A prescription drug called Suboxone helps wean people off of heroin and pain pills, but addicts have a hard time getting prescriptions. So they're turning to the black market.
Suboxone is used in the treatment of opiate dependence.
An Albuquerque man who goes by the name Mystery Man has stepped in to fill the void. He says he illegally sells Suboxone every day.
To get Suboxone, Mystery Man has to find a patient with a Suboxone prescription, and give that person the $50 co-pay to fill it. He gets that money by selling, among other things, crack and guns.
He sells each pill for $5. He uses the profit to pay himself and his bodyguards, and to invest in his next deal. He says he notices a difference in his customers. "People don't overdose no more. They're just mellow," he says. "If you take it you won't be stealing, you won't be robbing, and you won't be prostituting."
Special Agent Keith Brown oversees the Drug Enforcement Administration's operations in New Mexico. He disagrees with Mystery Man. "Mystery Man [is] not a doctor. He doesn't know anything about how the medicine should be used, the dosing of it, any side effects. I think is dangerous for all involved."
Unlike pain pills and heroin, Suboxone (generic name: buprenorphine) is very hard to overdose on. Addicts can take it to avoid withdrawal symptoms and manage their cravings for these drugs.
"People who are treated with Suboxone are able to go back to school, they're able to go back to work, they're able to start paying taxes and taking care of their children," says Dr. Miriam Komaromy, who directs a state-funded addiction treatment hospital in New Mexico. "It's making them able to return to being a functioning member of society."
New Mexico has the highest fatal drug overdose rate the U.S. For years, it's battled against one of the worst heroin epidemics in the country. And while heroin use has pretty much held steady, a recent report from the New Mexico Department of Health shows the sales of opioid pain relievers that are popular recreational drugs increased by 131% between 2001 and 2010.
Some physicians do prescribe Suboxone to treat addicts. But many do not.
"A lot of physicians are very resistant to prescribing Suboxone because they fear it will attract opiate addicts to their practices which brings with it a whole can of worms in terms of managing those clients," says Seth Williams, a nurse practitioner who treats the homeless in Albuquerque.
Scientists have long searched for a prescription to treat addiction. But companies were hesitant to develop one. Charles O'Keeffe is the former president and CEO of Reckitt Benckiser, the company that developed Suboxone. "There's not much money to be made in it," says O'Keeffe. "This is not a disease space that a lot of people want to treat."
National figures. Some deaths may be counted twice because they involved both heroin and opioid-based prescription drugs.
The U.S. government stepped in and partnered with Reckitt to bring the drug to market in 2000. Buprenorphine — the main ingredient in Subxone — became the only drug doctors could prescribe to treat heroin and pain pill addiction in their offices. Because it is an opiate, the regulations are strict. Doctors have to complete a special training, and there's a limit to the number of patients they can see — about a quarter of them may treat no more than 100 per year; the rest are limited to 30. But the need for opiate treatment has drastically increased, beyond what Reckitt could have anticipated.
The prescription drug overdose death rate in the U.S. is three times what it was in 1999, and yet the number of new doctors certified to treat these addictions with Suboxone has plateaued. Dr. Komaromy — in New Mexico — says she thinks her state could multiply the number of providers by five and still not be meeting the need.
The Center for Substance Abuse Research at the University of Maryland, College Park recently warned of an emerging buprenorphine misuse. But a survey of physicians who are certified to prescribe Suboxone underscores Mystery Man's role. The majority believe patients who seek Suboxone on the street are doing so to self-medicate.
Doctors who treat addiction are worried that Suboxone will gain a reputation as a street drug. But for now, the street is the only marketplace keeping up with demand.