Planet Money
11:45 pm
Wed July 25, 2012

Meet The Drug Dealer Who Helps Addicts Quit

Originally published on Fri July 27, 2012 2:56 am

A prescription drug called Suboxone helps wean people off of heroin and pain pills, but addicts have a hard time getting prescriptions. So they're turning to the black market.

An Albuquerque man who goes by the name Mystery Man has stepped in to fill the void. He says he illegally sells Suboxone every day.

To get Suboxone, Mystery Man has to find a patient with a Suboxone prescription, and give that person the $50 co-pay to fill it. He gets that money by selling, among other things, crack and guns.

He sells each pill for $5. He uses the profit to pay himself and his bodyguards, and to invest in his next deal. He says he notices a difference in his customers. "People don't overdose no more. They're just mellow," he says. "If you take it you won't be stealing, you won't be robbing, and you won't be prostituting."

Special Agent Keith Brown oversees the Drug Enforcement Administration's operations in New Mexico. He disagrees with Mystery Man. "Mystery Man [is] not a doctor. He doesn't know anything about how the medicine should be used, the dosing of it, any side effects. I think is dangerous for all involved."

Unlike pain pills and heroin, Suboxone (generic name: buprenorphine) is very hard to overdose on. Addicts can take it to avoid withdrawal symptoms and manage their cravings for these drugs.

"People who are treated with Suboxone are able to go back to school, they're able to go back to work, they're able to start paying taxes and taking care of their children," says Dr. Miriam Komaromy, who directs a state-funded addiction treatment hospital in New Mexico. "It's making them able to return to being a functioning member of society."

New Mexico has the highest fatal drug overdose rate the U.S. For years, it's battled against one of the worst heroin epidemics in the country. And while heroin use has pretty much held steady, a recent report from the New Mexico Department of Health shows the sales of opioid pain relievers that are popular recreational drugs increased by 131% between 2001 and 2010.

Some physicians do prescribe Suboxone to treat addicts. But many do not.

"A lot of physicians are very resistant to prescribing Suboxone because they fear it will attract opiate addicts to their practices which brings with it a whole can of worms in terms of managing those clients," says Seth Williams, a nurse practitioner who treats the homeless in Albuquerque.

Scientists have long searched for a prescription to treat addiction. But companies were hesitant to develop one. Charles O'Keeffe is the former president and CEO of Reckitt Benckiser, the company that developed Suboxone. "There's not much money to be made in it," says O'Keeffe. "This is not a disease space that a lot of people want to treat."

The U.S. government stepped in and partnered with Reckitt to bring the drug to market in 2000. Buprenorphine — the main ingredient in Subxone — became the only drug doctors could prescribe to treat heroin and pain pill addiction in their offices. Because it is an opiate, the regulations are strict. Doctors have to complete a special training, and there's a limit to the number of patients they can see — about a quarter of them may treat no more than 100 per year; the rest are limited to 30. But the need for opiate treatment has drastically increased, beyond what Reckitt could have anticipated.

The prescription drug overdose death rate in the U.S. is three times what it was in 1999, and yet the number of new doctors certified to treat these addictions with Suboxone has plateaued. Dr. Komaromy — in New Mexico — says she thinks her state could multiply the number of providers by five and still not be meeting the need.

The Center for Substance Abuse Research at the University of Maryland, College Park recently warned of an emerging buprenorphine misuse. But a survey of physicians who are certified to prescribe Suboxone underscores Mystery Man's role. The majority believe patients who seek Suboxone on the street are doing so to self-medicate.

Doctors who treat addiction are worried that Suboxone will gain a reputation as a street drug. But for now, the street is the only marketplace keeping up with demand.

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Transcript

RENEE MONTAGNE, HOST:

Deaths from drug overdoses across the country are at an all-time high. And there's a legal drug that's proven to treat certain drug addictions, but getting a prescription can be difficult. So, as Mara Zepeda reports for our Planet Money team, addicts seem to be turning to the black market.

MARA ZEPEDA, BYLINE: The drug is called buprenorphine. The brand name is Suboxone. Dr. Miriam Komaromy is the medical director for the only state-funded addiction treatment hospital in New Mexico. Komaromy explains the drug's major benefit.

DR. MIRIAM KOMAROMY: Suboxone is very hard to overdose on and kill yourself with, as opposed to heroin and pain pills.

ZEPEDA: Studies show Suboxone is an effective treatment for addiction to heroin and pain pills, like oxycodone and morphine. And addicts take Suboxone to manage their cravings for these drugs. Suboxone has also been shown to decrease HIV transmission and drug-related crime.

KOMAROMY: People who are treated with Suboxone are able to go back to school. They're able to go back to work. It's making them able to return to being a functioning member of society.

