Top Menu

Doctor Says Restrictions on Buprenorphine Prescriptions Hurt Patients

/By

An Oklahoma doctor who treats patients with opiate addiction by prescribing buprenorphine says federal restrictions on the number of prescriptions he can write for the drug are hurting patients.

The Tulsa World reports that under the Drug Addiction Treatment Act of 2000, doctors can only treat up to 100 patients a time with the drug, which is marketed as Suboxone.

Dr. William Yarborough, an internal medicine specialist at the University of Oklahoma-Tulsa, told the newspaper that he would like to be able to treat more patients with the drug. “I have people out there sick on heroin and other things, and I can’t do anything to help them because I don’t have any slots left,” he said. Dr. Yarborough noted that many of the patients he treats for opiate addiction with buprenorphine are middle and upper class, including lawyers, teachers and other doctors.

34 Responses to this article

  1. Art Adkins / July 21, 2014 at 10:53 pm

    The patient limit problems are made worse by current patients (most) never leave the practice,and because of others selfishness. New slots are practically impossible to open up for others to use suboxone benefits. I think out of a 100 patients some or even a few can eventually give it a go after months of gradually reducing dose. But that ain’t happening,because no slots are ever open. It’s so sad for those who need help and selfish for those who get it just for a buzz!

  2. trista / June 9, 2014 at 8:39 pm

    I hv found this to be sooooo true! I went to rehab n hv been trying to find help. I went three months completely sober but then was drunk on to get rid of my pain n cuz I told my doc I went to rehab I cant get anything so of course im trying to get help w suboxone n every place I call is either full or has a very long waiting list!! Its pathetic that u can get drugs easier than getting help!!

  3. Avatar of Becky
    Becky / May 10, 2013 at 8:37 am

    I take suboxone. I am switching doctors because I am close to relapse and my doctor now won’t help. Will I have issues with my insurance company by doing this? I’m mainly worried about
    the pharmacy. Will my meds be covered?

  4. Avatar of Stepper
    Stepper / February 17, 2012 at 6:32 pm

    I was seeing a doctor for about a year and he was prescribing me suboxone and then I tapered off and stored goin to him and he said he couldn’t prescribe it to me again after I relapsed….can another doctor practice it to me?

  5. Avatar of larry
    larry / February 14, 2012 at 4:08 pm

    Opiate addiction is rough, and it seems like buprenorphine might be a ‘lesser evil’ in this case. I feel like a medical clinic should be supervised pretty closely with these kinds of drugs for safety reasons, even if the doctor is treating upper class people. They can have prescribed medication addictions, too, that can be out of control. However, I also think that there should be exceptions made and treating opiate addictions maybe affords a second look by officials.

  6. JimaJ / December 11, 2011 at 1:19 pm

    Buprenorphine saved my life! I had a35 year opiate addiction and spent 20 years in prison.I started taking Suboxone 4 years ago and have been drug free since then.I am not interested in tapering and if I have to stay on this life saving medicine for the rest of my life then so be it!I tried N.A.and other self help groups and there was something missing….nothing worked until my first dose of Suboxone. I receive counseling once a month at the Washington, D.C. veterans hospital and that is enough!

  7. Sandra / August 29, 2011 at 2:10 am

    In Portugal they have had great success with any Physician and also OP clinics dispensing buprenorphine, so Pharmacists also can now prescribe it. They do not prosecute users of drugs, or street level dealers in Portugal since 2001.

  8. Avatar of ron oneal
    ron oneal / August 26, 2011 at 5:34 pm

    I take 2 20 mg opana er everyday but find myself sucking on them every 4-6 hrs to get a faster reaction time. I want to go off the drug but not in a fast way. Been on them now for 6 yrs 90 day supply from my doctor. want to bring iit up with my pain dr. about weening myself off but I also take 2-3 antidepressants too! Can I go to Oxycodone 20 mg 2 times a day to start or go straifht for the Bup pill or the film way. I take the pills for chronic pain for lumbar spondylosisand am on SSdisability for 6 yrs now along with a diagnosis of ptsd. Give me an idea what I should do!!Thanks

