slimvictor
Bluelight Crew
- Joined
- Dec 29, 2008
- Messages
- 6,483
Lebanon, Va. — LATE on Christmas night 2013, April Hileman was summoned for a drug test. She had broken the curfew imposed on her by a drug court and relapsed with the opioid pills she’d been hooked on for six years. Earlier that day, Ms. Hileman had driven to a neighbor’s house here in far southwestern Virginia to buy a handful of Suboxone pills, or “Box,” as the drug is sometimes called. After she tested positive, Judge Michael Moore of Russell County ordered her to jail, and her 3-year-old daughter spent the rest of the holidays with relatives.
Like methadone, Suboxone prevents “dopesickness” and reduces cravings, without getting you high. It is now the gold standard for opioid addicts in medication-assisted treatment, or M.A.T. A combination of the opioid buprenorphine and the anti-overdose drug naloxone, Suboxone is supposed to give addicts a chance to get their lives together before they taper off it.
But Suboxone can get you high if you inject it or snort it or take it in combination with benzodiazepines, a sometimes fatal blend. And Ms. Hileman, then 24, did all those things.
Among public health officials, the effectiveness of M.A.T. has become an article of faith; after all, treatment with buprenorphine and methadone has been found to cut opioid overdose deaths in half when compared to behavioral therapy alone, and it’s hard to argue with that. An addict treating his opioid disorder with Suboxone, many argue, is no different from a diabetic taking insulin. But increasingly, law enforcement officials — and many former addicts and their families — are lining up on the other side, arguing that Suboxone only continues the cycle of dependence and has created a black market that fuels crime.
Many judges in Virginia’s drug treatment courts are refusing to approve Suboxone treatment, especially for those who have already abused the drug. But last year the White House Office of National Drug Control Policy announced that it would not fund drug courts that cut off access to M.A.T. Judges who won’t comply will be forced to scale back or scare up additional state and county funds. And now President Obama’s proposed 2017 budget includes $1 billion for the expansion of M.A.T. What looks like a common-sense investment in Washington looks more complicated here in Appalachia, where the OxyContin “hillbilly heroin” epidemic began back in the 1990s and where opioid overdose death rates remain among the highest in the nation. These are the “Box Wars.”
The problem is the plethora of cash-only Suboxone clinics that operate without proper counseling or monitoring procedures. Oversight is crucial because drug testing alone doesn’t effectively reveal whether a participant is taking more Suboxone than prescribed.
For years Ms. Hileman had been “Box shopping”: Addict friends drove her to clinics across the Tennessee border, in Kingsport or Bristol, and paid her visit fees of $100 to $150 in exchange for six or seven Suboxone pills or films, which dissolve in the mouth. Eventually the drug court cut off her M.A.T. But even with a prison sentence of two years and nine months hanging over her head for drug-related felony thefts if she didn’t obey the drug court’s rules, she continued using and selling black-market Suboxone.
Ms. Hileman’s judge, Judge Moore, doesn’t believe in treating people who have abused Suboxone with Suboxone, instead favoring abstinence with rigorous drug counseling and testing, and near daily monitoring by drug-court probation and surveillance officers.
“I know people Suboxone has helped, but unfortunately a lot of the clinics are not forthright in trying to taper people off,” said Mark Mitchell, the Lebanon police chief and a member of Judge Moore’s drug court team.
cont at
http://www.nytimes.com/2016/05/29/o...ule=Recommendation&src=rechp&WT.nav=RecEngine
Like methadone, Suboxone prevents “dopesickness” and reduces cravings, without getting you high. It is now the gold standard for opioid addicts in medication-assisted treatment, or M.A.T. A combination of the opioid buprenorphine and the anti-overdose drug naloxone, Suboxone is supposed to give addicts a chance to get their lives together before they taper off it.
But Suboxone can get you high if you inject it or snort it or take it in combination with benzodiazepines, a sometimes fatal blend. And Ms. Hileman, then 24, did all those things.
Among public health officials, the effectiveness of M.A.T. has become an article of faith; after all, treatment with buprenorphine and methadone has been found to cut opioid overdose deaths in half when compared to behavioral therapy alone, and it’s hard to argue with that. An addict treating his opioid disorder with Suboxone, many argue, is no different from a diabetic taking insulin. But increasingly, law enforcement officials — and many former addicts and their families — are lining up on the other side, arguing that Suboxone only continues the cycle of dependence and has created a black market that fuels crime.
Many judges in Virginia’s drug treatment courts are refusing to approve Suboxone treatment, especially for those who have already abused the drug. But last year the White House Office of National Drug Control Policy announced that it would not fund drug courts that cut off access to M.A.T. Judges who won’t comply will be forced to scale back or scare up additional state and county funds. And now President Obama’s proposed 2017 budget includes $1 billion for the expansion of M.A.T. What looks like a common-sense investment in Washington looks more complicated here in Appalachia, where the OxyContin “hillbilly heroin” epidemic began back in the 1990s and where opioid overdose death rates remain among the highest in the nation. These are the “Box Wars.”
The problem is the plethora of cash-only Suboxone clinics that operate without proper counseling or monitoring procedures. Oversight is crucial because drug testing alone doesn’t effectively reveal whether a participant is taking more Suboxone than prescribed.
For years Ms. Hileman had been “Box shopping”: Addict friends drove her to clinics across the Tennessee border, in Kingsport or Bristol, and paid her visit fees of $100 to $150 in exchange for six or seven Suboxone pills or films, which dissolve in the mouth. Eventually the drug court cut off her M.A.T. But even with a prison sentence of two years and nine months hanging over her head for drug-related felony thefts if she didn’t obey the drug court’s rules, she continued using and selling black-market Suboxone.
Ms. Hileman’s judge, Judge Moore, doesn’t believe in treating people who have abused Suboxone with Suboxone, instead favoring abstinence with rigorous drug counseling and testing, and near daily monitoring by drug-court probation and surveillance officers.
“I know people Suboxone has helped, but unfortunately a lot of the clinics are not forthright in trying to taper people off,” said Mark Mitchell, the Lebanon police chief and a member of Judge Moore’s drug court team.
cont at
http://www.nytimes.com/2016/05/29/o...ule=Recommendation&src=rechp&WT.nav=RecEngine
