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Daryl, who has had an opioid use disorder for more than a decade, prepares to inject Suboxone he bought on the street. He said it helped him remember what being normal felt like. (Seth Herald/WFYI)

Months in prison didn鈥檛 rid Daryl of his addiction to opioids. 鈥淏efore I left the parking lot of the prison, I was shooting up, getting high,鈥� he said.

Daryl had used heroin and prescription painkillers for more than a decade. Almost four years ago, he became one of more than 200 people who tested positive for HIV in a historic outbreak in Scott County, Ind. After that diagnosis, he said, he went on a bender.

But about a year ago, Daryl had an experience that made him realize he might be able to stay away from heroin and opioids. For several days, he said, he couldn鈥檛 find drugs. He spent that time feeling terrible because of withdrawal sickness.

His friend offered him part of a strip of Suboxone Film, a brand-name version of the addiction medication buprenorphine that is combined with naloxone.

鈥淎t first it felt like I was high,鈥� Daryl said. 鈥淏ut I think that鈥檚 what normal feels like now. I have not been normal in a long time.鈥�

is a long-acting opioid that is generally used to treat opioid addiction. It reduces cravings for the stronger opioids he had been taking, prevents physical withdrawal from those drugs and comes with a significantly lower risk of fatal overdose.

Daryl injected the buprenorphine, and his opioid withdrawal symptoms disappeared. (Daryl is his middle name, which NPR and Kaiser Health News are using to protect his identity because it is illegal to use buprenorphine without a prescription.)

Weeks later, the grind of chasing heroin had worn on him. Buprenorphine controlled his withdrawal symptoms longer, and Daryl decided to use it to stay away from other drugs.

鈥淚 didn鈥檛 crave nothing. I wasn鈥檛 sick. My belly didn鈥檛 hurt. I wasn鈥檛 hurting in my joints,鈥� he said.

Buprenorphine is one of just three federally approved medications to treat opioid addiction. It鈥檚 an opioid itself, so some people misuse it 鈥� they snort or inject the medication. And patients who have prescriptions for buprenorphine sometimes sell or give it away, which is known as diversion. Some policymakers and officials point to diversion as a reason to further increase regulations. Providers already need to be certified to prescribe it, and there鈥檚 a cap on the number of patients they can treat with the drug.

But addiction treatment professionals argue the problem of buprenorphine diversion is often misunderstood. A black market exists in part, they point out, because addiction treatment can be聽. President Donald Trump is expected to sign a bill that would increase access to the medication, but it鈥檚 unclear how quickly that access will grow.

In the meantime, many people dealing with addiction will turn to the black market for buprenorphine 鈥� sometimes using it to get high, sometimes using it to prevent withdrawal until they can get something stronger and sometimes using it exactly as it is intended to be used: to treat addiction.

It鈥檚 A Weaker Opioid

, president of the American Society of Addiction Medicine, which supports the measure that would increase access to buprenorphine, contends that making the drug more widely available outweighs the risk. For one thing, buprenorphine is not as dangerous as other opioids. 鈥淭he risks of overdose with buprenorphine are minimal,鈥� she said.

滨迟听is聽possible to fatally overdose on buprenorphine 鈥� especially if users don鈥檛 have a tolerance to opioids or they mix it with other substances. But聽.

Buprenorphine鈥檚 effects are less potent than those of heroin and fentanyl, and the medication can block other opioids鈥� effects. Because of these attributes, few people use buprenorphine to get high. Instead, more people use it to聽聽and to stay away from other illegal drugs such as heroin and illicit fentanyl.

Some leading addiction experts argue that self-treatment with buprenorphine can save lives because it is used in place of more dangerous substances that are blamed for the聽.

鈥淚t was not diverted buprenorphine that鈥檚 responsible for our current situation,鈥� 蝉补颈诲听,听an addiction specialist and instructor at Harvard Medical School. 鈥淭he majority of people are using it in a way that reduces their risk of overdose.鈥�

鈥淚t鈥檚 definitely illegal,鈥� Daryl said. 鈥淏ut would they rather me be driving to Louisville and picking up two 8-balls of heroin?鈥�

Staff members at CleanSlate, an addiction treatment center in Anderson, Ind., count patients鈥� Suboxone wrappers to make sure they adhere to their buprenorphine regimen.(Jake Harper/WFYI)

Staff members at CleanSlate also test patients鈥� urine.(Jake Harper/WFYI)

Limited Access

People often try to treat themselves when they聽蝉补颈诲听, an addiction specialist and researcher at the University of Kentucky.

鈥淭hese people want help, and they tried and they didn鈥檛 succeed. So now they鈥檙e going to go get it if it鈥檚 available,鈥� she said.

Professional treatment with buprenorphine can be difficult for patients to get. Prescribers need a special waiver to prescribe the medication, and federal rules limit the number of people they can treat, a cap that is specific to buprenorphine.

Federal guidelines changed under the Obama administration to increase the number of prescribers and the number of patients they can treat. Nurse practitioners and physician assistants can now apply for a waiver to prescribe buprenorphine, and doctors who meet certain requirements can now treat up to 275 patients 鈥� that鈥檚 up from the previous limit of 100.

The new bill on its way to Trump鈥檚 desk would let more nurses prescribe buprenorphine and allow some doctors who recently got waivers to treat more patients.

Amid these efforts, some law enforcement officials and policymakers have said that聽聽actions are needed to stop diversion.

But Basia Andraka-Christou, an assistant professor and addiction policy researcher at the University of Central Florida, said increasing regulations or shutting down prescribers would limit treatment options for people addicted to opioids.

鈥淚 guarantee you,鈥� she said, 鈥渢hey鈥檙e either going to go and buy heroin and get high 鈥� which surely is not a great policy solution here 鈥� or they鈥檙e going to go buy Suboxone on the street.鈥�

A Step Toward Safer Treatment

Getting Suboxone on the black market is obviously not ideal. Addiction is a complex, chronic disorder and patients need comprehensive care. That means a treatment professional to help them figure out the proper dose and counseling to address other mental health needs that are common among people with addiction. But Lofwall said people addicted to heroin or painkillers often realize they want professional help in quitting after trying buprenorphine illegally.

鈥淭hey鈥檝e had it and they know it works for them and they want to get it legally,鈥� Lofwall said. 鈥淭hey want to get their life back.鈥�

Daryl had that sort of experience. Several weeks after he began using buprenorphine regularly, Daryl tried to sign up for insurance so he could get help 鈥� medication and counseling 鈥� in staying away from other opioids.

鈥淚 think if I had never started [Suboxone] on the street, I wouldn鈥檛 have no interest in doing nothing but getting high,鈥� he said.

Daryl still hasn鈥檛 made it into treatment. He had trouble starting his insurance, and the market for illicit buprenorphine can be fragile. Daryl struggled to stay away from heroin when the person from whom he bought buprenorphine lost the prescription. Addiction can take years to conquer, and many attempts, but Daryl said his time on buprenorphine allowed him to see a way back to a normal life.

鈥淚鈥檓 at a point of my life now where I know I鈥檝e got to change something, or I鈥檓 going to go back to prison,鈥� he said. 鈥淚鈥檓 definitely ready to do something different.鈥�

This story was produced in partnership with ,听, and Kaiser Health News. A longer version of the story appears in Side Effects鈥� podcast聽