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Opioid agonist medications, such as the buprenorphine-based Suboxone, are becoming increasingly important tools for caring for people with opioid use disorders. Yet, whether at the level of the family, the clinic, or pharmaceutical companies, the circulation of Suboxone can involve forms of concealment, secrecy, and deceit, even as it is used to provide a vital form of care. In exploring the moral economies that shape the licit and illicit circulation of Suboxone in southwest Virginia, we aim to unpack the logics of obligation, care, and secrecy that emerge within a family network caught in a set of sociopolitical, economic, and therapeutic conditions. In exploring how Suboxone circulates at these different scales—in families, in clinics, and in the global pharmaceutical economy—this article shows how secrets lubricate the social, economic, and moral mechanisms through which relationships are sustained and substances circulate. [moral economy, secrecy, substance use, care, rural United States]