Addiction Expert Calls for More Doctors to be Trained in Prescribing Suboxone

With great unmet demand for substance abuse treatment, addiction experts are looking for ways to expand treatment options. Many experts agree there is a need to increase the number of patients treated with Suboxone (buprenorphine/naloxone). Elinore McCance-Katz, MD, PhD, Professor of Psychiatry at the University of California San Francisco and former president of the American Academy of Addiction Psychiatry, talked with Join Together about ways to increase Suboxone treatment.

Join Together: Currently physicians who receive a waiver to provide Suboxone treatment are limited to treating 100 patients with the drug at one time. Why is that?

Dr. McCance-Katz: There are both historical and clinical reasons. The Harrison Narcotics Tax Act, passed in 1914, criminalized physicians who prescribed narcotics for people addicted to the drugs. The Act was passed in response to the many people who had become addicted to opiates that were prescribed to them by their physician. That changed when the Drug Addiction Treatment Act of 2000 (DATA 2000) was passed, which allowed qualified physicians to obtain a waiver from the requirements of the Narcotics Addict Treatment Act to treat opioid addiction with Suboxone and other approved opioid medications in their office-based practices. The law allowed these physicians or group practices to treat only 30 patients with opioids at one time. In 2006, the law was updated to allow approved physicians to treat 100 patients at a time with these medications. If all doctors in a group practice receive a waiver, each can have 100 patients. In the first year after receiving their waiver, physicians must stick to the 30-patient limit before going up to the 100-patient limit.

The reason for the cap on the number of patients is that a person with opioid dependence has substantial needs. These are not patients who can come in a couple of times a year. In addition to having a physical dependence, many of them have medical and mental disorders and behavioral issues, all of which require a lot of time and effort to treat. We know from research that just giving these patients medication does not heal their addiction. They need more than that. Because of these multiple needs, a doctor would be hard pressed to meet the needs of more than 100 such patients.

Join Together: What is the best way to increase access to Suboxone treatment?

Dr. McCance-Katz: All physicians need to be trained in how to appropriately assess and treat opioid addiction. We need more doctors who feel comfortable and competent in providing Suboxone treatment. The government has developed a training program to allow doctors to receive a waiver for Suboxone treatment, but we don’t have nearly enough doctors participating. I am the Medical Director of the program, called the Physicians’ Clinical Support System for Buprenorphine (PCSS-B). The program provides training and clinical mentorship to practicing physicians and physicians-in-training who want to include office-based treatment of opioid use disorders in their practice. This program, sponsored by the Center for Substance Abuse Treatment (CSAT) of the Substance Abuse and Mental Health Services Administration (SAMHSA), includes training at no charge to physicians. The peer mentoring program allows doctors to ask questions on setting up a practice, and to discuss treatment issues as they arise.

Join Together: Why aren’t more doctors signing up for this program?

Dr. McCance-Katz: There is not a big emphasis on treating substance abuse disorders in medical school or residency training, therefore many doctors come out without a broad knowledge base about how to treat these patients. There is some stigma around substance abuse patients, which comes from doctors not having a lot of experience with this population. So they aren’t comfortable or experienced in treating addiction disorders. Others simply don’t know about the program.

Join Together: What is the best way to address the problem of Suboxone diversion?

Dr. McCance-Katz: Suboxone is in demand for obvious reasons. People who are addicted to opioids and cannot get their drug of choice want Suboxone to deal with their withdrawal symptoms. The way in which people are able to get their hands on doses of the drug may in part be linked to the way it is prescribed. The package insert for Suboxone indicates an upper dosing limit of 24 milligrams per day. However, in 2004 CSAT published Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction, which recommended an upper dosing limit of 32 mg per day. When I train doctors, I tell them 12 to 16 mg is the average clinical dose. I can count on one hand the patients who have needed more than 16 mg. When patients are given a higher dose, they quickly realize they don’t need such a high dose, and they then have extra doses that can be diverted. Instead of starting with 24 mg, I tell doctors to start with 16 mg and inform patients that if after several weeks they still need more, they can come back and discuss it. I find it’s very rare for patients to need more, but they find it empowering and respectful to have a doctor tell them they have the option to raise the limit if they need to.

