Suboxone

Suboxone is a combination medication used in medication-assisted treatment (MAT) for opioid use disorder, and in Dopesick it sits at the intersection of medical evidence, uneven care, and social judgment. When appropriately prescribed and used, it can stave off withdrawal and reduce cravings without producing a high. But the accounts also show how brief treatment, gaps in clinical oversight, cost, waiting lists, and resistance to medication can limit its value. Suboxone is therefore not simply a drug in the narrative: it is a test of whether treatment systems can deliver continuing care without treating medication itself as failure.

What the medication does

At an addiction clinic in Lebanon, Virginia, Crystal Street and Debbie Honaker were receiving Suboxone as part of MAT. Both described lives shaped by opioid dependence, incarceration, and difficulty maintaining employment. Their accounts made a distinction central to the book’s treatment of addiction: as dependence progresses, drug use may be aimed less at seeking euphoria than at avoiding withdrawal. Suboxone’s practical purpose in this setting was to relieve withdrawal and reduce cravings, allowing treatment to address more than the immediate cycle of sickness and drug seeking.

The medication’s benefits are conditional, not automatic. The account describes Suboxone as not producing a high when prescribed appropriately and used correctly. That qualification matters throughout the book: the same medication can be part of a structured clinical program or circulate outside that setting, where its use and risks are different. Suboxone is also distinguished from Subutex, a buprenorphine product without the added Naloxone blocker. The distinction becomes especially important in accounts of pregnancy, diversion, and prescribing practice.

Treatment and the cost of interruption

The book repeatedly contrasts sustained medication with short-term detoxification. In January 2013, Jesse Bolstridge entered a ten-week residential program in Jacksonville that included counseling and medical detox. He briefly received Buprenorphine, but was taken off it after three weeks. He still owed $25,000 for the treatment, despite having insurance and making weekly payments from his checking account. The episode brings together two different limits on care: a financially burdensome residential stay and a brief medication course that did not provide ongoing maintenance.

The National Institute on Drug Abuse, the Institute of Medicine, the World Health Organization, and the White House drug czar’s office supported indefinite, potentially lifelong, maintenance treatment over abstinence-oriented rehabilitation for opioid use disorder. The book presents this consensus against a treatment culture in which medication could be tapered quickly even as the evidence favored continued maintenance alongside behavioral treatment and recovery support. A study cited in the account found a high likelihood of unsuccessful outcomes after patients were tapered from buprenorphine-naloxone, including patients who had received counseling. In 2012, Hazelden Betty Ford Foundation, associated with the twenty-eight-day rehabilitation model, also changed its approach and began offering Suboxone to some patients.

The financial and logistical burdens were not limited to one residential program. The Waldrop family found that its outpatient Suboxone programs had not worked, while later residential rehabilitation and sober-house aftercare programs did. Between outpatient care, multiple residential stays, and aftercare, the family spent more than $300,000, not counting legal fees or money lost through drug-related theft. The sum illustrates how repeated treatment episodes could drain family resources without guaranteeing continuity or recovery.

Access, oversight, and risk

Access to medication depended on where a patient could go, what a facility would accept, and what a family could pay. When Tess Henry left jail in June 2015, nearly seven months pregnant, she first stayed with her mother and then entered the Life Center of Galax for the final month of her pregnancy. It was among the few Virginia facilities that accepted patients receiving MAT. Private insurance covered most of the $20,000 bill, while her father paid a $6,500 deductible from the remainder of Tess’s college savings. She was taking Subutex, then recommended for some pregnant patients. By 2017, Virginia Board of Medicine guidelines recommended that pregnant patients use Subutex for no more than seven days before transitioning to Suboxone.

Even after medication was obtained, the cost of monitoring could create another barrier. Tess’s insurance covered 80 percent of her medication costs, but visits with her addiction doctor were cash-only: $700 up front and $90 to $100 for each follow-up, as many as four in a month. The book also notes waiting lists at many treatment sites. These conditions make the distinction between medication’s clinical promise and its availability tangible: a prescription required not only a suitable treatment program but also money, appointments, and ongoing access to a prescriber.

The book does not treat all prescribing as equally safe. Some rural clinics failed to drug-test patients or require counseling and prescribed benzodiazepines alongside treatment medication, a combination associated in the account with heightened danger. Sarah Melton, a pharmacy professor and patient advocate who helped her husband, Hughes Melton, run Highpower, described their contrasting model: strict urine screening and on-site group and individual counseling. She also reported deaths involving people who injected high doses of Subutex. Subutex’s lack of Naloxone made it more attractive to some patients seeking to use other opioids as well; the book further notes that buprenorphine can produce a high when injected or snorted, or when combined with benzodiazepines, and that the latter combination can be fatal. These risks do not erase the medication’s therapeutic role; they underscore the importance of formulation, supervision, and clinical support.

Families, stigma, and the meaning of treatment

When Ashlyn Keikilani Kessler left rehabilitation after only a few days, her grandparents acknowledged that they had enabled her. They had paid for repeated treatment and sometimes bought Suboxone for her on the black market because they feared that without it she would become sick and turn to heroin. Their actions show how families tried to bridge the distance between formal care and a loved one’s immediate need, even when the medication came through an unsafe or unsupervised channel.

Medication also carried a social cost. Tess Henry had attended Alcoholics Anonymous and Narcotics Anonymous meetings, but felt stigmatized because some participants viewed Buprenorphine as incompatible with being clean or as merely substituting one opioid for another. Although Narcotics Anonymous’s official policy accepted MAT, members approached to sponsor or mentor Tess declined. The result was a divide between a treatment supported by medical evidence and recovery communities in which abstinence could function as the test of legitimacy. The book follows that divide over two years, showing that medication’s effectiveness cannot be separated from whether patients are welcomed and supported while taking it.

Building a care pathway

The Hope Initiative tried to make treatment access more practical. Its volunteers developed a five-page spreadsheet listing thirty-six rehabilitation and aftercare providers across the southeastern United States, so that referrals could take account of a patient’s finances and the availability of beds. Some volunteers also helped arrange outpatient MAT, though views within the group remained divided over treating addiction with medication. At the Bradley Free Clinic, people could meet trained volunteers on the second Monday of each month, subject to having no outstanding warrants; social-service workers could help eligible patients apply for Medicaid. The service model addressed several points where care could break down, from finding an opening to navigating payment and public benefits.

A related effort sought to connect emergency treatment more directly to continuing medication care. Warren Bickel received a $1 million grant for a Virginia Tech Carilion Research Institute pilot to streamline transfers from emergency departments to outpatient treatment. Patients who had overdosed would be connected to outpatient Buprenorphine through Sublocade, a once-monthly injection newly approved by the U.S. Food and Drug Administration. Bickel argued that a patient who tested positive for additional opioids during follow-up needed an increased Suboxone dose rather than a punitive reduction. His proposed pathway treated the emergency visit not as an isolated crisis but as an opening for ongoing care.

Across these episodes, Suboxone’s significance rests on a repeated contrast: medication can reduce withdrawal and support recovery, but the benefit depends on continuity, competent supervision, and a system patients can actually enter. The book’s accounts of short tapers, unaffordable appointments, inconsistent clinic practices, family improvisation, and peer rejection show how treatment can be interrupted at multiple stages. Suboxone becomes both a concrete means of managing dependence and a measure of whether health care and recovery institutions can accommodate evidence-based treatment.