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The Spokesman-Review Newspaper
Spokane, Washington  Est. May 19, 1883

Little relief in sight for painkiller addicts


Post Falls internist Dr. Michael Carraher is the only doctor within an hour's drive of Spokane able to provide Suboxone, a drug that helps addicts kick their painkiller habits. 
 (Kathy Plonka / The Spokesman-Review)

Pent-up demand for a drug that helps addicts kick prescription painkillers has prompted a new federal law that more than triples the number of users each doctor can treat.

But new rules expanding the use of buprenorphine – sold as Suboxone or Subutex – will put barely a dent in the need in the Inland Northwest, experts said.

President Bush on Friday signed an amendment to the federal Controlled Substances Act raising the number of patients doctors may treat with the drug from 30 to 100.

Only two active area doctors are certified to prescribe the pills that help addicts get and stay clean, however, according to a national database. And now one of them says he’s out.

“I no longer prescribe the Suboxone,” Dr. John H. Edwards of the Spokane Veteran’s Affairs Medical Center wrote in an e-mail. “When I did it was limited to military veterans treated through the VA.”

That leaves no doctors in Spokane – and just one within 100 miles of the city – willing to prescribe the only drug federally approved to treat addiction to oxycodone, hydrocodone and other opiates in a doctor’s office setting. Other treatments, such as methadone, are dispensed in highly controlled clinical settings.

Across Washington and Idaho, 86 prescribing doctors are listed in a national buprenorphine locator, but only eight are within a day’s drive of the Inland Northwest. One of those, Dr. Billy Barclay of Coeur d’Alene, has left the area, office staffers said.

That means Dr. Michael Carraher of Post Falls is the region’s primary source of Suboxone. He said he’s considering taking on 50 patients, an increase of 20, but only half the expanded number approved by the new law.

Treating 20 more patients will make almost no dent in demand so great that Carraher long ago stopped keeping a waiting list, he acknowledged.

Still, the doctor worries about the impact that treating so many addicts might have on other aspects of his internal medicine practice.

“I’m not sure I’m going to take a full 100,” Carraher said.

Nationwide, doctors have been reluctant to acquire the simple certification to prescribe buprenorphine out of fear of becoming known as the local “addiction doctor.” Others have avoided treating addiction because they didn’t adequately understand the problem or there weren’t enough resources for follow-up care, according to the American Academy of Family Physicians.

But Carraher said doctors’ concerns pale next to the desperation of growing numbers of people addicted to painkillers.

In 2005, 2.5 million people in the United States age 12 or older improperly used prescription medications, according to the National Survey on Drug Use and Health. The report produced by SAMHSA, the federal Substance Abuse and Mental Health Services Administration, includes painkillers, tranquilizers, sedatives and stimulants.

In addition, nearly 10 percent of high school seniors reported abusing the pain reliever hydrocodone – better known as Vicodin – according to a just-released report from the National Institute on Drug Abuse.

Locally, prescription drugs accounted for more overdose deaths in Spokane County than illegal drugs in 2005, according to the county medical examiner. In the methadone program operated by the Spokane Regional Health District, painkiller addicts have outstripped heroin addicts for years, officials have said.

For many opiate addicts, there’s no question that Suboxone is the treatment of choice, Carraher said.

Buprenorphine generally decreases the symptoms of opiate addiction with milder withdrawal and less risk of dependency than other drugs such as methadone, Carraher explained. It also blocks receptors that create a user’s high, eliminating the euphoria that contributes to addiction.

One 49-year-old Spokane addict said Suboxone saved her life. The woman, who asked to be identified only by her nickname, Jen, has been taking the drug for 2 ½ years, 12 milligrams a day, at a cost of $212 a month. Even though she’s disabled and on Medicaid, she has to pay for the drug herself because Washington’s program will only pay for a six-month supply. In Idaho, there’s no such limit.

The tiny pills help stave off cravings for prescription painkillers that cost the woman her marriage, her children and nearly her life, she said.

“I started using painkillers when I was 18 years old,” the woman said. “By the time I was 25, I was going all over Idaho, trying to hit every emergency room to get them. Sometimes I would hurt myself to get them.”

All that has changed, said Jen, who credits Suboxone with decreasing her anxiety and allowing her to repair damaged family relationships.

“I don’t see my kids very often because they’re still angry with me because I pretty much messed up their childhood,” said Jen, the mother of three sons, ages 24, 27 and 28. “That’s the biggest thing I deal with now, is trying to fix everything.”