#14: Fentanyl, Heroin, Suboxone, Methadone.

The View from the Street.

A few years ago, I co-wrote a book on opium. While I gathered a lot of information in the process, I’ve since learned I was clueless in terms of how the use of (and rehab from) opiates really plays out on the street.

For example, I used to think either you’re using or trying to get clean. Either you’re doing medication-assisted treatment (MAT—typically Suboxone or methadone) or you’re back on drugs.

It’s way more complicated than that. Just as you might snitch a cigarette when you’re trying to quit, you might take a sniff of an opioid while you’re trying to get clean—except, of course, you’re dealing with something far more addictive.

Since Kenny didn’t quite answer my questions about this [see last post], I asked Suzanne and Jake for details.

Suzanne’s hardly ever used. Jake says he’s about 100 days clean with Suboxone, which he buys for $28 at the drugstore—for head-shaking reasons explained below. I have good reason to believe both are telling me the truth about their past use of opioids.

NOTE: I want to emphasize that the following is a lightly edited transcription of what one couple on the street told me about addiction, addictive behavior, and medication-assisted treatment. These posts are about the everyday words and worlds of my friends, not the “issues” they raise for some people. So, while this is how they see things, some of the information might not be either medically or scientifically accurate. It’s important to remember that everybody’s experience is different. So please don’t hesitate to comment to correct any facts they or I have wrong.

Also, since they finish each other’s sentences, I usually just indicate them by both initials.

S/J: Some people on Suboxone go back and forth. They go on but then they want a hit, so they do a sniff. It depends.¹

D: But I hear that some people sell their Suboxone script as soon as they get it.

S/J: Some they do. That happens.

D: Who’s buying it? Who would anyone buy Suboxone on the street when they could get it from the Clinic, or a pharmacy with a prescription.

S/J: People who don’t have their scripts yet or aren’t on Medicaid or just haven’t made it to the Clinic for another piss test or appointment.

D: OK, if a kid who’d never done drugs buys a bunch of Suboxone or something—maybe they think it’s an edible or speed—would they get high?

S/J: No, you don’t high.

D: You really don’t get high? You mean because naloxone [Narcan’s] in it? And it blocks the opioid? Really? No one’s doing it as a cheap way to get a little high?

S/J: No. I’ve never heard of that. [They later clarified that the drug Subutex contains only buprenorphine, which lowers dependence on opioids, but doesn’t have the naloxone which blocks the action of them.]

D: OK, so why do people do methadone instead of Suboxone? I thought it had to do with what drug you were addicted to.

S/J: No. Suboxone has a blocker so you have to detox, methadone you don’t have to detox. You don’t have wait the three days.² You can go immediately to methadone because technically it’s another opiate and doesn’t have a blocker so you don’t get sick. But once you’re on Suboxone you can’t really get high right away off the dope. 

D: But methadone you can get high on?

S/J: You gotta do a lot. We knew this chick who tried to buy 4 or 5 doses in a day. Like 1000 mg just get high to ‘cause she had to piss clean but wanted to stay high.³ 

D: How much do you [Jake] pay for Suboxone?

S/J: Usually about 28 bucks for a week. 

D: Isn’t it like free at the Clinic?

S/J: If you have insurance or Medicaid. Otherwise it’s probably 12 - 15 bucks a day. 

D: You’re saying at least 80 bucks a week at the Clinic and 28 at the drug store with your Rx?

S/J: About.

D: And you don’t have insurance?

J: Trying, brother. S: He is trying. Me, I fell off my dad’s insurance and haven’t been able to get on Medicaid yet. He didn’t receive some mail so he has to reapply. It’s nuts.

D: Huh. So, I’m not an idiot. It is nuts. 

S/J: Yup. No matter what, hands down it should be free. 

D: Sure. If we’re serious about dealing with it. OK, so Fentanyl is like 10 or 15 dollars? And most people need 2 or 3 hits a day? So it’d cost a couple of hundred a week to get through the day using fentanyl.

S/J: Yeah, you’re about right. Or more. Depends on tolerance and how much you need. 

D: But, if you’re serious about quitting, it “just” costs you like $30 for Suboxone for the week at the drugstore if you can get a script? I’m asking these questions ‘cause it’s so nonsensical. I just assumed if you didn’t have the money or insurance they’d still give it to you.

S/J: Yeah. One way or another, you should be able to go to the Clinic and get it. 

D: I kinda thought it was like that.

S/J: Nope. It’s cheaper at the drugstore. Or on the street. But then you don’t know for sure what you’re getting.

D: Jeez.

1. This is very different for everyone. Some people wouldn’t get high because of the naloxone (Narcan) in the Suboxone. It depends on how much of the opioid they have been using, how much Suboxone they are taking, their size/weight, when their last dose was, how they metabolize substances, etc.

2. I’ve seen different numbers for how long you have to wait to begin Suboxone after using an opioid—from 12 hours to 3 days. I suppose it has to do with the same factors. Otherwise, the Suboxone would send you into rapid withdrawal. But stopping your opioid cold turkey would do the same thing. Again, I’m just relating what I’ve been told on the street and read online. If you need to know how this might relate to your situation, you really have to talk to a professional.

3. I don’t get how this works. Seems like you’d have more opioids in your system. I’ll ask next time I see them.