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Your Responsibilities in Suboxone Therapy

If you’ve decided to seek help for your pain pill or heroin addiction at a medication-assisted treatment center, you may be wondering if you should opt for methadone or Suboxone therapy. While methadone treatment has been accepted for quite some time and the regulations are pretty straightforward, things are a little stricter with Suboxone. Even so, some of the rules are changing a bit. How and why should that affect your decision? What rules must you follow in order to remain in Suboxone therapy?

It has been notoriously difficult to find Suboxone programs with openings in many communities. That is, the medication-assisted treatment clinics are there, but when you call to get into treatment you are told you must wait three months or longer in order to receive help. What are you supposed to do, you ask the person on the other end of the phone. They don’t know what to say because they don’t have an opening for you on their schedule and they really don’t want you to keep taking drugs.

You may not be aware that as of this writing the federal government controls how many patients can be seen by the doctors who prescribe buprenorphine or Suboxone therapy. The doctors must undergo a brief but mandatory training before they can write for Suboxone, and in the first year following their approval they can see only 30 patients. If the doctor maintains more than one office, they can see only a total of 30 patients across all their locations and not 30 patients at each office. After that first year, their total allowance of patients increases to 100—again, that is a grand total of 100 patients no matter how many offices they go to.

There was a good reason for this initially. The Substance Abuse and Mental Health Services Administration (SAMHSA) recognized that treatment of opioid addiction required more patient visits per patient in a given year than the average patient. In other words, you might see your regular family doctor a few times per year for your physical and to treat any cold or flu that comes your way, but treatment of opioid addiction is not successful without much closer monitoring of the patient. The number of patients was limited in order to assure that the doctor would see each patient as much as necessary.

Right now, SAMHSA reports doctors approved to order Suboxone therapy in Georgia as 55 doctors who can treat 30 patients and 26 doctors who can treat 100. Suboxone therapy in Texas is limited to 87 doctors who can treat 30 patients and 41 physicians who can treat 100. Suboxone therapy in California is limited to 276 doctors who can treat 30 patients, and 104 doctors who can treat 100.

Because opiate addiction has grown to epidemic proportions, there are plans in the works to expand this. Some proposed legislation will lift the restriction to 30 patients in the first year. Other legislation could lift the restriction altogether, and there is also proposed legislation that will permit nurse practitioners and physicians assistants to qualify as providers of Suboxone therapy.

What You Must Do During Suboxone Therapy

Since it is so difficult to get into treatment at a medication-assisted treatment facility, the rules are often pretty stringent.

  • Going hand-in-hand with the need to expand treatment options because of the opiate epidemic, doctors are changing requirements for prior treatment. In the past many doctors did not want to provide Suboxone therapy unless you had tried and failed at some other kind of treatment. Now doctors and OTPs are moving beyond that requirement.
  • Your attendance at therapy sessions with your counselor will be monitored if you seek treatment at an opioid treatment program (OTP). Licensed, certified OTPs must provide individual counseling. The treatment provider must schedule it whether you attend or not. Some of them offer both individual and group counseling. Because openings in the program are scarce, you can be administratively discharged from the program if you refuse to attend.

What about the doctors who don’t care whether you seek out any therapy? There are many out there who will have their receptionists line you up, move you in, move you out, and laugh all the way to the bank. They don’t care whether or not your treatment works. They are in it for the money and not because they care about your recovery. Is that really where you want to go?

  • Many of the doctors at OTPs will ask you about your attendance at 12-step groups. Again, your interaction with peers who have been where you’ve been and walked where you’ve walked is an important part of your Suboxone therapy. You cannot practice a lifelong recovery from opiates without embracing the 12 steps.

Some people avoid the 12 steps because the people at AA and NA disapprove of their participation in medication-assisted treatment. Other people simply don’t care for the religious aspects of 12-step groups. In the case of those who frown on Suboxone therapy, your best bet is to try a variety of meeting groups until you find people you like, and keep your treatment preference to yourself. Eventually you will come across like-minded or open-minded people who accept you for who you are. If it’s the religious aspect that you are avoiding, remember that there are many options available such as Secular Organizations for Sobriety.

  • Expect strip counts to continue as an annoyance that you simply must put up with. The rules at the OTP will most likely require you to bring in the empty film strips that contained your medication. You cannot use up your own medication or divert it to someone else and then bring in someone else’s, because there are little numbers on the film wrappers that identify the series of strips that you received. The same applies to the pills—you may be called in to show your pill bottle, including the date it was filled and with the requisite number of pills still inside. This is to insure that diversion is not occurring.
  • As you are no doubt aware you will be required to screen regularly for use of other drugs. Many people feel that as long as they are no longer using opiates, especially if they were needle-users, that their treatment providers should overlook their use of weed or alcohol. However, the doctors who provide Suboxone therapy believe that addiction is addiction, and if you’re going into recovery you’ve got to abstain from all non-prescribed substances. Because spaces in Suboxone therapy programs are so limited, if you refuse to comply and you continue to test dirty, you will most likely be administratively discharged.

In the case of alcohol use, or if you are taking benzodiazepines, you will also be warned about discharge from the program. The interaction between Suboxone and alcohol or Suboxone and benzodiazepines is very dangerous and could be fatal, and the doctor simply cannot overlook your continued use of those substances.

Despite the requirements of Suboxone therapy, the benefits of treatment mean that you can return to a normal lifestyle. Unlike those who participate in methadone therapy, you will not have to go to a location on a daily basis to receive your medication. Your visits will occur once weekly initially, then biweekly, and eventually monthly. It will be possible to go through each day without experiencing the cravings and withdrawal symptoms that lead to inevitable relapse. If you haven’t considered Suboxone therapy, call your local treatment program and find out if there’s a waiting list. Even if there is, there’s no time like now to get your name on it.

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