Suboxone, a prescription medication used to treat opioid addiction, increasingly is found at the scenes of overdose victims and in toxicology reports, say professionals at the Regional Forensic Center in Knox County.
The medication is not normally deadly on its own, but it can be when combined with other opioids or illicit substances, said Knox County Medical Examiner Dr. Darinka Mileusnic-Polchan.
The reason has to do with buprenorphine, one of the two primary components of Suboxone. Buprenorphine is a partial-agonist opioid and is used to help those addicted to opioids defer the worst of withdrawal symptoms.
Added on top of another drug, however, and it can tip a user toward overdose.
Some deaths already have been attributed to it, Mileusnic-Polchan said.
She said since last year, it increasingly has been common for investigators from the Regional Forensic Center to discover buprenorphine in toxicology tests of overdose victims, and also to find physical evidence of Suboxone use at the scene.
John Lott, a senior director at the regional center, said these cases present a “conundrum” for advocates of Suboxone and other medication-assisted therapies.
“The expectation is that you’re not taking any other opioid,” he said.
The problem is compounded by the legal use of opioids in the medical field. Drugs like morphine and oxycodone often are given to patients in acute pain, such as car accident victims.
However, hospitals might do so without realizing that the patient already is on Suboxone.
“We’ve had cases like that,” Mileusnic-Polchan said.
Prescriptions for Suboxone are not always included in the Controlled Substance Monitoring Database, or CSMD — a system created by Tennessee in 2016 to allow doctors to track opioid prescriptions.
Opioid addiction is a serious problem in Tennessee. And it is shifting. Because of recent measures taken by lawmakers and health care professionals to limit the availability of opioid medications like oxycodone, many individuals suffering from addiction are turning to harder, cheaper and more readily available drugs like heroin and fentanyl analogues.
The death toll is growing larger every year.
In 2016, the latest year for which data from the Centers for Disease Control and Prevention is certified, 1,861 Tennesseans died from drug overdoses, the overwhelming majority of which were related to opioids.
Preliminary figures for 2017 indicate that 1,847 more died that year, marking a more than 10 percent increase. Nationwide, 72,000 Americans overdosed.
Statistics from the Regional Forensic Center for 2017 deaths will be available at the beginning of September. Although the center performs autopsies for surrounding counties, including Blount County, those cases will not be included in the data.
Problems in one county, however, likely are to be present in the next county, Mileusnic and Lott said.
Blount County’s medical examiner, Robert Potter, is not employed by the county, and there is no forensic center. Potter, who works at the Blount Pathologies lab in Blount Memorial Hospital, did not respond to several messages.
How best to treat the growing opioid crisis is an open question in the medical community, and whether Suboxone will be seen as a true long-term benefit remains to be seen.
“It really is unclear,” Mileusnic-Polchan said. “It’s complicated.”