  9. Avatar of Victoria Rivas-Estronza
    Victoria Rivas-Estronza / July 28, 2011 at 2:19 pm

    So do methadone clinics have a limit on how many patients they can treat? I have a small center in South Fla. Yes the Pill Mill Capital. Down here if a patient gets any controlled medication we must register as a pain center. They seem to clump us together no distinction what so ever. Patients who get Roxicodone for whatever amount it is for can’t use their insurance at the smaller pharmacies and the national chains just refuse to stock them. For some reason this state forgets that we have the largest rate of geriatric patients, so if Grandma breaks her hip or she has RA good luck .. It’s embarrassing and it should not be tolerated

  10. DrJJMD / July 17, 2011 at 9:39 pm

    I Completely agree with the article. I view Buprenorphine as a Harm Reduction drug that can be used in several ways. It can be used to detoxify highly motivated patients or patients who have that as their final goal. However, I also do not see a problem with maintiaining patients on Buprenorphine, the way it is done with methadone. As a matter of fact it provides several benefits to methadone in that we are able to prescribe it to the patient for many days in a row as it is virtually impossible to OD on Suboxone due to it’s pharmacollogic / pharmokinetic properties. So YES they must increase the number of patients we are able to see and prescribe Buprenorphine too. I would go as far to say that we should also be able to prescribe Methadone to patients in need of Opioid Replacement therapy.

  11. Dale Welling / June 25, 2011 at 6:06 pm

    Ps i love my wife and i will do what it thacks.

  12. Avatar of Mark Publicker, MD
    Mark Publicker, MD / June 8, 2011 at 6:34 pm

    I practice full time addiction medicine. I advocated for the increase in slots from 30 to 100. 100 patients is a lot for one practitioner, if done properly. I am concerned about the doctor’s implication that class determines worthiness for treatment. There is a tendency to assume that professionals need less treatment and that medication is sufficient therapy. Opiate addiction is a pan-dimensional disease and must be seen as a chronic disease for which a chronic disease model of treatment needs to be provided, just as diabetes cannot be effectively treated with medication alone. Buprenorphine is a valuable medication but needs to be combined with long-term treatment. I always encourage my patients to work join the Fellowship and work a program, because ‘the same person will use again.’

  13. Carlos / May 10, 2011 at 4:52 pm

    You got it NAABT you got it. Let do the research and then have the government shot up

  14. NAABT.org / May 9, 2011 at 12:05 pm

    END BUPRENORPHINE RATIONING

    This policy of limiting access to lifesaving treatment is ill-conceived and is having a profound impact on patient lives and on the price of treatment. I’ve been contacted my many patients who suffered greatly due to government intrusion into medical decisions. BY artificially limiting the supply of doctors in a demand rich environment, high value providers reach capacity soon allowing other more profit-focused doctors to raise the price to levels that would normally not be accepted by free market dynamics. $500 office visits is one result of this access limiting policy. It’s time to end these restrictions on care.
    NAABT

  15. Avatar of John Conner
    John Conner / May 6, 2011 at 8:27 pm

    Suboxone has saved my life! Unfortunately, my provider (a board-certified psychiatrist and addictionologist) is being pressured by the state Medicaid group to begin to drastically taper all of his clients off of Buprenorphine…CBT is great, but I have been “on the couch” for over 20 years and it has never been able to keep me off of heroin & morphine…it is a physiological craving from receptors in the brain…all the talk in the world won’t change that…try holding your breath while “thinking positive”…see my point?

  16. Avatar of middletowngirl
    middletowngirl / May 6, 2011 at 4:33 pm

    Buprenorphine is only effective when used properly. Addicts are currently snorting the powder in the capsules to get high.

  17. Fred C / May 6, 2011 at 10:03 am

    I forgot to mention, my clients are homeless, thieves and hookers; the kind of people who are robbing the doctors and lawyers houses while they are at work. It is worth whatever it takes to keep them off the drug.

  18. Fred C / May 6, 2011 at 9:58 am

    Good work Deborah, but, on the other hand, small doses of Bup have been shown to reduce cravings for heroin and since it is a drug with the highest recitivism,(85%) anything that works is fair in the fight against it.

