Big Pharma Is Who We Need For The Opioid Epidemic
State of the opioid epidemic: The acceptance of a gold-standard for opioid addiction is growing, but its creators are hampering adoption and compromising their investor’s interest. But there’s a way to fix it.
It was only the other day that I learned that Lysol and opioid treatment medication are created by the same company. (Or written like: the companies that keep your counters and toilets germ-free, are also the holding company fo the makers of the best antidote to opioid addiction. The price is high, and if they effectively keep the generic, FDA-competition down through their hearing slated for the end of January, then those prices will stay that way. In their shareholder meeting on Dec 18, they assured that their profit targets will stay intact. If they must make an affordable buprenorphine-naloxone to rival the new ones, they will cut research and production costs to meet their targets. Otherwise, it will be business as usual.
The pharma companies are dancing to the same tune as they always have— on the attack to protect their IP from being genetically available for the masses when in fact their profits could skyrocket if they expanded access, subsidized provider waivers, and promoted long-term usage. It is the most underused solution for overdoses.
Evidence of success: Extensive research, randomized trials, anecdotal evidence and professional consensus identifies Suboxone as the most cost-effective, reliable form of opioid treatment. The stigma it receives and limits in availability are waning rapidly with incontrovertible proof and bipartisan support. Companies must capitalize on this.
In all the hand wringing and discussion about the opioid crisis, there’s one that has been proven to be effective in the long term. Buprenorphine, aka suboxone, has its pros and cons, and yes, used improperly (much like pain killers that continually are prescribed) has the ability to kill, but all that bad dwarfs in comparison to the good.
It’s got the least side-effects, the most success, greatest level of access, and is the closest thing to a life people want to live after their brain has been irrevocably hijacked by opioid addiction. It may never balance itself out again, but that’s okay.
The article from the other day lucidly explains the warring factions of abstinence vs MAT, and the tide shifting to the latter, evidence-based ways. But MAT is not a simple magic bullet. At best, it can seamlessly carry a hopelessly dependent, dopesick addict into a state that skips over the horrors of withdrawal, sparing them the psychological tortures that go along with it, and be a short-lived panacea to their opioid dependence. That is the ideal journey. The more common, stigmatized one is those who must live with an FDA-approved, dose-controlled opioid for the foreseeable future, constantly considering the mysterious of long term consequences.
That’s where my best friend Gary lives. Five years heroin-free, she still vomits and dry heaves if she misses a dose by an hour or so. But she doesn’t mind that life. Her psychiatrist is the best she’s ever had, her apartment is paid, her dog is great, and parents see her for a jovial family dinner every Friday night. It’s as if the multiple times she was involuntarily committed to psych wards have receded from existence. And that’s the power of suboxone. It can turn around a life so profoundly that the darkest days of attacking family in the kitchen, cruising around Yonkers looking for anyone who knows anyone with heroin as just a small behavioral blip, all thanks to the long term promises of suboxone. My friend Gary has been on suboxone for over five years, she takes a tiny silver in the morning and needs it every 24 hours or the withdrawals are unbearable. But nothing else has worked, and it even has a the added advantage of the subtle reminder, everyday, how much her body has changed, and all this time later, it still craves opioids to a point that it will revolt in less than a single day.
It goes beyond anecdotal- the studies are vast, randomized, and worldwide, proving time and time again that there’s a tragically underutilized treatment for effective detox that can, when coupled with the essential components of addiction treatment such as CBT and community support, yield a life beyond one’s wildest dreams. It is not a pipe dream.
Embrace of this evidence: The public opinion and provider protocols are slowly shifting, with promising approaches (explain hub and spoke model)
States that have experienced the success of suboxone are clamoring for more of it after their supplies deplete almost immediately. Dissenters warn against the diversion rate of this opioid-relative, but it is less than 1%, and its illicit dealing is almost exclusively used to self-treat withdrawal symptoms because there are not enough providers who can prescribe it, or their inherent/unconscious professional bias has made them wary of giving a partial agonist to a heroin addict who is living in agony. They would rather prescribe the drugs the law has granted them permission to push with reckless abandon— the pills that started it all— the Oxys, Vicidon, Codeine, which have been the three-pronged cause of this mess we’re in and the clean up method is what is under regulation.
Vermont is a beacon of success, with overdoses going down, and the correlation lies in the increase of access to suboxone.
Vermont has spent more of their budget on Suboxone than any other state, and its standout success in reducing overdoses can serve as a powerful example across the country for other healthcare systems that investing in Suboxone is the best way to combat this cunning, yet completely baffling epidemic. It isn’t diabetes, a disease with endless permutations of successful pharmacological cocktails and highly personalized diets.
