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.

Beyond the regionalization pressures, doctors are discouraged from becoming certified to treat opioid dependence using buprenorphine.  The coursework is limited by medical school standards, and the cost for buprenorphine training and registration is relatively minor.  But to become buprenorphine-certified, doctors must sign an agreement that allows random inspections by the DEA without cause.  Other doctors enjoy privacy rights similar to other businessmen, where search of the premises and review of records would require probable cause and issuance of a warrant by a judge.  But in order to treat with Suboxone or buprenorphine, doctors must waive that right of privacy and allow inspections with no notice, even if such inspections require closing the clinic doors for the day.

The requirement to allow random inspections has an effect on individual doctors, especially since the 100-patient limit (30 patients the first year) guarantees that buprenorphine-prescribing will not support a practice without a significant number of non-buprenorphine patients.  And now that most doctors are employees of large health systems, the requirement for inspections is a greater hindrance.  Most major health systems are not as interested in treating addiction— an area of medicine with low reimbursement rates, and patients who are more likely to be impoverished by their illness– as in attracting orthopedic or heart patients, the ‘cash cows’ of modern medicine.  If you were CEO of a multi-physician network, would you permit random DEA inspections of your physicians’ offices in exchange for the ability to treat more patients addicted to drugs including opioids?

The requirement to allow random inspections has an effect on individual doctors, especially since the 100-patient limit (30 patients the first year) guarantees that buprenorphine-prescribing will not support a practice without a significant number of non-buprenorphine patients.  And now that most doctors are employees of large health systems, the requirement for inspections is a greater hindrance.  Most major health systems are not as interested in treating addiction— an area of medicine with low reimbursement rates, and patients who are more likely to be impoverished by their illness– as in attracting orthopedic or heart patients, the ‘cash cows’ of modern medicine.  If you were CEO of a multi-physician network, would you permit random DEA inspections of your physicians’ offices in exchange for the ability to treat more patients addicted to drugs including opioids?

There are calls to raise the patient cap, or to find other ways to reduce the stigma over opioid dependence that discourages doctors from entering the field of addiction treatment.  But now as more and more states are writing regulations of their own, sometimes through well-motivated but misguided efforts to reduce ‘diversion’, I’m not holding my breath that the shortage will end soon.   And since much diversion consists of people using Suboxone on their own after failing to find a physician, don’t expect state regulations to move the diversion problem in the right direction!

Find Suboxone doctor locators here.

2 thoughts on “Why So Few Suboxone Doctors?

  1. I received this comment from a physician:

    I have been certified to prescribe Suboxone since 2008, but I no longer prescribe Suboxone. A couple of years ago, I had the pleasure of having 3 DEA agents come to my office and go through all my charts of patients who were being prescribed Suboxone. I was told they just wanted to talk to me and it would take a few minutes, but they ended up staying for 3 hours. This left a bad taste in my mouth and I have decided to stop prescribing as I cannot afford to cancel clinic just so the DEA can make sure my charts are in order. It seems backwards that a medication that is fairly safe and is designed to help people is monitored more, also there is a limit to how many patients you can treat, than those medications that can wreak havoc.

  2. I have been taking Subutex for 2 years now. I see my Dr. once a month at $175 per visit and have been on maintenance of 12 mil. per day (1 1/2 tab) for legitimate pain issues. I hated the “opiate chase” before I got on this program. In 2 years I have almost completed college, I have never tested dirty, and haven’t had a drink in 2 years either. What disgusts me is the fact that I went to my appointment the other day and was told I would be switched to Suboxone. This medication is 4 times the price of the generic Subutex but my Dr. insists that “all” of his patients are being switched over. He said the DEA was in his office and is cracking down on the generic form because people are “abusing” it. I had no clue what he was talking about-and after filling my script I was physically sick because it was so expensive. When I called the Dr. office again to ask them to please explain they told me people are shooting up Subutex or selling it….blah, blah! I feel like this is just a scam to get his legitimate, long term patients out of the program so he can recycle in new $500 for first visit and every 2 weeks @$175 until they screw up and get kicked out or cannot afford it. I overheard the receptionist on the phone telling a patient, “no you have to start over for $500 if you don’t come once a month”. Does this sound legitimate to you- My complaint, that is? What does the DEA care if I get a cheaper medication and am on a “clean”, stable, program. I think my Dr. is just being a money hungry jerk. Who needs the “regular” patients when you can recycle in NEW ones so the doc can maintain his “limit” of buprenorphine patients? How do I get information on “NEW, STRICTER, GUIDELINES by the DEA”?

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