  19. Avatar of Michael W. Shore, M.D.
    Michael W. Shore, M.D. / May 5, 2011 at 8:46 pm

    Both Dr. Yarborough and Deborah are correct. I also have to turn away patients due to being at my 100 patient limit. I have had 2 potential patients die of heroin overdoses waiting for an opening for Suboxone treatment!! It is ridiculous that there is no limit on the number of patients that a doctor can treat with oxycontin or percocet, but there is a limit on the treatment that can be lifesaving. However, Deborah has a point that many doctors treat patients with fairly inadequate treatment in addiction medicine and do not know how to manage the biopsychosocial aspects of the addiction, and also do not understand the intricacies and subtleties of patient selection and timing for dosage reduction and medication tapering. Clearly, more training for physicians would be helpful in managing the addictive disease. Dr. Shore

  20. Avatar of Deborah
    Deborah / May 5, 2011 at 3:05 pm

    The number of patients do not need to be increased! the number of patients tapered off of buprenorphine would be a better solution. Therefore you could continue caring for more people. We have clients coming to us to get off Subutex & Suboxone because so many Dr. are leaving them on high doses for such long periods of time and they want a drug free life.
    Our clients are Lawyers, nurses, teachers and such and Our goal at ARC of Georgia is to taper them off and with CBT empower them to live a drug free life.

  21. Deborah / May 6, 2011 at 2:53 pm

    Fred, I agree with you about the issue with heroin. And yes you are right about your clients and unfortunately the doctors, nurses and teachers are stealing as well. My biggest complaint in our area is the Dr. that write the prescriptions with no therapy to guide them through the process.Gives them 30 day supply and sends them on their way. Most of our clients have been using some type of drug their whole lives and has no clue on how to live any differently. Again I say CBT along with the bup is key to success stories!

  22. Avatar of Mattie Herald
    Mattie Herald / May 6, 2011 at 5:16 pm

    I agree with Dr.Shore. I am a licensed addictions counselor and was working within a facility where the patients were given Suboxone, but no requirement of treatment to address the behavior associated to use. Suboxone is a wonderful life saving drug, I have seen it work, however if one does not change behavior (people, places and things), the risk of returning to old habits and use is much higher. Addiction isn’t just about the actual use of a substance, but the inclusion of the use, physical and mental addiction, and the behaviors associated to the those components. How one can justify to themselves, “just this one more time isn’t going to hurt and put at risk every thing they love an value to continue the use”. It would appear raising the number of patients doctors can treat with suboxone, and adding the requirement, not just a suggestion, of all patients taking such a drug would also be required to participate in out-patient treatment.

  23. Mrs p / July 22, 2011 at 3:57 am

    Just want to remind the great Drs on here to consider this. If Methadone is prescribed, please please please tell your patients it will be almost a full hour before they FEEL THE EFFECTS OF IT or NOT FEEL SICK ANYMORE. If you tell them it will be an hour before it works…they will hear you, but that word FEEL is what theyre looking for. My very good friend Judy did this the first time (I was out of town) it was prescribed to her. She was use to percocet and oxy which you start to feel in 20 minutes. She was prescibed a bottle of 120 and got them home from the pharmacy and I knew her well… When she didnt feel any better 20 minutes later, she took more, than more then more. When we found her… she had taken 58 10mg methadone. I know thats what it was..As several months before, I had bathed her face and listened as she would say..how much longer. please how much longer? Please make it stop. She just wanted to not feel sick. She wasnt trying to get high. Miss her a lot. She was 65 and an awesome mom and grandma. So Please just consider it. I know you all are the ones educated and I would never second guess the medical or psychological aspect of your knowledge. I unfortunatley know what an addict will feel and think, regardless of how irrational taking 58 methadone may seem. Just imagine starving. Then you are given a fridge full of food. AMOUNT doesnt cross your mind. You eat…but you still FEEL starving, so you eat more, then more, until you dont. Unfortunatley methadone isnt as safe as food. Thanks

