Is Suboxone a Wonder Drug that Helps Heroin Addicts Get Clean--Or Just Another Way to Stay High?

Is Suboxone a Wonder Drug that Helps Heroin Addicts Get Clean--Or Just Another Way to Stay High?
Pablo Iglesias

Five months ago, Chris resolved that it was finally time to get clean.

Suboxone is "not being used in the context we've seen it to kick a habit or even to replace a narcotic dependence. It's just a way to control your habit a little bit better."

Sort of.

The 34-year-old Brooklyn real estate broker (who declined to be identified by his real name; "Chris" is a pseudonym) had begun using heroin and quit once before, in his late teens. But family problems and a few tough months caused him to relapse, and soon he was snorting the drug two or three times a week.

Special Narcotics Prosecutor Bridget Brennan says dealers carry Suboxone to keep their clientele happy.
Caleb Ferguson
Special Narcotics Prosecutor Bridget Brennan says dealers carry Suboxone to keep their clientele happy.
Internist Dana Jane Saltzman is one of the 1,600 doctors in New York state authorized to prescribe Suboxone.
Caleb Ferguson
Internist Dana Jane Saltzman is one of the 1,600 doctors in New York state authorized to prescribe Suboxone.

After nearly a year of using, the days between doses started to get dicey, and Chris got worried. On the off days, he says, "I was never myself. I was irritable, exhausted, had no motivation or desire to do things I once enjoyed doing. I wasn't happy."

So, in between bags of heroin, Chris scored Suboxone, a prescription painkiller used to treat opiate addiction. He'd use it when he was making a halfhearted attempt to get sober, or when he just didn't want to feel bad between bags. Thanks to its main ingredient, buprenorphine hydrochloride, Suboxone eliminated the agonizing heroin withdrawal, the "three days of complete hell" he had to go through every time he tried not to use.

Chris didn't get Suboxone through a doctor, at first. He didn't have to. It was easier and quicker to buy the drug from a friend who had a prescription and lots of leftovers, which he was willing to sell to Chris for $5 a pop. "Subs," as people often shorthand the drug, come in paper-thin strips, a lot like the Listerine kind, that melt under the tongue. Chris's friend took half of a two-milligram strip each day and sold the extras to Chris.

Eventually, Chris decided he was spending too much money on the subs. He found a physician willing to prescribe him 24 milligrams a day—a "totally ridiculous" dose, he says, far too much for one person to take. (According to the drug's manufacturer, U.K.–based Reckitt Benckiser, the recommended maintenance dose is anywhere from four to 24 milligrams.) He takes one or two strips each day, two to four milligrams, and sells the rest on Craigslist.

"I don't work with everyone," Chris says. "I'm probably more cautious than most." He tries to weed out law enforcement by asking for Facebook or LinkedIn profiles to back up the buyer's identity. "I'm not a full-blown addict. I do have a job. I have a lot to lose." Besides, he adds, "I'd rather sell to someone who wants to get clean, rather than someone who just wants it in between their heroin binges. I'd rather help someone."

Other dealers up and down the East Coast who sell buprenorphine take the same tack in their Craigslist sales, positioning themselves as stops on the road to recovery.

"If you're trying to kick your diesel habit, then TEXT me asap!" writes one dealer. "Heroin is overwhelming here in New Jersey, so please do the right thing and get on Subutex asap!"

"Not LE here," writes another dealer in Soho, using the shorthand for "law enforcement." "Just a guy with a few extras and looking to help someone in need. Please be real about getting clean."

"No bs and no le," echoes a poster in upstate Montgomery County. "I'm just trying to help someone who needs to be off of pain medication."

The technical term for what Chris and other dealers are doing is "diversion," and it is, as you might guess, illegal. Selling your meds is a class C felony in New York, carrying a minimum of one year and a maximum of 10 in prison.

In the case of Suboxone and its generic equivalents, diversion is also increasingly common. Suboxone has been on the market in the U.S. since the late 1990s. Over the past two years, sales have skyrocketed, corresponding to a rise in heroin and (especially) painkiller addiction. The number of pain-pill prescriptions hovered around 209.5 million in 2010; the National Institute on Drug Abuse estimates that 5 million people in the U.S. abuse painkillers.

It's hardly surprising that a drug that can help people get off opiates has become a runaway success. According to IMS Health, a company that collects data about the drugs U.S. doctors prescribe, Suboxone reached $1.4 billion in sales in the first quarter of 2012—nearly 10 times the figure from 2006. Seven years ago, Suboxone was the 198th-most commonly prescribed drug in the U.S. Today, it ranks 26th. In 2012, doctors wrote 9.3 million prescriptions for buprenorphine. From January to March of this year, they wrote 2.5 million more. A majority were for Suboxone, which controls about 70 percent of the buprenorphine market.

As the legal market for the drug expands, so does the black market pooling underneath. If Chris is too picky, Craigslist drug seekers can do business with 24-year-old Luis, who teams up with a friend with a prescription to sell the drug. Luis, who calls himself a "distributor," is homeless and says he's selling Suboxone to finance his move out of the shelters. That, and a desire to help folks.

"People thank me," he says earnestly. "I'm not doing a bad thing. I'm not selling drugs."

In her line of work, Bridget Brennan sees—and busts—a lot of drug dealers. She's immensely skeptical of the notion that anyone buying Suboxone on the street is taking it to get clean.

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