One day, several years ago, I was sitting in my office cubicle and trying my best to make it through each hour. I was cold–yet sweaty. My anxiety was through the roof and I wasn’t sure if I wanted to cry or vomit. I was going through withdrawals.
As I stood up and peered over the top of my cubicle at my coworkers, I knew I was living a much different life than most of them. While I overheard them making lunch plans with each other, I was slinking off to buy drugs or selling company stock to fund my addiction for another month.
My most consistent dealer lived only a few miles from my work, so it was a quick trip on my lunch break to buy a couple hundred dollars worth of pills–just enough to fight off withdrawals for the day.
At this point, I had not started injecting heroin, but I was using 5-10 30mg Oxycodone pills each day. I would crush them, typically two at a time, and snort them. I wanted to stop, but I was afraid to tell anyone how bad it was, didn’t know where to go, and I was terrified of the stigma associated with having a substance use issue.
I texted my brother to see if he could help with the withdrawals and he told me that he had something that would make me feel better. What he brought was a strip of Suboxone, the sublingual films manufactured to treat opioid addiction.
The packaging is a small, flat, foil-like pouch that you tear open to reveal the medication in the form of a small orange rectangle. He instructed me to cut a small strip off and allow it to dissolve under my tongue.
I followed his instructions, and within fifteen minutes I felt better. My withdrawal symptoms had subsided. It was the closest I had felt to being a normally functioning human being in several years.
Finding a doctor willing to help
After being turned away a few times by some doctors because they had no openings for new patients, I would soon after find a local doctor who would prescribe me Suboxone.
When I called, the receptionist very clearly outlined their expectations of me. I would need to bring $300 cash to my consultation. The fee was non-refundable and it was the only way they would consider taking me on as a new patient. If they accepted me, I would have to pay an additional $200 cash each month for them write me a new prescription.
After a brief conversation with the doctor, I left holding my first prescription for Suboxone and was on my way to the local pharmacy. It would cost me another $550 to fill my prescription without insurance. That’s $850 total out-of-pocket for a one-month supply of medicine designed to treat opiate addiction.
After jumping through hoops, I would eventually get my commercial insurance to cover the medicine. They required pre-authorization that included “proof of treatment” but couldn’t explain to me what they considered treatment or what was accepted as proof. After several phone calls, I reached someone who gave it to me straight.
He said: “Listen, just go to a local Alcoholics Anonymous meeting and have someone sign a pamphlet showing that you attended. We can use that for your pre-authorization.”
In order for me to get insurance coverage for my potentially life-saving medication, I needed the signature of a stranger in an anonymous meeting held in a church basement.
Each month I would need to walk into the doctor’s office, pay $200 and pick up my new prescription. The pharmacy refused to fill my prescription even a single day early, so I would be taking my last dose as I picked up my new prescription–fingers crossed that my insurance was still covering it.
This need for constantly obtaining new, short-term prescriptions is what has inflated the numbers to make Suboxone appear more readily available than it actually is. The headlines have recently reported that it is the second most prescribed drug in Maine, however, the number of patients receiving prescriptions doesn’t even come close to cracking the top ten.
I would eventually come off Suboxone but started using opioids again a couple of months later. I don’t attribute this reoccurrence to Suboxone not working. It gave me the opportunity to have a better quality of life and to work on building a foundation of recovery, but I didn’t utilize this opportunity at that time.
The truth about buying Suboxone on the street
Did I always take my Suboxone as prescribed? No.
Did I ever sell it to other drug users? Yes, and I don’t regret doing so.
If I was uninsured, Suboxone would have cost me close to $10,000 out-of-pocket each year, but prescribing the medication is only part of the expense. Patients who are prescribed the medication also need the required counseling and other supportive services.
The supply of doctors who prescribe Suboxone is low. If more doctors are willing to become prescribers, it will help to meet the treatment demand for the thousands of Mainers suffering from opioid addiction, but there are barriers preventing them from doing so. These obstacles include cultural stigmas in treating patients with addictions, financial disincentives, and bureaucratic red tape.
I was one of the lucky ones who were able to afford the monthly doctor’s visit and prescription. In my experience, people don’t buy Suboxone on the street because they want to abuse it–it’s just easier to access on the street. Government restrictions, high costs, patient limits and lack of access prevent people from obtaining it legally.
While a gram of heroin in Portland can fetch as-much-as $160 on the street, a single sublingual strip of Suboxone can usually be had for under $20, helping to fight off withdrawals for several days. Government restrictions and lack of participation by doctors have likely only helped cause Suboxone to be more accessible and cheaper on the street for many people.
When I was finally able to find extended sobriety, I used illegally purchased Suboxone to help myself detox, tapering my dose before moving into a sober-living home. If it wasn’t for this medicine being readily available on the street, I probably wouldn’t be writing this column, and I might not even be alive.
Removing shame from treatment
Ironically, a popular saying in the abstinence-only based program, Alcoholics Anonymous is “Progress, not perfection.” Taking Suboxone isn’t a perfect solution, but it’s better than using heroin, and it’s better than death. Those with substance use disorders are shamed for being addicted, and later have to experience shame for taking action towards recovery if their pathway differs from someone else.
It’s important to understand that there are many ways to achieve recovery, and that word is defined differently for each person. As long as someone is living a better quality of life today than they were yesterday, they are moving in the right direction.
In a perfect world, abstinence-based recovery would work for everyone, but the reality is that it’s not always the most effective and immediate solution to help save a life. “Stop using” isn’t an acceptable treatment plan and we need to improve access to all pathways.
If you would like to be notified when Seth Blais posts a new column, you can subscribe to his email list. He can also be contacted at:
Facebook: www.facebook.com/sethblais
Twitter: @sethblais
Send questions/comments to the editors.
