New York Times Panics Over Un-Risky Drug Buprenorphine

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.