Imagine the life of an opioid addict desperate for help. They are addicted to a substance that controls their life. They no longer want to take pills or shoot up, but they have to because the pain of withdrawal is so great that continuing to use is the lesser of two evils. Taking Suboxone may be their only hope, but doctors refuse to treat them. They hear excuses like “I’ve reached my limit,” “I’m not certified to prescribe that to you,” or simply, “I can’t help you.”
Suboxone is proven to help opioid addicts recover from addiction. However, unnecessary hurdles that prevent doctors from prescribing the drug mean millions of addicts who want help go untreated.
Problems With Prescribing Suboxone
The unique nature of buprenorphine, Suboxone’s active ingredient, causes it to fall under the Drug Addiction Treatment Act (DATA) of 2000. DATA requires that doctors to fill out a waiver — essentially an application — in order to prescribe the drug. The government also requires doctors take an eight-hour online course about buprenorphine. Once the course is taken and the waiver is approved, the doctors are allowed to prescribe Suboxone — with a catch. Within the first year, they can prescribe the drug to only 30 patients. After the first year, they are allowed to write up to 100 prescriptions.
This government’s primary fear is dealers’ ability to sell Suboxone’s on the streets. The government cites tertiary evidence that addicts use Suboxone as a substitute for heroin, or as a temporary fix, until their next score is obtained. However, buprenorphine’s primary effect is to stop opioid withdrawal, not to feel an opioid high. When interviewed, former addicts claim most people use Suboxone illegally to wean themselves from their addiction.
A Doctor’s Perspective
The process of prescribing Suboxone to a patient is a complicated one. One out of every five doctors feel overworked as it is, so in addition to their already heavy workload add:
- Using an entire working day to take an online class
- Filling out, sending, and waiting for the waiver application
- Announcing to the public that they are prescribing Suboxone
- Screening the candidates who need help, then choosing those they feel will benefit from the drug
- Waiting for the patient to take the drug at the appropriate time
- Giving the right dosage to the patient
- Seeing the patient three times a week for two weeks
- Seeing the patient once every other week for a month to check their progress
- Seeing the patient regularly after that to check on their progress
- Deciding when, if ever, the patient can go off the drug.
Multiply the patient process by 30, and that is the additional strain a doctor experiences in the first year of prescribing Suboxone; add another 70 patients after year one.
A Drug in Demand
Close to a million doctors can prescribe opioid-based medications in the United States, yet only 32,000 are authorized to prescribe Suboxone. Of the 50 states, only three adequately fill the needs of their opioid-addicted population; 28 states serve less than half. Millions of addicts can’t get the medicine they need, and doctors are starting to take notice.
Fighting for Change
In 2015, U.S. Senators Edward Markey of Massachusetts and Rand Paul of Kentucky proposed The Recovery Enhancement for Addiction Treatment Act, which sought to remove some of the regulations surrounding buprenorphine. This included the 30-patient limit and allowed certain nurse practitioners and physician’s assistants to prescribe the drug. In September of 2015, Health and Human Services Secretary Sylvia Burwell announced that the organization would rewrite certain policies surrounding the distribution of buprenorphine.
The Future of Suboxone
As the number of people addicted to opioids rise, so does the need for effective opioid treatment. Suboxone is proven to help addicts recover, and prescriptions increased more than 10 times from 2003 – 2013. Government regulations surrounding the drug are slowly disappearing. With innovative ways of taking buprenorphine on the horizon, we may be closer to a time where opioid addiction is a thing of the past.