Setbacks, stigmas, & side-effects: Barriers of adoption come from misconceptions, low-information providers and patients, and lack of executing effective distribution protocols (go into diversion, timing, tapering, and poly-treatment complications and ostracization from the major fellowships).
Less than 40% of nurse practitioners have the waiver which allows them to prescribe Suboxone, and provider numbers are even worse. If you are a nurse practitioner, health care professional, sign up for the waiver here. I understand that your patient rotation is strained, and you do not want to irresponsibly give Suboxone in fears that they will….abuse it? If you have a fear, please tell me what it is.
Of course it would be preferable if these opioid addiction survivors could go on without depending on other, sanctioned drugs to cope with psychological pain, but that almost seems hypocritical when I fully support pharmacology for my bipolar disorder.
Treatment for opioid addiction is reliable, accessible, safe, and supported bipartisanly.
It’s also complicated, controversial, convoluted, nuanced, and constantly at odds with those who tout its benefits.
You’ll hear wild tales for everything, especially on reddit, where people exchange war stories of weaning themselves off their meds and the hell their body made them pay for doing that, the dramatic loss of appetite, the fast onset of 20 extra pounds, this drug interacts with everyone in different ways. The biggest challenge we have is understanding that pretreatment puzzle. The pieces are there— CBT, MAT, CRA, PT(Pharma-treatment). But that is for another day.
Buprenorphine has rarely been linked to overdoses outside of concurrent alcohol or other sedative abuse and lacks the QTc prolongation and drug-drug interactions of methadone.31
Because it is an opioid, there’s a stigma attached to it. While subsisting one opioid for another isn’t moving the dial much, there is a big difference in that micro-distance of turning the dial from on illegal drugs to off.
The valid arguments and concerns against suboxone surround its chemical makeup akin to opioids, the ability to overdose from it, and the dangers of using it as a long term solution.
The misplaced stigma of MAT should be confined to 2018, like many of the bad things we don’t need to continue to bring in through the new year. Public opinions can change in an instant, all it takes is a few good tweets, emotive tales, and a functional product that can scale. That’s what we have in suboxone.
Premature termination of MAT is a major contributing factor to relapse. Doctors don’t know how long after detox patients must be on medication, so they prescribe shots in the dark, while the researchers have shouted from proverbial peer-reviewed rooftops saying there’s a better way, and it’s legal, proven, publicly supported, low-risk, and affordable.
My opinion: Truly successful businesses put the interests of the customers first and think 2 years into the future, and successful addiction recovery comes from putting yourself first living one day at a time.
While I am not the founder of a multi-billion corporation, quite the opposite. Addicaid has yet to bring in any money beyond grants and awards from Harvard, NYCEDC, BCBS, and a few others. Addicaid was the first mobile addiction recovery platform to enter the market, and then other products entered the arena. As entrepreneurs, we are often conditioned to think of business as a competition with clear winners and losers and a hierarchy that dictates our successes.
The business of addiction recovery is one of the few exceptions. The demand is endless, there will always be more, and the supply of effective solutions is limited and subjective, and the fewer there are that capture the market, the smaller the market gets (because your target audience dies).
Early on in developing the platform, when I saw other players enter the space and got paranoid that others were ‘stealing my IP’ but after seeing the lack of success with B2B digital therapeutics, hockey-stick trajectory of overdoses and new abusers, it became clear that this is not the time to be suing other Pharma companies.
As the founder of Addicaid, one of my jobs is to be knowledgeable of the trends, anecdotal evidence, and randomized trials of cutting-edge treatment, and the past year has.
As a business person, I sympathize with the need to appease investors, but my main priority was always doing the right thing for the end users and beneficiaries than those looking to turn a profit.
Indivior Suboxone accounts for 80% of their revenue, and they lose over 70% of a truly viable market- of people who are resuscitated from overdoses by the standalone opioid-antagonist naloxone.
My second time in rehab was 2008, and it was the first time I heard of the wonder drug ’Suboxone’. I vividly remember the verbal exchange because it came from the Staten Island accented mouth of a girl named Bella who finally decided, because she acquired endometriosis (or whatever). Her first stint with MAT didn’t go as planned, we all witnessed her seizing on the dining hall floor right after intake. The growing pains of healthcare professionals learning the nuances of withdrawals, tapering, and detox timing (or however I need to rephrase it).
