The perils of illegalizing Subutex

I wrote a reply to three TODAY articles on Subutex dated 11 August. Reproduced as follows.

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I refer to the three articles, “Its promise distorted, Subutex fades on a low”, “Subutex fix for addicts available in JB”, and “Doctors investigated for lax prescription” which revolves around classifying Subutex as a “Class A Controlled Drug, alongside the likes of cocaine, morphine and heroin.”

While I might not be a trained physician, possible problems may arose due to the new legislation.

Although the drug could be abused by heroin addicts undergoing treatment, classifying Subutex as a Class A drug to an already currently long list will not necessarily solve this problem.

Classifying it as a serious drug will only drive addicts or users into sourcing for subutex in the black market; inadvertently creating more criminals. In addition, by classifying subutex as a Class A drug, we need to question if its heavy handed penalties, which includes canning, are overly harsh or improper.

In addition, there will also be problems when administrating the new program. As patients need to take the medicine in the presence of their doctors, both parties will have to work their schedules to ensure they are both physically available. The right dosage, which needs to be prescribed every time, will create administrative nightmares for the clinics. Doctors will fear about prescribing the right dosage or even being entrapped by narcotics officers posing undercover as heroin addicts.

As it is, as many as 10 doctors are already being investigated by the Singapore Medical Council (SMC) for being lax while dispensing Subutex to heroin addicts. By illegalizing subutex, it will only create more stigma and force more doctors to stop prescribing the treatment to needy patients. It may even force addicts already in the current subutex program to turn back to heroin.

According to the US Food and Drug Administration website, Center for Drug Evaluation and Research, http://www.fda.gov/cder/drug/infopage/subutex_suboxone/subutex-qa.htm, subutex is currently prescribed by trained doctors and can be used at home prescription as it is less susceptible to abuse.

As FDA is a reputable regulatory body, we need to question if there is a need for the Singapore authorities to be overtly cautious by classifying it as a Class A drug and to impose extreme strict regulations on how it is being prescribed.