WELCOME TO MY DIGITAL DIARY

A Critique of Full-Scale Decriminalization of Buprenorphine

The opioid crisis remains one of the most complex public health challenges in American history, with innovative solutions constantly being sought. In 2013, the U.S. Department of Health and Human Services declared the misuse of prescription opioids a public health epidemic. By 2017, it was recognized as a national public health emergency by the Trump administration. Since then, nearly 200 Americans died from drug overdoses every day, an increase that has continued to alarm public health officials and policymakers. 

The issue of opioid addiction first caught my attention when I attended an opioid seminar at Brandeis University in 2018, just one year after the epidemic was declared an emergency. The shocking statistics and complex challenges associated with opioid addiction have led me to continuously pay attention to the changing landscape and the steps taken to address this crisis – policies I wish to explore in my writing.

The idea of exploring the decriminalization of opioids emerged when I read “Decriminalization of Diverted Buprenorphine”, a piece written by Brandon del Pozo, an assistant professor in health services and policy at Brown University, for my philosophy class. Del Pozo advocates for the decriminalization of the possession of unprescribed buprenorphine, a partial agonist effective in treating opioid use disorder (OUD). His approach removes criminal penalties for the possession and use of the drug without a prescription, thereby adopting a harm reduction strategy multiple benefits: it corrects the counterproductive criminalization of individuals seeking OUD treatments, reduces stigma and fear associated with the use of medication-assisted treatment without legal repercussions, and addresses gaps in treatment capacity and access by allowing individuals to use buprenorphine outside the formal healthcare framework. Proponents of this approach argue that it significantly improves access to buprenorphine, which had previously been hindered by stigma, legal restrictions, and a lack of treatment capacity, forcing many individuals to seek the medication through illicit means. 

While decriminalizing buprenorphine has shown promising results in places like Burlington, Vermont, with a 50% decline in opioid overdose deaths, questions remain about whether this approach alone can effectively address the persistent challenge of opioid overdoses. A significant issue with decriminalization is that it doesn’t tackle the root cause of the opioid crisis: the illicit market and the toxic supply of opioids.

To elaborate, decriminalization, if not accompanied by other supply-based interventions, may inadvertently bolster the demand for illicit opioids, sustaining black market availability, exacerbating addiction, and undermining the efforts to combat the very crisis it seeks to mitigate. This counterproductive outcome stems from the highly restrictive nature of federal and state regulations on the legal prescription and distribution of buprenorphine. Such regulations can create significant reluctance and fear among physicians to prescribe this life-saving medication and deter patients from seeking it legally. Consequently, individuals who face barriers to accessing buprenorphine through legal channels might turn to the black market, where fewer restrictions exist. Knowing that possession without a prescription is no longer criminally penalized could further increase the black market demand, both from current opioid addicts and new users looking to experiment with the drug. Over time, this could make the illicit market more resilient, thus complicating public health efforts to address opioid addiction. 

Addressing the opioid crisis requires interventions that extend beyond simple decriminalization. A comprehensive solution lies in optimizing drug regulations and policies governing the legal supply and distribution of opioid medications within hospitals, medical practices, and third-party distributors. This would ensure that legal medical use of opioids is appropriately managed and becomes more accessible to those in need. Specific interventions could include refining clinical guidelines for opioid prescriptions, enhancing oversight of pharmaceutical companies and distributors to prevent opioid diversion, educating healthcare providers on opioid prescribing practices and alternative pain management, and promoting public education campaigns to raise awareness about opioid misuse and the availability of legal treatment options for OUD. Additionally, implementing community-based interventions, such as establishing low barrier access to buprenorphine in the local emergency rooms and eliminating waiting lists for medication-assisted treatment, could significantly improve treatment effectiveness. 

Together, these efforts could minimize stigma and fear surrounding the legal pursuit of OUD treatment, significantly reduce the demand for illicit opioid supplies, and ultimately provide a more comprehensive approach to combating the opioid crisis.

While the decriminalization of the possession of unprescribed buprenorphine marks an important step in addressing opioid addiction, it is not sufficient on its own. It is necessary for the regulatory healthcare sector to implement a broader and more integrated strategy that combines decriminalization with stringent measures targeting the supply chain is necessary to effectively tackle the opioid epidemic from its root causes.