Medication used to treat opioid addiction has now been blamed as a factor in dozens of overdose deaths in Tennessee. According to data released by the state health department, toxicology reports found buprenorphine played a role in 67 of the 1,600 overdose deaths in 2016.
The drug in question comes in several varieties under brand names like Suboxone and Bunavail, but the generic form — buprenorphine — is similar to methadone. Instead of being administered in clinics like methadone, doctors who've been certified can prescribe buprenorphine for patients to take on their own.
It's still an opioid, though not nearly as powerful as many prescription painkillers or heroin. For someone who isn't addicted to opioids, state officials say it can create a euphoria. And the drug does have street value, though sometimes just to be a "bridge" to stave off withdrawal symptoms. Primarily, it's prescribed to reduce the intense drug cravings that lead to relapse.
"For many — if not most — people, that is a significant step toward recovery," says David Reagan, Tennessee's chief medical officer.
But the drug is a respiratory depressant. When combined with other prescription drugs like sedatives or even alcohol, it can be dangerous or in some cases deadly.
"Substance abuse disorder is generally not limited to one substance. So it's not uncommon for folks to have been using multiple drugs," he says.
Reagan says he's not surprised to find buprenorphine contributing to deaths. The more perplexing finding to him is that 10 overdose deaths over the last four years involved no other drugs in the person's system except buprenorphine. Some brand names like Suboxone are meant to be overdose-proof by including the reversal drug nalaxone.
"The association with deaths is concerning. I'm glad it's being brought to light," says Richard Soper, a Nashville physician.
Soper is a big proponent of buprenorphine, but he says the health department's findings should "tamp down" unbridled enthusiasm that it's a magical cure for addiction.
"Medication-assisted treatment is not cookie-cutter — take an aspirin because you've got a fever and your fever goes away," he says. "There's complexity too, and there needs to be a more holistic and comprehensive package trying to help someone."
Soper says opioid addiction treatment has to also include counseling and behavioral therapy. Otherwise, as some critics charge, patients are just trading one opioid for another.
There's concern — even among state officials — that the latest findings could add to the stigma that surrounds medication-assisted treatment.
"I don't think there needs to be an overreaction," Soper says.