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The National Alliance of Advocates
for Buprenorphine Treatment

Buprenorphine (Suboxone®, Subutex®3, Zubsolv®4, Bunavail™5, Probuphine®6) is an opioid medication used to treat opioid addiction in the privacy of a physician's office.1 Buprenorphine can be dispensed for take-home use, by prescription.1 This, in addition to the pharmacological and safety profile of buprenorphine, makes it an attractive treatment for patients addicted to opioids.2

The Birth of a Stereotype

For thousands of years opium was used as a medicine and relieved the suffering of many people for many aliments. There were few cures so relieving suffering until the inevitable end was welcome treatment. There are few mentions in early literature to addiction and even fewer concerning “opium sickness” or later termed “withdrawal.” It is suspected that the supply of opium was abundant so there was little reason for someone to discontinue use and suffer through withdrawal. People suffering from some sort of pain would simply start smoking opium and continue for the rest of their lives.

Smoking opium was the method of administration used then. The side effects of opium are minimal and taken in small to moderate amounts is not visibly intoxicating (as with alcohol) especially once one gains a tolerance. Overdose from smoking opium is difficult, because the smoker will eventually pass out or fall asleep while attempting to smoke a fatal dose. The drug creates an illusion of being benign to the user. Some call it the “opium trap”. Problems with opium become evident in the advent of its absence, or otherwise limited supplies.

In the US, the propaganda began in 1890 with stories in the San Francisco Examiner, published by William Randolph Hearst. He ran stories of white women being seduced with opium by Chinese immigrants. The Chinese immigrants, at the time, were taking jobs from Americans and working for wages far less than normal. Racism was high and the “invasion of the yellow man” was seen as a tremendous problem that had to be dealt with. Opium had been part of the Chinese culture for many years by this time, and was associated with the Chinese. Although opium smoking had not had any significant effects on society, it seemed the perfect weapon to curb what was referred to as the ‘infestation’ of Chinese.

This resulted in wide spread withdrawal sickness and brought more attention to the drug.

Due in part to Hearst’s racist tabloid articles, Congress imposed a tax on morphine and opium. With opium in shorter supplies, people formerly content with daily dosing now were forced to discontinue or substantially cut down. This resulted in widespread withdrawal sickness and brought more attention to the dangers of opium. Lawmakers saw the suffering caused by decreased availability of opium and blamed it on the opium itself not on the shortage. This further reduced supplies and in 1914 Congress passed the Harrison tax act making it illegal to prescribe opium (or other drugs derived from opium) without registering and paying a tax.

The stereotype of the drug user had been formed, with little distinction between using drugs for medication or recreation.

In the following years amendments for mandatory sentences and increased jail times made using opium a bigger and bigger crime. Then in 1942 the Opium Poppy Control Act, prohibited growing poppy without a license. As years went by, small changes in the law and jurisdictions swayed from public health concerns to an emphasis on law enforcement and the criminalizing of a substance. While it became evil to grow opium, the opium users (the legitimately prescribed patients) became a questionable sort – indulging in an evil substance that would cause the average person (someone not in severe pain) to go to jail. The stereotype of the drug user had been formed, with little distinction between using drugs for medication or recreation.

Now when someone had to discontinue opioids, their reluctance to stop was seen as reluctance to conform to the rules of society and a desire to indulge in reckless, selfish, lawless behavior. There was no empathy for the withdrawal symptoms because there was no understanding of them. Due to the restrictive laws of the next 50 years, few physicians were experienced in opioid withdrawal and little research had been done since it had become illegal to obtain drugs like heroin, even for research.

President Nixon formed the DEA (Drug Enforcement Administration) in 1973 – the same year The Methadone Control Act was introduced. For about 10 years prior, physicians could prescribe methadone, and it was discovered that it would help addicted patients stay off heroin.

