The Opioid Crisis and Why Buprenorphine is Just a Band-Aid

As a country, we continue to do a phenomenal job of working downstream, then spend and inordinate amount of time glad-slapping each other on the back. And, here we go again; specifically, the recent news on treating addiction and the 

medicines used for the treatment of Opiate Use Disorder. For those of us who walk in the world of addiction on a daily basis, we are well aquainted with this song and dance. 

But, how did we get here? In 1974 the Narcotic Addiction Treatment Act required doctors to have specialized training, a separate license, and additional regulation by the DEA to prescribe Buprenorphine for treating the disease of addiction. However, this did less to treat the disease and did more to entrench the stigma associated with addiction. Now, not only were addicts stigmatized, so was the treatment associated with helping them. For example, doctors are not required to possess a waiver to treat any other disease and dispense opiates freely without the DEA’s direct involvement. 

This week, the Biden administration, thankfully, eliminated this requirement to prescribe Buprenorphine. And this should help de-stigmatize the disease of addiction. However, this is a small fraction of what needs to occur in treating addiction in the long term. The unintended consequence is that things may get worse.

While well-intended, lifting these restrictions is woefully inadequate. On average doctors receive about 2 hours of addiction training in their entire career. Here is how one report described it, “ a failure of the medical profession at every level—in medical school, residency training, continuing education and in practice—to confront the nation’s number one disease (Columbia University, 2000).” While some medical schools have addressed this issue since the report, most have not and most physicians are woefully ill-prepared for this easing of restrictions. 

What Could Possibly Go Wrong? 

1) We have untrained physicians, nurse practitioners, and psychiatrists prescribing addiction medicine to addicts. An article in the Journal of the American Medical Association in 2013 states that most medical professionals who should be providing addiction treatment are not sufficiently trained to diagnose or treat it. Further research found that 94% of physicians in the United States have failed to include substance abuse among the five diagnoses they offered. 

2) Buprenorphine is an opiate. And this means that the very people we are prescribing it to are inclined to abuse it. I have been working with Medically Assisted Treatment (MAT) since 2013. To be effective, at a minimum, there will need to be pill counts to stem diversion of medicine and monitoring to make sure other drugs are not being used in conjunction with Buprenorphine. Most overdose deaths occur due to a combination of substances, in addition to Fentanyl. For example, cocaine historically ranks second or third in overdose deaths involving more than one drug. Gabapentin has been found in as high as 33% of opioid-related overdoses in some regions. Buprenorphine is a phenomenal drug to help minimize the effects of withdrawal and diminish cravings. At some point, the addicted individual will have to suffer the withdrawal of coming off of Buprenorphine. Many I have worked with have described coming off of Buprenorphine as worse than coming off of heroin.

Why Harm Reduction Isn’t Enough and Drugs Are Not Addicting

The argument will be made to keep these addicted individuals on a long-term maintenance dose, i.e., the harm reduction plan. I am reluctantly in the business of harm reduction. Even though we prescribe MAT’s (we call them MARs, Medically Assisted Recovery, because there is a difference). However, I am not a proponent of harm reduction. I completely get it, I understand the argument for it, but ask yourself, whose harm are we reducing? I would propose to take harm reduction to its most logical conclusion; decriminalization of all drugs. Why? Because drugs are not addicting, and we have to stop perpetuating that narrative. Again, the research has already been done. Spain and Portugal got out of the failed “war on drugs” mentality years ago with incredible results. 

That isn’t a typo above. Drugs are not addicting and we need to stop perpetuating this myth. If drugs were addicting, everyone that ever tried a drug would be currently addicted. I am not suggesting that you test this. However, if you do, your chances of becoming addicted are about 20%. That means you have an 80% chance of not becoming addicted. While I believe that Dr. Carl Hart may be one of the most dangerous voices in the addiction dialogue right now, I also agree with him on many points, especially when he states “if most users of

a particular drug do not become addicted, then we cannot blame the drug for causing drug addiction.” Which begs the question: why do people become addicted? This question makes most people squirm. As Dr. Gabor Mate states, “not everyone that has trauma becomes addicted, but every one that is addicted has experienced trauma.” 

Opiates are strong painkillers, so the question that needs to be asked is “why are people in so much pain?” This question gets us to much more nuanced and difficult answers. Ones we that may be uncomfortable to hear. Opiates can only mask the pain, it’s the best they can do. They are incapable of alleviating the source of the pain. They can’t, they aren’t designed to. They only alleviate the pain for short periods hence the need for more. So Buprenorphine, at best, is only a part of the solution. We already know the solution to addiction is long-term care with compassionate and empathetic caregivers, just like all the other acute and chronic diseases we treat. 

What is the Answer to Addiction? 

We already have the model for long-term recovery from addiction. The HIMS model has been around since the 1970s and has a success rate of better than 80%. We could tweak this just a little to fit a broader demographic, but it would force us to take a more humanistic look at addiction than most are willing to. Many people with addiction will need more than a 28-day treatment program. They will need job skills, education, relationship counseling, stress reduction skills, parenting classes, connection, meaning, and purpose. At this point, the need for medically assisted treatment would be minimal 

Let us also not forget that this epidemic is very specific to North Amercia. The US makes up 4.6% of the world population, yet uses 80% of all opiates worldwide and specifically, 99% of the worlds Hydrocodone/Vicodin. Let us also not forget that alcohol, the most destructive drug of all, kills 5% of the worldwide population annually. So where is the outcry over this epidimic? But, that is another topic for another day. The why’s to this phenomena of American opioid us are complex. Yet again, we have to ask ourselves how and why are so many people in so much pain? 

If you look at the maps of where the highest rates of overdose occur, the answer becomes clear. Loss of jobs, poverty, way of life, abandonment, dissolution, high

stress, lack of meaning, of purpose. Basically, a loss of what it means to be human. Herein lies the state of suffering and emotional pain that opiates do such a tremendous job in alleviating. 


From a broad lens perspective, this is a positive step in the treatment of addicton. If history is any indication we have to be cautiously optimistic and we must remain vigilant in our work to help some of the most vulnerable people in our society. There is a need to unify our definitions of abstinence, remission and recovery from substance use disorders and always treat those who suffer with dignity and compassion. Until we stop giving the disease of addiction lip service, addiction rates will remain stagnant and deaths will rise.



National Centre on Addiction and Substance Abuse at Columbia University. Missed opportunity: national survey of primary care physicians and patients on substance abuse. Accessed April 28, 2021. 

Wood E, Samet JH, Volkow ND. Physician education in addiction medicine. JAMA. 2013;310(16):1673-1674. doi:10.1001/jama.2013.280377

Spread the love

Speak Your Mind


435 W. Washington
Springfield, IL 62702
(217) 203-6600

Got Questions?
Send a Message!