28 Responses to Addiction Expert Calls for More Doctors to be Trained in Prescribing Suboxone

  1. Kay | September 16, 2011 at 1:49 pm

    I am a chronic pain pt who became physically dependent on opiates and built a tolerance after thirty years of taking prescribed opiates to manage serious chronic pain. My physician suggested I try subutex to manage both chronic pain and the dependence that often happens after many years of opiate pain management. To my surprise the subutex works well to manage both my pain and to address my opiate dependency.There is no amount of pain medication that totally eleviates all pain, subutex offers enough relief for me to live a quality of life I did not have while using precription opiate medications, moriphine, percocet..ect. I believe subutex/suboxone works well to address chronic pain without the euphoria that regular opiate pain medication gives you, I HAVE A MUCH BETTER QUALITY OF LIFE DUE TOSUBUTEX/SUBOXONE and highly recommend it for painmanagement.

  2. Ray | September 16, 2011 at 2:43 pm

    We need to address docs who run suboxone mills. Typically it goes like this: 100 patients = 100 monthly meciation visits x the rate, average income for a doc: $125,000 per year for this portion of practice alone. Also: the majority of docs do not send folks to recovery oriented systems of care. Who lost the ethics on this one?

    • Carlos | September 21, 2011 at 12:21 pm

      Ray:

      Where did you get this numbers from? seems like a substantial amount of money. I heard for a long time the Parmaceudical Sales Representatives for the Company were given scholarships to Physicians to take the course and the license number. Of Course their biggest intest was the sale of Suboxen and Subtex not the patients’s need. I am not too sure that this doctors are doing treatment plans etc. Like the SAMHSA guidelines where promoting.

  3. Diane | September 16, 2011 at 8:44 pm

    I do agree that more doctors should be trained in Suboxone in order treat patients who suffer from addiction and have not been able to manage their addiction in the past without the aid of medication management.
    But I don’t think it should stop there. Training more doctors isn’t the only answer. Continuing education for doctors that have already taken the online course would be something that I and many other patients would like to see. As an advocate of MAT, I often see providers not following the guidelines taught within the training. I recently spoke with a patient who was trying to discuss her treatment with her provider and he acted like she had no right to ask any questions what so ever. This happens more often than not. So often many people do not get the treatment outcome desired. If they cannot talk to their provider, they give up. They are made to feel inadequate. Treatment should be team approach between the provider and the patient. More training in this area should be addressed. Suboxone has saved many lives, mind included. I am one of the lucky ones. I have a provider that not only listens to me but she cares about my recovery. And this is what has helped me to have a successful recovery.

    • Carlos | September 21, 2011 at 12:27 pm

      DITO same experience I am having. In fact I got a copy of the SAMHSA Guidelines and have them sent to my Doctor. When he asked me why I have them sent to him? I told him exactly why. I told him that I know how to read too, and he did not seem to be following guidelines.

  4. Michael W. Shore, M.D. | September 16, 2011 at 11:11 pm

    As one of the original Suboxone doctors who also trains other doctors, I am dismayed by the current approach to certify more doctors, without taking into consideration their training and experience in treating Addiction. It is very clear to me that Suboxone prescribing should be only done by physicians with addiction certification and experience. Diversion and overprescribing is most often related to the naivete and inexperience of newly waivered doctors. Many of us in the addiction field can treat more than 100 patients if only the law would allowed it. There is no limit on the number of patients that a doctor can prescribe traditional opiates for, such as percocet and oxycontin. Why should there be a limit on the treatment for addiction to these opiates? Dr. Michael Shore

    • Carlos | September 21, 2011 at 12:34 pm

      You know, back in the 70 and thru the 90s the DEA was making all kinds of stink about Methadone Diversion. Obviously for doctors this is a code of ethics. Around 90 or 2000 before Vincent Dole, There was a longitudinal study about diversion and Dr. Dole’s responds was done in JAMA. Turn out the amount of diversion by methadone patients was a percentage of a percentage, the number was tiny. He pointed out that those who were buying methadone were patients who would need to be in treatment but wouldn’t want to put up with Methadone Clinic policies etc. Perhaps we should be looking at what in our way of treating patient is not so attractive so those patients come into treatment.

