Saltzman says some Suboxone doctors operate as little more than drug mills. "I had one of them get arrested right in front of me on 57th Street the other day," she says. In part, she goes on, the problem may have to do with how Suboxone doctors get their licenses. Ten years ago, in order to be able to prescribe the drug, she was required to complete a two-day class at Mount Sinai Hospital. These days, she says, "it's an Internet course that takes a couple of hours."

Chris also was disturbed to hear his doctor tell him that he might have to use buprenorphine for the rest of his life. "It made me feel like a loser," he says.

Adam Bisaga takes a different view. "This is the push that they hear from [12-step programs]," the Columbia professor says. "That recovery with medication is something inferior. That you're not truly in recovery until you take nothing. It's not science. It's just ideology from a 12-step movement that makes them vulnerable to relapse." (Responds a spokesman for Narcotics Anonymous: "The experience of NA members is that being clean means complete abstinence from all mood- and mind-altering drugs. That said, NA welcomes everyone. Ultimately, we're not in the business of telling people blanket statements about whether they're clean or not.")

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.

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"On the other hand," Bisaga adds, "you do hear the stories of the pharmaceutical industry pushing people to stay on as much medication as possible. Depending on where you stand in this conversation, you can hear arguments on both sides. We rely on science and effective treatments, and we'd like patients to make informed decisions on their future."

Saltzman says some of her patients are, for all practical purposes, on the drug permanently, but she doesn't encourage it. "I don't like that idea. It's not a healthy way to live," she says. "To me it speaks to someone not wanting to look at themselves."

Chris gazes out a window and rubs his legs, which sometimes still hurt. "At some point," he says, "you have to pay the piper. There's no easy way out with opiate addiction."

Asked how long he's been clean, he smiles, looking both proud and more tired. "Two weeks," he says.

amerlan@villagevoice.com

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