CLEVELAND -- It is a medication that the drug court judge in Cleveland calls the "gold standard" in helping people recover from heroin addictions.
Yet astonishingly, less then two percent of doctors practicing in the county are allowed to prescribe it.
We are operating without one of the tools that has been proven, by science, to help someone the most," says Drug Court Judge David Matia.
The judge is talking about buprenorphine - one of a group of drugs that is used in what's called "medicated-assisted treatment" to help wean addicts off of opiates such as heroin.
A recent Harvard study revealed that 94 percent of people on buprenorphine completed their initial phase of rehab treatment.
The federal government requires doctors to obtain a special waiver to prescribe the medication.
According to the Ohio Medical Board, there are 7,088 doctors practicing in Cuyahoga County.
As of July, only 109 - or about 1.5 percent - have the waiver that allows them to prescribe the medication.
"It's a buprenorphine desert," Judge Matia says.
In the surrounding counties, there are fewer doctors, but the pattern remains the same: only a small percentage of physicians in each county have the waiver needed to prescribe the drug.
Alex Selerowski, 21, is going through drug court right now, and is on buprenorphine.
He says the drug takes away his craving for heroin.
"It was key to any success that I've had," Alex says.
The drug is essentially a low-dose opiate designed to reduce the cravings addicts have for heroin.
But the fact that it contains some opium has brought criticism that people will have to "detox from the detox" because they are trading "heroin for heroin."
Judge Matia says the Harvard study, and his daily experience with addicts, debunks both those concerns.
"It's not that we're giving you 'heroin from heroin,'" he says, "it's that we're giving you something that allows you to be a parent, to be an employee...to ride the bus, maybe even drive the bus...you can function that well on medicated-assisted treatment."
Matia says taking away the cravings for heroin allows addicts to think straighter, which can help lead them to decide to seek treatment.
Now in treatment, Alex Selerowski is planning to enroll in a Tri-C engineering program with the hope of one day being allowed to enlist in the Air Force.
He says buprenorphine has been "extremely important" in his recovery.
All three major medical institutions in Cleveland (Metro, University Hospitals, and the Cleveland Clinic) say they are working to get more of their physicians the waiver needed to prescribe the medication.
At times, Ohio has had the highest per capita death rate from overdoses in the nation. In recent years, the state has lost more people to overdoses than has California - even though its population is only about a third of California's.
Judge Matia says medicated-assisted treatment is only of the three legs needed to support a successful recovery.
The other two are a good detox program, and accountability to stay clean (in drug court, people who stay clean can have their records expunged. Those who don't can go to jail.)
But for the first time since he saw the opiate crisis start to explode almost seven years ago, Judge Matia sees a pathway can work for a lot of people in recovery.
But, for it to work, he says more doctors must be able to prescribe a medication that is helping people save themselves from a life - and often, a death - on heroin.