    • Susan Markievitz | February 8, 2012 at 1:35 pm

      Dear Michael, My thoughts on the Suboxone is that it is just another addiction!! My gosh when they run out they are looking in every direction to get some. Their actions are such, Their fix! I have a son now in Re-hab. He spent 5 days in detox in Lynn Mass. he came out and he was so proud that he hadnt even taken a suboxone for 2 days. He is now in the Re-hab. part of the program and I can only hope that he takes everything from this. I also hope that he understands that even when he leaves this program he still will need to maintain going to meetings or meeting with a physcoligist, or other rescource. I so recommend that these doctors that hand out this precsciption really need to meet the crucial piece to help their patients maintain soberity. Iam so tired of hearing the cost of the docotrs visit and the presciption cost for soboxone. My other fear is that someday someone will buy a suboxone off of the wrong person and a family will face the loss of a loved one.
      Thank You for reading my post.
      Sincerely
      Susan

    • Tyler Leonsteiner | April 1, 2012 at 1:35 am

      Whom ever disagrees with suboxone treatment are sadly mistaken! I was an oxycontin/oxycodone addict for 5 years before I switched to heroin due to the cheaper price and more effective high, and then from there on started mainlining heroin. My life was in shambles and my family was absolete. For years I was numbing myself and lost everything I ever had, lost every job I ever had, everything just gone from using drugs. Wanted to have a normal life, but didnt know how to quit and was too scared of getting withdrawls to even attempt to quit using opiates and heroin. I tried quiting without anything and had a few seizures and was hospitalized and encouraged to take methadone. But I did some research and found out once you get prescribed methadone your pretty much in treatment for your entire life and on the medication. Now I wanted to get off completely and wanted to be free of opiode dependence, not be addicted to methadone. So when I did that research and talk to a few addiction specialists who were also in recovery themselves all of them suggested suboxone. So once again I did more research on the medication/suboxone and found out that it had a 60% turnover rate for addicts in recovery to get off opiated dependency, compared to methadone with its less than 15% rate of successful recovery. Which is just intolerable. So I started on 24 mg. dose of the suboxone and was dosed down, not up like the methadone and find my life better then before I was an addict. My thinking, attitude of indifferences, morals, ethics, friends, family everything did a 180 degree change and my life has gotten better then ever before and whoever talks about suboxone and their child just being addicted to something else and having withdrawls is abusing their medication or selling them. If you properly use the medication with advice from your doctor, psychitrist and with the help of a program such as N.A. also known as Narcotics Anonymous, that person will not face withdrawl if they are taking it as prescribed!! The person has to be ready and want to quit for themselves and not for anyone else! They will not be a successful recovering addict if they truely don’t hit their bottom and want to quit using! Thank-God for the doctors out there prescribing this medication called suboxone it was with the help of you that got my life in order, though I will always be a recovering addict, there is no cure, it is a disease though those arrogant people do not understand this. Too bad for them this is the attitude of indifference! Thank you Reckitt- Benckiser dearly…………Tyler Leonsteiner

      • Disappointed | April 23, 2012 at 9:22 pm

        Hi Tyler I am glad to hear that your expeirence with suboxone has been a positive one and that you are using it correctly.I do love to hear sucess stories of people in recovery, it gives me hope for my own daughter. I agree that suboxone can be very helpful for SOME to assist in their recovery from opiates and agree 100 percent with you when you say that an addict has to be fully ready and willing to make changes, but please dont be under the illusion that others who dont agree with suboxone treatment are sadly mistaken or arrogant because I am neither one of them and for the most part i dont agree with the treatment.Im interested to know where you got your results of success from.I have done excessive research on suboxone and even though my own daughter seemed willing and ready to take recovery seriously I was against suboxone. I dont think it has such a high sucess rate cause addicts abuse their medications all the time, they also sell them on the street and some suboxone clinics give addicts more than one chance if they find that they are abusing it. It is going from one drug to another suboxone is a controlled substance that you need to be detoxed from,even if used correctly.I didnt hear you write about the suboxone withdrawals that you expeirenced so Im assuming that you are still on the drug.So the battle with withdrawals is far from over.I do wish you the best and do hope that you are sucessful in your recovery, but please be mindful of others who dont share your veiws. For many suboxone has been a living hell, for addicts as well as those who love them.

