Doctors, patients: Efforts to block opioid addiction are also blocking treatment

Doctors, patients: Efforts to block opioid addiction are also blocking treatment

MILWAUKEE — Just walking up to a pharmacy window is enough to send Tina Kasten’s brain into overdrive.

“You freak out,” Kasten said, using words like “anxiety” and “stress” to describe how she feels when she tries to pick up her prescription.

Kasten, who lives in Manitowoc, takes Suboxone as part of her treatment for heroin addiction. She said she has experienced delays in filling her prescription a half-dozen times over the last year.

Thirteen other patients described similar experiences in Wisconsin to the FOX6 Investigators. They did not want to be identified, citing the stigma of addiction.

Doctors, counselors, and pharmacists in Wisconsin say efforts to fight opioid addiction are inadvertently making it difficult to get addiction treatment.

The ‘devil and the angel’

Suboxone is a medication that contains buprenorphine and naloxone. It is used in combination with counseling and behavioral therapy to treat opioid addiction.

Drugs like Suboxone work by partially acting like an opioid and binding to the same receptors in the brain.

“That’s what allows it to be so useful in addiction treatment,” Dr. Selahattin Kurter said. Kurter is the executive director of West Grove Clinic, which provides mental health and addiction treatment.

“[Suboxone] doesn’t give you the euphoria associated with opiates,” Kurter continued. “But it protects you from the cravings and withdrawals.”

Kurter is Tina Kasten’s doctor. Kasten credits the combination of Suboxone and therapy for her addiction recovery.

“I didn’t have the cravings all the time,” Kasten said. “It wasn’t constantly on my mind like, ‘OK, am I going to use? Am I not? Am I going to use? Don’t do it. Oh, but you should.’ It’s like the devil and the angel and Suboxone tells them to be quiet and go home.”

“I put the work in to deal with the emotions and deal with everything that led me to be a drug addict,” Kasten added. “The Suboxone didn’t do that work. I did. But the Suboxone helped.”

But there is a danger patients could abuse Suboxone or illegally sell it for its opioid-like qualities; it is a Schedule III drug, which the U.S. Drug Enforcement Administration says could lead to “moderate or low physical dependence or high psychological dependence” if abused.

“It can be used to help somebody get rid of the addiction to opiates, it itself can be addictive,” Dr. Hashim Zaibak, pharmacist and CEO of Hayat Pharmacy said. “So the pharmacist has to balance between the risk and benefits of Suboxone and that can be a challenge.”

Red flags

As the opioid crisis spread, there was a push for Medicated-Assisted Treatment (MAT): The combination of drugs like Suboxone and therapy.

The Director of Wisconsin’s Prescription Drug Monitoring Program says the state has seen a 66% increase in Suboxone dispensations since 2016. A federal rule change expanded the number of patients that providers can treat with MAT, and gave more providers the ability to use MAT.

The Department of Health Services has also been facilitating training to give health providers the ability to prescribe buprenorphine, the active ingredient in Suboxone. Data from the Department of Health Services says one year ago, there were 850 available buprenorphine prescribers in Wisconsin; now, there are 1,117.

While these measures made it easier to have initial access to drugs like Suboxone, other measures made it more difficult to take the medication home.

To curb opioid abuse, pharmacists are guided to turn patients away if there are too many “red flags.” Examples  include cash payments, returning too frequently for refills, signs of doctor shopping, family members receiving prescriptions from the same prescriber, and driving long distances to fill prescriptions

The U.S. Drug Enforcement Administration says it is a felony offense for a pharmacist to deliberately ignore a questionable prescription when there is reason to believe it was not issued for a legitimate medical purpose.

Dr. Kurter says these measures are important to prevent opioid abuse, but also says it’s easy to forget that one patient’s “red flag” could be another patient’s reality.

“So many patients actually need to travel distances because there’s no provider in their rural communities,” Kurter said.

