Why isn’t medication that eliminates opioid cravings more widely used?

For William Cope Moyers, a vice president at Minnesota’s Hazelden Betty Ford Foundation treatment organization, Suboxone was “a magic bullet.”

After struggling for three years to get off prescription opioids, Moyers was given the medication in 2013 to ease his cravings for painkillers. It worked quickly and completely.

“I was like, “Oh, OK, I’m done, yeah,” he said.

Moyers credits the procedures he’d learned in a 12-step program as equally important in getting off opioids, but Suboxone “allowed me to clear my head, literally and figuratively.”

So it might be surprising that in the recovery community, the use of Suboxone can be controversial.

“Some people believe recovery should not include mood- or mind-altering chemicals,” said Dr. David Frenz, a Minneapolis-based addiction specialist who prescribed Moyers’ Suboxone.

“There is a lot of stigma around the use of anti-craving medication,” Moyers said. Even though he was a longtime Hazelden leader, public speaker and author of books on addiction and recovery, “there was some wariness about me once I revealed that I had taken the Suboxone,” he said.

“I had peers, I had colleagues, who didn’t quite trust me anymore. In fact, I had one who said that I should not be speaking for the organization until I had a year of sobriety again.”

He recalled talking to treatment specialists who said “they don’t use Suboxone with their patients because it’s a crutch,” Moyers said. “I’m like, ‘Wow. It’s FDA-approved.’ I did a webinar the other day and there was a lot of positive reception to my story, but there were some people — including one woman I know very, very well — who said, ‘I don’t care if it’s FDA-approved or not. There’s no room for mood- and mind-altering drugs in recovery.’”

Suboxone contains an opioid called buprenorphine. But it acts differently than opioid pain medications do, Frenz said. In addition to ending cravings, it eases withdrawal. And it doesn’t create a “high” — on the contrary, Frenz said, it eliminates the euphoria that many people feel after taking painkillers.

“So if somebody does slip, it prevents the opioid from doing anything,” he said.

Addiction recovery has become especially urgent in recent years because an influx of illegal fentanyl, a synthetic opioid 50 to 100 times more potent than morphine, is causing overdoses to skyrocket. In Minnesota, deadly overdoses have almost tripled, from 342 in 2019 to more than a thousand in 2022.

Fentanyl, which can be deadly in tiny amounts, frequently is added to street drugs like heroin, even non-opioid drugs like Xanax or Adderall, without users being aware of its presence.

“You could certainly die of an overdose earlier in my career, but it was harder,” Frenz said. “The margin for error with fentanyl is zero. Even if you’re a savvy user.”

Moyers never turned to illegal opioids because he was able to keep getting prescriptions. But prescription painkillers are generally tightly controlled, so addicts may turn to heroin or other opioids they can more easily obtain on the black market.

“Do not take any pill unless it came from a pharmacy in a bottle with your name on it,” Frenz stressed.

For anyone who might ignore that warning, Frenz urged using fentanyl test strips on drugs they plan to take and keeping a supply of Narcan (generic name naloxone), an over-the-counter nasal-spray medication that can reverse an overdose.

Frenz also advised never using when you are alone, using only clean needles and syringes and not hesitating to dial 911. In Minnesota, he said, “Steve’s Law,” or the “Good Samaritan Law,” provides some legal protections for the person who calls 911.