Potential for abuse

DOCTORS PRESCRIBE DRUGS used for medication-assisted treatment (MAT) as a remedy to addiction, but that doesn’t prevent people from abusing them.

Former drug enforcement officer Keith Graves said he’s watched addicts on the streets of San Francisco use a spoon to melt down Suboxone, “stick a syringe into that orange, goopy mess, and then inject it into their body.” In fact, that kind of abuse is something Graves encountered frequently, beginning in the late 2000s when an informant told him she snorted her Suboxone pills to get high.

Technically, that’s not supposed to be possible with medications like Suboxone. The substance is chemically engineered with naloxone, a drug that blocks the euphoria-like effects of opioids on the brain’s opioid receptors. It’s designed to kick in if users inject or inhale their pills. But Graves said addicts still find ways to get around those safeguards and abuse their medications.

Data from the Substance Abuse and Mental Health Services Administration substantiates Graves’ claim. The agency estimated about 8,500 people who were enrolled in publicly funded treatment centers in 2019 sought help for buprenorphine abuse. About 43 percent of these people listed buprenorphine as their primary drug of choice.

It’s an associated risk of MAT that practitioners and pharmaceutical companies sometimes sweep under the rug. In 2019, the Department of Justice reached a major $1.4 billion settlement with the former parent company of Suboxone manufacturer Indivior after a federal grand jury indicted the company for marketing its film version of Suboxone as “less-divertible and less-abusable” than pills “even though such claims have never been established.” The company denied any wrongdoing.

In July 2024, Indivior agreed to pay another $86 million to 16 states over allegations the company targeted buprenorphine product sales to “doctors running pill mills.” New York Attorney General Letitia James said the money will be used to “invest in opioid addiction treatment”—which under New York’s current budget priorities likely includes funding more MAT.

Still, Suboxone and other variants of buprenorphine are nowhere near as potent or deadly as illicit heroin and fentanyl. “It’s not like we’re having shoot-outs in the street over Suboxone sales, like you do with other drugs,” Graves said. But demand has created a black market for the drug that not many people want to talk about.

Despite the risks, Graves said he truly believes MAT is the best hope for people struggling with addiction. But he said medical professionals need to be more honest about the potential for abuse since law enforcement sees this happening frequently on the streets.

Dr. Timothy Allen, an addiction physician in Milwaukee, is wary of the potential for diversion and abuse when he prescribes MAT drugs to patients. He requires his patients to bring back the empty Suboxone packaging to ensure they’re not reselling it. If a patient immediately sells a week’s worth of Suboxone pills to obtain their drug of choice, Allen considers referring them for methadone treatment, which requires daily clinic visits, since he “can’t trust them to take seven days home with them.”

But he still believes that MAT is essential for effective addiction treatment. “Live patients are the best type,” Allen said. “And MATs clearly reduce mortality.”