Everyone agrees, with the continuing increase in opioid overdose deaths, that access to Suboxone doctors must become easier. There’s no reason why someone should struggle with pain pill or heroin addiction and then die while waiting to get into a program that offers Suboxone or its generic equivalent, buprenorphine. Experts still have not agreed, however, on whether to change the ways that Suboxone is regulated.
It has been several years now that we’ve been bombarded with information about opioid overdose deaths and their rise to epidemic proportions in the United States. We are not just bombarded: We are splashed in the face with the icy cold reality of statistics telling us brutal facts such as the 14 percent increase in one year of opioid overdose deaths. Almost daily we are exposed to stories describing people in our own communities who gave up on finding recovery and died.
It’s unreasonable that it should take so much time to reach an agreement on regulations for Suboxone doctors. They include leaders from federal agencies that regulate medication-assisted treatment protocols as well as the societies of addiction specialists who mull over policy and procedure. These decision-making experts come from the Substance Abuse and Mental Health Services Administration (SAMHSA), the Drug Enforcement Administration (DEA), and other mental health and addiction agencies.
According to Gary Enos, an editor of Addiction Pro online journal, experts from all of these organizations are debating on what changes to make to the original Data Waiver Act of 2000. In was that Act that set the standard for physicians who wish to prescribe Suboxone to do so only after completing mandatory training, and also limiting their patient roster to 30 patients in the first year and then 100 patients in the years following.
Those patient limits established for each physician apply to all of his or her practice locations. So if Dr. John Doe sees patients at two office locations, he can only see a total of 100 patients at both locations; he cannot see 200 patients. The 100-patient limit is really quite restrictive; consider how many patients a doctor sees in a day or a week—and then multiply that by 4.3 weeks in a month.
The Best Way to Expand the Reach of Suboxone Doctors
All of these experts agree on one thing: Suboxone must be made available to more of the people who need it. Some think that the impact Suboxone doctors can make should be expanded by increasing the number of patients that each current prescriber can care for. Others believe that the number of prescribers should be increased, but the same limit on the number of patients should apply.
Many doctors refuse to prescribe Suboxone because they do not want to be monitored or inspected by the Drug Enforcement Administration. The AAAP believes that by loosening monitoring requirements, more doctors would be interested in moving forward with the training and expanding their practices to include Suboxone treatment. If such doctors limited their patients to just 30—not just the first year but for each year—then they would only be subject to the DEA inspections if some question arose concerning their prescribing practices.
A second suggestion expands the number of patients to 150 per prescriber instead of 100, once they’ve passed the first year. Physicians who practice in multispecialty groups would be permitted to prescribe buprenorphine to 340 patients per year if they utilize nurse practitioners (NPs) or physician assistants (PAs). This proposal has been met with objections from some, particularly SAMHSA officials, who do not want NPs or PAs to prescribe buprenorphine.
Why would SAMHSA object to including new types of prescribers in Suboxone treatment protocols? Primarily this concern relates to making supportive services available to patients seeking recovery from opiate addiction who take Suboxone or buprenorphine. Just about all addiction professionals agree that medication-assisted treatment, whether it’s utilizing methadone or Suboxone or even Vivitrol, works best when it’s accompanied by individual counseling. Many methadone and Suboxone treatment programs also offer group counseling.
Dr. John Renner, who is president of the American Academy of Addiction Psychiatry, says that it’s time to change the Data Waiver of the year 2000 because the ways that medicine is practiced have changed. Back then, most physicians were in private individual practices or small groups practices. Nowadays, larger multispecialty group practices are more common.
Advantages of Expanded Care
Multispecialty group practices offer many advantages for the person who starts out seeking help from a local Suboxone doctor. Once you’ve been screened at a local medication-assisted treatment program, the case manager and the physician who see you will ask you about other health problems you may be having. Some people with opiate addictions have simply neglected their health and they may not be receiving proper medical care for ongoing conditions such as hypertension or diabetes. Yet others develop health problems directly related to their addiction: Hepatitis, tuberculosis, HIV/AIDs, and sexually transmitted diseases are more common among persons with addictions. At a multispecialty group practice, or at a medication-assisted treatment program that provides a good health checkup, it’s easy to get a referral to someone who will address those other health issues.
Another benefit of larger Suboxone treatment programs is the ability to address emotional problems you may be dealing with. Approximately half of the substance-abusing population experiences some kind of mental health issues. Sometimes they use drugs to mask their symptoms, and sometimes the symptoms develop because of the drugs they’re using.
No matter which way you look at it, visiting a Suboxone doctor or treatment program provides expanded opportunities to stop using drugs, improve your health, and take care of the emotional baggage that often comes with drug addiction. We are all waiting to find out which way the chips will fall and how the next generation of Suboxone doctors will be organized and regulated. In the meantime, don’t wait to get help.
