Recent press reports from Straits Times has revealed that there may be as many as 3800 Subutex abusers in Singapore. For the 31 general practice clinics allowed to dispense Subutex, they have dispensed a total of 580,000 pills since the Health Ministry started tracking prescriptions in November 2005. In contrast, five public hospitals and two specialist clinics sold only 20,000 pills at that time.

According to Central Narcotis Bureau, these GPs were making a profit of $15 for one 8 mg pill,which means that in less than 10 months, these clinics have made a profit of around $8.7 million between them.  Some of the most prolific Subutex dispensing clinics sold more than 50,000 pills. 

Health Ministry Mr Khaw Boon Wan said one of the most prolific Subutex dispensing GP clinics was in his constituency in Sembawang, and Subutex abusers would congregrate at a vacant HDB block near the clinic to inject the drug. Residents in the area would call the police to complain at least once a week, but as the drug was not illegal, there was nothing they could do.  An earlier New Paper report said that public complaints to the CNB rose to a high of 31 in the month of Nov last year.

According to a CNB news release, investigation into the reports on the abuse of Subutex discovered that the drug supply came primarily from licit sources. There was no known illicit supply of Subutex as there was no demand for it. Subutex could be lawfully obtained from GPs. As Subutex is a licensed drug under the Medicines Act, CNB could not take action against the abusers of Subutex. Any effort to make Subutex a controlled drug must be accompanied by measures to tightly control its administration as a treatment regimen. The alternative is to completely regulate and prohibit the distribution, possession and consumption of Subutex 

Mr Khaw reflected on how Subutex became a substitute for heroin after addicts learnt to inject it with a cocktail of other drugs. The only correct way to take it is to dissolve the tablet under the tongue.

"If we had known all these then I suppose we wouldn't have introduced it," he conceded. But Mr Khaw saw it as a learning experience.

"Therefore I prefer a conservative approach to introduction of new drugs or new devices or new technologies," said Mr Khaw.

The abuse of Subutex appears to have cut short its undoubted effectiveness in countering heroin addiction.

Approved for use in over 40 countries worldwide, Subutex has a success rate of 80 to 90 per cent based on clinical studies carried out in Malaysia and the United States — success was defined as patients remaining heroin-free. Its manufacturer, Schering-Plough, said it was not aware of any death in Singapore from injection of Subutex alone.

Its medical director in Singapore and Malaysia, Dr Thomas Korompis, said that Schering-Plough had worked with the Singapore Government over the past several years to help those prescribing Subutex to recognise signs of abuse in patients.

A year long IMH survey of 120 Subutex users found that 40% of them had started on the drug to kick their heroin habit and became hooked. As much as 99% abused the drug daily and half of them injected it as part of a cocktail. Many of them injected the drug by crushing it and mixing it in water with other drugs like Dormicum, giving rise to a previously non-existent needle culture here and adding to the risk of diesases such as HIV/Aids.  HSA has reported 22 deaths between Sep 2003 and August 2005, caused by a combination of Subutex and other drugs.  TTSH took in 8 patient with Subutex related conditions between March and Aug 2005.One patient had to have a leg amputated above the knee after developing gangrene as a result of his habit.

Following a review of the use of Subutex  as a drug to treat opiate dependence, the Ministry of Home Affairs (MHA) and the Ministry of Health has classified Subutex into a Class A controlled drug wef 14 Aug 2006.

As the dateline draw near before control steps in, Subutex users are now flocking to some authorized clinics for the drug.  At a clinic in Marsiling, News 8 saw 6 patients visiting the clinics within the span of 20 mins in the afternoon. And within leaving the clinic, a few of the patients were seen selling white pills to others.

The full MOH press release can be read here

Sources: Straits Times, New Paper, Todayonline

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