Buprenorphine, sold in different formulations under the brand names Suboxone, Buprenex and Subutex, is the new methadone. It's given to people hooked on prescription opioids or street drugs like heroin to ease their transition to abstinence.
There's a lot of scientific evidence that it helps, but the drug itself can also produce a euphoric high for non-addicts and has become a sought-after commodity on the black market — making it one of the most controversial pharmaceutical products today.
In looking at the history of health-related debates, it's clear that the involvement of celebrities from Hollywood, sports or politics can be very powerful and swing public opinion — especially when they bring attention to a condition that tends to be stigmatizing. Rock Hudson created a new empathy for AIDS patients when he announced he was infected. Michael Botticelli, the White House drug czar, challenged the stereotypes of addicts when he revealed he was a recovering alcoholic. Angelina Jolie showed that a woman can still be beautiful and sexy after getting both breasts removed for cancer. And Bruce Jenner, when he became Caitlyn Jenner, showed us that even Olympic athletes can be transgender.
Sally Satel, a psychiatrist and lecturer at the Yale University School of Medicine who will be moderating a panel with Gingrich, Jones and Kennedy at the American Enterprise Institute on Monday afternoon, acknowledged that the trio makes for “strange bedfellows.”
After all, Republican Gingrich was slapped with numerous ethics charges by Democrats during his time leading the House and even his fellow Republicans sought to replace him. And Jones, who served as special adviser to President Obama on green jobs, resigned from his position after what he called a “vicious smear campaign” after he used some strong language to refer to congressional Republicans.
But that's exactly what Satel believes gives them some political credibility. “They are all very visible,” she said.
Satel said that she doesn't know how the three came together but that Gingrich has talked about his mother Kit's mental health issues in the past and has become involved in health reform as a consultant since he left Congress. Jones's interest, she said, may come from his history of involvement in criminal justice.
Keith Humphreys, a professor at Stanford School of Medicine whose research focuses on federal drug policy, said he agrees with many of the position statements the group has outlined on its website but is somewhat puzzled by the strategy of making Gingrich and Jones the public faces of the organization. He's also wondering why the group hasn't revealed who is funding their work. Representatives for Gingrich did not respond to requests for comment for this story.
“The cause is a worthy thing. I myself advocate for more access to treatments for people who are addicted and that includes pharmaceuticals. But you always wonder when a group like this comes up who is paying the bill?” he said.
The story of buprenorphine is complex. In 2000, Congress — fearful of creating more “pill mills” like the ones that contributed to the current epidemic — allowed doctors to use the drug in outpatient settings but set restrictions on the number of patients a single doctor can manage on the medication and required clinicians to take an eight-hour mandatory course to get permission to prescribe the drug. While the patient limit has grown from 10 to 100 and, most recently, to 275, many patients seeking treatment still complain that they can't access the drug, and there has been an effort to loosen restrictions even further.
There are prominent and thoughtful medical professionals and public health officials on both sides.
According to the National Institute on Drug Abuse, the medication helps to reduce opioid cravings and withdrawal by restoring balance to the brain circuits affected by addiction. "This makes it possible for the person to function normally, attend school or work, and participate in other forms of treatment or recovery support services to help them become free of their addiction over time," NIDA says. However, those who are opiate-naïve might get high because they haven't developed a tolerance for the drug.
In September, the controversy over buprenorphine took on another dimension when 35 states and the District sued drugmaker Indivior for violating antitrust laws. The state attorneys general say Indivior, a British company which was previously known as Reckitt Benckiser, and MonoSol Rx conspired to block generic competitors for Suboxone by moving from a tablet to a dissolving film that is taken by putting it under the tongue. The lawsuit alleges that the companies then fabricated claims that the new version was safer than the old.
New York Attorney General Eric T. Schneiderman said in a statement that the scheme “unlawfully extends their monopolies — and their monopoly profits — on drugs.” Both companies have denied the allegations.
Another point of contention regarding buprenorphine is whether inmates should be treated with the drug. While some doctors have argued that this would be the humane thing to do for addict in the criminal justice system, others have been against the idea because Suboxone has become currency in prisons, with people smuggling it in via a paste of crushed Suboxone pills on the back of stamps or sewn into waistbands of clothes.
This post has been updated.