The Food and Drug Administration approved a monthly injection for treating opioid addiction last week, and drug-court professionals are saying it'll be a boon for them. The new treatment is actually a novel form of an old drug, called buprenorphine. But it appears to resolve a long-standing problem for the courts, which aim to funnel people convicted of non-violent drug crimes into addiction treatment: It seems more difficult to sell on the black market than other, popular forms of buprenorphine. (If used improperly, buprenorphine can give the user a euphoric high.)
Because of the diversion issue, it's been difficult to convince some judges to allow burenorphine treatment among their participants, Connie Payne, the former head of Kentucky's drug courts, said during a conference this spring. But denying defendants medicines that help prevent relapse can be deadly, as Maia Szalavitz reported in Pacific Standard's May/June 2015 issue. For her story, Szalavitz spoke to the parents of one man who overdosed and died at 28 after weaning himself off of methadone, a drug that works similarly to buprenorphine, at the direction of a drug-court judge who philosophically opposed medication-assisted addiction treatment.
The new FDA-approved injection gets around the issue of buprenorphine's black-market value in a few ways: A health-care professional must administer the injection, which is brand-named Sublocade. There are no pills or little strips to be sent home with the user. Once injected, Sublocade turns into a solid mass under the skin that slowly dissolves over the course of a month. A black-box warning on the medicine says that, if people try to inject it into a vein, the way they might abuse heroin or prescription painkillers, it could create a fatal blockage. "From a court standpoint, you're not having to worry about: Are they taking it every day? Are they abusing it? Are they selling it?" explains Mary Covington, program director for Houston's drug courts. "It kind of takes away some of those barriers that we put out in our minds."
The injection should also make life easier for drug-court participants, Covington argues, because it eliminates the need for early morning stops at a methadone clinic and regular blood-samplings taken by doctors to ensure a patient is indeed using his script. "It's a win-win for everybody," she says.
Could Sublocade diminish the number of courts that forbid their participants from using buprenorphine? "I would like to think it would," Covington says. In a survey published in 2012, one in six drug courts didn't allow defendants to take the drug because of worries people would sell their strips. Yet among addiction doctors, giving opioid-addicted patients buprenorphine or similar medicines, alongside counseling, is considered the standard of care. Folks who are funneled to abstinence-based treatment programs instead often fail, overdose, and die, as HuffPost found.
Medication-assisted opioid addiction treatment—which includes counseling plus buprenorphine, methadone, or a drug called naltrexone—is already more available through drug courts now than it was in 2012, says Christopher Deutsch, spokesman for the National Association of Drug Court Professionals. "The treatment court community has really embraced the use of M.A.T. [medication-assisted treatment]." But it's not known how much more available it really is because nobody has done a survey since.
Outside of the criminal justice world, doctors are a little skeptical that many patients will want a buprenorphine injection if they're not prodded by a judge. Folks tend to like buprenorphine strips, which dissolve under the tongue, doctors Pacific Standard consulted say. Still, they're happy to have an option for patients who seem to stumble in taking their buprenorphine every day, or whom they suspect are selling their strips.
"We'll definitely use it," says Joshua Lee, a doctor who studies addiction therapies at NYU Langone Health. "Those of us in the field are delighted that Indivior have gotten approval for this," says Thomas Kosten, a psychiatrist who studies addiction at the Baylor College of Medicine, referring to the company that makes Sublocade. And there's more to come: Another company, Braeburn, is currently seeking FDA approval for its long-term injectable buprenorphine, which may arrive in the coming months.