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 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, the most important thing isn’t to open more doors to treatment, but rather that the film be successful.


Why Suboxone?

Opioid dependence, A.K.A. addiction to pain pills, kills thousands of young people in the US every year.  Those who have read my columns on the topic at my blog, forum, or at my PsychCentral site probably have a good sense of my attitude toward Suboxone:  While it would be wonderful if people could stop using opioids completely, in reality the relapse rate after treatment is over 90%.  And frankly, not treating people with such a fatal condition is, in my opinion, a shameful way to practice medicine.

Suboxone has unique properties.  People who are taking Suboxone as prescribed become tolerant to the effects of the medication, and within a week they look and feel completley normal.  They are not ‘on’ anything, anymore than a person with hypertension is ‘on’ blood pressure medication.  Although while medications for hypertension reduce the risk of cardiovascular disease to a varying degree, Suboxone has a more direct and constant effect, by blocking the effects of heroin or pain pills.