We were at mountainside, one of the few places a decade ago that supported this new drug that was only FDA-approved 6 years prior.
A decade has passed, and she’s passed away, from complications of endometriosis or whatever I guess.I could say. Overdose deaths have done from being a burgeoning danger in urban outskirts to the country’s worst epidemic ever, unchallenged in its title as the #1 killer of Americans under 55.
Before I came to terms with my addiction (rather, my parents did, and forced me into treatment), my best friend from high school Cooper Union program had descended into a life of the railroad ride hitching gutter punk excuse for life. The last night I saw her, she told me that snorting heroin wasn’t a big deal. My mind was too preoccupied with alcohol dependence to recognize the insanity of that sentiment, and she boarded a bus back to Baltimore, where she would graduate from MICA with a degree in fine arts and a loss of the ruthless creative spirit that was what bonded us from the beginning.
It would be another year until I learned through the facebook grapevine of her demise, in an east Texan holding cell on a Tuesday night after being caught shoplifting (what?), compounded by aggression and an outstanding warrant.
It is easy to conjure up a scene— her begging for a doctor, promising that she is sick, the graveyard shift officers dismissing her, perhaps kicking her in attempts to summon her from unconsciousness when it was time to see her public defendant.
This was over a decade after Suboxone became regulated. The saddest part is, if there was a sympathetic officer on duty that recognized the real dangers of her symptoms, she could have been saved.
But there would be a fallout. Illegal distribution of Suboxone is a class II felony (what is it in Texas) that has up to a 10 year sentence and $500,000 fine, just because they have the drugs that could at best, save someone's life, at worst, save them from buying heroin, and these days, it’s likely laced with much worse.
The waiver (which only healthcare professionals can acquire, a privilege that should be extended to law enforcement, crisis counselors, volunteers, and social workers to expand distribution, worst that can happen is that heroin (side note: weird that for an American made word processor, it can’t even identify the inverted i and o in spell check. It does it for every other word I’ve misspelled, which is a plenty) epidemic evolves into a suboxone epidemic, which would, if it were as bad at is it is now, mean 99% fewer fatalities and X% people regaining their dignity and ability to live a life of quality, much like that of a diabetic and their reliance on insulin.
A desperate plea to Pharma companies: Big Pharma can cleanup the epidemic they started and make more money than they fathomed and save lives
In the spirit of New Year's resolutions, I would like to call upon treatment providers to take a personal moral inventory and ask themselves, are we doing everything we possibly can to help that person get better, give them an option that we have yet to consider, put our medical biases aside and look at the latest facts, with unequivocal evidence of success for something that we perhaps have been against? You can’t fight fire with fire, but you can fight opioids with opioids.
This piece is a mea-culpa plea to you, the primary gatekeepers of the frontrunner treatment to opioid epidemic, which is gripping more and more communities around the globe.
As you’re drifting off to sleep tonight, presumably without the dread of the nausea, existential . Most of them are yet to turn 45, and experience the unique joy and despair of ‘mid-life crisis’ (which is now younger than it has ever been since this epidemic has taken so many young lives that it actually reduced US American average lifespan). Some perhaps died awful and alone after alienating everyone who has said ‘I will do whatever it takes to save your life.’
If you are an Invidor executive, have your most competent analysts run some forecasts of what would happen to your bottomline if you dropped your price to match Dr. Reddy's, then flushed the market, every emergency responder vehicle, ER facility, methadone clinic, captured the methadone base, promoted long-term usage, expanded your drug base to have a CBD-based tapering approach to get people down to a life of a .5 Sub dose that they could sustain with minimal side effects and warn against a life without it. Recovering opioid users realistically would use your drug for years, and as the first in market, you have a massive leg up on the competition. Do not dwell on them and waste time, energy, money on filing repeated injunctions. Medical breakthroughs move fast, and soon, there will be non-habit-forming opioids that treat the pain without the lethal consequences and that will be the real competition you will have to grapple with.
For now, your business is safe, as long as you play it smart and put the people you serve before the profits.
Key takeaways & proposed solutions:
If Kingsley Amis had a say in how to grapple with opioid epidemic today, I bet he would update his wisdom from everyday drinking (seltzer and a splash of bitters to get through the day) to a slice of suboxone and your preferred antipsychotic to keep you from digging your grave everyday. He wrote of hangovers in a way that would give a withdrawal a massive run for their money.
And while all those who seem so far gone get in the mode of the sweat and shake, we can fire up a solution that will distance them from a shameful early grave. We—they will welcome them before our willpower breaks. We’ve got soul, so much.