There’s good news and bad news for the treatment of opioid addiction. They’re the same thing: Probuphine, an implant that delivers a controlled dose of buprenorphine for six months to patients who are recovering from opioid addiction. It was approved for use by the Food and Drug Administration at the end of May 2016, following a promising clinical study.
Buprenorphine is a semi-synthetic opioid used to treat withdrawal from and lessen cravings for opioids, such as heroin and oxycodone, and is a key ingredient to Suboxone. It is a longtime favorite in medication-assisted treatment for heroin addiction help. The implant would assure that the patient doesn’t forget to take the pill or take it too often. That’s good.
The implant also would stop patients from selling the pills on the black market. Buprenorphine can get you high, especially if you aren’t already addicted to heroin or some other opioid (if you are, it’s probably not strong enough to get you high), and is among the most confiscated drugs by the Drug Enforcement Agency. Probuphine, because it is an implant, would be harder to remove and sell. Special training is required to implant and remove the rods safely. In the clinical study, no one removed their implant. That’s good also.
And in the clinical study, only 12 percent of participants relapsed following the removal of the implants, as opposed to 28 percent who didn’t get the implants. That’s very good.
But no one knows yet how much Probuphine will cost from your addiction physician or at a heroin detox center, or how much of the cost will be defrayed by insurance or other subsidies. The cost of Vivitrol, a similar long-term treatment (a once-monthly injection) can cost $1,000 or more for one shot. If Probuphine is competitively priced, as the company says, one implant could cost $6,000. Even training physicians or other providers to insert and remove the implants will be costly, and it’s unclear who will pay for that. That’s bad.
And some heroin abuse treatment providers don’t like the idea of medication-assisted treatment in the first place, saying it doesn’t address the underlying emotional or mental reasons the patient became an addict in the first place. (Of course, some organizations who question the wisdom of Probuphine may have an agenda of their own. The Church of Scientology-affiliated Narconon opposes all MAT and advocates total drug-free living.) That also is bad.
Then there’s the danger of consuming alcohol or taking another opioid while the Probuphine implant is in the body. Alcohol is another depressant, so that could be fatal. And taking enough of an opioid to get high despite the implant could be a fatal dose. That’s very bad.
Weighing these pros and cons, FDA still cautiously approved Probuphine because of its concern over the growing abuse of opioids. Its Opioids Action Plan calls for supporting better treatments, and it seems to feel this could be one.
In the end, the best inpatient drug rehab centers will offer the option of the implant, probably, though not all patients can or will want to get it. And after it’s been in use for awhile, the centers and regulators will evaluate the results. That probably is the best we can hope for.
Buprenorphine is a semi-synthetic opioid used to treat withdrawal from and lessen cravings for opioids, such as heroin and oxycodone, and is a key ingredient to Suboxone. It is a longtime favorite in medication-assisted treatment for heroin addiction help. The implant would assure that the patient doesn’t forget to take the pill or take it too often. That’s good.
The implant also would stop patients from selling the pills on the black market. Buprenorphine can get you high, especially if you aren’t already addicted to heroin or some other opioid (if you are, it’s probably not strong enough to get you high), and is among the most confiscated drugs by the Drug Enforcement Agency. Probuphine, because it is an implant, would be harder to remove and sell. Special training is required to implant and remove the rods safely. In the clinical study, no one removed their implant. That’s good also.
And in the clinical study, only 12 percent of participants relapsed following the removal of the implants, as opposed to 28 percent who didn’t get the implants. That’s very good.
But no one knows yet how much Probuphine will cost from your addiction physician or at a heroin detox center, or how much of the cost will be defrayed by insurance or other subsidies. The cost of Vivitrol, a similar long-term treatment (a once-monthly injection) can cost $1,000 or more for one shot. If Probuphine is competitively priced, as the company says, one implant could cost $6,000. Even training physicians or other providers to insert and remove the implants will be costly, and it’s unclear who will pay for that. That’s bad.
And some heroin abuse treatment providers don’t like the idea of medication-assisted treatment in the first place, saying it doesn’t address the underlying emotional or mental reasons the patient became an addict in the first place. (Of course, some organizations who question the wisdom of Probuphine may have an agenda of their own. The Church of Scientology-affiliated Narconon opposes all MAT and advocates total drug-free living.) That also is bad.
Then there’s the danger of consuming alcohol or taking another opioid while the Probuphine implant is in the body. Alcohol is another depressant, so that could be fatal. And taking enough of an opioid to get high despite the implant could be a fatal dose. That’s very bad.
Weighing these pros and cons, FDA still cautiously approved Probuphine because of its concern over the growing abuse of opioids. Its Opioids Action Plan calls for supporting better treatments, and it seems to feel this could be one.
In the end, the best inpatient drug rehab centers will offer the option of the implant, probably, though not all patients can or will want to get it. And after it’s been in use for awhile, the centers and regulators will evaluate the results. That probably is the best we can hope for.