This Tiny Implant May Disrupt America’s Opioid Addiction Problem
Think of it like a microscopic IV with no physical traces.
Illustration courtesy Probuphine
It was only after Sarah Wilson's parents accused her husband of stealing from them that she came clean about her opioid problem. The Jacksonville mother of four was hit by a drunk driver in 2008, leaving her with significant nerve damage in her back. Wilson worked as a police dispatcher and her insurance was good and publicly funded, but eventually she had to give up her career as the pain became too much for her to bear.
"It got to the point where my legs were giving out from under me," Wilson said. "I couldn't feel my hands. I lost my health insurance and eventually my doctor told me I couldn't afford treatments anymore, but I could afford narcotic painkillers."
Wilson's doctors prescribed her hydrocodone, a widely-used opioid pain medication, but as her tolerance grew, so did the order. Eventually her doctor was prescribing her the maximum legal dosage he could, and before long she developed a dependency.
"My own personal beliefs on people that suffered from addiction wasn't the greatest," Wilson told me. "I always thought, 'Oh, they should just put it down,' even though I had relatives that suffered from the disease. I was jaded about it."
Wilson diverted family funds to source drugs from more questionable corners, and at the peak of her addiction was taking 30 pills a day. Occasionally she'd try to rally, but like so many others in chronic pain there was only so much she could do. She recognized she'd become dependent, "but I was also hurting," she said. "Somedays I would wake up and say, 'Okay, I'm not going to take anything.' But then I'd have chills, I'd be vomiting, and I'd be in pain as well."
Eventually the Wilsons lost their home, forcing Sarah to move back in with her parents. At her lowest, she pawned off some of her mother's jewelry, which proved to be the final straw.
"When they accused [my husband] I was immediately like, 'No, it's not him. It was me, and this is why,'" she explained. "Who wants to believe it's their own child?"
Wilson, finally, took her family's advice and sought medical attention. Her doctors prescribed her Buprenorphine, a common semisynthetic opioid medication specifically designed to mollify opioid dependency. Every night Wilson put a tablet under her tongue, let it dissolve, and woke up to live another day. She's still in pain, but said she hasn't relapsed in almost four years since she got clean. Wilson told me that she intends to take anti-opioid medicine for the rest of her life, which is why she signed up for a clinical trial of a new product called Probuphine.
Probuphine isn't a drug as much as it's a novel way to administer treatment. In a 15-minute in-office visit, a doctor will insert four white, tube-like flexible implants into a patient's upper arm. Those implants are each the size of a matchstick and will continuously release a low dose of medication into the bloodstream and up to the brain. The drug will then fasten onto the same neural receptors triggered by heroin or prescription narcotic painkiller use, effectively curbing one's desire to get high. The implants will be replaced every six months. Think of it like a microscopic IV with no physical traces. The convenience is the primary perk—Probuphine patients don't have to worry about remembering their pills or refilling their prescriptions. But Wilson was drawn to its safety.
"I was 100 percent onboard because I'm a mom. Even though the drug itself is a life-saver for me and my family, we had it in a locked safe, because it scares me having it in the house," she said. "Like, if one of my kids got a hold of it, or if our house got broken into and somebody else got a hold of it, [with the implant] I don't have to worry about that anymore."
Probuphine can only be prescribed to those who've already successfully been on traditional Buprenorphine treatment in order to make sure patients aren't rushed to mismatched treatment. But the promise is still intriguing. Probuphine was featured in a double-blind, double-dummy phase III clinical trial earlier this year. The trials were overseen by Dr. Richard Rosenthal, a psychiatrist at New York's Mt. Sinai Hospital, who told CBS Evening News that what excites him most about Probuphine is that it's "a new weapon in our armamentarium to fight drug addiction."
"The risk of relapse is reduced," he added, "because you're not going to miss a dose."
Braeburn Pharmaceuticals, the company that manufactures Probuphine, reported "significant superiority for the implant versus the oral formulation" during the trials. The Food and Drug Administration approved the drug in May.
Behshad Sheldon, CEO of Braeburn Pharmaceuticals, told me implant-based medicine could be applied to any chronic condition that requires daily maintenance.
"We have heard of people who use Probuphine to protect them from their future selves," Sheldon said. "They might think, 'Right now I'm really determined to not use, but in three days I might slip up. It's easier if I had to make the choice to take the medicine to not take it.' There are people who use this medication who like that idea."
Anyone who's ever been on long-term medication knows how difficult it can be to stay disciplined between side effects, scheduling, and the loose, wax-and-wane bell curve of the therapeutic duration. But what if, someday, the very concept of a daily prescription becomes a thing of the past? That was the primary perk for another recovering opioid addict who was involved in the Probuphine trials.
"I felt fine, honestly," said the patient, a firefighter who requested anonymity. "I just felt normal. Sometimes I'd take my [medication] early one morning and then not so much the following day, but with the Probuphine I just felt right all the time."
"I do think this is the wave of the future," Sheldon said. "A lot pharma companies are looking [at implants] for things even beyond mental health like long-term infections. There's even one looking at an implant for diabetes."
But others aren't as convinced about the treatment's efficacy and safety. Diana Zuckerman is a former post-doctoral fellow at Yale Medical School and currently serves as the president of the Washington, DC-based think tank The National Center of Health Research, which recently noted gaps in Probuphine's trials.
"I think the big issue is the transition," said Zuckerman, who was not involved with the trials. "People are going to go from taking pills to using this implant. The implant doesn't work immediately. It takes a while for it to work and settle into the level that it's supposed to be. And during that time the person is still going to be taking pills, and that becomes a vulnerable time. How many pills should that person take before the implant is really working, and should they continue to take pills after it's working?"
"It takes a while for it to work and settle into the level that it's supposed to be. And during that time the person is still going to be taking pills"
According to Zuckerman, medical companies rarely have the motivation to do research once a treatment has been approved by the FDA. At the end of the day, her main concern is that a subdermal implant like Probuphine treats opioid addicts with more opioids.
"Obviously we've got a huge problem in this country, and we've got to find a way, and I think step number one is to prevent people from becoming addicted by having doctors not prescribe [opioids] so loosely," Zuckerman said. "But step number two is finding out a better way to help people once they're addicted. We don't seem to have a good handle on that."
The National Institute on Drug Abuse estimates that some 2.1 million Americans are dependent on prescription opioids like Percocet and Oxycontin. The Center for Disease Control has called it an epidemic. Like so many other addicts, Sarah Wilson's story isn't about someone being reckless. She's a mother who got the raw end of a deal.
"The doctor was between a rock and a hard place," Wilson said, describing the moment she was first prescribed painkillers. "I had no health insurance, I didn't qualify for state-funded health insurance, and I was hurting. He had an oath to do no harm, and he was helping me to not hurt."
It can be easy to categorize the US opioid epidemic in a seedy, faraway place where good morals and prudence will always conquer. But opioid dependency finds everyday people. Probuphine is making the disease easier for some of those addicts to live with, but treatment, which costs an estimated $6000 per six-month session, is only one part of recovery.
"Going through this experience has really opened my eyes. I hate to say that I needed to be knocked down a notch or two, but I definitely have a greater appreciation for people who are battling it," said Wilson. "Especially people who've been battling it for 15 or 20 years. This technology is so new, I can't imagine what it'd be like to be battling it for that long. It's just amazing how your perception of a situation can be changed once you've been through it."
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