        • Tom | July 11, 2013 at 4:36 pm

          I read the reply from this lady who still insists on holding on to the same old paranoid scare tactics. Even after she read the letter from the addict who has changed her life completely. I have come to this conclusion. You all not ever get these people to see the light. All you can do is walk away. Do not even get into a debate with them. It is a complete waste of time and energy. Instead surround yourself with people who believe in and support you. The best you can do is pray for them and especially the addicts in their lives that they believe they are helping. BTW, you are completely correct about there opinions. You do have the right to tell them that you think they are wrong. Have you ever noticed that the first thing they do is to feign being indignant? Respect for another’s opinion does not mean that you can not say you think that are wrong. But once you have. Stop there. Get back to the people in the rooms that believe in you. Thank you for sharing…

  5. David Jefferson | September 17, 2011 at 10:29 am

    The Addiction Technology Transfer Centers have been preparing a four part self paced training module to increase the use of medication assisted treatment. They should be released in the coming months. They are designed for medical staff and treatment providers and include four modules on how to reach special populations like Asian and Pacific Islanders and the Latino community. Be glad to forward the announcement once they are released. The web site is: http://www.attcnetwork.org/index.asp
    Regards,

  6. karen | September 17, 2011 at 3:31 pm

    I’m happy to hear Kay is enjoying a better quality of life with the pain relief she is getting from Suboxone. It’s positive to hear it’s doing someone real good. I see the other uses for Suboxone, the addicts chasing after it, snorting it, selling it for heroin. It’s difficult for addicts to use drugs as prescribed.

  7. karen | September 17, 2011 at 3:37 pm

    After seeing Suboxone abused and misused by sick and sufferring addicts I know and care for, it’s difficult to see it’s use promoted. Have we learned anything from the Chineese people about addiction? They had to plow the poppies under and plant wheat and rice. Reformulating and repackaging the product in the lab doesn’t seem like a real solution to me. This drug and Methadone are for profit drugs. Is there a time for the drugs to be prescribed? Are young people to continue indefinately at these clinics and doctor’s offices indefinately for the opportunity to treat their addiction?

    • Barbara DeStasio | September 21, 2011 at 8:53 pm

      What would you recommend be done?

    • Tom | July 11, 2013 at 4:51 pm

      You asked a question. As a recovering addict. Let me answer it. Yes. We can go to clinics for the rest of our happy productive lives. There is no cure for addiction. Once again, you too are raising the same old paranoid scare tactics. It saddened me that the only points you can find to talk about are the failures. Do they happen? Of course they do. Do you understand why you know about them. Its because they are sensationalized news. You won’t find the addicts that are doing well on the 5:00 o clock news. But if one in ten screws it up for all of us. Its news. Then those failures are held up by opinions such as yours and presented as how it is for everywhere and for everyone. Sad…

  8. cheryl | September 18, 2011 at 9:25 pm

    I believe doctors should have sensitivity training when it comes to treating people in recovery. Many doctors have insensitive attitudes when it comes treating folks who have this history. If they don’t approve of the patient’s past choices some are verbally abusive, condescending, and some are abusive in their treatment choices, such as under-medicating patients who are truly in pain.

  9. carol | September 19, 2011 at 3:41 am

    How many more trials will tax payers have to pay for while families bury their children to accidental overdose caused by Naltrexone.

    It does not stop cravings, nor does it end addiction.

    I speak for the people who are dead, because autopsy does not.

    This time there is evidence of death but noone to listen.

    • Carlos | September 21, 2011 at 1:09 pm

      With all due respect Carol, but Naltrexone is not a drug where patients can over dose from. Perhaps you mean suboxone with another downer type medication, because Suboxone by itself the risk of overdose is near to none.

  10. Richard Solomon, PhD | September 20, 2011 at 9:37 am

    As a licensed clinical psychologist with 30+ years of experience working in the field of addictions I must add a cautionary note to this plan to encourage more MD’s to prescribe meds to treat addiction. I have seen far too many MD’s who write prescriptions without adequate knowledge and/or understanding of the dynamics of addiction. Ie, they are often enabling the addict to simply ‘get their drug’ rather than fostering/requiring recovery as part of their engagement with the ‘patient.’ Some people may never achieve complete abstinence from pain meds. But they can and must do more to help themselves manage their lives than simply take a medication that has been rx’ed by an MD. It is incumbent on the doctors, and non-medical professionals, working with these individuals to motivate them, support, and monitor their efforts to do this.

    • back to myself | February 26, 2012 at 6:42 pm

      Suboxone cuts out the ugliest part of addiction. When an addict is no longer obsessed with how and where they will get their next dose, to dodge the crippling withdrawls, they can free their mind to face the true problem at hand.. Finding out what caused the deppressed feelings they were trying to numb with opiates. I agree that a doctor needs to know a lot about addiction in able to prescribe Sub.. I am a “soccer mom” on Suboxone.. The other patient my doctor may see is a person with a 20 year heroin addiction.. Both of us needing help, but in a very different way..

