Big Island task force, doctor, former opioid addict plead case for Buprenorphine

Years ago Amanda DeGuair had her three children in the car on a Thursday night at sunset, one of the most beautiful times of the day in Kona on the Big Island’s west side. Her kids were happy, singing and laughing.

“It was a moment that any mother could ever ask for,” DeGuair said.

But she was in crisis. Her Vicodin supply was running low and would be gone by the weekend. Her brain raced, trying to figure out what to do. Should she look online or somewhere else? Every pharmacy had already caught on to her game of trying to fill prescriptions too early, so where could she go?

“The kids’ laughter and noise began to make me more angry because my mind was racing,” DeGuair said. “It was the moment that I knew that I was so wrapped in addiction because nothing else mattered. Those kids in the car, they didn’t matter.”

That was her “ah-ha” moment.

DeGuair recounted her traumatic ordeal with addiction on Friday via Zoom during a press conference hosted by the Hawai’i Island Fentanyl Task Force. Her story has a happy outcome and she hopes her experience will help others. 

DeGuair said she found a doctor on the Big Island who offered Suboxone, another name for Buprenorphine, or Bupe, which also goes by the brand names Subutex, Zubsolv and Sublocade.

The medication is approved by the U.S. Food and Drug Administration and eliminates acute and chronic opioid drug withdrawl and drug cravings. It also has 20 years of research and a documented record of effectiveness to its credit.

But it had federal government restrictions that severely limited its use. That changed on Dec. 29, 2022, when the U.S. Drug Enforcement Agency lifted all restrictions on Buprenorphine and urged medical providers around the country to prescribe the life-changing medication to appropriate patients with opioid use disorder.

Only 1 in 10 people who suffer from substance abuse receive evidence-based treatment, but that can change for opioid addicts, especially now when the state and nation are being overwhelmed by the opioid and fentanyl epidemics, said Dr. Kevin Kunz, who has lived and practiced medicine on the Big Island for 40 years.

Federal data shows there is a drug overdose death every 11 days on the Big Island, the overwhelming majority involving fentanyl, a highly potent and addictive synthetic opioid primarily used as an analgesic. Since 2018, fentanyl and its analogues are responsible for most drug overdose deaths in the United States, causing more than 71,000 deaths in 2021.

After 50 years of a war on drugs that has not been effective, with addiction mainly being viewed as primarily a criminal problem, Kunz said breaking the barriers to prescribing Buprenorphine as a part of opioid addiction treatment, like the disease that it is, ushers in a new era.

“The simple message is: Treatment works, it is available and recovery is possible,” he said.

It’s good news that any medical provider in Hawai‘i can now prescribe the medication, yet they need encouragement and support to do so. Kunz said most don’t know they can even offer medication for opioid addiction and many have fears about prescribing such treatment to addicts.

Even with the federal restrictions in place, medical providers were able to prescribe Buprenorphine since 2002 by meeting the requirements of the DATA-Waiver Program. However, less than two dozen of the island’s 500 providers and only a few hundred of the state’s 5,000 did.

“So our medical providers islandwide, we ask you to step up,” Kunz said.

Many already have, he added, and want to be part of the solution. Kunz, DeGuair and the task force now ask and encourage all medical providers to answer the same call. The new reality is that every licensed physician, nurse practitioner or physician’s assistant can be part of the solution now that restrictions have been lifted.

“Step up, do what only you can do, write a prescription for Buprenorphine for your appropriate patients with opioid use disorder,” Kunz said.

DeGuair is like many people addicted to opioids. It started with a doctor prescribing Vicodin or another opioid for legitimate reasons. In her case, it was for back problems while she was in her 20s. The addiction worsened 10 years later after she had a spinal fusion, which she felt justified taking the pills even more.

She had grown up in a home with good values, love and support. But she’d missed too many joyful moments and didn’t want to live like an addict anymore. During that car ride, she knew she needed help.

“The snowball effect was unbelievable,” DeGuair said.

She went home and had an honest conversation with her husband. She started looking for help, but the fear of withdrawl was at the top of her mind. She thought she’d have to suffer to get better “and I didn’t think I would survive that.”

That’s when she found the doctor who offered Suboxone. About 30 minutes after being administered the medication, DeGuair couldn’t believe how well she felt as she sat in the exam room.

“I felt more normal than I’d felt in 10 years,” she said. “I had walked into that office terrified, craving a pill, and my mind was racing, and within 30 minutes, I felt like the fight was over and there was hope again. I also didn’t feel ‘high.’ To not feel ‘high’ and to not be craving a pill was unbelievable.”

She’s had other medical issues since, including a rare brain condition, and deals with chronic pain daily. Had it not been for Buprenorphine, immersing herself in a recovery group and living life with the support of that fellowship, she likely would have started taking opioids again. Instead, she’s now 18 years clean.

“Subox takes care of my addiction and my chronic pain and allows me to live a life in recovery,” DeGuair said. “I know, had it not been for Suboxone, I would not be standing here today and my children would be without a mother.”

There are two ways to reduce demand for addictive drugs such as opioids and fentanyl: reduce the supply and reduce the demand. One key way to reduce demand is by using Buprenorphine as part of treating opioid addiction, Kunz said.

The gold standard of treatment combines medication and support such as counseling or participating in a help group such as Narcotics Anonymous, he said.

Buprenorphine can stabilize the brain disease of addiction, allowing counseling or group participation to be more effective. Kunz said it’s hard to load new brain software for living if the brain’s hardware is out of order.

“We cannot let this medication sit in warehouses and in unopened pharmacy boxes while our children, our cousins, our neighbors die,” he said. “Let’s treat opioid use disorder like we treat other diseases. Let’s start using the standard of care, and that includes this medication.”

The message also went out to government officials, hospitals, insurance companies, pharmacies, treatment programs, psychologists, social workers, therapists, counselors and family members of those suffering from or who have been lost to addiction to get onboard and support the use of Buprenorphine as part of treating opioid use disorder.

“To those of you struggling with opioid addiction: We know you are a good person with a bad disease. We know it has kidnapped you. It has brought you to places and to feelings unimaginable,” Kunz said. “You may think you are alone or that very few without this condition could understand your situation. We understand it has hurt your sense of self. We understand it has hurt your relations with all who you love and all who love you. We understand that it has crashed your dreams and your hopes. It has changed your life for the worst.”

Kunz wants addicts to know that treatment is available and it works.

“Don’t give up,” he said. “Never give up.”

It wasn’t easy for DeGuair to open up about her addiction, but she’s proof that there is a way out. By sharing her story and being part of the coalition fighting against the opioid crisis, she hopes even just one person can feel comfortable enough to reach out and get help. She also wants those who are in a position to help understand people who suffer from addiction are not bad people.

“We are people who have a disease and we need help,” she said. “Not judgement or criticism. Recovery and a normal life is possible.”

For more information about Buprenorphine, opioid use disorder and the ongoing efforts to combat the opioid and fentanyl epidemics, contact Hawai‘i Island Fentanyl Task Force leader Dr. Kimo Alameda at 808-345-9280.