Health Experts Push To Decriminalize Addiction Treatment Drug

Mar 22, 2019

The House Judiciary Committee has approved legislation decriminalizing possession of buprenorphine. But some law enforcement officials say non-prescribed use of the drug, which is used to treat opioid use disorder, should remain a crime.

It’s been six years since Scott Pavek stopped using opioids. But he wanted out of his addiction long before he was able to get clean.

“I just wanted … some relief from the cycle of using opioids, getting sick, finding ways to acquire more, and then doing the same thing over again,” Pavek said in an interview recently.

Pavek said he was able to find that relief in a drug called buprenorphine. It’s a long-acting opioid that’s far less powerful than heroin or fentanyl. And it allows people with substance use disorder to stave off the symptoms of withdrawal.

“The need for relief from constant withdrawal and drug seeking is something that people could achieve with buprenorphine, and that’s why we see people buying it on the street,” Pavek said.

"The research shows that taking non-prescribed buprenorphine predicts an increased eventual desire to enter into formal treatment." — Burlington Police Chief Brandon del Pozo

Public health officials say buprenorphine has proven itself to be a successful pharmaceutical intervention for people with opioid use disorder. And while the drug - itself an opioid - often finds its way onto the black market, Pavek said people aren’t taking it to get high. He said they’re taking it because they want to get better.  

“It’s quite frankly absurd that we would do anything to deter people from treatment, recovery, harm reduction, and that’s what our laws are doing now,” Pavek said.

The judiciary committee has approved legislation that would change those laws. Specifically, it would decriminalize possession of misdemeanor amounts of non-prescribed buprenorphine.

Not everybody is on board.

“Buprenorphine is an opioid,” said Tom Anderson, commissioner of the Department of Public Safety. “It can cause sedation, physical dependence, respiratory depression, decreased heart rate and blood pressure. So I start there - it’s a dangerous drug.”

Anderson said he’s all for the use of buprenorphine, so long as it’s part of a doctor-supervised treatment program. Outside those medical confines, Anderson said it’s another narcotic that poses a public safety risk.

“What I have serious concerns about is proponents equating the effectiveness of buprenorphine usage as part of a treatment program with the unsupervised use of diverted buprenorphine,” Anderson said. “I just find that to be misleading and potentially dangerous.”

“Danger,” however, is a relative term, according to Timothy Shafer, a family physician in Townshend who’s been a licensed prescriber of buprenorphine for 12 years. The drug is also known by the brand name suboxone.

Shafer said some of the buprenorphine he prescribes undoubtedly finds its way onto the black market.

“And I’m not crazy about that,” he said.

"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." — Commissioner of Public Safety Tom Anderson

But Shafer said that black-market buprenorphine isn’t a gateway drug for first-time users. Rather it’s a lifeline, he said, for long-term users looking for some way out of addiction.

“Any lifeline you can throw into the water when the ship is [foundering] is important,” Shafer said. “So the alternatives to not having a certain pool of street suboxone, the alternative is a lot more overdoses.”

That view is gaining traction in the criminal justice system.

Burlington Police Chief Brandon Del Pozo said his department stopped arresting people for misdemeanor possession of buprenorphine nine months ago.

“That we’re aware of, there’s been absolutely no collateral consequences of a negative kind so far,” del Pozo said.

In fact, it’s been quite the opposite, according to del Pozo. Overdose deaths in Chittenden County were down by 50 percent last year. Del Pozo says it’s impossible to credit any single policy change. But he said access to buprenorphine, even when it’s acquired illegally, is helping to mitigate the deadly effects of what he calls a “public health crisis.”

“Almost everybody takes it to manage their addiction, to stave off withdrawal, to self-treat,” del Pozo said. “And the research shows that taking non-prescribed buprenorphine predicts an increased eventual desire to enter into formal treatment.”

Access to formal treatment has increased dramatically in Vermont over the past five years. And Anderson said the build-out of that treatment infrastructure undermines one of the central cases for decriminalizing buprenorphine.

“So 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,” Anderson said.

Deb Richter, who’s treated hundreds of patients with opioid use disorder, said her patients don’t always have access to that treatment apparatus.

“If they for example are really trying to stay clean and sober, can’t yet get into a program, or don’t have transportation to a program or something like that, often they will use street suboxone,” Richter said.

Richter said she estimates that about 80 percent of the patients she’s treated have used black-market buprenorphine at some point in their recovery process. And she said there’s no public safety benefits to criminalizing its use.

“Most people, by the time they get to point where they’re using suboxone, want treatment,” Richter said. “And I just hope people really understand that.”

The buprenorphine decriminalization bill has cleared one key committee. But it still needs support from the House Health Care Committee in order to get a vote on the House floor.