saves lives, and cuts overdose death rates in half. It shouldn’t be this hard. I shouldn’t be talking to people buying life-saving medication on the streets just because it’s easier than finding treatment. But here we are.
Unfortunately, the sheer lack of addiction medicine doctors isn’t the only barrier holding patients back from care. The number of ways our world keeps addicts in sickness is myriad: the refusal of pharmacies to keep buprenorphine in stock. The endless prior-authorizations for life-saving recovery medications required to fill a prescription. The time spent on the phone with insurance companies and pharmacies, rather than handling other critical issues related to client care. Negative reactions by friends, family, and the ousting of individuals on medication from many twelve step groups. The list goes on.
My day to day work includes the relaying of this message far and wide. The lack of providers in the U.S. means we’ve had clients drive many miles and hours for their first in-person visit due to lack of treatment options in their area. Every day our team receives emails from those located in out of our prescribing areas: “My doctor is sick/retiring/got shut down… What do I do now?” And I wish I had answers.
Again, a reminder that cannot be overstated: The evidence shows that people who stay on this medication decrease their risk of overdose by half. A study in MA found that those who received buprenorphine or methadone after an overdose dramatically decreased future opioid death rates, but the same study found that only 1/3 of overdose victims receive these life-saving medications.
Suboxone clinics get a bad rap — but they are a key solution to the overdose crisis. Of course the ones implementing poor medical practices need to be weeded out, a common self-healing practice across all industries. But each time a clinic is shut down, its patients are left without a medication that, I repeat, is a key tool in the overdose crisis. Finding a new doctor is a near-impossible feat, and many die (overdose) before getting to that first appointment.
So where does that leave us? If you want to help end overdose, talk about how to prevent it. But when you do, mention recovery meds, like buprenorphine (Suboxone), methadone, and naltrexone (Vivitrol). Yes, look out for blue lips. But look out for stigma against medication, too. It’s also a silent killer.