PITTSBURGH — The patient is an addict. His doctor is an addict, too. Over the last decade, both men hit their own versions of rock bottom. For the patient, it was the concrete floor of a jail where he writhed in withdrawal. For the doctor, it was the food stamp office where, his career as a child psychiatrist in tatters, he ashamedly sought help.
Then they both found buprenorphine, the patient as a user, the doctor as a prescriber. And because of that drug, an opioid used to treat opioid addiction, they both rebounded, even thrived.
The patient, Todd Smith, 27, who had developed a painkiller addiction because of a kidney disorder and — “I ain’t gonna lie” — moved on to mainlining heroin, built a life with solidity: a car, a townhouse, a job as a mine safety inspector, a live-in fiancée and “knees worn out from praying.”
The Double-Edged Drug
Part 1
Addiction Treatment With a Dark Side
The doctor, Allan W. Clark, 52, despite losing his Ohio medical license and being on probation in Pennsylvania for eight years, built a buprenorphine business so bustling that five doctors now work under him. His South Hills Recovery Project, tucked behind a 7-Eleven and beneath a hair salon, vibrates with the hubbub of the 600 addicts treated there.
Over the last couple of years, their fates have entwined, with Mr. Smith dependent on “Doc” for the treatment that keeps him stable at an out-of-pocket cost of $7,200 a year and Dr. Clark on “Smitty” and all the other cash-paying patients whose recovery he champions with an us-against-the-world fervor. They have shared, too, a keen awareness that their stability could be precarious.
“In recovery, you’re constantly facing down your demons and dealing with the echoes of your past,” Dr. Clark said. “But in the crazy world of buprenorphine, where this medicine that saves lives is harder to get and afford than the drugs that ruin lives, you’re battling outside forces, too.”
It is indeed a crazy world, or at least a vibrant, volatile subculture of people who see “bupe” as a lifeline, often difficult to reach, in an era when drug deaths outnumber those from car crashes. They scramble to find legitimate, affordable treatment even as buprenorphine is increasingly available on the street, with rising indicators of misuse and abuse tainting its reputation.
Buprenorphine was developed as a safer alternative to methadone for treating heroin and painkiller addiction, a take-home medication that could be prescribed by doctors in offices rather than dispensed daily in clinics. But in some areas a de facto clinic scene, unregulated, has developed, and it has a split personality — nonprofit treatment programs versus moneymaking enterprises built by individual doctors, some with troubled records.
The clinics serve as a crossroads where the tumultuous lives of recovering addicts converge and collide with a turbulent treatment environment.
Since March, The New York Times has visited and tracked the patients of two of the largest buprenorphine programs in this region, where addiction rates are high, for-profit clinics have proliferated, doctors go in and out of business and the black market is thriving.
![:\](https://bluelight.org/xf/BL_Images/Orig_Emoji/wrygrin.gif "wry grin :\")
