MILWAUKEE — Just walking up to a pharmacy window is enough to send Tina Kasten’s brain into overdrive.

“You freak out,” Kasten said, using words like “anxiety” and “stress” to describe how she feels when she tries to pick up her prescription.

Kasten, who lives in Manitowoc, takes Suboxone as part of her treatment for heroin addiction. She said she has experienced delays in filling her prescription a half-dozen times over the last year.

Thirteen other patients described similar experiences in Wisconsin to the FOX6 Investigators. They did not want to be identified, citing the stigma of addiction.

Doctors, counselors, and pharmacists in Wisconsin say efforts to fight opioid addiction are inadvertently making it difficult to get addiction treatment.

The ‘devil and the angel’

Suboxone is a medication that contains buprenorphine and naloxone. It is used in combination with counseling and behavioral therapy to treat opioid addiction.

Drugs like Suboxone work by partially acting like an opioid and binding to the same receptors in the brain.

“That’s what allows it to be so useful in addiction treatment,” Dr. Selahattin Kurter said. Kurter is the executive director of West Grove Clinic, which provides mental health and addiction treatment.

“[Suboxone] doesn’t give you the euphoria associated with opiates,” Kurter continued. “But it protects you from the cravings and withdrawals.”

Kurter is Tina Kasten’s doctor. Kasten credits the combination of Suboxone and therapy for her addiction recovery.

“I didn’t have the cravings all the time,” Kasten said. “It wasn’t constantly on my mind like, ‘OK, am I going to use? Am I not? Am I going to use? Don’t do it. Oh, but you should.’ It’s like the devil and the angel and Suboxone tells them to be quiet and go home.”

“I put the work in to deal with the emotions and deal with everything that led me to be a drug addict,” Kasten added. “The Suboxone didn’t do that work. I did. But the Suboxone helped.”

But there is a danger patients could abuse Suboxone or illegally sell it for its opioid-like qualities; it is a Schedule III drug, which the U.S. Drug Enforcement Administration says could lead to “moderate or low physical dependence or high psychological dependence” if abused.

“It can be used to help somebody get rid of the addiction to opiates, it itself can be addictive,” Dr. Hashim Zaibak, pharmacist and CEO of Hayat Pharmacy said. “So the pharmacist has to balance between the risk and benefits of Suboxone and that can be a challenge.”

Red flags

As the opioid crisis spread, there was a push for Medicated-Assisted Treatment (MAT): The combination of drugs like Suboxone and therapy.

The Director of Wisconsin’s Prescription Drug Monitoring Program says the state has seen a 66% increase in Suboxone dispensations since 2016. A federal rule change expanded the number of patients that providers can treat with MAT, and gave more providers the ability to use MAT.

The Department of Health Services has also been facilitating training to give health providers the ability to prescribe buprenorphine, the active ingredient in Suboxone. Data from the Department of Health Services says one year ago, there were 850 available buprenorphine prescribers in Wisconsin; now, there are 1,117.

While these measures made it easier to have initial access to drugs like Suboxone, other measures made it more difficult to take the medication home.

To curb opioid abuse, pharmacists are guided to turn patients away if there are too many “red flags.” Examples  include cash payments, returning too frequently for refills, signs of doctor shopping, family members receiving prescriptions from the same prescriber, and driving long distances to fill prescriptions.

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