Editorial Statement on the Criticism of Suboxone

To our listeners,

Crackdown’s recent episode (#27), titled “Cop Baked In”, was critical of the medication Suboxone (sublingual buprenorphine/naloxone) for its design, which (as a partial agonist) blocks feelings of euphoria from other opioids, and questioned the highly hyped rollout of new Suboxone prescribing guidelines in BC around 2016, when the province’s “overdose crisis” was declared a state of emergency.

That declaration was more than five years ago.

And yet, we continue to see rising numbers of overdose-related deaths, and a poisonous drug supply that doesn’t seem to respond well to our traditional models of Opioid Agonist Therapy (OAT) prescribing.

Crackdown has wanted to open the conversation about Suboxone for quite some time. Because, as it stands today, Suboxone is still considered (by many prescribers and healthcare/government-funded research orgs) to be the first line of treatment for persons diagnosed with opioid use disorder (OUD). This concerns us as we have received preliminary research data suggesting that Suboxone patients are more likely to discontinue treatment than those prescribed methadone. This is not surprising to us at Crackdown because for years we have heard people who use drugs saying that Suboxone does not work for them. 

As investigative journalists on the front lines of the war on drugs, we decided to use a personal narrative as well as qualitative research on youth’s experiences and perspectives on OAT to start a dialogue about something that we felt had not yet been discussed as a barrier to care. 

Since the publication of “Cop Baked In”, we have received positive feedback from drug users. We have also received negative comments from doctors and other prescribers across the country. This was expected, and we have certainly started a dialogue. 

For example, it has been suggested by one listener that we implied (or stated) that Suboxone is “ineffective”. There has been speculation that by starting a dialogue about Suboxone’s limitations, we may “harm people by scaring them away from a lifesaving treatment.” 

That same listener said, “Garth makes it seem like Suboxone does not work for anybody, not worth trying, or implementing as a policy response.

Another listener said our reporting “ludicrously claims that the buprenorphine molecule itself is coercive.”

A Twitter user even commented, “I guess I’m a basic bitch because I prescribe Suboxone to my patients.”

We received more comments in a similar vein.

The Editorial Board of Crackdown felt compelled to release a statement in response.

  • We did not describe Suboxone (or any treatment) as “ineffective.” I encourage critics to listen to the episode again, and really listen to the words we use. Because our language and the way we use it is intentionally designed to avoid sweeping generalizations. We ask questions; we don’t claim to have all the answers. Also, I (Reija Jean) attained periods of stability while on Suboxone. What we attempted to show was the difficulty that some can experience when trying to stabilize or re-stabilize after a period of using street supply. 
  • We do not believe that by raising concerns about a treatment like Suboxone that patients will be “scared to take it.” Many folks in our communities are already wary of Suboxone, because they’ve had bad experiences like precipitated withdrawal (have our critics ever been in precipitated withdrawal?). Every body is different, and will experience drugs differently. Furthermore, drug users are already talking about their experiences with each other. If prescribers want to close their ears to our concerns about Suboxone, we wonder why? Perhaps we are raising concerns because what we want and need is a range of OAT treatment options that are informed by drug users and what we want and need from our medication. Why does it seem like some care providers don’t want to hear it?
  • We did not claim that Suboxone or the buprenorphine molecule “is coercive.” But the lack of choice we are given and the disempowerment drug users experience in our relationships with doctors, nurses and prescribers is coercive. We told my (Reija Jean’s) personal story in which I felt Suboxone was my only option, that it was “better than methadone”, that it was “easier to come off of”, and a host of other claims that are not, it turns out, entirely accurate. I believed these things because that was the information given to me by healthcare providers and I felt coerced into accepting Suboxone or leaving with nothing.

Here are some suggestions for listeners who found themselves reacting defensively to our episode:

  • Try to listen to me—the human, Reija Jean—tell my story. Listen to my words. Listen to the words used by our host Garth Mullins and by our scientific advisor Dr. Danya Fast. If you find yourself feeling upset, angry, or defensive, perhaps pause the episode and ask yourself, “Why do I feel this way? What is being triggered here?” Because those kinds of feelings are rarely about the external; generally, they come from somewhere deep inside ourselves—perhaps a feeling that remains unresolved. Who knows? Only you.
  • See if it is possible to listen to the episode with a different frame of mind. Experiment with different lenses. Such as, the lens of a person who actually has experience taking drugs like Suboxone, and the fear generated by folks who have experienced unexplained withdrawal-type symptoms post-lapse or relapse, as well as precipitated withdrawal. Try to put yourself in the body (as much as is possible) of the person who has undergone a series of medication changes and alterations, and the person who has hoped for a miracle cure—or just to feel joy, pleasure, or an absence of pain—who has been disappointed again and again. Consider what it is like to depend on a medication like Suboxone for your survival. Consider what it is like to get a prescription for this medicine, after a period of using street supply, taking it at home, and still feeling sick. Imagine you are sweating it out at home, with no support because it’s the weekend and your clinic is closed. There is nowhere to go. No family or friends. And your dealer, who can make you feel better in an instant, is just down the street.

Crackdown will not stop talking about Suboxone, or any other aspect of OAT. Ultimately, we want drugs that are preferred by us, not (only) by prescribers. We, as patients and end-users, deserve to be asked what we need and what is missing. We deserve to be treated like the subject-matter experts we are. Because, believe it or not, we know what we need. We know what is missing. Many of us understand the flaws in many of the methods that have been conducted by pharmaceutical companies. We know what research questions need to be investigated (like the effect of setting and care quality on withdrawal symptoms, or about what actually happens to the patient who takes a bupe to-go pack home).

How can we work together to address the social determinants of health, including equitable access to healthcare, housing and proper individualized medication support, so that we can finally stem the tide of this unprecedented flood of death?

Rather than complain about our reporting (or at least, in addition to complaining), why don’t you commit yourselves to trying to understand Suboxone’s limitations, as well as the limitations of other OAT treatments—many of which are not keeping up with today’s toxic fentanyl and (now) venomous benzodiazepine-laden supply.

Sincerely,

Reija Jean and the Editorial Board of Crackdown

P.s. 

Basic bitch or not, it’s not all about you.