RAND Research: Fighting the Opioid Crisis

Paul Yabor spent enough time with a needle in his arm to shake his head at the simple notion of ever really hitting rock bottom. He prefers to say he had a moment of sanity one afternoon in a Philadelphia flophouse, surrounded by the hollow-eyed faces of fellow heroin addicts.

He was 51 years old, with the beaten body of a lifelong hard-drug user. "When you're younger, you know you're going to live forever," he thought. "I can no longer live with that illusion."

His salvation came in the form of a little orange tablet that he could hold under his tongue to block the gnawing cravings of withdrawal. It's called buprenorphine -- "bupe" on the street -- and when it was approved in 2002 for widespread use against heroin and other opioid drugs, experts predicted it would change the face of addiction medicine.

Instead, its uptake as a recovery drug has often been painstakingly slow, even as the abuse of heroin and prescription painkillers became a national crisis. A recent series of reports from the RAND Corp., a nonprofit, nonpartisan research organization, found that the number of doctors certified to prescribe the drug still lags far behind the need in large areas of the country. In part, that reflects the double edge of buprenorphine, a wonder addiction drug that can itself become a drug of addiction.

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