WISE — Tanessa Patterson crushed her Suboxone and snorted it through a straw. William Hicks mixed his with water in a spoon, heated it, drew it into a syringe and injected it into his arm. Misti Perry put two or three doses under her tongue and waited for them to dissolve.
They all felt the familiar numbness of the painkillers that years before had trapped them in the downward spiral of addiction.
Soon, they were hooked on “box” in much the same way they had been addicted to the drugs — Percocet, Opana, heroin — that made them eligible to take Suboxone in the first place.
Suboxone, a mixture of the synthetic opioid buprenorphine and the overdose reversal drug naloxone, has become the go-to drug in the U.S. for helping people to stop taking painkillers or heroin.
Virginia aims its substance abuse funding toward medication-assisted treatment, which is meant to combine a drug such as Suboxone with recurring counseling sessions. Studies suggest that addicts are less likely to relapse if the drug is used as part of a complete treatment program.
But recovering addicts, elected officials and law enforcement agents throughout the mountain towns near the southwestern tip of Virginia say the drug is more menace than miracle.
It’s the most-abused, most-sought-after street drug across this region, which has been flooded with the drug like nowhere else in the state.
Federal funding for drug courts requires localities to offer Suboxone in their treatment programs. Some judges have said they’d rather do without the funding — or even close their courts — rather than agree to using Suboxone.
“For maybe the rest of the country, Suboxone is a savior, but it’s actually been a plague in our county,” said Brian Patton, commonwealth’s attorney in Russell County. “We have an issue with the federal government saying you have to use this in our drug court.
“We don’t have a heroin problem. We don’t have an oxycodone problem anymore. We have a buprenorphine problem. It seems counterintuitive for us to give it to them.”
The total amount of buprenorphine distributed here more than doubled any other region of the state in 2014, according to a database from the U.S. Drug Enforcement Administration that tracks controlled substances.
Adjusted for population, this region and the northeastern tip of Tennessee that includes Johnson City, Bristol and Kingsport see the drug prescribed at eight times the national average and nine times the Virginia average.
Oxycodone and the painkiller epidemic struck harder in Wise and Russell counties and the other rural counties they border than anywhere else, so it makes some sense that the region would need more of the recovery drug.
But Suboxone hasn’t lived up to early expectations, officials across the region say. Instead, it too often is the new fuel that keeps people in active addiction and tears apart families.
Tiffany Sanders, the child protective services supervisor in Wise County, said her caseworkers deal with the consequences of Suboxone abuse nearly daily.
“It’s just destroying the families in their situation. The kids are often not able to stay in the homes because the drug problems are getting too bad,” Sanders said.
“What we find is they’re often neglected because the money goes towards their addiction. The utilities aren’t paid. The children aren’t receiving the care they need — basic needs — because there’s no money to get that.
“There’s been times children have been injured because you have caretakers under the influence who can’t adequately supervise their kids, caretakers driving around under the influence with their children in their car. It really does affect them in every degree.”
Sanders remembers hearing in training sessions how Suboxone wasn’t going to make people high and that patients eventually would be weaned altogether.
But day after day, she encounters people who have been injecting the drug or taking it for years with no endpoint in sight.
Some law enforcement leaders say drugs are to blame in at least 90 percent of all the crime they see, and more often than not, the drug being blamed is Suboxone.
The coal mining jobs that once drove the economy here mostly have evaporated, leaving people unemployed or working in jobs that pay less than half of a coal-mining wage.
Buprenorphine is most prescribed as the name-brand Suboxone in pills or strips that dissolve under the tongue. A version called Subutex, meant to be used almost exclusively by pregnant women, includes the synthetic opioid with none of the drug-blocking naloxone added.
In theory, the drug satiates the brain’s desire to take other opioids without providing a euphoric high and triggers instant sickness and withdrawal if a user tries to mix it with painkillers or heroin.
In reality, Suboxone sells for about $25 a pill here, and Subutex goes for double that. Those who have used them rank the high alongside the strongest painkillers they ever took — even similar to heroin.
“I got the same feeling I got when I was on Oxycontin. I got the same feeling. That narcotic high,” said Perry, 38, who fell back into a pattern of addiction five years ago when she started taking Suboxone strips.
“I didn’t have to take a whole Suboxone a day. One or two lines of that a day would rock your world.”
Perry’s addiction began with painkillers prescribed more than a decade ago after surgery. After almost a year of steady prescriptions, Perry’s body needed it. So when the doctors cut her off, she turned to friends and old acquaintances to buy pills.
The pills consumed her life. They cost her a marriage and custody of her children, and they landed her in jail.
Six months after her release in 2010, she called a local clinic about starting Suboxone. She’d remained clean and found a new job since her release, but she had a craving and picked up the phone. Within half an hour, she had a prescription.
“Once I started going to the clinic, everything started falling apart,” Perry said.
She lost her job. She started selling some of her drugs, because she couldn’t afford the $540 every month to see her doctor and fill her prescription.
She totaled her car because she nodded off while driving with prescription Suboxone and Xanax in her system. And she ended up back in jail for violating probation.
But for people dealing with the issue here, it often can seem like their stories never bubble to the surface in Richmond, across Virginia and in Washington.
Gov. Terry McAuliffe came to Wise County last month to visit the country’s largest free medical clinic. The previous month, he attended a discussion on the painkiller epidemic in nearby Abingdon alongside U.S. Secretary of Agriculture Tom Vilsack and the governor of Tennessee.
