Subutex – where heroin addiction therapy meets high profit trafficking


Prescribed over the last 30 years, Subutex, the first heroin replacement treatment in France, has saved thousands of lives. But in recent years, dealers have taken hold of it and are supplying international drug rings.

On 30 January 2015, Aurore Gros-Coissy was condemned to 20 years in prison for drug trafficking in Mauritius.

The 27-year-old French woman was stopped at Port Louis airport in Mauritius in the summer 2011.

Her suitcases contained 1,680 Subutex tablets, a heroin replacement treatment authorised in France but prohibited on the island of Mauritius.

Released in 1995, Subutex, the main ingredient of which is buprenorphine, is the most widely used opioid replacement therapy (ORT) in metropolitan France.

In 2012, 105,000 heroin addicts tried to kick the habit by replacing their daily shots with these pills prescribed by general practitioners and reimbursed by the public health insurance fund.

Whilst this replacement therapy has undeniably helped to prevent AIDS transmission and thousands of overdoses, it is estimated that one prescription in four is currently being diverted towards small and large-scale trafficking.

“Its wide availability linked to the framework for its prescription and the possibility of injecting it has promoted its misuse,” reveals a study by the French drug and drug addiction observatory Observatoire Français des Drogues et des Toxicomanies (OFDT).

Unlike methadone, Subutex, a treatment used by 50,000 people and tightly controlled, is not registered on the list of narcotic drugs in France.


Seven doctors and a pharmacist investigated

Over the last ten years or so, to reduce the trafficking, the public health insurance fund has been trying to tighten the controls in place.

It requires general practitioners to indicate the name of the pharmacist on the prescription, the aim being to stop patients doing the rounds of various dispensaries with the same prescription.

A control and monitoring plan has also been set up targeting the people prescribed over 32 mg of HDB (high dose buprenorphine) a day.

But that does not stop prescriptions from being stolen or health insurance cards from being borrowed.

For a number of years, the public health insurance fund has also been monitoring health professionals. “This aim is keep a check on outrageous ORT billings and to expose networks between prescribers, insurees and pharmacists.”

A number of legal cases arose, as a result, in 2013, in Moselle, known as France’s number one department in terms of Subutex sales.

Seven doctors and a pharmacist were placed under investigation, on suspicion of supplying international resale networks.

For Isabelle Adenot, president of the National Council of the College of Pharmacists, “the problem is that prescribers and pharmacists are placed under enormous pressure and find it hard to say no. This leads to transgressions. The case of a colleague in Toulouse comes to mind. She was the victim of regular assaults in her pharmacy, and having received no help from the police, she finally gave up.”


“We don’t really know who to turn to”

Eighteen months ago, RB-Indivior, the laboratory producing and selling Subutex (seven million boxes in 2014), also raised the alarm.

It even went as far as visiting the authorities concerned: the Health Ministry, the Agency for the Safety of Health Products, members of parliament, senators, etc. The result was rather disappointing.

“We don’t really know who to turn to. One person sends us to another,” says one of the lab members. There has to be stronger political will for things to progress.”

Clément Vivès, police superintendent and head of the anti-drug unit Mission de lutte anti-drogue (Milad), ensures that there has never been any question of “fighting against cocaine at the expense of Subutex”.

In 2014, the French police dismantled 75 trafficking rings selling Subutex alone.

Whilst the street dealing operations, involving people selling part of their treatment, are relatively easy to dismantle, the same cannot be said of the organised trafficking rings supplying international networks.

“France is the country that consumes the most buprenorphine, as other countries have largely opted for methadone. The most alarming thing is that part of the traffic goes to countries where the population has less access to this medication,” says one of the heads of the laboratory.

Boxes of Subutex bought in France are resold in Mauritius, Scandinavia, North Africa, eastern Europe and even Australia. Depending on the country, the price is between €20 and €80 (US$22 and US$88) per tablet.

As the laboratory points out, it is a very profitable business, given that a box of seven pills is sold, depending on the dose, for between €2 and €16 (US$2 and US$17.50), and 65 per cent is reimbursed by the health insurance fund.

“Drug trafficking is being financed by public money,” says the laboratory.

In Lebanon, for example, where replacement therapies have not yet been legalised, a drug prevention association has, since 2005, been buying boxes of Subutex illegally.

“Around a hundred patients are benefitting from these treatments. They are the ones who pay but the problem is that the demand is too high. There are many heroin addicts and not enough replacement therapies, and some people don’t understand why we can’t give them it,” explained one of the association’s psychiatrists, anonymously, in 2011.

Although the trafficking is difficult to eradicate, homogenising the treatments at European level could handicap the traffickers. That is the view held by the Indivior laboratory.

“The lack of European convergence remains a problem, but there needs to be more regulation and training of doctors in France,” says a spokesperson from Indivior, anonymously.

“How can a doctor provide real patient care when dealing with 300 drug addicts? At this stage, all they are doing is renewing prescriptions.”


This article has been translated from French.