    • Tom | July 11, 2013 at 5:15 pm

      You may be a professional. But are you an addict? Once again you are lumping all doctors in to the same boat. Or at least implying that. I am 58 years old. Have been in and out of recovery over a 40 Year span. I am currently clean and have been for the last 6 years. Yes I take sub. As prescribed. I do not abuse or sell it. I have a psychologist that I see once a month. At one time I was prescribed several drugs including traxadone, alprazolam , and others to deal with my issues. At the encouragement of my doctor and family and fellow addicts. I slowly withdrew from these drugs. What I am trying to tell you is that you can lead a happy productive life with all of these things combined. Can you at least admit that its a possibility? I know of at least 10 addicts that can not get a appointment with my doctor because he is full up. These addicts sincerely want help. We in my my recovery group help them as much as we can. But addiction to heroin is very powerful. We need more doctors. Please, take it from an addict that see’s this everyday. Please think about it…

  11. notwhatyouthink | September 20, 2011 at 2:45 pm

    My experience is more Suboxone Doctors are definitely needed. I get calls weekly from desperate opioid dependent folks or their parents, spouses, or other concern family or friends who frantically have been searching for help for an opioid dependent person. All they run into is barriers to treatment. Treatment centers won’t treat people who are physically dependent on opiates and want them detoxed before entering treatment. Few hospital settings want to treat or even will treat the opioid dependent. With luck you may be able to find an ineffective too short three day detox that too often releases the patient still in withdrawals, which sets them up for relapse. Suboxone Doctors are at there limit and not taking new patients way more than you might think. It makes much more sense, given the current treatment options, to put the person on methadone or Suboxone and than taper them off slowly. It would nice if we had some magic wand treatment, but we don’t. Heck, more often than not the addict won’t agree to any treatment at all but opioid replacement therapy. So what is one going to do? Suboxone and methadone are way better than the alternative.

  12. recoverydefender | September 22, 2011 at 10:12 am

    In this debate I wear a few different hats.I am in recovery and have been prescribed Suboxone by an addiction treatment M.D. and a general practice physician. They both were questionable in their delivery and the one main difference between the two was that the addiction physician came with the standard addiction treatment program attached. Neither of them were very good about following the guidelines when prescribing Suboxone. They both tried to keep me on the drug as long as possible, soaking my insurance dry. I reviewed the bills from both doctors and they significantly overcharged, charged for services that were not provided, and used the wrong billing codes. Most people suffering from pain killer dependency would not look into these things, but I did. It upset me to be taken advantage of in this vulnerable state. There are other issues such as prescribing other drugs that were questionable, but that is a debate for another day.
    As an addiction treatment professional I feel there is a significant need to treat opiate addiction with Buprenorphine. Many posters have brought very good points to the discussion such as, who actually prescribes this drug and ongoing training for those prescribing. I am amazed at the misinformation patients are receiving about Suboxone. If you investigate through reviewing online Suboxone patient forums you will see that many people are being mistreated and misinformed. Sure there is diversion- as with any mind altering prescription drug. If we as professionals are going to use this as an argument on whether more doctors should prescribe Bupe., then argue the fact that all diverted medications should be addressed.There are people out there selling everything from Xanax to Tramadol. There are senior citizens supplementing their incomes by selling their prescription medications to teenagers. It exists everywhere. Most people I have spoken with who sell Suboxone or give it to a friend do so because they want to stop someone from suffering. These people know how awful withdrawal from opiates is. I have spoken with addicts who were getting Suboxone through diversion- they all wanted to be free of the hell opiate addiction brings and were taking 2-4mg doses a day, living productive lives. They just wanted to treat their addiction without a label. They feared losing jobs or children. Do I condone diversion? No, but I believe every human being has a right to live free of addiction because it is an awful existence.
    As an advocate for Buprenorphine treatment, education is something that anyone coming in contact with Suboxone/Subutex should have on an ongoing basis. Peer Support services need to be more readily available to people in Bupe. treatment exclusively. I feel no doctor should prescribe these drugs without providing individual counseling or group support to go along with it. Simply handing a prescription to an addict is just giving them permission to do as they choose- this is not treatment!
    The issues I have experienced in my personal recovery prompted me to become an addiction professional. I was tired of the stigma, the unfair treatment, the prejudice from pharmacists. It became my personal mission to stay grounded not only for myself, but for my fellow man. Buprenorphine treatment saves far more lives than it harms and more physicians should educate themselves on this treatment, but more of the addicted should feel safe about seeking the treatment as well.