ZEPEDA: New Mexico leads the nation in fatal drug overdoses. From 2000 to 2009, heroin and pain pills killed 2,000 people in the state, so you'd think physicians here would be eager to prescribe Suboxone. But it's not so easy, says Seth Williams, a nurse practitioner in Albuquerque who treats the homeless.

SETH WILLIAMS: And a lot of physicians are very resistant to prescribing Suboxone because they fear it will attract opiate addicts to their practices, which brings with it a whole can of worms in terms of managing those clients.

ZEPEDA: Plus, most primary care doctors think: Treating drug addicts? That's not my job. And for a long time, that's pretty much been true. Until Suboxone, opiate addicts have had limited treatment options - mostly rehab centers or daily visits to methadone clinics. Scientists have long searched for a prescription to treat addiction, but the question was who would develop it.

CHARLES O'KEEFFE: Most pharmaceutical companies have studiously avoided developing drugs for addiction simply because there's not much money to be made. This is not a disease space that a lot of people want to treat.

ZEPEDA: That's Charles O'Keeffe. He's the former CEO of Reckitt Benckiser, the company that developed Suboxone with funding from the federal government. In 2000, Congress passed legislation that brought the drug to market. Buprenorphine, the main ingredient in Suboxone, became the only drug doctors could prescribe to treat heroine and pain pill addiction in their offices. The regulations are strict. Doctors have to complete a special training. There's a limit to the number of patients they can see - no more than 100 per year. This might have been enough, except, says O'Keeffe...

O'KEEFFE: We've seen the number of patients who are addicted to prescription medications increase enormously. And that was a phenomenon that we had not seen when we were developing the drug.

ZEPEDA: The prescription drug overdose rate in the U.S. is triple what it was in 1999. And yet the number of new doctors certified to treat these addictions with Suboxone has plateaued. And the treatment is expensive, especially if you're not insured. Again, Dr. Komaromy in New Mexico.

KOMAROMY: Everybody I know who prescribes Suboxone is full to their maximum number of patients they can handle. I would guess that we could multiple the number of docs who prescribe Suboxone in our state by five and still not be meeting the need.

ZEPEDA: High demand, limited availability: the perfect conditions for a black market. I went searched in Albuquerque to find someone who's filling the void.

Why don't you start by introducing yourself, however you want to be referred to?

MYSTERY MAN: OK. My name is Mystery Man.

ZEPEDA: Tell me what street we're walking on right now.

MAN: We're on Second Street. All kinds come through this neighborhood.

ZEPEDA: And when did you notice that Suboxone was being sold on the black market?

MAN: When everybody started wanting it.

ZEPEDA: And so how often would you say you sell Suboxone?

MAN: Every day.

ZEPEDA: Mystery Man does not need a special certification to sell Suboxone. He says he finds someone with a coveted Suboxone prescription and gives them $50 to fill it.

How will get the money to give to the person?

MAN: We sell crack. We sell guns. We sell whatever. We give them the money, and then they take it and go get a prescription filled.

ZEPEDA: People line up, and Mystery Man sells each tablet for $5. He says he notices a difference in his customers and life on the street.

MAN: People, they don't need drugs no more. People don't overdose no more. They're just mellow. Like, once you take it, you don't have to scratch no more. You don't have to nod no more. If you take it, you won't be stealing, you won't be robbing and you won't be prostituting. There it is.

ZEPEDA: So you think it's a good thing?

MAN: Yeah, it's a good thing.

ZEPEDA: Special Agent Keith Brown disagrees. Brown oversees the Drug Enforcement Administration's operations in New Mexico.

KEITH BROWN: Taking any dangerous drug out of the controls that were established and interjecting into someone like the Mystery Man, who is not a doctor. He doesn't know anything about how the medicine should be used, the dosing of it or, you know, any side effects, I think is dangerous for all involved.

ZEPEDA: Brown says there's no way to know how many of Mystery Man's customers are self-medicating and how many are abusing the drug. When you combine Suboxone with other street drugs, it's not nearly as safe. The Center for Substance Abuse Research at the University of Maryland College Park recently warned of an emerging buprenorphine misuse epidemic. But for some in the medical community, it's hard to be dismissive of Mystery Man. Again, Seth Williams, the nurse in Albuquerque.

WILLIAMS: The cost of this is much lower than going out and finding their fix of heroin and engage in whatever other illegal activities to support their habit.

ZEPEDA: But what you're saying is that this is an instance where the black market seems to have almost a positive effect.

WILLIAMS: Yes. I'm not endorsing that practice, and if more prescribers were willing to prescribe the drug, then I think that wouldn't be an issue.

ZEPEDA: Dr. Komaromy, the addiction doctor, says she has patients who have managed to stay off heroin for years by buying Suboxone on the street. Her concern now is that Suboxone will gain a reputation as a street drug. But right now, the street is the only marketplace keeping up with the need. For NPR News, I'm Mara Zepeda. Transcript provided by NPR, Copyright NPR.

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