Subsections below:
1. A state newspaper outlines a widespread increase of heroin addiction, and new “business practices” behind it
2. Some basic information on buprenorphine, and a mixed set of assessments of it, particularly regarding newborns
I. Basic medical parameters: A nursing drug guide’s information
II. A cheerleading view, heard anecdotally: A lecturing doctor’s assessment
III. A critical media view: A major newspaper’s look at newborns dependent on buprenorphine, because their mothers had been taking it during pregnancy
IV. A strongly critical view of buprenorphine from a recovering addict
3. A derivative statement that is a sort of conclusion to this blog entry
[Note: I am not a licensed medical professional, and the information in this entry is not meant to substitute for medical advice from a licensed professional for consumers. This entry is posted pending a little further development, because of its potential value, however limited, to public health interests. Edit done toward end, 1/3/13.]
1. A state newspaper outlines a widespread increase of heroin addiction, and new “business practices” behind it
An article in the October 7, 2012, Star-Ledger, the main newspaper of New Jersey, headlined “The Heroin Boom,” discussed how the trade of heroin to suburban users had grown and become more sophisticated in recent times. Not only was heroin use up, but there was a customer-friendly way of distributing it that obviously facilitated the increased use—involving the simple measures of transporting it up major highways within the state, and increasing the price (to still-affordable levels) to reflect “the cost of the further transportation.”
So, instead of bags costing $5 each if you bought them in the urban areas famed for being locations for buying illicit drugs (like Newark or Paterson), the cost could go up to merely $10 a bag if it was brought a certain distance in to the suburbs, and $15 a bag further in.
What interested me about this article was the role that prescription narcotics played in young people’s getting addicted to the illicit narcotic of heroin. “ ‘What is significant about this cycle [the current phase of increased drug use] is the introduction of prescription opiates that have come upon the scene,’ said Hunterdon County Prosecutor Anthony Kearns III. ‘We’re seeing a greater number of addictions to heroin as a result of prescription painkillers’” (The Star-Ledger [October 7, 2012], Section One, p. 1).
The increase in opiate use is shown in stark numbers. “Statewide, the number of New Jerseyans between the ages of 18 and 25 admitted to addiction treatment centers for heroin rose by more than 12 percent between 2010 and 2011, the last year for which data is available, according to Gov. Chris Christie’s Council on Drug and Alcohol Abuse” (Section One, p. 8).
The new distribution system—distribution being an important hurdle to square with for many businesses that want to be successful—is described. “Suburban high school students, afraid or unable to travel to urban centers like Irvington or Paterson Newark can cost $10 in Morristown and as much as $15 in Sussex
The role of prescription opiates in the development of the recent increase in heroin use is most interesting. “Teens and 20-somethings have fallen into what the Drug Enforcement Administration calls a ‘cycle of addiction,’ graduating from painkillers to heroin, according to Brian Crowell, the DEA’s top agent in New Jersey.
“ ‘The problem is it escalated so fast, doctors were unintentionally overprescribing the pain pills like they were antibiotics[,]’ he said. ‘There were so many painkillers out there in people’s medicine cabinet that it just created a massive wave of heroin users’” (p. 8).
One opioid of abuse is buprenorphine
Which prescription opioid—opiate-like—drug is subject to abuse, much like Oxycontin and other prescription medications meant more specifically for pain? Buprenorphine, which of course is indicated for treatment of opiate addiction, as methadone had classically been.
The fact that buprenorphine would be subject to abuse should be no surprise, and here is but one police-blotter news item reflecting this, as you can probably find many examples of throughout a wealth of local newspapers: headlined “Woman admits prescription fraud try,” the item starts, “A Newton[, N.J.,] woman has admitted she altered a prescription for Suboxone [i.e., buprenorphine] to read 40 doses instead of 10, the Sussex County Prosecutor’s Office said” (New Jersey Herald [December 30, 2010], p. A-8).
##
2. Some basic information on buprenorphine, and a mixed set of assessments of it, particularly regarding newborns
Buprenorphine, which comes in generic and name-brand forms (one name brand is Suboxone), is a sort of synthetic opioid, a type of medication that has biochemical actions like an opiate or opioid (like morphine, heroin, oxycodone, etc.), which is used to help opioid addicts recover from their addictions. (An opiate is a substance derived from opium poppies, like heroin or morphine. An opioid is a substance that functions like an opiate, a synthetic version, with something of the same action; synthetic opiates such as OxyContin and hydrocodone are examples.)