In a brief interview after the he visited the medical clinic, McAuliffe was quick to mention the volunteers who gave away free kits of the overdose revival drug naloxone.
He referred to the “opiate crisis” as a “huge issue.” But when the topic turned to Suboxone, McAuliffe had questions.
“Why do they do that instead of heroin, which is now so cheap?” McAuliffe asked a reporter, who then explained more about the drug. “You say it’s prescribed by the doctor?”
He suggested that more detailed questions should go to Bill Hazel, Virginia’s secretary of health.
Dr. Ben Carey, an addiction psychiatrist from Virginia Beach who volunteered at the clinic, said he was surprised by the stories about Suboxone here — stories he doesn’t hear in his corner of the state or at his California office.
“Theoretically this should be a much safer medicine for people who need analgesics,” Carey said. “But I’m hearing things since I’ve been here that are things I didn’t know, about people abusing Suboxone. ... In theory it works very well, but if it’s being abused, it’s being abused.”
Mellie Randall, director of the state’s Office of Substance Abuse Services, said in a February interview that “you cannot get high from Suboxone.”
The state added $11 million to its budget for battling the opiate epidemic, with the money expected to be matched by federal funding.
That money will go primarily toward incentives meant to increase access to medication-assisted treatment such as Suboxone. And federal regulations changed last month to increase the limit for doctors prescribing buprenorphine from 100 patients to 275.
Studies have shown that patients exposed to drug therapy such as Suboxone are more successful than those who try to quit cold turkey. One study last year found that people using Suboxone or methadone were 50 percent less likely to relapse.
But a key word that’s missing in too many settings is “assist,” which means the drugs should be used in tandem with intensive counseling, Hazel said.
“Suboxone by itself is not adequate treatment for substance abuse. It is safer than heroin. You’re not going to die from the overdose. People tend to function better when they’re on it, but I wouldn’t call that treatment,” Hazel said.
“(Paired with counseling), it does help a lot of people. The evidence is that it is very useful.”
Virginia law doesn’t require counseling alongside the prescription of Suboxone. And a state work group forming regulations on the drug’s use needs to make the requirements more stringent than they have in their latest draft, Hazel said. Counseling should be required, not strongly recommended, he said.
“We’re going to have to need to be careful with this,” Hazel said.
Hazel’s argument about the relative safety of Suboxone rings true to even some of its most vocal critics in the Virginia mountains.
There have been 47 reported overdoses that included buprenorphine in Virginia since 2007, most of them in the western part of the state. But prescription painkillers took 213 lives in Virginia during the first three months of this year, and heroin claimed an additional 103.
Circuit Judge Michael Moore, who oversees the drug court program in Russell County, doesn’t allow Suboxone in the program. He said two clinics in the county have good programs with oversight and counseling. But nothing stops addicts who get kicked out there from finding another clinic or making the hour drive into Tennessee to places where the prescriptions are easier to get, he said.
“I believe our Suboxone issue is different than anywhere else in the state. So when people from New York or Washington say you’re on the wrong side of this medication-assisted treatment issue, I say you don’t know where I live. ... It’s led to more crime and more families being displaced, more children in foster care, less people in the workforce,” Moore said.
“It’s such a tough issue. If my kid was shooting up oxy, I would try to get them on Suboxone. To be truly clean, I think, would be a higher goal.”
Even as Suboxone use has expanded across the state, overdose deaths haven’t shown any signs of decline. Drug overdoses, which have been the leading cause of accidental deaths in Virginia for the past two years, increased almost 30 percent in the first quarter of 2016 compared with the same time last year.
Perry spent 14 months in jail after her wreck, with distribution charges for selling Subutex and Xanax hanging over her.
The judge asked for one reason why he shouldn’t lock her up again. She told him that if he did, she’d just go back to getting high when she was released. She was asking not only for mercy but for help.
Perry spent 10 months assigned to drug court. She found a job, attended daily meetings and reported for drug tests.
Today, she has been clean for three years and is rebuilding her relationship with her children. Perry is adamantly opposed to Suboxone treatment, which she said seems to enrich doctors on the backs of poor, addicted patients.
“We’re not going to stop getting high until they stop writing it for us. I’m living proof that I don’t have to have it,” Perry said.
“I don’t want to ever feel like that again. You’re hustling every day for that. You’re not living a normal life when you’re on Suboxone. I don’t care what anybody says.”
But inside the Watauga Recovery Center in Abingdon, business development director Penny McElroy said doctors see patients every day who are thriving with the combination of Suboxone and counseling sessions offered there.
People who take Suboxone properly soon feel nothing from the drug, and its only effects are to stop them from going into withdrawal and kill their cravings for more dangerous opiates, she said.
“Is it the best thing that we’re doing? I don’t know. I don’t know what the answer is. But I know that without it, they’d all be dead. That’s the theory behind harm reduction: How do we keep these people alive long enough for that lightbulb to go off?” McElroy said.
“No wonder law enforcement has a problem against buprenorphine issues, because they see doctors prescribing it irresponsibly in places, and we try not to do that.”
McElroy said treatment is helping more people than it’s harming, but officials in law enforcement encounter only those who are struggling.
“Maybe we are seeing the worst of the worst, but I’ve seen enough of it in our community to know it’s killing our community,” said Chuck Slemp, the commonwealth’s attorney in Wise.
“They’re spending all their money on drugs rather than being able to support health care for their children. They can’t invest in their future and save up for retirement, because they’re living from addiction to addiction, from pill to pill. ... I think that we can do better and that we should do better.”