The Biden administration’s much-heralded effort to promote distribution of buprenorphine may not be a game changer in our battle to subdue the opioid crisis. This new campaign resembles yet another social experiment in our national clash with addiction, especially when coupled with so-called harm reduction policies that promote drug abuse.
Buprenorphine is a narcotic drug that is marketed under the brand name Subutex. Suboxone is the brand name of a drug that combines buprenorphine and the overdose reversal drug naloxone. Physicians long needed a special waiver to write buprenorphine prescriptions, which the federal government recently abolished in a bid to increase distribution.
\Because it is an opioid, buprenorphine can be a highly effective tool for curbing cravings in patients with opioid use disorder (OUD). When dispensed properly and with therapeutic structure, buprenorphine is indeed invaluable. Many patients report that the drug significantly curbs their cravings for opioids, thus improving their prospects for recovery and overall quality of life.
I have learned from my experience as a Colorado state judge who presided over drug and DUI courts that public health theory sometimes diverges from the realities of practice. I am aware that many people with OUD have a history of misusing buprenorphine in pursuit of euphoria.
Furthermore, the French study cited as evidence to support the efficacy of buprenorphine to treat OUD stated that they achieved their results with daily supervised dosing for 6 months. Supervision and structured accountability are key ingredients to help ensure success.
Do not mistake me. I do not say that buprenorphine should be withheld from patients it can help. My point is a modest one – we should ensure that buprenorphine is dispensed by qualified persons with expertise in OUD, and in practices able to provide necessary oversight and support for patients. All these changes – abolition of the waiver and dubious drug promotion policies – bear the hallmarks of another social experiment without due consideration of consequences.
Many of the benefits of this new buprenorphine policy will likely be offset by a lack of therapeutic support and other disastrous drug policy implementations under the guise of harm-reduction. Harm reduction, as a therapeutic intervention, has been greatly distorted by self-anointed experts.
For instance, San Francisco’s Linkage Center was supposed to be a revolutionary intervention where people could safely use dangerous and addictive drugs, so they could be effectively linked to treatment services. This $19 million dollar boondoggle resulted in 18 people receiving treatment out the 23,000 who visited this site to use drugs. Mayor London Breed closed the center less than one year after it opened, and it is doubtful that extra buprenorphine would have offset this travesty.
In 2020 Oregon passed Measure 110, which eliminated criminal penalties for possession of controlled substances such as heroin, cocaine, oxycodone, and methamphetamine. By 2022, the overdose rate in Oregon increased by 700%. When asked for an explanation, Dr. Andrew Mendenhall, a chief proponent, said, “It’s important to recognize that the Measure 110 experiment came during a perfect storm, and that its benefits may not be seen for several more years.” So, was drug legalization an experiment and is the new buprenorphine policy a similar social experiment?
Or consider the poster campaign New York City’s public health department ran proclaiming that the intentional illicit consumption of fentanyl is empowering, if used safely. In reality, ingesting fentanyl is life-threatening, and this false advertising only further promotes self-destructive behavior. Once a person becomes addicted, boundaries, person responsibility, and wise decision-making are exponentially compromised.
No surprise that the health department’s own data show the overall overdose death rate per 100,000 residents grew from 31.6 in 2020 to 39.4 in 2021. Unfortunately, black New Yorkers, suffered the highest increase in overdose deaths per 100,000 as the number grew from 39.8 deaths in 2020 to 53.5 in 2021.
In addition to their ill-advised poster campaign New York City officials are now offering free drug paraphernalia, including crack pipes in vending machines, which are funded by taxpayer dollars. Even though the vending machines are offering Narcan to reverse overdoses, there is absolutely no need to furnish smoking utensils.
People with a severe substance use disorder need little encouragement to continue ingesting dangerous drugs and these harm reduction policies only breed the progression of a potentially fatal disorder. If we truly care about a vulnerable population, we should promote self-efficacy, independence, sobriety, and a true belief in the miracle of recovery.
Katharine “Katie” Sullivan serves on the Board of Recovery for America Now Foundation, was as an Acting Assistant Attorney General and a senior advisor to the White House Domestic Policy Council under President Trump. She previously served 11 years as a Colorado State Trial Court Judge
