Vermont Debates Decriminalizing Buprenorphine

Vermont Debates Decriminalizing Buprenorphine

Lawmakers in Vermont are debating the decriminalization of unprescribed "misdemeanor possession" buprenorphine, widely known by the brand name Suboxone.

The idea is that decriminalizing the drug would make it easier for opioid addicts to simply "cop some bup" on the street and self-medicate to treat their opioid addiction.

Sponsored by Rep. Selene Colburn and 10 others, it has received some legislative support. However, numerous other elected officials along with the state's health and safety commissioners are not on board.

Bill H.162, "an act relating to removal of buprenorphine from the misdemeanor crime of possession of a narcotic," recently cleared the House Judiciary Committee. However, it awaits support and passage by the House Committee on Human Services to get a vote on the House floor.

According to Health Commissioner Mark Levine, however, the state's new treatment centers can treat "everyone who knocks at the door. We are a state that has no waiting lists, so there's no reason for a person to be on the streets with nothing else to turn to but illicitly obtained buprenorphine," Levine told Vermont Public Radio (VPR) recently. In other words, anyone addicted to opioids who walks in the door of one of the many new treatment centers in the state could be on buprenorphine the same day, hassle-free.

Department of Public Safety Commissioner Tom Anderson told VPR that he supports the use of buprenorphine - as long as it's part of a doctor-supervised treatment program. But he pointed out that the whole idea is unnecessary.

"The idea that you have diverted buprenorphine as a self-treatment option, because of barriers to treatment - I just don't think that holds water any longer in Vermont, because we've done such a good job of making this kind of treatment available virtually on demand."

So why legalize an addictive opioid?

The idea forwarded by supporters of the bill is that opioid addicts on the streets are wary for many reasons to avoid surrendering to legitimate treatment. And, they are known to occasionally self-medicate with illicitly obtained buprenorphine when they want some relief from their dangerous opioid addictions.

Buprenorphine is itself a long-acting opioid, and when properly administered, usually sublingually, can help prevent opioid withdrawal symptoms while not causing euphoria.

However, when snorted or ingested, it very definitely causes an opioid euphoria, and can lead to overdoses and other problems.

"Buprenorphine is an opioid," Anderson said. "It can cause sedation, physical dependence, respiratory depression, decreased heart rate and blood pressure. So I start there - it's a dangerous drug."

Buprenorphine and real treatment

As a component of opioid addiction treatment, the use of buprenorphine varies widely depending on the treatment modality.

Buprenorphine is most often cited by proponents of medication assisted treatment (MAT), because it immediately relieves opioid withdrawal. But like methadone "treatment" before it, MAT too often can omit or limit the counseling needed to recover a drug-free life. As a result, and also like methadone, there are more and more examples of buprenorphine "treatment" continuing on and on.

By anyone's definition, that isn't a real recovery from opioid use disorder. It's more of a milder, perhaps a hopefully less dangerous, but nevertheless never-ending opioid use disorder.

Meanwhile, buprenorphine is a vital component of many comprehensive medically supervised treatments that do lead eventually to recovery of a drug-free life.

Many detoxification clinics, such as at Novus Medical Detox Centers in Florida, rely on buprenorphine as part of an opioid detox program.

At Novus, for example, buprenorphine is used to help transition patients through opioid withdrawal more comfortably - even a years-long high-dose methadone addiction. The patient-tailored programs, that include nutritional and other supportive modalities, step the buprenorphine down to zero, and in just a few days most patients are ready to continue with their recovery in the rehab program of their choice.

The solution becomes a new problem

Health Commissioner Levine told the legislature that decriminalizing buprenorphine could mean more people with legitimate prescriptions that they need for themselves will be selling their medication to others.

He said he's worried that it will fall into the hands of "casual users" leading them to develop dependency and opioid use disorders.

Levine said he "knows buprenorphine decriminalization may save some lives." But lawmakers need to weigh the other consequences that could arise, similar to how people who started with Vicodin and OxyContin got into trouble.

The drugs were circulating at levels they shouldn't have been, he said, and "people were using at higher and higher doses and becoming addicted to it."
"Everyone's always focused on one less person will die because of this and so we've done a lot of good," he said. "But there can be a lot of harm coming to other people that one might not have anticipated right away."

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