Editor’s note: This commentary is by Rick Barnett, Psy. D., the president of the Vermont Psychological Association. Dr. Barnett has worked in the field of addiction treatment and training for nearly 20 years, including as director of a training program for resident and faculty physicians at the Hazelden Foundation. During his work there, he collaborated with one of the lead researchers in the development and clinical trials of Suboxone (buprenorphine) prior to FDA approval.
Sept. 27 marked the Burlington premier of “Hungry Heart,” a compelling new documentary chronicling the heart-wrenching rampage of prescription drug abuse in one northern Vermont community. The debut marked the first in 31 showings of this film across the state this fall. The public owes a debt of gratitude to all the people involved in the film (producers, editors, sponsors, etc.), and especially those willing to share harrowing personal stories of addiction and recovery. Unfortunately, the film is also dangerously misleading.
The film dips into the world of Fred Holmes, MD, a seasoned pediatrician and his young patients (affectionately called “youngsters”). Their mutual struggle through the perilous and sometimes fatal culture of addiction conveys hope and despair, tragedy and triumph, doubt and faith, sadness and joy. Nearly two-thirds of the film shows Dr. Holmes learning about the lives of his patients with opioid addiction and how to treat them using Suboxone. And yet the film fails to underline how dangerously addictive Suboxone itself is.
There is no doubt that Dr. Holmes is a saint — a saint who is nonetheless ill-equipped to fight against the devastating power of addiction. Physicians get almost no education and training in medical school and residency on alcohol and substance abuse. In the case of Suboxone, a physician only needs to complete eight hours of in-person or online training to prescribe it in outpatient office-based practice settings.
What is not made clear in the film is that Suboxone is more powerful and several times more difficult to withdraw from than any other available legal or illegal narcotic. What is not made clear in the film is that prescription drug addiction typically results in heroin addiction because heroin is cheaper.
Since Suboxone, and its cousin Subutex was released in 2002, prescription drug abuse and specifically opioid abuse has soared. Vermont is leading the nation in the prescription drug abuse epidemic. It also has high rates of alcohol-related issues, high rates of suicide, and a fragile and fragmented mental health system. Dr. Holmes acknowledges his exceptionally limited education and experience in the treatment of addiction. He admits that his prescription pad to dole medication for countless numbers of patients may be bad medicine. He states clearly that prescribing such a medication to young people can be dangerous and potentially irresponsible. Indeed, during the film, the audience learns of a young woman’s fatal overdose from — you guessed it — Suboxone.
What is not made clear in the film is that Suboxone is more powerful and several times more difficult to withdraw from than any other available legal or illegal narcotic. What is not made clear in the film is that prescription drug addiction typically results in heroin addiction because heroin is cheaper. And what is not made clear in the film is that many people using Suboxone to help reduce or eliminate other opioid abuse consistently produce urine samples that show the use of other prescription drugs of abuse such as sedatives and stimulants along with alcohol, marijuana, cocaine, etc.
Indeed, it is often the case that Suboxone is not even present in the urine samples of patients who are supposed to be taking it daily, which is virtual proof of its street value, addictive properties, and its fatal flaw.
There are no programs available to those physicians prescribing Suboxone that are focused on helping someone get off Suboxone and adjust to living drug and alcohol free. In the film, the audience is told by a leader of the largest community mental health system in the state that there can be a two-year waiting list to get into addiction treatment that involves group and individual counseling. That person, however, goes on to say that people should not be afraid to take Suboxone because, after all, everyone takes pills for aches and pains, for high blood pressure so “what’s the big deal” to take a medication for addiction.
Suboxone sales have skyrocketed from $137 million in 2006 to $1.4 billion in 2012. The film “Hungry Heart” promotes Suboxone treatment and its major sponsor is Burlington Labs. The pharmaceutical company and urine testing industry make record profits while the funding for mental health and substance abuse agencies and providers gets slashed year after year.
The truth that this otherwise worthy film failed to express goes something like this: Suboxone is one of many treatment options for opioid addiction. It should be used sparingly and as a last resort for those under the age of 25 or those who have been dependent on opioids for more than eight to 10 years. Suboxone should never be prescribed without being certain that a patient has established a reliable connection with a qualified psychologist or other mental health provider with specialized training in addiction. There must be structured programs to help patients taper completely off Suboxone within one to three years (if not sooner). Being on Suboxone indefinitely should always remain an option only if a person shows no evidence of other drug use or diversion.
The heart and soul of “Hungry Heart” are those individuals and families whose stories are told with the tragedy and loss, hope and redemption. Addiction is the villain. Recovery is the hero. Dr. Holmes is also definitely a hero, albeit a reluctant and tragic one. Suboxone, sadly, is a terrible wolf in sheep’s clothing.
