Inconsistent and Specious Laws Criminalizing Addiction 

In my blog, “Is Suboxone the New Kleenex®?,” I attempted to clarify which opioids are used to treat addiction as well as pain, depending on their brand name or where they are being prescribed. A recent article in MEDPAGE TODAY titled “Suboxone Underused, Opioids Overused in Medicine” added some confusion to the already complex discussion of opioids.

But there’s a lot more complexity to explain. Specifically, I want you to be aware of how the inconsistent and specious laws have contributed to irrational drug polices that have harmed, and continue to harm, millions of Americans.

A Wired article provides a historical perspective on the problem: “…In 1914, Congress passed the Harrison Narcotic Act, barring doctors from prescribing opiates to known addicts.” According to a Wikipedia article, the Act mostly applied to the marketing of opiates. However, a particular clause in the Act allowed doctors to distribute narcotics only in their professional practices. They were not allowed to supply narcotics to addicts. The Act stigmatized and criminalized the disease of addiction and, since then, it has shaped our cultural attitude toward people with opioid addiction.

Narcotic legislation and Drug Enforcement Administration (DEA) regulations are at the core of the legal dissonance about using opioids for medical conditions.

Methadone Regulation and Use in Addiction 

Let’s talk about how methadone is used and regulated. This will shed light on some of the difficulties that well-intentioned, competent physicians face because of the convoluted laws that apply when they try to treat opioid addiction.

Methadone treatment for addiction is a model of the failure of laws to focus on helping patients with addiction. The chemical has been used for more than 60 years to treat opioid addiction and is one of the most powerful opioids available. It is also used to treat pain.

However, if methadone is used to treat opioid addiction, it must be provided in a special licensed methadone maintenance treatment facility. Any physician with a DEA-controlled substance license can prescribe methadone in a licensed methadone facility.

Methadone also can be prescribed in a physician’s private office for pain, but not for addiction, providing they have a DEA controlled substance license. Methadone does not have to be prescribed in a methadone-licensed facility when it is prescribed for pain.

Physicians can lose their license if they prescribe methadone for an opioid addiction in their office, but not if they prescribe it for pain.

Morphine, by contrast, can be prescribed for pain, but it is always illegal to prescribe it for an opioid addiction in the U.S. However, in some areas of Europe, physicians can legally provide morphine for opioid addiction in their own offices.

The reason methadone has been used to treat opioid addiction is because:

• It has a long half-life and,
• Will remain attached to the opioid receptors for 12-24 hours.
• Historically, morphine and other similar opioids had only a half-life of 2-4 hours.
• However, today most opioids have been formulated into extended release formulations that will last 12-72 hours. That makes methadone less important as a drug to treat opioid addiction than it used to be.

So, people with an opioid addiction can be prescribed an opioid for addiction, but only certain opioids can be used to treat opioid addiction. That is dictated by the DEA, not by medical science. Other opioids, like morphine or oxycodone, might be as effective as methadone or buprenorphine in treating opioid addiction, but they are not legal options.

Buprenorphine Use in Addiction and Sanctions 

Speaking of buprenorphine (often shortened to “bupe”), which is the active ingredient in Suboxone, Wired reports, “Bupe is also safer than methadone – which, like any strong opioid, can suppress breathing if too high a dose is taken. And instead of visiting a treatment center every morning, as is the case to receive methadone from a methadone treatment facility, addicts can get a bupe prescription from their regular doctor,” provided he/she has a special license to treat addiction with bupe.

In all situations, buprenorphine and methadone can be prescribed in a private clinic for pain as long as the physician has a DEA license to prescribe schedule II drugs.

Physicians need to know this to comply with the law or risk serious sanctions, including the loss of their license, or being incarcerated for prescribing without a legitimate medical purpose. Even worse, patients can be, and often are, harmed because of the barriers to access for patients who need treatment for their addiction.

The Criminalization and Stigmatization of Addiction

The criminalization and stigmatization of addiction is largely responsible for the large number of people who have not been willing to seek timely treatment for their disease. In my view, addiction needs to be treated like any other serious chronic disease and not be controlled by antiquated, convoluted laws.

Perhaps, when the laws finally are clear and reasonable, physicians will be able to focus on what is best for a patient instead of putting their energies into complying with laws that have no scientific justification.

 

Purchase my book The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us (available on Amazon) or read a free excerpt here.

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Copyright 2016, Lynn Webster, MD