Blocking the drug of choice

Last month I wrote about the increasing misuse of buprenorphine in Indonesia, by drug users who grind up the tablets, mix the powder with water and inject the resulting murky mix. Thus they not only continue to spread viruses through sharing needles, but also frequently suffer health problems as a result of putting lumps of buprenorphine into their bloodstream.

Because drug users have a habit of doing things like this, in many parts of the world plain buprenorphine is no longer sold. It is only approved in a fixed-dose combination with naloxone. Naloxone is usually used alone to bring people rapidly out of a opiate-induced overdose, by taking over the receptors in the brain which are occupied by the opiate. After an injection of naloxone, people with an overdose experience a very rapid and very painful withdrawal.

But naloxone only works if injected; it has no effect if swallowed. So if you inject buprenorphine mixed with naloxone, it has no sedating effect whatsoever, since as an opiate, it is blocked by the naloxone. But if the combined tablet is taken as it should be, under the tongue, the naloxone has no effect, and the buprenorphine does its job.

Now comes news that Schering-Plough, the supplier of buprenorphine in Indonesia under the brand name Subutex (the name all the drug users use), says it has decided to withdraw this from the market. It will be replaced by Suboxone, their name for the buprenophine/naloxone combination. Usually this combination is more expensive, but they say they will not increase the price.

Will this work? Drug users are notoriously tricky, and can often find their ways round barriers. Problem is (so they tell me), they don't inject for greater effect, or to get a better high, but because it's become a habit, I guess an addiction to needles. Schering-Plough say it's pretty difficult to separate the buprenorphine from the naloxone, but no doubt someone will try. And probably other manufacturers will jump in to replace the Subutex. But I fear those currently injecting buprenorphine will find something else. Still I guess we must welcome any reduction in injecting.

Babé