Bummer…. I recently had an SEO expert review my blog and forum, wondering why my hundreds of pages about buprenorphine and Suboxone are a page or so further down the Google lists than a single-page web site offering rapid detox. I learned that the theme I used for the blog, while fresh with features 6 years ago, has not been updated for a long time, causing the pages to be inconsistent with many of the modern coding standards.
For you, the reader, that means that one of these days you’ll have to wait an hour or two as I transfer to a more-modern theme. In the meantime, I’ll continue to ask for your support by linking to the blog whenever possible, for example after commenting on a related article in the papers that allow for links to be placed.
I changed another patient over to Zubsolv today at his request. I’ve heard positive reactions to the medication, particularly regarding the menthol taste of the rapidly-dissolving wafer. Some insurers are dumping Suboxone from their formularies in January, so I expect significant change-over in the next year.
I admit to worrying about the future of buprenorphine, given the number of articles fanning fears of the drug. As state legislatures get more involved, fewer doctors will stay involved. We’ve seen that clearly with opioid agonists, where the people who truly need pain relief from opioids have lost the battle with the non-opioid movement to the point where many doctors are afraid to prescribe opioid agonists at all, and many health systems forbid their employed physicians from treating pain with opioids.
As I read about the moratorium on buprenorphine treatment programs in Bangor, Maine, I thought about the scene from the movie Titanic where the people who found safety in lifeboats struggled to keep those in the water from climbing aboard. The Bangor city council recently voted to impose a moratorium on expanding buprenorphine treatment programs for 180 days, at least in part because of concern that Bangor had become ‘port in the storm’ for heroin addicts with nowhere else to turn.
I haven’t been to Bangor, but I live in Bangor-like conditions. Bangor clinics treat more than the city’s share of people addicted to opioids. The city has three methadone clinics, treating a total of 1500 people, many of whom travel from outside the city for treatment. Numbers on buprenorphine treatment were not provided in the articles I’ve read, and so I don’t know if buprenorphine/Suboxone prescribers in Bangor carry the same heavy load. Some editorials about the Bangor situation have suggested that buprenorphine treatment is unfairly targeted because of the large number of methadone patients. The two types of treatment are often confused, especially since methadone clinics now dispense buprenorphine to some patients and methadone to others. But buprenorphine-based products differ from methadone in that they can be prescribed for addiction treatment, whereas methadone can only be dispensed—initially on a daily basis. The medications are similar in that both are the most reliable methods to cut the number of overdose deaths from pain pills or heroin.
By ‘Bangor-like’, I’m referring to the lack of buprenorphine-certified physicians in northeast Wisconsin and the Michigan Upper Peninsula, and the need for residents of those regions to travel in my direction to see a buprenorphine-certified provider. There are also regions of the Upper Peninsula where pharmacies have stopped providing Suboxone. The exit of one pharmacy created greater pressure on remaining pharmacies, creating a death spiral that ended with no pharmacies dispensing Suboxone across a wide region.
The name ‘SuboxDoc’ created an online identity, but I’ve always realized the moniker was a double-edged sword. Once when I testified for a young man linked to an overdose death, the DA undercut my testimony by asking ‘Is it true, doctor, that sites on the internet refer to you by the name SUBOXDOC??!!!’ (Insert dramatic music here). So I’ve tried to move away from the name, removing it from posts and replacing it with ‘J’ or ‘Admin’.
Good thing, because there is a new SuboxDoc coming to your area…. Your state’s new regulatory agency! As fear of buprenorphine diversion sweeps the nation, some states have passed legislation adding more rules for practices that treat addiction using buprenorphine. Never mind that buprenorphine is linked to about 400 deaths over ten years, one tenth of the number of deaths from acetaminophen during that same time, and 0.1% of the number of overdose deaths overall.
Many parts of the country have seen a reduction in number of buprenorphine-certified physicians over the past few years. Many rural areas have no buprenorphine prescribers at all. The lack of prescribers, combined with the limit of 100 patients per prescriber, leaves opioid addicts with one legitimate treatment option— the early morning line for methadone or buprenorphine at methadone clinics. I’m not against the clinics, but the need to report each morning is a significant barrier to employment in many patients who would do just as well with a prescription for the medication—and a first-shift job. Their other option is to do what all the news stories have been reporting—use buprenorphine without a doctor’s supervision and attempt to stop heroin or pain pills on their own, aka diversion.