“What does the Hippocratic Oath say?” he asks me. Before I can answer he does: “It says that if you can provide them something to make them feel better, you provide it.”
Curran was an early adopter of buprenorphine, a medication for the treatment of opiate addiction that, unlike methadone, was approved for use in a general office setting. A doctor can take an eight-hour course and apply to get a waiver to prescribe buprenorphine, and, for the first time ever, could treat someone suffering with addiction. Instead of waiting in line at a clinic each morning for a dose, patients could visit their doctors monthly, receive a prescription, and medicate like anyone else.
The difference between the drugs is chemical—methadone is a full opiate agonist, the way heroin is. It binds to your opiate receptors and produces euphoria without any ceiling, until overdose. Buprenorphine is a partial agonist: it binds much longer and tighter to the opiate receptors than methadone (blocking other opiates from binding) and it stimulates them, but only to a ceiling of 47 percent stimulation. So, those consistently using buprenorphine experience a limited or nonexistent high, and are unable to feel the effects of any other opiate. In the US, buprenorphine is most commonly combined with naloxone, an anti-overdose drug, creating a medication (usually called Suboxone, though there are other brands) that’s extremely difficult to abuse: it produces withdrawal symptoms the moment someone attempts to use it intravenously.