Buprenorphine is like a step down in terms of a similar drug with some of the same (potentially abuse-prone) narcotic action. In this general way, it is like methadone, which was used as a stepping-stone for helping heroin addicts stop using heroin for years, but buprenorphine is considered an improvement over methadone.
Patient-information documents, such as are required by the U.S. Food and Drug Administration (FDA) to accompany all packages of prescription medication dispensed to patients, need to be correct in their every detail. Of course, the preparation of them should be competent and not managed cynically or stupidly. The referenced information below will suggest some of the reasons why.
I. Basic medical parameters: A nursing drug guide’s information
From the 2003 Lippincott’s Nursing Drug Guide, edited by Amy M. Karch, R.N., M.S. (Philadelphia: Lippincott Williams & Wilkins, 2003), on buprenorphine: The drug is classed as a narcotic agonist-antagonist analgesic (the terms “agonist” and “antagonist” means it both stimulates and hinders the neuroreceptors that are most susceptible to an effect by opiates; “analgesic” means it reduces pain) (p. 210). In this book, it is noted as (for purposes in the U.S.) Pregnancy Category C (generally, in the middle range in terms of whether it is potentially harmful to a fetus; the category is explained via “Animal studies have shown an adverse effect on the fetus but there are no adequate studies in humans; the benefits from the use of the drug in pregnant women may be acceptable despite its potential risks, or [alternative definition] There are no animal reproduction studies and no adequate studies in humans” [p. 1354]).
This drug was also classed (as seen in the 2003 Karch book) as a Schedule V controlled substance (p. 210); this categorization was changed to Schedule III in about 2003 (see here; more on the new categorization below). Among contraindications and cautions it is noted: “Use caution [in patients] with physical dependence on narcotic analgesics ([a] withdrawal syndrome may occur)…” and there are listed several potential problems including the possibility of raising cerebral-spinal fluid pressure, “toxic psychosis,” “hepatic [liver] or renal [kidney] dysfunction,” and others (p. 210).
As a historical matter now, the book’s information on DEA (Drug Enforcement Agency) schedules of controlled substances notes, on Schedule V (p. 1355): “Limited abuse potential. … Under federal law, limited quantities of certain Schedule V drugs may be purchased without a prescription directly from a pharmacist. … All such transactions must be recorded by the dispensing pharmacist.”
Relevant to U.S. citizens’ health interests today, the change in categorization of buprenorphine means people need to heed this definition of Schedule III (p. 1355): “Less abuse potential than Schedule II drugs [but two steps up in seriousness of abuse potential from Schedule V—actually midway between V and I] and moderate dependence liability ([examples of such drugs are] nonbarbiturate sedatives, nonamphetamine stimulants, limited amounts of certain narcotics).” (Interestingly, according to the Wikipedia article on it, the medication is still classified as Category V in some U.S. states—see table of basic information in the upper-right of the article page.)
II. A cheerleading view, heard anecdotally: A lecturing doctor’s assessment
On May 25, 2011, Howard Rudominer, M.D., presented an educational lecture in a monthly lecture series offered by DBSA Morristown Area (DBSA stands for Depression and Bipolar Support Alliance), in Morristown , N.J.
Among other things, he noted that buprenorphine’s opiate-agonist quality (its way of replacing an opioid’s function in terms of stimulating opiate neuroreceptors), relative in strength to heroin, was such that if you put a person who was high on heroin on buprenorphine right away, the person goes into acute withdrawal (notes on lecture, May 25, 2011).
He also said there is controversy in the field (i.e., among those doctors who ordinarily prescribe buprenorphine in their practices) about how long you maintain the patient on it (notes on lecture, May 25, 2011).
III. A critical media view: A major newspaper’s look at newborns dependent on buprenorphine, because their mothers had been taking it during pregnancy
In the April 10, 2011 New York Times, an article starting on the front page—“Newly Born, and Withdrawing From Painkillers”—looks at a trend in which “Like the cocaine-exposed babies of the 1980s, those born dependent on prescription opiates—narcotics that contain opium or its derivatives—are entering a world in which little is known about the long-term effects on their development. Few doctors are even willing to treat pregnant opiate addicts, and there is no universally accepted standard of care for their babies, partly because of the difficulty of conducting research on pregnant women and newborns” (p. 1).
The article looks at several points in the collective phenomenon of buprenorphine use and its effects in pregnancy and in the observed behavior of newborns from mothers who had used buprenorphine. “A growing number of addicts are instead [of methadone] taking buprenorphine, another drug used to treat addiction that some studies suggest staves off drug cravings as effectively as methadone but is less likely to cause withdrawal in newborns. […]” (p. 21).
