When nearly 100 people were charged with drug offenses last month in an operation led by the Northumberland-Montour Drug Task Force, it wasn't surprising that a substantial portion of the defendants are alleged to have bought or sold prescription medication.
What did stand out was the abuse of one drug in particular, Suboxone - a brand-name, prescription-only medication designed to actually help addicts kick their opioid addiction.
As Glenda Bonetti, director of Northumberland County Drug and Alcohol, said, "Suboxone will instantly stop an opiate withdrawal." She agrees that its value to an addict, who is not seeking treatment, is using it illegally as a stopgap between fixes.
The illegal possession or sale of Suboxone led to charges against eight defendants in the November operation. A ninth was charged for delivery of Subutex, a comparable prescription drug.
Similar charges have been reported against a handful of defendants this fall and in the past two years.
The number of defendants reported to have been
charged for possessing Suboxone isn't overwhelming, but that the medication is traded illegally locally is indicative of a larger problem: opioid addiction.
"The nature of opioid addiction is such that the opioid addict may sell the Suboxone to buy heroin or OxyContin or something," said Dr. David Withers, addiction medicine specialist at the Marworth Chemical Dependency Treatment Center in Waverly.
"The Suboxone does have a street value because someone going through heroin or opioid withdrawal may end up taking street Suboxone to stave off the effects of withdrawal," he said.
What it is
Suboxone was first approved by the Food and Drug Administration in 2002 as an addiction-treatment medication. It's a combination of buprenorphine and naloxone and is an opioid blocker that works to discourage its user's desire to abuse heroin and oxycodone-based and hydrocodone-based medications like Percocet, OxyContin, Vicodin and the like.
Unlike methadone, the more common addiction medication, Suboxone and its generic versions are prescribed by primary care physicians rather than at clinics. That means patients take the drug home in either tablet or film form - both are ingested under the tongue - versus enrollees at methadone clinics who show up daily for the medication.
Shared responsibility
In the Substance Abuse and Mental Health Services Administration's Treatment Episode Data Set from 2010 - data collected by treatment providers - 6,909 Pennsylvanians were admitted into programs treating abuse of opioids other than heroin, more than 11 percent of the 59,085 who sought addiction treatment statewide.
Of those seeking treatment for opioids other than heroin, more than half were between 21 and 30 years old.
Withers, the addiction medicine specialist from Marworth, said his clinic annually admits between 1,300 and 1,400 patients. Of them, he estimated about 40 percent are addicted to opioids, the majority of whom are seeking treatment for prescription drug abuse.
He calls Suboxone a "great drug." It's effectiveness, however, hinges not only on addicts' commitment to recovery, he said, but on a doctors' commitment to their patients.
"Now here's the problem: The problem is that many family practitioners and many internists don't understand addiction that well," he said, speaking in general terms and of no specific doctors.
"Suboxone was intended to be used in office-based practices. That said, I think that its use is more problematic than trying to prescribe penicillin for bronchitis or tonsillitis."
The proper procedure begins with inducing patients onto the drug in an effort to keep them from abusing opioids, he said, and continues with ongoing counseling and working through the 12-step program toward abstinence. It also includes random drug screenings, he said.
"Addiction is treatable and people do get better. Suboxone can be a valuable tool in helping people recover, providing it's done correctly," he said.
Local availability
The dispersal of Suboxone and generic buprenorphine is tempered by federal regulations that call for physicians to apply for a special waiver to prescribe it, with approved applicants limited to 30 patients in their first year and no more than 100 patients total.
This restriction would mean that a doctor isn't necessarily prescribing the drug to local patients; rather, it is more likely patients seeking addiction treatment may travel a substantial distance to meet with a doctor approved for a buprenorphine waiver.
There are 732 doctors approved to prescribe buprenorphine across the state, a number that's continually growing since the drug's approval. Nine are located within 30 miles of the Shamokin and Coal Township area, according to the SAMHSA voluntary registry. They include Dr. Jacinta Perez-Rodriguez-Wood, of NHS Human Services' Susquehanna Center in downtown Shamokin, and Dr. Alakananda Chakrabarty, of Coal Township.
Calls to Perez-Rodriguez-Wood and Chakrabarty for insight on the effectiveness of Suboxone and details about their treatment programs were not returned.
Dr. Sanjay Sen, of Coal Township, is among five doctors within the same 30-mile radius who are listed on Suboxone's own Here to Help Certified Physician Network.
On the rise
Bonetti, the county drug and alcohol director, agreed with what several employees of four local pharmacies had to say - that abuse of prescription pills is a growing problem.
The top drug of choice, the pharmacy employees all agreed, is oxycodone.
And while there were no figures specific to Northumberland County available through the state and federal departments contacted, state and national statistics provide some insight.
SAMHSA annually publishes a National Survey on Drug Use and Health (NSDUH), documenting trends in drug abuse and treatment. The latest year for which specific state information is available is 2009.
In that report, the study found 4.46 percent of people 12 years and older in Northumberland County and a dozen other central and north central counties with which it was grouped - including Columbia, Montour, Snyder and Union - abused pain relievers in the previous year - the third-highest rate in the state.
The number of first-time users is increasing nationally, according to federal studies, as is the number of people seeking treatment.
From docs and friends
Bonetti said Northumberland County's addiction treatment program - which is entirely voluntary - had 295 enrollees as of last month, the vast majority of whom are seeking treatment for alcohol abuse.
She said 46 enrolled in the county program have admitted that heroin is their drug of choice and another 22 claim it's prescription opioids.
These are simply people who sought help on their own. The county doesn't account for those who seek treatment through third-party health providers or through other avenues. And, of course, it can't account for unreported addicts.
"I think it's a large problem because people aren't recognizing it as a problem because they're getting it from their doctors or they're getting the meds from their parents' medicine cabinets," she said.
They're also getting it from friends.
In SAMHSA's 2010 NSDUH, the nationwide study found that half of those abusing prescription pain relievers got them free from a friend or relative, three-quarters of whom, in turn, got them from a single doctor.
'Pill for everything'
That said, Bonetti believes society's presumed comfort with pill-form medication may play a role in the prevalence of prescription drug abuse.
"Society has a pill for everything. Rather than face the problem head on, we'll give you something to cure it that's a band-aid, and that's where I have an issue."
That issue extends to medication-based addiction treatment.
The methadone program has gone through a rise and fall, she said. While it's proven successful for some, others treat is as another avenue to feed addiction, noting that Suboxone, too, can be abused.
"I've also witnessed the methadone programs where you stand in line and the people are all giddy and all great and then they get to the nurse and say, 'I don't feel good,' so they increase their dose."