‘Sometimes, that voice is a scream’

Wisconsin has more than 1,000 in-state, actively licensed pharmacies. The northern part of the state has fewer pharmacies; not all of them carry Suboxone.

Nine of the 14 patients the FOX6 Investigators spoke to said they have to drive 20 miles or more to their pharmacy; eight said at least once, a pharmacist has cited the distance as a reason to turn them away from filling their Suboxone prescription.

Others, like Kasten, say they’ve been turned away because the pharmacy did not have the medication available.

“If they have it, great,” Kasten said. “If not, you’re SOL.”

The measures to prevent opioid abuse make it difficult to get the prescription quickly switched to a different pharmacy. Those same efforts are the reason patients receive just enough Suboxone to last until they can fill their next prescription; they get turned away if they attempt to refill too early.

As a result, Kasten says she has gone up to five days without her medication.

“It totally takes them off their tracks of recovery,” Dr. Kurter said. “Because they’re so focused on the withdrawal, and their physical pains of withdrawal, and the emotional pains of withdrawal, oftentimes, patients will likely relapse with the drug that they were offending in the first place.”

“It’s definitely not a, ‘Oh shuckey, darn. Let’s wait until next week or tomorrow,'” said Jaimie Hauch, licensed professional counselor. “It’s usually ‘I need this medication today.'”

Hauch works at West Grove Clinic and says the emotional impact of not being able to access treatment medication is just as important as the physical impact.

“Here, these people are trying to make positive changes, and then there’s a bump in the road that derails those positive changes,” Hauch said.

“You have one day that you’ll be OK because it’s still in your system,” Kasten said, describing what it feels like when she has to wait to get her Suboxone prescription filled. “But after that, I mean, you have sweats, headaches. You sneeze all the time. You’re throwing up.”

“There’s that little voice since you don’t have your safety net, that little voice like, ‘Well, if you just do this, you’ll feel better. You’ll get your homework done. You’ll get your kids taken care of,'” Kasten added. “And sometimes that voice is a scream.”

Getting answers from pharmacies

Kurter says he supports efforts to prevent doctor shopping and pharmacy hopping, but he’s concerned that inconsistencies will negatively affect his patients’ treatment if they continue to have difficulty getting their medication.

“I think it’s important for pharmacies to identify what their rules are and what their protocols are,” Kurter said.

The FOX6 Investigators asked CVS, Walgreens, Walmart, Pick ‘N Save, Costco, Aurora, Meijer, and Hayat pharmacies about their policies related to opioids, specifically dispensations for drugs like Suboxone.

12 Responses

  1. Follow the money, all the way to the graveyard.

  2. A private Army is being assembled, comprised of disposable conscripts, lured into likely suicide missions, but willing undertaken by soldiers, now painfully aware of the other…..

    You’ve already filled in the rest. My message is to young folks. Put your arms around each other and hold on strong. Support each other!
    I see too many young and healthy people being told they need to be on the Suboxone in order to feel better than they’re feeling now. While it may be true for a week or two please realize that you are swallowing a weird chemical and you will be stuck on this shit for life, unless you stay on your own mission.

    Try everything you can to get clean using any other method besides this. It can very likely ruin your life and it is really difficult to get off of this. You are being duped and God knows where you’ll end up. I do not see the efforts made to help you to get off Suboxone once your on it. They want to make money on you I keeping you a patient for life. Make sure you have an exit strategy to leave suboxone behind.

    I’m afraid that you may end up in some weird army of sorts that could persuade you to do anything, or else they won’t give you your Suboxone. You will take any suicide mission so ordered, in lieu of the withdrawal mission. And from what I’ve learned, it is much easier to taper off anything other than suboxone.

    If you need it, do it, and with pride, knowing that it’s for you and you’re fighting your own war – not another man’s evil plan. You now have the knowledge. Knowledge is power!