  24. Carlos / May 7, 2011 at 4:26 pm

    Debra, you are assuming that every patient needs therapy? That psychotherapy (or the talking therapy) actually has efficacy and is harmless. There is a lot of information that we are taking at face value. I have several book recommendations that are actually Reviews of the Scientific Literature. The 1st one is The Manual of Alcoholism by Hester and Miller, a fascinating book is Studying the Clinician by Howard Garb; and recently I picked up. The Great Ideas of Clinical Science edited by Scott Lilienfeld and William O’Donohue. In this last book the contributors outdid themselves. Is a mash of 17 Principles that every Mental Health Practitioner should understand. The chapter is fascinating and those who believe that Psychology is not a science; they are not walking in the 21 Century. The vast amount of scientific research in psychology especially on the clinicians and how the make judgment and decision Is a breakthrough for the world to know, it is outstanding work without precedence. Excellent work that is being done in
    Psychology, we can not just assume that the best work is done in psychotherapy although some good work is being done there too.

    I think it is a shame that the feds to assume that Doctors can only handle 100 patients. In the absence of research data (and I think that there is some available strategies to improve practitioners effectiveness in providing better services. The Feds should consider that perhaps and arbitrary number like 100 should be reevaluated. What was the number that the Feds initially only allowed doctors to have in Suboxone? Wasn’t it something real low like 15 or 20? I don’t remember.

  25. Carlos / May 7, 2011 at 4:42 pm

    The patients that want to get off Suboxone should have been part of their treatment plan from the beginning to keep them at a necessary dose and no more. I understand the patient dose should be as high as the amount they need that stops them from doing illicit opiates. Dr. Jeffrey Kamlet in Miami informed me that with the new stripped Suboxene. The dose can actually be cut 1 mgs even a 1/2 an mgs and patients have walked out on this dose. Some of the patients even reported that there were days they forgot to take their Suboxone and that they did not suffered any painful consequences

  26. NAABT.org / May 9, 2011 at 12:48 pm

    Deborah,
    Maintaining the limit and forcing patients to taper off effective treatment to make room for someone else ignores the fact that addiction is a chronic condition, meaning it’s long-lasting and may last a lifetime for some. For the patients who require long-term or lifetime treatment forced cessation of the treatment is unethical and would put them at risk of relapse, which is a life threatening event. It would be (is) cruel and unnecessary to force someone off a treatment that helps them maintain their quality of life, especially for no reason other than a flawed policy. No other lifesaving treatment should be rationed like this. What if other chronic conditions had the same policy? Take Diabetes for example, imagine if after patients became stable and were able to be productive again and engage in normal life, we took away the medication and allowed their symptoms to return, all because of some insulin limit. The stigma associated with addictive disorders corrupts logic and results in poor policies like rationing safe and lifesaving treatment like buprenorphine. Drug-free is not the goal Addiction-free is. It’s past time to end the limit.
    NAABT

  27. Avatar of Tammy
    Tammy / June 29, 2011 at 2:40 pm

    Deborah,
    I agree totally.

  28. Avatar of DrJoeMD
    DrJoeMD / May 21, 2011 at 11:58 pm

    MUST echo Deborah and the other physician observations pertaining to buprenorphine and that the treatment plan is a major part of what services I provide my patients. A patient may come in and after being stabilized on buprenorphine may initially have as his/her goal= detoxification off of ALL medications. That is something I ALWAYS encourage! However, I also re-iterate that there are certain ways of going about detoxifications, which would stack the deck in their favor; i.e. Providing the patient with a set of ancillary services appropriate to him/her. But unfortunately many patients do not fully understand the nature of opioid addiction; particularly if they’ve been using for a long period of time. If so, they most probably fall into the group of patients Volkow et. al described as having a brain disease. This is the population that pays the price for the regulations on our “waivered” licenses, allowing us to treat a limited number of patients; when in reality, I’ve anecdotally found that many of my patients (at least for the time being) would be considered to be on buprenorphine maintenance. Now, it is my individual patients’ prerogative if they wish to continue receiving replacement therapy and I have NO problem detoxifying them, while providing them with ancillary counseling services and have even found that Clonidine transdermal 0.2mg-0.4mg TD q7d is helpful in reducing the mild symptoms associated with detoxifying off of 0.5 mg SL buprenorphine. In addition, I’ve also found that hydroxyzine 50mg PO qhs alleviated any form of sleep issues the patient experiences. Finally, I feel it’s VERY important for patients detoxifying off of buprenorphine to receive ancillary medical services in particular therapy in one form or another as the patients’ addiction did NOT form in a vacuum NOR will their recovery occur in one. And I’ve found that my patients with a diagnosis of 304.00 have an above average rate of psychiatric co-morbidity and in many instances, antidepressants are indicated for the post acute withdrawal period. That having been said, I will continue to maintain my patient on buprenorphine as a means of harm reduction (like methadone maintenance therapy). By the way, does anyone know what happened to the push to incorporate methadone into the medical clinic model similar to buprenorphine?

