Why So Few Suboxone Doctors?

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. The shortage of buprenorphine-certified doctors parallels shortages of mental health practitioners in general, including psychiatrists and addictionologists. Larger cities and areas near the east and west coasts are less likely to have shortages of doctors than are smaller and more-rural parts of the country, particularly across the Midwest.

The shortage of Suboxone doctors is caused by a number of factors.  All doctors train in medical schools, which are primarily located in larger cities.  So by the end of training. most doctors have spent several years living in larger cities, establishing friends and business partners and sending their children to area school districts.  As with members of any profession, doctors are more likely to choose positions in areas they know than to move to unknown areas, unless the area holds special attractions like morning sunrises over the ocean or mountain views.  Even doctors who grew up in rural areas find it hard to move back, after living in more urban areas during the 12 years of college, medical school, and residency.

 

Why Limit Care?

My personal practice receives several calls per week by people asking for help in treating their addiction to pain medications or heroin, or often both.  As people seeking treatment usually discover, each physician is capped at the total number of patients who can be treated with buprenorphine at any one time.  During the first year of buprenorphine certification, physicians can have up to 30 patients under treatment at one time.  After a year, a physician can apply to have the number increased to 100.

I have been at 100 patients for years, and I have relatively slow turnover, since I am an advocate for long-term treatment using buprenorphine.  My wait-list has about 60 names, although when a spot opens up and I start calling people on the list, many of the numbers have been disconnected.  Opioid dependence tends to do that to telephone accounts, either through poverty or death.

 

‘Here to Help’ Not Helping

I am removing the link to the ‘Here to Help’ program, a thinly-veiled piece of Reckitt Benckiser propaganda that does much more to harm the lives of opioid addicts than to improve them. The connection isn’t real complicated, but might take a moment or two of your concentration to understand.

I’ve written in the past (as have others) about how RB profits from the misunderstandings about the value (or lack thereof) of naloxone, a chemical that turns generic buprenorphine at $0.25 per mg into the identically-acting drug Suboxone at $1 per mg.  I’ve written about RB’s mad rush to promote Suboxone film, to replace the profits expected to disappear as generic buprenorphine/naloxone enters the market. And I’ve written about the latest stunt by RB of declaring their own tablets unsafe shortly after their patent expired, essentially eliminating the ‘risk’ that affordable generic ‘Suboxone’ will ever reach suffering addicts.

The impact of RB’s actions extend beyond raising the price of their signature product– an action that by itself costs untold lives.  The hyped concern over the safety of buprenorphine also strongly impacts the debate over raising the 100-patient limit faced by current providers.  That means the doctors like me, with a waiting list of 80 people, must reconcile the wait list with obituaries as they appear in the paper each week– rather than treat those in need.  But to RB, as the deaths add up each week, the most important thing isn’t to open more doors to treatment, but rather that the film be successful.