    Should post this? I was going to write only the first paragraph and throw out that concept I had imagined about what I see with the prescribing of Suboxone. Then I went into this rant directed towards young people. The reason being is that I really do see many young people that seem perfectly healthy but have developed some dependency or Addiction on a substance and these people are herded onto Suboxone and it seems like they are replacing a short-term abuse situation with a lifetime of dependent treatment. It seems that there must be some other ulterior motive to this process because it just seems too wasteful human potential.
    I would think it more healthy to taper people off of whatever substance they are using and set them free of it, hopefully forever, rather than place them on Suboxone and not have a clear and written treatment plan that includes ASAP taper from Suboxone. It would be criminal to maintain people on Suboxone unless absolutely needed and I just don’t see that with these young people. I do see the potential for greed to influence the continual need for suboxone treatment and they monthly doctor visits and all of the drug screens and other paraphernalia associated with the so-called treatment industry.

    With the amount of greed and Corruption that we see in the pharmaceutical and healthcare industry I’m concerned that the push to force multitudes on Suboxone is just ripe for the equally dangerous abuse of power and greed. I’m concerned that many inside players in the healthcare industry are heavily invested in these types of medications and there is something going on.

  3. They should be bending over backwards to give MAT to people with addiction. Every time they get an addicted person to take a replacement, rather than buy dangerous and illicit drugs on the street, they potentially save a life, and a lot of of taxpayer money. They also take another customer away from the evil drug cartels. People on MAT do not use dirty needles, engage in illicit behavior or end up in the ER with serious infections or dead. This kind of will full ignorance and uninformed judgement, is why there is a problem in the first place.

    The ignorant and misinformed have no place in any policy decisions.

  4. Annnnd, once again we have some jackass spouting lies: good ole Doc Kurter blathering “[Suboxone] doesn’t give you the euphoria associated with opiates…” WRONG. Suboxone addiction is a growing problem.

    “Suboxone addiction is a real problem…. the medication has caused its own epidemic that requires its own course of treatment (pharmacological and psychological) to remedy.” [https://americanaddictioncenters.org/suboxone]

    So not only is the stigma causing people to avoid addiction treatment, the very “treatment” is causing an addiction problem. Wunnnnderful.

    Why is this country so stupid that it can’t learn from, say, Portugal? Since they de-criminalized everything, both addiction rates & ODs have plummeted something like 50%. Fewer addicts, less addiction, fewer deaths, and people who actually have legitimate need for medications can get them. But then what would the DEA do?? They’d have to maybe stop being heavily armed attackers of innocent, law-abiding patients & doctors & get decent jobs, I guess. God forbid; bring on the deaths & suffering instead!

  5. MAT is just switching one addiction for another. Too many people don’t understand that fact! Also why should addicts access their “medication” any easier than people who are in physical pain?? I’m sick of the games the local, state and federal government are playing with our lives!!

    • Many pain patients have and pushed in the Suboxone direction as well. We all know that this is tantamount to medical malpractice. Suboxone Is A Dangerous Drug and you could get in an accident and need and opioid but it would not work due to influence buprenorphine. It could be the end of your life.

  6. Saying that suboxone doesn’t give people a high is false. It is the drug of choice for many addicts. Getting to the REAL cause of addiction is the solution. MAT is a bandaid for people to hide their head in the sand. Because conventional medicine doesn’t accept the true explanation of addiction because it doesn’t sell pills, we will continue down a road of causing more addiction in more people. Especially young people put on MAT, and then they have children. Their children will potentially be addicts because of epigenetics.

    • We’re going to have to follow the money on this and I’m afraid we may have to get our own law enforcement group involved.
      It all sounds so senseless and illogical on the face of it, that a reasonable person would suspect that evil plan is in the works.

  7. I had to stop reading when I got to the first lie. ”
    “Acts like an opioid” no it is an opiod that people are getting high on and addicted to! False narrative!!!! I will not be brainwashed.

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