Prescription Drugs

New York Times Panics Over Un-Risky Drug Buprenorphine

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The New  York Times on Sunday did one of its usual bits of fearmongering over the fact that someone, somewhere might use a useful drug in a way they and authorities disapprove of or which might even be dangerous to a few people.

This very, very, very long story was about buprenorphine, a drug used to treat opioid addiction, and unlike methadone actually available by prescription in the form of "suboxone," where it is mixed with naloxone, an opiate-cancelling drug. (You know, so no one would enjoy it.)

While occasionally acknowledging its lifesaving properties, the piece can't help but make it seem more important that someone somewhere is using it in unapproved ways, or harming themselves with it, with its long, long narratives of people unhappy with their choice to take too much of it, or people committing armed robbery to get it, or doctors who sell it to people who aren't "supposed" to have it, or allowing the drug to slip from the state's control when the permitted choose to sell it to the unpermitted.

But, way, way toward the end of this stunningly long story you find:

Most buprenorphine advocates interviewed said they believed that deaths were extremely rare. But Suboxone and Subutex [a version lacking naloxone] were considered the "primary suspect" in 690 deaths — 420 in the United States — reported to the F.D.A. from spring 2003 through September…..

The F.D.A. information, which is spare, does show that more than half the American buprenorphine deaths involved other substances and that only two of 224 cases specifying "route of administration" indicated injection — the primary concern of regulators.

Fifty deaths are listed as suicides, and 69 involve unintentional overdoses, drug abuse or drug misuse. Thirty were fetal or infant deaths after exposure in the womb….

The F.D.A. cautions against assuming that a "primary suspect" drug was indeed a cause of death.

What does that mean, comparatively? According to U.S. DEA data:

IMS HealthTM National Prescription Audit Plus indicates that 9.3 million buprenorphine prescriptions were dispensed in the U.S. in 2012. From January to March 2013, 2.5 million buprenorphine prescriptions were dispensed. 

And that's just in the past couple of years, those over 10 million licit uses for people who think (or whose doctors think) it might be useful for them, compared to those 420 deaths over about the past decade for which the drug might maybe have been responsible.

Occasional Reason contributor Maia Szalavitz at the Huffington Post took on the Baltimore Sun for trying to do the same five years ago:

Using story after story of street abuse and sales, it presents a bleak picture of a drug that has actually done exactly what it is supposed to do when it is provided medically: reduce harm related to opioid misuse.

The Sun
 seems to see such harm reduction as failure: To the reporters, the existence of any level of misuse is cause for concern, and perhaps, increased regulation. It doesn't much matter whether buprenorphine saves lives, reduces infections and increases functioning - all that counts are that some addicts are still injecting and getting high and some prescriptions are still being sold.

Former Reason man Mike Riggs at the Atlantic has some data on how many opioid-related drug overdose deaths are happening while the FDA dither over making the lifesaving anti-opioid drug naloxone (a part of suboxone, recall) available over the counter:

More than 300,000 people died from drug poisoning in the U.S. between 1999 and 2009. That first year, opioid analgesics—drugs like methadone, oxycodone, and hydrocodone—were responsible for 21 percent of drug poisoning deaths. By 2009, that number had increased to 42 percent, or 15,597 dead, making prescription painkillers the leading cause of drug-poisoning deaths…

…..over the decade-long period covered in the study, the number of counties that had more than 10 drug-poisoning deaths per 100,000 residents increased from 3 percent to 54 percent, and the drug-poisoning death rate increased 394 percent in rural counties and 279 percent for large central metropolitan counties. The study authors say 90 percent of those deaths were related to prescription drugs, opioids in particular. 

Reason on naloxone.