(April 2005) The Bitter Pill


“We’re doing all the work for the drug company,” Sederer says laughing. “Here you have a couple of psychiatrists launching a marketing campaign!”

Kolodny reminds his colleagues of the drug’s advantages. He stresses that bupe in the form of Suboxone is safe and almost impossible to abuse, a huge selling point at many of the clinics they will visit…

Sounds like Big Pharma selling opioids… And I believe they got in trouble for that.

Until the early 20th century, you could order just about any narcotic you wanted from the Sears, Roebuck & Co. catalog: morphine, heroin, opium. But in 1914, Congress passed the Harrison Narcotic Act, barring doctors from prescribing opiates to known addicts…

Meanwhile, methadone regulations effectively ostracized addiction treatment from the medical mainstream. Most med schools leave it off the curriculum for all but psychiatry students, who get a mere four weeks of exposure. When young doctors train at big-city hospitals, most of their encounters with addicts are hard cases showing up in the ER in the middle of the night. “The top attendings make fun of them,” Salsitz says…

The doctors ask about side effects. Good news there. They ask whether it shows up on a drug screen (methadone does, so many people who might face a urine test at work avoid it). Nope, Kolodny says, a bupe patient’s urine tests negative – more good news. They ask about the potential for black-market dealing; inmates learn to hold their methadone in their throat, spit it back up, and sell the spit. That’s pretty much impossible, Kolodny says, to nods of approval. Will inmates be able to keep receiving bupe after they leave prison? Some, but not all, Kolodny says. That’s because of the nearly 300 doctors in New York licensed to prescribe bupe, only a handful will accept Medicaid, even though it covers the treatment.

I can see why bupe gained popularity in some circles…

On the drive back to his office downtown, Kolodny’s Treo rings twice, just minutes apart. Two more people looking for bupe treatment at his private practice…

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