More than a third of Maryland residents have a family member or close friend who has suffered from opioid addiction. This shocking statistic sadly comes as no surprise given that overdose deaths from heroin and fentanyl are up by 62 percent from 2015 to 2016. Maryland has been a trailblazer in their effort to combat the opioid crisis by declaring the crisis a state of emergency and introducing legislation that improves access to detox programs, prevention education and medical treatments — including buprenorphine.
The drug buprenorphine, a partial opioid agonist, has become a very common opioid addiction treatment because it suppresses cravings and blocks the effects opioids without a euphoria or high effect. Some patients also have reduced withdrawal symptoms. Combined with therapy or counseling, buprenorphine is proven to be one of the most effective treatment options for opioid addiction recovery.
While this drug has good intentions, and has helped many people recover from addiction, a specific Buprenorphine drug, Suboxone, has proven to cause as more problems as it fixes. Maryland took bold action last year to reduced access to suboxone.
Suboxone, which was introduced in 2002, has become a huge money maker as the opioid epidemic swept the country since the beginning of the 21st century. In 2015 alone, more than 52,000 Americans died from heroin and synthetic opioid overdoses, according to the Centers for Disease Control, nearly the number of Americans who died during the entire Vietnam War. The drug has capitalized on the growing epidemic and has generated $1-2 billion a year in revenues, first for its initial British manufacturer, Reckitt Benckiser, and the Richmond, Va.-based company that it spun off two years ago, Indivior.
Many doctors and patients see the drug as effective, but its manufacturer has fought hard to keep generic or alternative drugs off the market. This has led to an antitrust suit initiated last fall by attorneys general from 42 states, including Maryland. However, Maryland is the only state that removed suboxone from the preferred drug list to allow other generic buprenorphine drugs to emerge and compete thus creating more effective treatments and better drugs.
Another problem with suboxone has emerged in correctional facilities across the country. A sublingual version dispensed as a film has become a contraband drug that has been smuggled into prisons, endangering inmates and correctional officers. In July, Maryland became the first state to fight back, taking the drug off its preferred Medicaid drug list — an action that Indivior appears to be vigorously fighting. Maryland replaced it with a newer treatment drug which comes in tablet form, that is said to be absorbed and processed by the body at lower doses and produce less harsh withdrawal symptoms than suboxone. Already, prison smuggling is down sharply.
“Smuggling has been extremely problematic,” Van T. Mitchell, former secretary of the state department of Health and Mental Hygiene, and Steve T. Moyer, his counterpart at the head of Maryland department of Public Safety and Correctional Services Van T. Mitchell, said. “Not only does it jeopardize prisoners’ health and safety but it also jeopardizes the security of correctional staff.”
As other states consider following Maryland’s lead, Indivior has recently more than doubled its lobbying presence in the state capital. In late January, it registered two more Maryland lobbyists and hired an in-house lobbyist for Maryland in October, bringing its Annapolis lobbying presence to five. The company has a highly paid nationwide network of lobbyists from Alaska and Wisconsin to West Virginia and Kentucky, and nearly tripled its spending on federal lobbying last year.
With Indivior’s market share falling and the antitrust suit looming over it, the company certainly has an interest in keeping other states from adopting Maryland-like policies and in weakening or reversing Maryland’s law. The company has only said that it “intends to defend” against the suit and “related actions.”
However, given Indivior’s harmful business practices and the dangers in prisons, it is clear that medical treatment for individuals suffering from opioid addiction should be dictated by science, not by one company’s attempt to make enormous profits with a drug that carries its own hazards.
Andrew L. Yarrow, a former New York Times reporter affiliated with several Washington think tanks, writes frequently on health and other public-policy issues and is working on his fifth and sixth books.
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