Why Has America Ignored Its Best Addiction Treatment?

Mallory Berry was ready to give up. It was 2019, and her addiction—prescription opioids had led her to heroin—had left her bedridden. An infection had eaten through parts of her pelvic bones, stomach muscles, and vertebrae, causing a pain so excruciating that she was afraid to move. Her partner, Randy, placed buckets under her body when she needed to use the bathroom. Bathed her and fed her. Before long, Mallory stopped eating entirely, subsisting on sweet tea and water, wasting away.

Four years later, Mallory would recount this memory to me over the phone from her house—a five-bedroom, three-bathroom colonial with a walk-in closet and a two-car garage—that she paid for with her earnings as a manager at a mortgage company, where she oversaw 10 direct reports.

When I spoke with her in March last year, she largely credited this remarkable turnaround not to her own willpower, or the grace of God, but to a widely available medication called buprenorphine.

The world of opioid addiction is one of morbid statistics. People struggling with opioid addiction have a mortality rate 10 times higher than the general population in the United States. The relapse rate for those in recovery is as high as 70 percent. As one doctor, an addiction specialist named Stephen Martin, put it to me, “The natural history of opioid-use disorder is: People die.”

Which is why the numbers describing buprenorphine’s impact stand out. Buprenorphine can stop cravings for opioids, and people who use it are 38 percent less likely to die of an overdose. After buprenorphine was adopted at scale in the midst of France’s opioid crisis in the 1980s and ’90s, overdose deaths dropped by 79 percent.