Suboxone use in Portland: A lifeline for recovering addicts or a new abuse problem?

PORTLAND, Maine — Law enforcement agents and drug users in Portland are saying street abuse of Suboxone, a prescription drug intended to help individuals become less dependent on opiates such as heroin, is a new counterculture fad in Maine’s largest city.

But a top addiction rehabilitation doctor said Suboxone has been unfairly vilified and is a “fundamentally safe” lifeline for recovering addicts who may always need some form of medication to survive.

Sgt. Kevin Cashman, supervisor of the Maine Drug Enforcement Agency’s Cumberland District Task Force, said different forms of Suboxone and its active ingredient, buprenorphine, began to emerge after prescription painkiller OxyContin, long a widely abused drug in Maine and elsewhere, was re-engineered.

“In the fall of 2010, when OxyContin tablets were reformulated to make them harder to abuse — harder to crush up and snort, harder to liquefy and inject — we started seeing the Suboxone sublingual strips,” said Cashman. “You could hide it inside the folds of envelopes. The [Cumberland County] jail started discovering that. They’re very concealable on the person. You’re not going to find them in a pat-down of a person, so they became a preference.”

In addition to the thin strips that dissolve on the users’ tongues, Cashman said agents continued to also see the street sale of the prescription Suboxone pills — called “stoppies” in slang because of their octagonal stop-sign shape. Suboxone is the brand name of a prescription drug made up of opioid medication buprenorphine and naloxone, an element intended to limit the euphoric sensations caused by opiates and therefore limit the abuse of the drug.

“People were being prescribed it, and just like methadone or any other replacement drug, it was being diverted,” he said. “People were getting prescriptions and then dealing it. It’s definitely one of the top diverted drugs that we deal with. But the majority of the people [found with Suboxone] were ‘polydrug’ addicts. They were using anything they could get their hands on. We rarely ever get it just by itself, as the single drug of choice.”

A man and two women interviewed by the Bangor Daily News outside a 255-259 Oxford St. apartment building described by residents as “an old crack house” — where two people were found dead two weeks ago because of still officially unknown causes — said Suboxone is skyrocketing in popularity on the streets of Portland.

The three individuals admitted being users of prescription and illegal drugs but declined to give their names.

The man said Suboxone pills had risen in street price from $8 apiece to between $20 and $30 apiece because of an increase in demand.

“The No. 1 story on the street is Suboxone,” one of the women said. “It’s bigger than crack or cocaine, and it’s better than heroin.”

But Dr. Mark Publicker of Mercy Hospital’s Recovery Center in Westbrook, the largest substance abuse and addiction treatment facility in Maine, said Suboxone is a lifesaver in a state with the highest rate of prescription drug addiction in America.

Publicker said the buprenorphine in Suboxone stimulates brain receptors enough to dull cravings or withdrawal symptoms in opiate addicts — but, at only 40 percent of the potency of heroin or oxycodone, not enough to push users into unnatural euphoria.

Additionally, Publicker said Suboxone effectively occupies those receptors to block the effectiveness of any other opiate taken while the Suboxone is active, helping drive away motivation to take other drugs such as heroin. The doctor also said Suboxone is formulated in such a way that “antagonizes itself” beyond certain dosages, meaning that its brain stimulation effects decrease in doses greater than 32 milligrams, further curbing users’ need to continue increasing the amounts to dangerous levels the amounts they use.

“You can’t overdose from Suboxone,” said Publicker. “We’re the largest detox unit in the state with 24 beds, and we’re one of the only ones that admits opiate addicts. We’ve never had to admit somebody for Suboxone withdrawal.”

Because of all of its formulated fail-safes, he said, Suboxone is a “fundamentally safe” replacement drug for longtime opiate addicts who may never be chemically able to survive without medication. Taking Suboxone away from those who are prescribed it, Publicker said, is akin to taking medications away from patients who need drugs to control epileptic seizures or diabetes.

The doctor said a proposal by Gov. Paul LePage to retroactively limit buprenorphine prescriptions to two years, as part of his widely publicized MaineCare overhaul plan, would be devastating to recovering addicts who rely on it.

“I’m trying to destigmatize it,” he said. “People don’t continue in drug addiction because they like it. They hate it. They wake up in the morning and feel terrible and do things they wouldn’t do if they were of their right mind. If you’ve been using intravenous heroin for a long time, your brain may never again normalize without medication.”

Those who are found with Suboxone on the streets of Portland, Publicker suggested, are more likely individuals trying to use it to manage addictions to other, more serious drugs.

But some in the law enforcement community remain skeptical of Suboxone.

Kenneth Pike, the Maine Drug Enforcement Agency’s Division I commander, acknowledged that Suboxone remains behind oxycodone on the force’s list of concerns. But Suboxone is still on that list, he said.

“You weren’t supposed to be able to get high from [Suboxone],” Pike said. “Supposedly, it was just supposed to take the edge off like methadone. But people have found ways to use it to get high. It didn’t live up to what it was supposed to be.”