Amid a raging opioid epidemic, many doctors and families in the U.S. have been pleading for better treatment alternatives. One option now under consideration by the Food and Drug Administration is a system of implanted rods that offer controlled release of buprenorphine 鈥� a drug already used in other forms to treat opioid addiction.
Because it鈥檚 implanted in the skin, this version of the drug can鈥檛 easily be sold on the illegal market, proponents say 鈥� a key treatment advantage. The FDA is expected to decide whether to approve the device 鈥� called Probuphine 鈥� within a week.
The implant system includes four rods, each about the size of a match stick, explained Dave, a paramedic in a small town outside of Boston; he was one of the patients recruited to test the device last year. Dave鈥檚 worried about reprisal if co-workers find out he is addicted to opioid pain pills, so NPR agreed to use only his first name.
鈥淢y implants were placed in my left arm, just above my elbow on the inside,鈥� he explained. He鈥檚 been in recovery for four years 鈥� previously with the help of daily聽 pills. Last year, he agreed to be part of an experiment that delivered regular doses of the drug to him via an implant instead. He鈥檚 sold on the new approach.
鈥淚 felt completely normal all the time,鈥� he said.
Probuphine implants, inserted under the skin by a trained doctor, are left in place for six months at a time. Dave said the rods are convenient, safe and discreet 鈥� they provided steady relief from his cravings.
When he takes the daily buprenorphine pills, he said, he has to be careful to hide them so that his 2-year-old granddaughter can鈥檛 get into them. And though he鈥檚 supposed to take the tablets at least 15 minutes before he eats or drinks anything, he sometimes forgets. Or he forgets to take the pills at all.
鈥淲ith the implant, you didn鈥檛 have to worry about that,鈥� he said. 鈥淚t was just there, and you felt good all the time.鈥�
The device doesn鈥檛 work for everyone. During the study, 12 percent of patients who had implants relapsed. But the relapse rate for the pill version of the drug was 28 percent.
And there鈥檚 a second reason implants can be better than pills, said Braeburn Pharmaceuticals CEO : A lot of buprenorphine winds up being sold illegally on the street. Though the drug produces a less intense high than most opioids, it is still sometimes abused.
鈥淏uprenorphine is the third most confiscated opioid by the DEA, so there鈥檚 certainly diversion going on,鈥� Sheldon said.
But during the clinical trial, she said, there were no cases of anyone trying to remove their implant so they could get to the drug inside and sell it.
An FDA advisory committee of the implant in January, and a final decision from the agency is expected by May 27.
鈥淎nything that might help people beat their opioid addiction is a good idea,鈥� said聽, president of the Massachusetts Society of Addiction Medicine. But she said聽she also has reservations about this method of delivering treatment.
The main one is price. The company says it will price the implants to be competitive with other injectable treatments used to battle opioid addiction, including a shot that costs about $1,000 a month. Buprenorphine pills, in comparison, typically cost $130 to $190 for a month鈥檚 supply.
Herbert said a high price may force providers to turn patients away 鈥� or cut back on other services.
鈥淗igh profits in the middle of this epidemic are really unconscionable,鈥� she said.
Sheldon, of Braeburn Pharmaceuticals, said the company will offer rebates to make sure appropriate patients can get access to the implant. She plans to negotiate with insurers and providers on a price that takes both their cost and savings into account, she said.
鈥淎nd if they don鈥檛 realize those savings, we鈥檙e happy to rebate them even further,鈥� Sheldon said.
If the implant is approved, demand for it is expected to be high even with the high price-tag, addiction specialists say.
Dave, the New England paramedic in recovery, said he鈥檚 thought about trying to wean himself off the treatment drugs altogether.
鈥淏ut then, the more I think about it, it scares the hell out of me,鈥� he said. 鈥淚鈥檓 scared of going backward. I honestly don鈥檛 know what would happen.鈥�
That鈥檚 a fear voiced by many of the growing number of Americans who have come to see their a condition they may have to live with 鈥� and need treatment for 鈥� for many years.
This story is part of NPR鈥檚 reporting partnership with WBUR and Kaiser Health News.