“But buprenorphine also appears not to work for some addicts” (p. 21).
How do babies of pregnant buprenorphine users fare?
“[A] study published in December [2010] in The New England Journal of Medicine [sic roman type style; I think this is the study] showed that babies whose mothers had taken buprenorphine required significantly less medication after birth and less time in the hospital than did babies whose mothers were treated with methadone. But researchers cautioned that exposure to buprenorphine in utero can still cause withdrawal symptoms and that further study was needed” (p. 21).
Differing from Dr. Rudominer, it turns out, “ ‘We don’t want it misconstrued that buprenorphine is a miracle drug,’ said Hendrée E. Jones, a Johns Hopkins University
Have there been dangers of developmental anomalies in babies arising from opiates they were exposed to in the uterus?
A little later in the article: “A recent study by the Centers for Disease Control and Prevention found that babies exposed to opiates in utero, in this case legally prescribed painkillers, had slightly higher rates of birth defects, including congenital heart defects, glaucoma[,] and spinal bifida” (p. 21).
Another authority is quoted as saying that drug exposure alone “is not the primary concern,” but that “It’s the cumulative effect of the drug-using lifestyle—poverty, chaos in the home, domestic violence. All those things affect development” (p. 21).
What about newborns withdrawing from buprenorphine they’ve been exposed to?
The article cites statistics that it seems to offer to show that “[n]ot all newborns exposed to opiates have severe enough withdrawal to need medicine,” yet “about 55 percent of babies exposed to buprenorphine and 80 percent of those exposed to methadone have needed treatment. But it is hard to predict which ones will need it…” (p. 21).
One practicing professional talks about what you witness clinically among affected babies: “ ‘They don’t stop crying, they can’t settle down, they don’t relax,’ said Geraldine Tamborelli, nursing director of the birthing unit at Maine Medical Center, which in 2010 diagnosed opiate withdrawal in 121 newborns. ‘They’re struggling in your arms instead of snuggling into you like a baby that is totally fine’” (p. 21).
How readily do doctors treat pregnant women who use buprenorphine?
It is noted that some doctors don’t even want the responsibility, or more exactly the potential for legal liability, of serving opiate-addicted pregnant mothers. This obviously implies that buprenorphine-dependent babies don’t get served by these cautious professionals either.
“Only a handful of doctors here [in Maine Mercy Recovery Center in Westbrook , Maine
The passage adds, “The fact that most hospitals [in Maine
“ ‘It’s mostly ignorance,’ Dr. Publicker said. ‘It’s a concern that it’s a risky proposition and that they’re going to wind up with an ill baby’” (p. 21).
IV. A strongly critical view of buprenorphine from a recovering addict
From the Web site Drugs.com, I printed out (on September 13, 2010) an entry in a chat room in the “forum” section of the Web site (here is the link; but be forewarned, the comments thread that follows the main entry, which is of primary interest, contains references to masturbation and other topics or ideas that may offend) where patients could comment on whatever drug they had to air views about. This person, who posted on February 16, 2008, commented in an entry that he or she headlined “Suboxone is a scam,” “It’s a narcotic controlled substance that will show up on background checks[;] [i]t’s addictive and habit forming[;] [i]t’s expensive[; and t]he withdrawal symptoms are as severe if not more severe than [those caused by] all the mainstream painkillers.”
He or she added: “It[’]s a more convenient and socially acceptable version of [m]ethadone. [It’s p]otentially suitable for someone who has been taking high doses of heroin or other hard street drugs, as a means to be free of committing felonies, but complete overkill and unsuitable for people taking [pre]scription painkillers. Even for someone who was taking 30 pills a day like I was.
[…]
“Don[’t] even bother with taking [S]uboxone. You’re simply trading one addiction for another. Don’t buy into its marketing BS [sic]. I will not be surprised if they [its pharmaceutical maker] receive a class action lawsuit in the near future, just like Oxy[C]ontin is dealing with now [I’m not sure of the factual basis for this], and the 634 [sic] million dollars they [the pharmaceutical maker of OxyContin, I believe is meant] are coughing up.”
##
3. A derivative statement that is a sort of conclusion to this blog entry
It would seem that use of buprenorphine and its various implications for other aspects of the user’s health—and that of her children if she has exposed them to it in utero—are concerning enough that, as an educated person would think, the product information documents that accompany containers of the medication dispensed to patients professionally should have been drafted, edited, and produced for publishing in a competent, honest manner.
