Subutex

Subutex is a buprenorphine medication without naloxone whose role in Tess Henry’s pregnancy exposes the tensions between treatment access, concerns about diversion, and the stigma attached to medication-assisted recovery. For Tess, it offered a way to continue treatment during pregnancy, but the systems around her did not consistently recognize that treatment as acceptable or sufficient.

Formulation and pregnancy care

Subutex is the single-ingredient form of Buprenorphine. Unlike Suboxone, which combines Buprenorphine with Naloxone, it lacks the added blocker. The book describes Subutex as having been considered safer for the baby during pregnancy, while also being more susceptible to misuse. That trade-off shaped Tess’s care at a moment when few Virginia facilities would accept patients receiving medication-assisted treatment with counseling and recovery support.

Tess left jail in June 2015 nearly seven months pregnant. After a month living with her mother and attempting to make the relationship with her baby’s father work, her family found a private treatment center two hours away that would admit her for the final month of pregnancy. Private insurance paid most of the $20,000 bill; her father covered the $6,500 deductible with the remainder of Tess’s college-savings fund. The Life Center of Galax was one of the few facilities in Virginia that accepted patients using methadone or buprenorphine. Tess took Subutex through the second half of her pregnancy, following the first half in the throes of Heroin addiction.

The medication did not remove the uncertainty surrounding childbirth. Tess worried that the baby might experience neonatal abstinence syndrome, a withdrawal condition that can require an extended hospital stay. The book notes that the syndrome also occurs among babies exposed to Subutex during pregnancy, and that about half of these infants require neonatal intensive care and medication to manage withdrawal. The risk made Subutex neither a simple solution nor a reason to deny treatment: it placed the family in a difficult medical situation for which access to informed care mattered.

Misuse and competing assessments

The same formulation that made Subutex a treatment option also carried risks. Patricia found spoons and Subutex powder among Tess’s belongings, and Tess said she doubled her dose when stressed. The account presents this misuse alongside the scarcity of pregnancy-appropriate treatment: nearly all the centers Patricia contacted had refused Tess until she had been detoxed from every drug, including buprenorphine.

Sarah Melton, a pharmacy professor and statewide patient advocate who helped her husband, Hughes Melton, run the Highpower clinic, described a sharp distinction between Subutex and Suboxone. Highpower required urine screening and provided group and individual counseling. Sarah reported deaths associated with people injecting high doses of Subutex, whose formulation lacks the blocker present in Suboxone. She also connected unsafe prescribing to financial incentives, arguing that some physicians supplied more medication than patients needed. The book notes that Buprenorphine was among the most frequently diverted opioids in the country. These accounts place the danger not only in the drug’s formulation but also in how clinicians prescribed it and whether treatment included monitoring and support.

The treatment gap around Tess

After Tess gave birth, the hospital did not provide her with a prescription for medication-assisted treatment. Instead, staff arranged for her to attend a local methadone clinic. Patricia refused for a day to take Tess and the newborn home, calling the proposed discharge unsafe; the family eventually arrived at the clinic just before it closed, with the baby. On days Patricia had to work, her father, then in his eighties and walking with a cane, drove Tess to the clinic. The practical burden of maintaining treatment fell heavily on relatives, even as the available institutions made continuity difficult.

Tess’s experience also extended into peer recovery. She had attended twelve-step meetings before, but felt stigmatized because some participants regarded buprenorphine as not being clean or as merely replacing one opioid with another. Although Narcotics Anonymous officially accepted medication-assisted treatment, members asked to sponsor or mentor Tess declined. Subutex thus became more than a prescription: it marked her as a patient receiving treatment and, in some recovery settings, as someone whose recovery was not fully recognized.

Significance in the book

The book places these disputes within a wider landscape of secrecy and institutional gaps. When reporting on the Heroin epidemic reached Roanoke’s suburbs in 2012, many families were too ashamed to speak publicly; that year, parents also lacked the online groups that could connect them with others seeking treatment advice and support. The narrative contrasts this isolation with the growing willingness of families to use their names as reporting continued. Against that background, the conflict over Subutex shows how stigma could persist inside systems meant to help: families confronted addiction in private, while treatment providers, hospitals, and recovery groups differed over which forms of care they would accept. The medication’s significance lies in this double role—as a pregnancy treatment available through only limited channels, and as a test of whether care and recovery would include people whose treatment involved medication.