The small rectangular film dissolves under the tongue. Or sometimes, it’s a pill.
Any certified physician can prescribe it. In the war against opioid and heroin addiction, it can mean the difference between breaking or remaking lives.
It’s called buprenorphine.
It comes in a couple of different forms and labels. The most common is Suboxone. Similar to methadone, it’s a medication that has been successful in treating those addicted to heroin and opioid pain killers. Unlike methadone, it’s considered to be safer, offers less potential for abuse and can be prescribed at a regular doctor’s office instead of a specialized clinic.
The drug has been available since 2000. Yet only some three dozen local physicians are trained to prescribe the medication despite the skyrocketing number of overdose deaths – roughly 250 this year alone in Erie County.
Far more people need this drug than get it. But local health leaders hope Saturday’s buprenorphine training for physicians, already at capacity, will mark another turning point in the battle for lives.
“If we can get even half of these people really interested – you’re talking about thousands of patients right there, being treated,” said Dr. Paul Updike, an addiction specialist and director of chemical dependency at Catholic Health. “Over the course of a year or two, we can make a tremendous difference.”
The drug, the problem
Buprenorphine is a narcotic replacement therapy that is also sometimes prescribed for pain. The brand Suboxone includes a second ingredient that further limits the ability of a drug abuser to use the drug to get high.
These medications curb the opioid withdrawal symptoms of addicts trying to get clean and can be a key tool in a person’s path to recovery.
But because buprenorphine is an opioid-based drug, it is still susceptible to abuse. So it’s strictly regulated. Only physicians who have undergone specialized training and become federally certified can prescribe the drug.
Currently, each certified physician is limited to only 100 patients.
The limited access to such an important medication is a major community concern, say public health leaders.
So far, fewer than 40 physicians in the region have pursued certification to administer buprenorphine. And not all of those who are certified actually go ahead and prescribe it, even though the prescribing process is not complicated, Updike said.
“A lot of physicians are a little afraid to do this,” Updike said. “If your only experience with this is, ‘I did an online course,’ and you see a patient who acts out ... it creates a lot of anxiety.”
Moreover, many physicians have previously shown lackluster interest in Suboxone or other addiction treatment medication because they never envisioned themselves becoming the primary caretakers of patients with addiction issues. But that attitude is changing.
“In this past year, our community has come to realize we have a problem with opioid addiction with all the deaths that we’ve seen,” said Erie County Health Commissioner Gale Burstein. “We know that abstinence only does not work. There’s an almost 100 percent failure rate with that strategy. Medication-assisted treatment is the best solution.”
Unlike buprenorphine, no special training or certification is required for any physician to prescribe other potent, opioid pain killers that are susceptible to dependency and abuse – drugs like oxycodone, hydrocodone and fentanyl, which have heavily contributed to the addiction and overdose crisis that communities struggle with today.
In June, the state passed a new law limiting the prescribing length for such drugs to seven days, except for chronic illnesses. The law also requires insurance companies to cover the cost of addiction treatment medication.
Now, the state is looking for ways to get more addicts into treatment. State Department of Health officials will attend Saturday’s local buprenorphine training session and hold a focus group to learn if the training program offered here can be replicated elsewhere.
The fact that a local health department managed to coordinate this kind of training is particularly unusual, Burstein said.
“If we relied on physicians to seek out the training themselves, it wasn’t going to happen in a timely fashion,” she said, “so we decided to make the program available here.”
In the spring, the Erie County Health Department began promoting the training session. No one expected a great response.
“We were hoping to get 10,” Burstein said.
Instead, the grant-funded training session filled up. Thirty-five doctors signed up. Now there’s a waiting list of seven. Another training will be scheduled within a few months.
“I’m a little surprised,” said Updike, who works closely with the Health Department and applied to become a trainer with the American Academy of Addiction Psychiatry in order to lead the workshop.
The training will qualify the doctors to become certified prescribers of buprenorphine.
Updike pointed out that any interested physician can take an eight-hour online course to become certified Suboxone prescriber.
But dealing with patients with addiction issues can be tricky. Updike knows this first hand. He abandoned his original intentions of being a rural practitioner after landing at an urban clinic where drug addiction was a huge problem.
“I basically just started to work through it,” he said. “I didn’t have any training.”
But he and Burstein agreed that the appeal of this training is the personal contact it gives primary care physicians who might be intimidated or cautious about treating addicts.
The doctors in the training will have questions, and Saturday’s session will be run by an addiction treatment expert who has answers.
Participants must complete four hours of online coursework before the session, and then they’ll spend four hours Saturday with Updike at the Catholic Health headquarters.
Those who attend will also be able to work with addiction clinics that can provide advice and assist in getting patients started on Suboxone therapy. That initial step in the therapy is more involved than supervising stabilized patients, Updike said.
Updike said he hopes Saturday’s training will help build the foundation of like-minded physicians committed to addressing the problem, like the county’s last physician training session in July on how to manage patients with chronic pain. With more physicians able to help, those with addictions will be less likely to turn to the streets for drugs that could wind up killing them.
“My message to people is, this is not something we can really avoid,” Updike said. “It’s a very common problem. As primary care physicians, we are absolutely going to see it. My approach to this is, if we’re going to see it, I’d want to do the very best job with this.”