With more than 34 million Americans taking antidepressants in 2013-14, addiction and withdrawal from psychiatric is a growing problem.

With more than 34 million Americans taking antidepressants in 2013-14, addiction and withdrawal from psychiatric is a growing problem.

A pharmaceutical company’s recent $1.4 billion settlement with the Department of Justice (DOJ) over probes into its addiction treatment drug, Suboxone Film (buprenorphine and naloxone), has raised concerns about psychiatric drug treatments offered as solutions to the opioid crisis, the mental health watchdog, Citizens Commission on Human Rights (CCHR) says. [1] Buprenorphine, one of the active ingredients in Suboxone, is a synthetic opioid that is potentially addictive. [2] The DOJ alleged Suboxone Film was falsely marketed by its manufacturer as safer and less susceptible to abuse than similar drugs containing buprenorphine. [3]

Suboxone Clinics have sprung up across the U.S., including within a major behavioral hospital chain, Acadia Healthcare that owns more than 100 Suboxone and methadone clinics. [4]

Jan Eastgate, president of CCHR International, says that “while the country suffers from the opioid crisis, huge profits and serious dangers derive from the treatment of addiction to opioids.” The Food and Drug Administration warns that people taking buprenorphine can suffer serious breathing problems and death—especially when injecting it, and in combination with benzodiazepines or other central nervous system depressants. [5] A New York Times investigation in 2013 found buprenorphine was a “primary suspect” in 420 deaths reported to the FDA since it reached the market in 2003. [6]

Suboxone Film is a sublingual strip that is placed on the tongue to dissolve. If enough strips are placed, it can result in a high.  U.S. sales of Sublingual Film were approximately $1.87 billion for the 12 months ending December 31, 2018, according to IQVIA. [7]

Other adverse effects of Suboxone Film include liver problems and opioid withdrawal. Long-term use of Suboxone may cause fertility problems in males and females. [8]

The other active ingredient in Suboxone, naloxone, may cause agitation, high or low blood pressure, cardiac arrhythmias, shortness of breath, pulmonary edema, abnormal brain damage, seizures, coma and death. [9]

Opioid dependence has become a lucrative business for the mental health industry, Eastgate says. The American Psychiatric Association’s Diagnostic & Statistical Manual of Mental Disorders (DSM) lists about twelve disorders associated with opioid use and abuse, for which psychiatrists can bill insurance. [10]

According to a study published in the Journal of the American Board of Family Medicine in 2017, adults said to have a “mental illness” receive more than 50% of the 115 million opioid prescriptions in the U.S. annually. [11]

Evelyn Pringle and Martha Rosenberg writing in Alternet wrote that addiction treatment companies are so lucrative, with profit margins of over 20 percent, “largely because of the booming specialty of addiction psychiatry, which has exploded and muscled its way into standard rehabilitation and monetized it.” [12]

Addiction psychiatry involves substituting one drug with another or a combination of two. The problem with this model, Pringle and Rosenberg pointed out is that “the substance abuser never recovers, but simply stays hooked on another or multiple drugs, while Big Pharma cashes in.”

Between 2006 and 2016, private equity firms also invested more than $2.2 billion in substance abuse treatment companies. [13]

For five years CCHR has investigated the use of Suboxone and other opioid addiction treatment drugs in for-profit psychiatric hospitals, including those owned by Acadia and Universal Health Services, which also has outpatient Suboxone programs. [14]

A Suboxone clinic can charge $200 to $300 per month, per patient, for a 5-to-10 minute checkup to renew a Suboxone prescription. According to psychiatrist, Steven R. Scanlan, “the lucrative nature of Suboxone on a maintenance basis creates a disincentive to tapering the drug and its income-generating potential.” [15]

In a sample of 12 psychiatrists CCHR identified as affiliated with Acadia facilities, two were among the top 20 state prescribers of Suboxone. [16]

In May 2019, U.S. Attorney announced that Acadia would pay $17 million in a Healthcare Fraud settlement over its billing Medicaid for fraudulent laboratory tests related to its addiction treatment programs in West Virginia, where methadone and Suboxone are administered. [17]

Psychiatrists have played an integral role in the opioid crisis. OxyContin (oxycodone) maker Purdue Pharma was started by three psychiatrists, all brothers. Oxycontin was developed by the two youngest, Raymond and Mortimer who made it the driving power that made them billions. The three coauthored more than 100 studies on the yet to be proved “biochemical roots” of mental illness, which justifies drug treatment. [18]

  • In 2007, Purdue paid $600 million to settle a case with the Justice Department over its marketing claims about Oxycontin and three executives, who weren’t Sackler family members, pleaded guilty to criminal misbranding over misleading the public about Oxycontin’s addictiveness. [19]
  • According to a 2015 deposition, Dr. Richard Sackler (son of Raymond Sackler and a physician and surgeon), the former president of Purdue, knew in 1997 that OxyContin was much stronger than morphine. [20]
  • In March 2019, Purdue agreed to pay the state of Oklahoma $270 million over charges of misleading marketing practices and misrepresentation regarding Oxycontin. [21]

CCHR Florida President Diane Stein says Federal data just released shows that Florida plays a large part in the nation’s “pill mill” industry with 85% of the country’s oxycodone prescribed in Florida in 2010. [22]

Eastgate sums up: “A greedy pharmaceutical industry profits from sales of a drug of addiction and obfuscates the risks. Psychiatrists push for ‘medication-assisted’ addiction treatment, replacing one addictive drug with others and hooking individuals onto the ‘treatment’ for opioid abuse. They profit from adding substance abuse disorders to the DSM and both psychiatrists and Suboxone clinics bill insurance companies.  This is an industry that’s creating or reinforcing legalized drug addiction across the country and should be held accountable alongside the manufacturers.” For more information visit www.cchrflorida.org or call 727-442-8820.

