Given addiction’s tendency to ravage a person’s life, it’s not clear how many of these are simply one-off misunderstandings between a busy doctor and a desperate patient. But something clearly isn’t working. Though opioid deaths have declined in some parts of New Jersey, in several counties—including Mercer, which surrounds Trenton—the death toll continues to climb. Meanwhile, more than three-quarters of people with drug addictions in New Jersey go untreated. From January 2017 to January 2018, overdose deaths in New Jersey rose by 21 percent, compared with just 7 percent nationally.
Read: Why can’t addicts just quit?
The stories of the people I met in Trenton who are dealing with addiction reflect the many ways heroin users not only in New Jersey, but in every state, can tumble through the cracks of the American medical system. Had a doctor placed the one-eyed woman on a higher dose of Suboxone than the one she claimed she was given, the medication might have worked. And the referrals to rehab programs her companion said he received from his doctors were not necessary, because any doctor can get licensed to prescribe Suboxone. Unlike the better-known methadone, Suboxone does not have to be prescribed at a special, carefully monitored facility.
For the past two years, the number of Americans dying of drug overdoses each year have outnumbered those who died in the entire Vietnam War. But there’s an overwhelming consensus among experts on how to bring deaths down: Opioid addicts should be treated as soon as possible, and with medication. When France allowed any of its primary-care doctors to prescribe buprenorphine, which is a form of Suboxone, heroin-overdose deaths plummeted by 79 percent in four years.
In almost every U.S. state, meanwhile, doctors, patients, and experts describe a situation in which too few doctors offer Suboxone cheaply or for free. Instead, addicted patients tend to be funneled into rehab programs, many of which are pricey, unavailable, or ineffective. “Most of the general public thinks you should go to rehab if you have opioid addiction,” says Adam Bisaga, a professor of psychiatry at the Columbia University Medical Center. “But 70 percent of the success is giving [patients] the medication.” Adding things like housing and psychotherapy can bring the success rate up, but, Basiga adds, “the core of it is really medication.”
He puts it this way: “If you have diabetes, you need insulin. Without insulin, you will perish.” Without easy access to Suboxone and other medications, people addicted to heroin continue to perish at a terrifying rate.
The grim overdose statistics in New Jersey are in part a matter of geography: The state is wedged between the drug-trafficking hubs of New York and Philadelphia, attached to a port, and webbed with well-developed organized-crime networks. “I’ve had patients tell me, ‘I had to go out of state, because no matter where I go in New Jersey, it’s so easy [to get drugs],’” said Rachael Evans, a doctor at the Henry J. Austin primary-care clinic in Trenton.