A person addicted to heroin must inject about every 4 to 6 hours to prevent withdrawal. Some addicted people would run out of money and commit crimes to support their addiction. Methadone, a synthetic opioid, allowed for 24 hour dosing. Doctors saw this as life saving and crime reducing. Then the Methadone Control Act was introduced and limited doctors from this practice. Some say it was a way for the Nixon Administration to somehow take credit for the doctor’s discovery of treating addicted patients with methadone.

No other disease in history had been subjected to such a system nor has any since.

The Act imposed conditions requiring patients to go to a clinic for dispensing of methadone daily. They could no longer get a prescription from their doctor, they were forced together with other addicted people to get treated at the same place and at about the same time. No thought was given to the implications of connecting thousands of people with addictions with each other or requiring daily trips to get medication. No other disease in history had been subjected to such a system nor has any since.

When understanding is low people have a tendency to create answers rather than to go on not knowing. In Greek times they invented numerous gods to account for meteorological events. Later demons were used to explain viruses and bacteria. Kings of villages would create tales of monsters to prevent his people from traveling beyond the village limits. Some of these tales were to protect people; others were to protect the governing authority.

Early US leaders apparently saw dangers resulting from opium; and, not knowing the science, they jumped to conclusions and made it evil to consume certain plants. A parent might tell a child “don’t go in the old abandoned mine because it’s haunted”. The parent’s motives are purely to protect their child and discourage them from entering the mine. Society may use the same technique and create falsities and exaggerations to keep members from straying into danger.

Sometimes there is a danger resulting from this type of deceptive manipulation. For example, now, after years of trying to dissuade people from drugs by demonizing them and the people who use them, drug addiction is not seen as an illness. Although science has now proven it is. Old beliefs die hard, and many are still in the dark ages in accepting that fact. The stereotype of a drug addict is difficult to break. It helps to substitute addiction with another illness to help see just how deep the stereotypes lie.

Imagine if you found out a family member had dangerously high blood pressure. And now imagine that, although the FDA approved a medicine to treat this, doctors were not allowed to prescribe it. Instead patients had to apply and be accepted to a clinic where they would be required to go every day, wait in line and receive their daily medication. Now let’s add a random witnessed urine test for foods with high salt contents, and if they tested positive for too much salt they would be kicked out of the clinic. Wouldn’t that cause a black market of high blood pressure pills to become available on the streets? Substitute another disease like cancer and then tell people that although there is a treatment, doctors are limited to treating only up to 30 patients each because Congress was influenced by stigma. If it were not for these carefully sculpted stereotypes built for the last 100 years and the misunderstandings, addiction would be treated like any other disease.

Read in depth about how the stereotype formed in the US. Excerpt from:
The Birth of Heroin and The Demonization of The Dope Fiend

<< Brief History of Opioid Addiction     |     Breaking the Stereotype >>

The Purpose of Buprenorphine Treatment:

To suppress the debilitating symptoms of cravings and withdrawal, enabling the patient to engage in therapy, counseling and support, so they can implement positive long-term changes in their lives which develops into the new healthy patterns of behavior necessary to achieve sustained addiction remission. - explain -

The National Alliance of Advocates for Buprenorphine Treatment is a non-profit organization charged with the mission to:

  1. U.S. Food and Drug Administration, FDA Talk Paper, T0238, October 8, 2002, Subutex and Suboxone approved to treat opiate dependence.
  2. Center for Substance Abuse Treatment. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Treatment Improvement Protocol (TIP) Series 40. DHHS Publication No. (SMA) 04-3939. Rockville, Md: Substance Abuse and Mental Health Services Administration, 2004.
  3. Subutex Discontinued in the US market in late 2011.
  4. Zubsolv (bup/nx sublingual tablet) FDA approved 7/3/2013 see buprenorphine pipeline graphic -in pharmacies now.
  5. Bunavail (bup/nx bucal film) FDA approved 6/6/2014 see buprenorphine pipeline graphic -in pharmacies now.
  6. Probuphine FDA approved 5/26/2016 - FDA Probuphine press release