by Peter R. Coleman, MD
Recently, the U.S. Department of Health and Human Services decided to increase the number of patients that physicians can treat with Suboxone®. Beginning around 2002, physicians who went to a training program have been allowed to prescribe Suboxone® for up to one hundred patients. This has become an important treatment option for opiate-dependent patients and has undoubtedly led to many patients stabilizing their lives and committing to long-term recovery.
When determining rules for Suboxone® treatment, the government intentionally chose a design that was different from methadone programs. Methadone was approved as a treatment for opiate addiction around 1970. Because it is an addictive and abused drug, it could only be given out in licensed clinics. Restrictive regulations were put in place, including required daily attendance at the clinic, and supervised consumption of medications. In some ways, the regulations contributed to the problem. It is difficult for patients on methadone to travel or hold a job, and they are regularly exposed to other actively using drug addicts.
In order to avoid the same consequences, rules for Suboxone® were designed to allow a physician in private practice to prescribe Suboxone® type products for up to one month or longer. There were, however, no requirements for counseling, drug testing, or any other case management services.
The Suboxone® program has been somewhat successful and has allowed many patients to change their drug addiction/dependent lifestyle. However, because there are very few regulations, we are experiencing an influx of clinics which provide prescriptions for Suboxone® with minimal psychological help for the underlying addiction. Some of these clinics only take cash, spend minimal amounts of time with the patients, and do little more than supply drug addicts with their drugs. Without these clinics providing any other resources or encouragements to transition to a sober life, it is sometimes hard to tell a difference between them and people on the street who sell their products for cash.
Thankfully, the latest regulations will be an improvement to the industry. The regulations have fairly strict requirements for physicians to be able to prescribe Suboxone® for more than 100 patients. Providers must be an Addiction Medicine Specialist with extra credentials, and they have to be in a qualified practice setting. The qualified practice has to accept insurance, provide case management, and be available for emergencies. These are major improvements that will hopefully change the Suboxone® process and enhance access for patients who need treatment.