Comments on
Why the Suboxone Doctor Shortage?


needleWith all the recent attention over the epidemic of opioid dependence, why do some parts of the country report a shortage of physicians who are DATA-2000 certified, i.e. able to prescribe Suboxone and other buprenorphine products?

6 thoughts on “Why the Suboxone Doctor Shortage?

  • January 6, 2014 at 7:02 am

    It’s all about fear and control. The endless War on Inert Chemicals has resulted in a mass hysteria where science is the first to be thrown out the window. Opiates and opioids, while i credibly destructive, one has to ask WHY are they so destructive? In societies where heroin is decriminalized and clinics provide thrice daily doses, ‘patients’ suddenly become active, productive members of society.

    My point is NOT to reach a goal of legalization. My point is to shift this punitive society to a treatment based one. Why do opiate/opioid addicts use in the first place? I know for me, it was the only chemical in a long, LONG string of chemicals that hit the right “switches” in my head to where I could function without constant fear, anxiety amd depression. I did not use to the point of “nodding”, but enough to feel what I percieved others as feeling “normal.”

    We have a society that views any medication that has the possibility of making one feel any level of euphoria as a terrible thing. Take Ultram ( tramadol). The FDA listened to the manufacturer who said it produced no euphoria, therefore is not addictive. (If euphoria is the addiction benchmark…look out M&M’s.)

    Turns out that taken in high doses, Ultrams first metabolite produces mild euphoria in some people. Once the FDA found out about this, now they want to reschedule it. This is not at all based on scientific evidence of the drug presenting a danger to society. It is the usual, knee jerk reaction.

    The same rule applies to suboxone. And when the New York Times writes a competely biased piece on suboxone, implying that it is diverted more than it is being used for its intended purpose, and people are dropping like flies as a result, this only adds to our societies chemical hysteria propogated by the government.

    Reply
    • January 6, 2014 at 11:51 am

      It will be interesting, if Alkermes is successful in gaining approval for their buprenorphine-based antidepressant, if society will reject the idea of treating depression using an opioid. When is ‘euphoria’ a treatment for the disease of depression– and when is it a bad thing?

      Reply
      • April 21, 2015 at 6:46 pm

        Dr. Junig, I look forward to learning about Alkermes’ trial. I think low dose buprenorphine could be an effective antidepressant in many people. Many of my pts on bupe can get down to a very low dose – 1-2 mg a day, but get depressed when they try to stop altogether. this kind of depression, in my experience, does not respond to other antidepressants.

        Reply
  • April 20, 2015 at 6:11 pm

    I prescribe buprenorphine, but I am leaving this field. Have not been harassed by the DEA, but by the state medical boards. If you dismiss a patient from your practice (for noncompliance, selling his meds, etc) they make a complaint to the medical board. The medication has helped so many people. But its too risky for doctors to prescribe.

    Reply
  • August 12, 2016 at 8:09 am

    I had a neighbor ask questions about suboxone that concerned him due to tx. for back pain with 60mg of oxycontin BID with vicodin ( 4 daily ) for breakthrough. I have been out of medicine for 6 years so am admittedly rusty. My only confusion is that narcan blocks effects of narcotics Why does narcan not block the effect of buprenorphine, hence why include the buprenorphine. I can think of a few possible reasons but rather than guess why not ask an expert. Thank you for your time.

    Reply
    • August 16, 2016 at 1:49 pm

      Narcan is poorly absorbed via the sublingual route- about 3% of a dose is absorbed, which is not enough to have any discernable clinical effect. The non-absorbed narcan (AKA naloxone) is completely destroyed by first-pass metabolism at the liver. The only way that the naloxone in Suboxone has an effect is if injected. Although even in that case, buprenorphine binds with much greater affinity, and so naloxone only partially-reverses the effects of buprenorphine. Narcan is added to Suboxone for one reason– to deter IV injection of buprenorphine.

      Buprenorpine has very unique actions at mu opioid receptors, such that as long as the buprenorphine level stays above a certain threshold, opioid effects never change. So from the patient perspective, no drug ever wears off, and no drug ever ‘comes on’. The stigma over diversion, largely fueled by ignorance, has interfered with acceptance of an amazing medication that has potential far beyond treating addiction, especially in combination with certain opioid agonists.

      Diversion is always worth some attention– but any discussion of diversion must include knowledge of a couple simple facts: about 30,000 people die each year from overdose in the US. The number of overdose deaths where the person has SOME level of buprenorphine in the body? Forty. The same as the number of deaths from lightning.

      In other words, even DIVERTED buprenorphine saves far more lives than it harms. That fact makes some heads spin– but look at the data.

      Reply
 

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