Sources:

[1] “U.S. Reaches $1.4 Billion Opioid-Drug Settlement With U.K.’s Reckitt,” Wall Street Journal, 11 July 2019, https://www.wsj.com/articles/reckitt-to-pay-1-4-billion-to-settle-u-s-opioid-addiction-drug-probes-11562831584; http://www.drugfree.com/drug-guide/suboxone-abuse-symptoms-signs-and-addiction-treatment/is-suboxone-an-opiate/; https://www.prnewswire.com/news-releases/watchdog-warns-about-replacing-opioid-epidemic-with-a-psychotropic-one-300525829.html.

[2] https://www.dualdiagnosis.org/suboxone-abuse/how-long-does-it-take-to-get-addicted-to-buprenorphine/

[3] https://www.justice.gov/opa/press-release/file/1153066/download

[4] http://www.methadone.us/acadia-healthcare/;

https://delrayaddictionmedicine.com/florida-drug-rehab/

[5] https://www.cchrint.org/2016/04/14/state-investigations-expand-into-psychiatric-hospital-patient-deaths-safety-violations/citing: “Treatment with SUBOXONE Film: Understanding the benefits,” Suboxone.com,

http://suboxone.com/patients/about_suboxone/Default.aspx?gclid=COKk7ey79rYCFceDQgodWioA7w.

[6] Deborah Sontag, “Addiction Treatment With a Dark Side,” The New York Times, 16 Nov. 2013, http://www.nytimes.com/2013/11/17/health/in-demand-in-clinics-and-on-the-street-bupe-can-be-savior-or-menace.html?_r=0.

[7] http://newsroom.mylan.com/2019-02-22-Mylan-Launches-Generic-Suboxone-R-Sublingual-Film-to-Treat-Opioid-Dependence

[8] https://www.suboxone.com/medical-treatment/side-effects-adverse-events;

https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/022410s000lbl.pdf

[9] https://www.rxlist.com/narcan-side-effects-drug-center.htm

[10] “Substance/Medication-Induced Mental Disorders,” DSM-5, (APA, 2013), p. 488-549.

[11] https://khn.org/news/patients-with-mental-disorders-get-half-of-all-opioid-prescriptions/

[12] https://www.alternet.org/2016/03/how-big-pharma-cashing-addiction-alcohol-and-illicit-drugs/

[13] Ibid.

[14] Steven R. Scanlan, MD, “Suboxone: concerns behind the miracle,” Addiction Professional website, 1 Nov. 2010, http://www.addictionpro.com/article/suboxone-concerns-behind-miracle.

[15] Ibid.

[16] https://www.cchrint.org/2016/08/17/cchr-calls-for-legislative-intervention-against-for-profit-psych-facility-planned-for-pennsylvania/

[17] “Pursuant to the settlement agreement, Acadia will pay $17 million to resolve allegations of a United States Attorney Announces $17 Million Healthcare Fraud Settlement,” U.S. Attorney’s Office, Southern District of West Virginia, 6 May 2019, https://www.justice.gov/usao-sdwv/pr/united-states-attorney-announces-17-million-healthcare-fraud-settlement

[18] “The Family Trying to Escape Blame for the Opioid Crisis,” The Atlantic, 10 Apr. 2018,

https://www.theatlantic.com/health/archive/2018/04/sacklers-oxycontin-opioids/557525/;

http://www.esquire.com/news-politics/a12775932/sackler-family-oxycontin/https://www.newyorker.com/magazine/2017/10/30/the-family-that-built-an-empire-of-pain;

[19] “Suboxone maker Reckitt Benckiser to pay $1.4 billion in largest opioid settlement in US history,” ABC News, 12 July 2019, https://abcnews.go.com/Business/suboxone-maker-reckitt-benckiser-pay-14-billion-largest/story?id=64274260; https://www.wsj.com/articles/oxycontin-made-the-sacklers-rich-now-its-tearing-them-apart-11562990475

[20] https://time.com/5520159/purdue-pharma-lawsuits/

[21] https://www.healio.com/family-medicine/addiction/news/online/%7B5e71a141-52f9-4095-90cc-a6437c0ef1ea%7D/first-opioid-lawsuit-settlement-raises-questions-with-dozens-more-cases-waiting

[22] “Florida ‘pill mills’ were ‘gas on the fire’ of opioid crisis,” New York Post, 22 July 2019, https://nypost.com/2019/07/22/florida-pill-mills-were-gas-on-the-fire-of-opioid-crisis/