OUR OPIOID CRISIS – The Suboxone Effect

The opioid addiction crisis is perhaps the most serious problem our region currently faces. It is not just a problem for the people who are addicted and their families, it is not just a problem for the health care and criminal justice systems—it is a problem for all of us due to effects on our economy and carry-over to future generations.

 Our region cannot compete economically with areas less affected by addiction because new businesses avoid moving here due to concern they won’t be able to hire enough employees who will pass drug screens. Carry-over to future generations is already visible in our education system. Tennessee children who survived drug withdrawal as newborns (due to their mothers’ addictions) now in many cases present developmental problems in grade school

 Congressman Roe touched on the opioid crisis in one of his recent newsletters.  Usually I don’t comment on his newsletters, but in this case, I feel a need to help the region understand more about the crisis and the missed opportunities to address it.

 Many readers know that I treat opioid addicted pregnant women in my medical practice. I work with them to reduce the risk of drug withdrawal in their newborn infants. The risk to babies comes not only from a mother’s original opiate addiction, but also from the medications used to treat that addiction (such as Subutex and Suboxone). Some patients are able to completely come off all addictive drugs, and as far as I can tell, none of their babies has experienced drug withdrawal. When elected to Congress, I’ll be the only member who has actually helped people end their drug addictions.

 This experience and my conversations with voters around the district have taught me a lot. I have learned that many people don’t understand that the same drugs used to treat drug addiction are themselves addictive. Yes, I’ve heard stories of people snorting these drugs and injecting these drugs. Some have even told me that drugs used to treat addiction are the only addictive drugs they have ever taken.  Subutex (street name Tech) and Suboxone (street name Box) have become what are known as entry or gateway drugs—the drugs that people first use on their path to becoming drug addicts. These unfortunate facts help explain why Subutex and Suboxone are the most common drugs found in drug tests in our region.

 From what I can tell, this situation appears to be a special problem in Appalachia. I remember working to publish a medical journal article on this topic, and one reviewer from another part of the country just flat-out refused to believe my data.  This reviewer, like too many other leaders in America, just couldn’t come to grips with the degree to which the drugs marketed and sold to help fight addiction have backfired and become the sources of addiction. Congressman Roe’s newsletter did not mention either Suboxone or Subutex, so apparently he also does not recognize this as a source of our expanding addiction rates. If you don’t understand something you can’t really work to fix it. 

 How did this situation happen and why is it a special problem in Appalachia? One reason is that we have a huge uncoordinated for-profit drug treatment system here. In 2017, when I studied local clinics, the average weekly price for a Suboxone patient was $100 cash—yes, that’s money out of the patient’s pocket. I am told the rates have gone up since then. Many patients don’t have this more than $5,000 a year, so they sell some of their prescription to pay for the next week’s visit to their doctor. This of course puts more Suboxone on the streets, which fuels the ever-growing opioid epidemic.

 Now don’t get me wrong—there are many well-intentioned physicians working in Suboxone clinics who are doing the best they can to help patients in the midst of a flawed system. I thank these doctors for their commitment to challenging work. But others appear to be making over a million dollars a year. Patients believe that this group is more interested in profit than in patient care, and even report that when the patients want to lower their medication dosages, these doctors will tell them, “No, you’re a drug addict, you need to stay on this dose.”

 Congresswoman Blackburn has been appropriately criticized for taking huge sums from drug companies while at the same time spearheading legislation that made it more difficult to prosecute drug company complicity in criminal diversion of prescription opioids. Congressman Roe has made no efforts to join in overturning this wrongheaded legislation. But he too has taken large sums—over $100,000—from the pharmaceutical industry and local clinics involved in some way with prescribing opiates or prescribing Suboxone. He either doesn’t understand the dynamics of our regional addiction crisis or doesn’t want to understand. At any rate, the opiate crisis has been building since before Congressman Roe was elected. He has had 10 years to act, and I feel that the missed opportunities are reflected in the continuing rise of addiction rates in our region.

 We can do better. We need to stop the diversion of prescription medications to the streets as a step toward diminishing recruitment of new people into addiction. We can start by enforcing the laws we already have, making sure patients don’t have to become drug dealers to afford treatment, and ensuring that doctors and insurance companies treat drug addiction just like all other medical conditions. Combating our crisis will involve doctors, hospitals, universities, law enforcement, educators, insurance companies, and yes, drug companies, but not as campaign donors and lobbyists buying laws to protect themselves from accountability for the problems caused by their products. As your Congressman, I pledge to encourage and, when necessary, to require all these groups to join the fight. And I pledge to support legislation that will impose appropriate consequences upon those who fail to fulfill their responsibilities.