  29. Avatar of D Hudzinski
    D Hudzinski / June 8, 2011 at 8:37 pm

    This is a VERY interesting conversation. It is on the other side of the spectrum from safe and appropriate pain care. Right now many legitimate chronic pain patients are dealing with dwindling access to resources to treat their pain ie Many providers are discontinuing care for chronic pain and are giving their patients 30 day supply of analgesics to find another pain care provider. They are told to “taper yourself off”. Then the patient calls or visits clinic after clinic in search of a new pain provider and they are told over and over “We do not treat chronic pain”
    The increase in addiction and diversion in the general population has stimulated state legislatures to enact legislation that limits the number and amount of prescriptions for pain medications namely opioids.
    So what is the difference? Both the addicted patient and the pain patient deserve respect and safe, appropriate and effective care. Neither population is more deserving than the other.
    There needs to be balance and we need to get government out of Medical practice. Where is our compassion for these poor vulnerable and unfortunate souls who are either have the disease of chronic pain or are have the disease of chronic pain or both.

  30. Avatar of Dale Welling
    Dale Welling / June 25, 2011 at 5:54 pm

    My wife is pain it is so bad.I have 2 have 2 find pain rxs on the street 4hre.The doctor cut the dose done 2 15 vics amouth.I do wath it takes.But she is in pain .Not addict but in nead of pain contol. We both in are 60s .

  31. Sandra, Vancouver, Canada / August 6, 2011 at 11:51 am

    I was afraid this was going to happen. Chronic pain patients aren’t going to go away, and there are always going to be patients that need opiates. And weaning patients of buprenorphine may be an ultimate goal in most people, but the scheduling shouldn’t be determined by when new patients in the community need to be added to the practice!!

  32. Avatar of M. Perry
    M. Perry / July 22, 2011 at 12:46 am

    Really? Your wrong there! They get absolutley no more effect snorting it than they do taking it under the tongue. Let me respectfully give you some insight that I bet you didnt think about. One, when your an addict…the way you ingest the drug is often as much a habit as the drug itself and they need to be on this med some time before they start thinkin norm. Once they do…that will likely change. However….I snorted it too a few times. Once because I was so sick that I knew it would make me throw up. I also snorted it once because the suboxone must have sugar and I have a bad tooth on the bottom and the saliva and med stays sitting there up against your tongue and my tooth. Talk about hurt! BAD! One other reason.. It tastes so bad And takes FOREVER to disolve!. those are typos, not misspells. Im educated, just have the grandbaby on my lap so whats easiest is what your getting. Please excuse. :)

  33. Avatar of JimaJ
    JimaJ / December 11, 2011 at 1:07 pm

    Wrong again….Buprenorphine is not manufactured in capsules!

  34. Sandra, Vancouver, Canada / August 6, 2011 at 11:56 am

    But the need for treatment, counselling, exercise, all of that doesn’t stop with the buprenorphine dosage! You seem to imply that people are in danger of relapse when they are on Suboxone, and need treatment, so they can get clean, and then they will know not to mess up their lives by using!

Leave a Reply

Please read our comment policy and guidelines before you submit a comment. Your email address will not be published. Thank you for visiting Drugfree.org


3 + three =

Disclaimer:
Reproduction in whole or in part of this publication is strictly prohibited without prior consent. Photographic rights remain the property of Join Together and the Partnership for Drug-Free Kids. For reproduction inquiries, please e-mail jointogether@drugfree.org.