Can my doc prescribe Subutex? SHOULD he?

Hi all!  Sorry for the lapse in posting… I have been gearing up to blog for Psych Central, an opportunity that I am very excited about, and I have a hard time writing one blog and being excited about a second blog at the same time!  Please be sure to visit my blog at psychcentral.com, called ‘An epidemic of addiction.’ The first few posts will be mostly introducing myself with information that people here already know, so come visit in a couple weeks when I am up to speed.

A question/answer post for tonight:

As you know, generic Subutex is cheaper than Suboxone. I want my doctor to switch me to Subutex, but I am so afraid to ask him.  Even though my doc is nice to me, what if he is one of those doctors….gets mad at me, and discharges me as a patient?  I can’t do something that could possibily send me back on that old course of life that seems more and more distant every day.

Can my doctor legally prescribe me Subutex rather than Suboxone?  What good reason could he have for not agreeing to, once I show him how much money it will save me?   Also, do doctors make extra money by writing a prescription that is filled at a certain pharmacy?

My reply:

Thanks for your question.  Isn’t it sad that people are afraid that their doctors will cut them off of life-saving treatment?  The writer is not paranoid;  there are practices where patients are treated as ‘guilty’ just for asking questions that make the doc uncomfortable.  Such a situation does NOT foster the open communication that keeps addiction out in the open, where it can be treated properly and effectively.  And such a situation is a far cry from treating addiction as the disease that it is, rather than a character deficiency.

Any doctor who can prescribe Suboxone can also prescribe Subutex.  There is no difference in the actions of the two medications when they are taken properly;  Suboxone contains naloxone, that supposedly reduces IV use of Suboxone.  But studies show that most ‘diversion’ of buprenorphine is for ‘self-treatment’ of opioid dependence– not for the sake of getting an opiate high.  I suspect– but have no proof– that the RB reps encourage docs to think that if they prescribe generic Subutex, their patients will be shooting up in their lobbies.  This keeps docs prescribing brand-name Suboxone– at least until the Teva generic becomes available.

The main reason a doc won’t prescribe the generic then is fear of diversion, which in my opinion is overblown– not  because there is no diversion, but because both Suboxone and Subutex are diverted at an equal rate and used for the same thing– for illicit self-treatment.  Some docs probably avoid the generic to avoid a common problem– if the pharmacy doesn’t have the generic they will substitute the very-expensive, name brand Subutex– often resulting in calls to the doctor for prior authorizations or replacement scripts.  It is currently easier for the doctor to simply write for Suboxone.  Docs should realize, though, that the cost difference is quite significant;  in my part of Wisconsin, generic Subutex is lesss than $3.00 per tab, and Suboxone is over twice as costly.

I have heard of places in Florida (sorry Florida– maybe it happens elsewhere too, but you folks have a reputation for this) where docs provide scripts for pain pills with the condition that people use specific pharmacies.  I am surprised that such an arrangement would be legal;  it is clearly unethical to have such a conflict of interest.  That arrangement would violate Medicare law, but if they avoid Medicare patients, perhaps they can get away with it…  But to answer the question, I have never seen such a situation in my part of the country.  Docs– post anonymously if you are willing– has anyone heard of profiting by prescribing certain medications?

To the writer, I would like to just say ‘ask your doc if he/she will prescribe the generic.’  I can tell you that I would certainly not be ‘offended’ in any way, or think poorly of you.  Of course there is always some value in being polite;  no doctor likes being told what he/she ‘has to prescribe!’   But you know your doc and I don’t.  If your gut says tread cautiously, then tread cautiously.  You could always ask your pharmacist if doctor so and so ever prescribes the generic– although pharmacists tend to treat addicts even  more poorly than doctors do!

For the docs out there, maybe it would be appropriate to ask yourselves, ‘is this MY patient writing to the blog?  And if it is, why is he afraid to talk to me?’

6 thoughts on “Can my doc prescribe Subutex? SHOULD he?”

