How the Lack of Addiction Treatment Options Created a Suboxone Black Market

As opioid overdose plagues many areas of the United States, addiction treatment remains out of reach for many individuals. The result is a growing black market for buprenorphine, used in medication-assisted treatment (MAT).
Buprenorphine in Medication-Assisted Treatment (MAT)
MAT combines prescribed medications with counseling and behavioral therapies to help treat opioid use disorders (OUD). The FDA has approved three drugs for use in MAT for opioid dependence: buprenorphine, methadone, and naltrexone.
Prescribers currently must be certified and obtain a special waiver to prescribe buprenorphine, also known by the brand name Suboxone. Under federal rules, prescribers can only treat a certain number of people with buprenorphine.
Current guidelines, issued under the Obama administration, allow nurse practitioners and physician assistants, as well as physicians, to apply for a waiver to prescribe buprenorphine for OUD. Some doctors can treat up to 275 patients.
Congress is currently working on a bill that would increase the number of patients a physician can prescribe for.
Barriers to MAT and Buprenorphine Use
Despite the reported effectiveness of MAT, however, its use remains limited for several reasons.
Although most insurers must cover addiction treatment benefits, not all plans cover every medication available for MAT. Some plans limit the number of dosages or refills available to each MAT patient. These limitations may make MAT too costly for some patients, especially those who may need MAT indefinitely.
Social stigma remains another barrier to MAT. Many addiction recovery circles believe that total abstinence should be the goal for all patients struggling with opioid addiction. Because buprenorphine is itself a type of opioid, some groups argue that MAT simply substitutes one addiction for another.
Evidence shows that MAT is an effective treatment for OUD, but may also require lifelong use for some patients. This has led to debates and disagreements about how to accurately define “addiction recovery.”
Creation of a Buprenorphine Black Market
Some regulators and law-enforcement officials argue that buprenorphine should be more tightly controlled. They believe that stricter control of buprenorphine can prevent diversion, which occurs when a patient sells or gives away their prescription.
According to many health professionals, however, the lack of addiction treatment options encourages buprenorphine diversion. If someone cannot obtain the appropriate treatment for opioid addiction, they may seek out buprenorphine on the black market to help control withdrawal symptoms.
While some people obtain diverted prescriptions as a way to get high, research shows that most people use buprenorphine as an alternative to more dangerous substances, such as heroin and fentanyl. One study at Harvard Medical School found that when people with opioid dependency illicitly use buprenorphine, they are most likely treating themselves for OUD, pain, and depression.
Help for Addiction Treatment Professionals
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