Monday, November 14, 2005
Several articles have appeared recently citing the growing black market in Methadone and Buprenorphine. Listed below are summaries from some of those articles...
BBC monitoring international reports, Oct. 13, 2005 Quoted the interior minister: "well-known and influential" Georgians are involved in drug-dealing. The article states the going "street value" is $80,000(US) for 800 tablets; 100 bucks per tab is mighty good, regardless what the individual tablet dosage is. The illegal price of methadone never reached that high, in US or anywhere else in the world.
ILLICIT SUBUTEX TRAFFIC IN EUROPE: (Sueddeutsche Zeitung 25 Oct 05)
Information provided by Hans-Guenter Meyer-Thompson, in Hamburg) Bavarian police report seizure of almost 4,000 subutex tablets.
The seizure is believed to reflect a trafficking line from France to Eastern Europe. Germany, where methadone and, more recently, buprenorphine, are quite readily available from general practitioners, is said to have no significant demand for illicit subutex. The demand elsewhere, however, is apparent in the street value of the seized medication - estimated to be over $230,000 USD. A major cause for concern is the negative impact stories such as this may have on countries that have resisted legalization of methadone but are said to be considering introduction of buprenorphine (e.g., Russia). See related posting on subutex "business" in the Baltic region.
NARCOTICS AND CRIME IN THE BALTIC SEA REGION. A report of a conference in April 2005 is available at www.silkroadstudies.org
One focus: problems associated with "prescribing subutex on a regular basis." Reportedly, "the illegal subutex 'business'" in Estonia was controlled through legislative reforms and medical regulations, but this caused "activity related to subutex" to move to Latvia. Particularly concerned is the Finnish government, since an estimated 500-600 Finnish addicts travel to Riga each month to purchase subutex. To the extent this traffic reflects a lack of legitimate treatment within Finland, one might applaud the resourcefulness of opiate-dependent citizens of that country. The reason for concern lies in the comment that "the trade with subutex and suboxone is illicit and a highly profitable business for some Latvian medical doctors," and the conclusion that "many heroin users have become abusers [of these medications] as well." It has been hoped that some countries long opposed to methadone maintenance (e.g., Russia!) might be more open to introduction of buprenorphine; experiences such as those reported for Estonia and Latvia make this less likely.
PRAGMATIC OBSERVATIONS FROM GERMANY
Hans-Guenter Meyer-Thompson, from a conference in Hamburg May 20, 2005.
Where there are opiate-dependent people who can not obtain (or who refuse) "substitution" treatment, there'll be a black market for agonist medications. For more...
The stricter the controls on prescribing, the greater will be the illicit demand for methadone and buprenorphine. Re. buprenorphine, the view that it is "not liable to misuse" has never been true, and has been disproven by experience in many countries. This reality, and the existence of a significant illicit traffic in buprenorphine (involving especially Scandinavian countries where legal availability of "substitution" medication is very limited) lessen the likelihood of its acceptance in other countries.
Financial considerations add to the likelihood of buprenorphine misuse by injection. Singapore is cited, where half the patients receiving subutex are said to inject it. The degree of pharmacological (as opposed to political) benefits of the buprenorphine-naloxone (i.e., suboxone) formulation is not clear.
Bottom line: "substitution:" treatment (methadone as well as buprenorphine) should be readily available throughout the world and should be a cornerstone of harm-reduction.