  13. jimmy | October 21, 2011 at 10:30 am

    Hello to all posters. I am a psychiatrist and will have the ability to treat with burenorphine shortly. I also run an addictions recovery program. From the training I have done, it appears that mthatdone, LAAM and suboxone MUST be coupled with recovery programs. I am astonished to read that some of you are knowledgeable of physicians prescribing without that crucial piece. The training and standards are very, very clear in that area. As someone who has worked with addiction for 15 years in my practice, many addicts have defensiveness and are angry about having to give control up of their addiction. But that belief is part of the addiction and one that provides thinking errors to continue using. A candid approach with empath and boundaries is they key to any successful recovery program. What advice would you provide as someone who will begin this component of care in the near future to opiate addicts? I do plan onposting the guidelines in my office and making it mandatory that cessation of maintenance be the goal for treatment.
    Thanks

  14. D. Sapphire Ahmed | May 9, 2013 at 4:18 pm

    First, stopped the abuse of the 2-3 medical organizations who are charging frontline providers $ 200.00 just to train to use one drug. Provide online FREE waiver training as the DOH is Baltimore, Maryland. This makes sense! Primary care doctors working in CHCC and with the indigent and public health frontline providers salaries have been frozen for a decade. We pay enough. We should not be asked to pay to become certified to use ONE drug. This is abusive!

  15. BB | August 22, 2013 at 1:09 am

    Hello all. I have really enjoyed reading all of the posts here. Some very great ideas and thoughts.
    I completely agree that Suboxone patients would benefit so much from treatment along with the medicine. I have been on Suboxone for 3 years. And so has my daughter. That’s right. I was a single mother with a beautiful teenage daughter who was getting into my endless supply of Lortab and by the time I realized that I could not function without pills, I realized she had the same problem. We went to the Suboxone Dr together. We recovered together. And today we are so proud of ourselves. She is excelling in College beyond belief. And my life is straight again. We attended NA a few times together. I still go. I am very into learning all about the disease of addiction. And I love reading everyone’s stories and comments. Drugs are just the devil himself. I hate drugs. And I do believe Sub has saved and bettered so so many lives. Including 2 in my family.
    I don’t know if I will ever get completely off of Suboxone. Why do I need to? If an alcoholic could take a pill to never drink again, and not endanger others anymore, they would..? Right? Or if a cancer patient could keep the disease at bay , they would, right? I am just so greatful for my life and mostly for the devil being out of my daughters life… I don’t want to risk it by stopping the Suboxone.. Just my thoughts… Thanks.

    • Annon | September 11, 2013 at 6:22 pm

      I have done the same thing, you know trying to get your life back in order. These people say once your an addict you are always an addict. Well they put you on these Suboxones and like I said you start getting your life back together then they suddenly want to take you off of them because they think you are starting to get better, but what happened to the whole once an addict always an addict??? It makes NO sense to me as to why they would want to take you off of the Suboxone’s. I mean a person can stay on pain meds forever by having a doctor prescribe them or by going to a pain clinic. A person can stay on methadone for as long as they want. But with this Suboxone they get you on it and then want to start taking you down and then completely off. It completely makes NOOOOO sense to me why they do this. I also don’t understand there are all of these laws and regulations about how many patients these doctors can have and they quit making the tablets so that they can make people take to CRAPPY strips and so they can look at your empty strip packages because each one has a unique code that they can identify back to the person who’s strips they are. Yes each packet has a unique number on it to where they can call you in for a strip count andx they check the numbers on the back with the pharmacy. Why go through all of this trouble so people don’t abuse the Suboxone’s when there is no way for them to identify anyone’s pain pills. Why don’t they start putting each oxycodone or hydrocodone in little packets with unique numbers and link it to the pharmacy so they can tell the person it came from. Or perhaps inscribe it on the pill. That way when drug dealers get caught with a buch of pills they can tell whose they are. But no they don’t want to do that they would rather try to mess with the people coming off of drugs. Who really and truly want help. Come on people if you really say you want this drug problem to stop then start inscribing numbers on these people’s high power pain pills.

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