  1. I shot heroin for 10 years back in the 70’s and thought I would surely die. I survived after many attempts at treatment and finaly found NA at age 27. Life was so good then. I was a grateful recovering addict. 20 years into sobriety I found myself abusing vicodin and oxycontin. I was absolutely amazed at how I reverted back to the same level of insanity over these stupid pills. I could not stop. I knew I needed to take the first step and get honest so I told on myself and started banging on the doctors doors looking for help. They wanted me to leave my employment for 90 days of treatment. They had no other options for me? I spent one year trying to find the right treatment but kept relapsing. I was so discouraged I did not think it would ever end. Then I saw a program on the Discovery Channel about suboxone. I was afraid to take it at first but I was desparate so I asked if my doc prescribed it but he had never told me about it??? That’s another story. Anyway….I’m staying on suboxone for life. My doctor didn’t agree with me at first and kept pushing me to start my taper. I was so amazed that this secret drug REALLY REMOVED my cravings that I was going to fight this taper issue in court if they forced me to taper. I’m so relieved to hear that the treatment community is on board with this approach now and willing to let us stay on suboxone for life. It’s a little unfortunate that I have to do a 30 minute counseling session once a month for life too but I do not want to rock the boat for fear of causing a problem with my refill. Damn shame that we are all afraid of our insurance carriers. It turns out that we can be restored to sanity, of course you have to do the work, but I have not had one thought in my brain about wanting an opiate for three years now. Thank God. The consequences of my addiction may be different today than back in the 70’s and the methods of using or type of drug may be different but one thing I can always count on.. the level of insanity is exactly the same every time. I’m completely obsessed and will go to any lenghts to get my next high. Thanks for all the good info you are sharing here…we need to continue to carry the message.

  2. i am an Internist who prescribes suboxone in NYC. I would love to prescribe my patients the cheaper generic subutex. However, I am afraid of the DEA. They have been looking at charts in nyc and long island. They have now required random subutex urine testing supposedly to prevent diversion. In new york state you cannot prescribe more than 1 month at a time. The point is I’m afraid to prescribe the subutex only. It’s not like I have anything to hide but I’m afraid of these guys and don’t want to jeopardize my license.

    SB MD

  3. I’m not surprised, but I AM disappointed. It seems as if they are much more concerned about buprenorphine than about the actual opioid agonists that are creating the problem. One month? While that makes sense in early treatment, it sounds onerous for people who have done well on buprenorphine for years! Even schedule II opioids can be prescribed in three month quantities, providing that (according to DEA rules) there are separate, 30-day scripts each for the same medication and dosing regimen, and each with the date they were written and a ‘fill after’ date.

    Thanks for sharing your experience, and for reading.

  4. Hi, I’m new to this site but am glad that this exists. We addicts need an outlet, and the more information we can give each other the better armed we are against those particulately pompus doctors who try to use fear as a tool to keep us in line. I have been on Suboxone sine the month it came out in 2003. So I have definitly been around the block. I too would really like to be prescribed Subutex, rather than suboxone. For one, subutex works a hell of a lot better than suboxone. I’m not sure why but I think it has to do with the absense of Naloxone. When suboxone is used sublingually we actually absorb a small amount of the Naloxone. This can cause unwanted side affects such as elevated heart rate, head-aches and more.
    Now the reason most Doc’s won’t prescribe Subutex is because you can shoot it. The Naloxone in Suboxone prevents it from being misused. Also, Doctors want you to use the same pharmacy so that in case you’ve been Doctor shopping or the like it will be caught by the pharmacy. They also want to keep tabs on you. Personally I’ve never had my Doctor check with my pharmacy. My question is about new regulations in New York State about doctors only being allowed to prescribe 2 8 mgs a day, rather than 4. Has anyone had a similar experience?

  5. I’m new to this site. About 2 1/2 years ago I was put on oxycodone for chronic pain. Over time it has increased to now I’m on 60 7.5mg oxycodone and 120 5mg methadone a month. I got to the point where even that wasn’t enough and I would resort to buying pills. Then I just flat out got tired of the dependence I have on them. It took a lot to finally get into the only Dr in my community that can prescribe saboxone. But when I did it was a freedom I hadn’t felt in such a long time. I would much rather have the daily pain I have then Chase the pills so I won’t be sick. I cold turkey’d it once and it was so intense. I made it 6 days of detox and couldn’t take anymore of vomiting, sweating, diarrhea, muscle pains and the sweats. I gave in and took my pills. I feel so lost right now. I’m scared more then anything , I lost my medical insurance at the end of October and couldn’t afford to continue my saboxone treatment. I talked to my Dr about this and practically begged him to help me find ways to continue. His only option was cash out of pocket. Well I don’t have that kind of cash. He told me that withdrawls would be minimal and very bearable. Maybe I’m just a baby but it was not minimal and bearable. Again I really gave it my best foot forward to kick it on my own. I failed. I was sick again. So back to my PC provider I went and picked up right where I left off. Back on oxycodone and methadone. Every time I put these in my mouth I have a great deal of shame and defeat that I feel. I continue to search for options to go back on saboxone with no success. When I was on the saboxone my pain was still there but it was bearable. I felt no shame. When I was put on narcs for my pain I never dreamed this is what would have happened. I have never had something control me so much. I realize this sounds very pathetic and I’m embarressed as I type it out, but it is truly how I feel. I wish there was a more cost effective way to be on saboxone. And I wish it was more available in our clinics. To SERENITYNOW how were you able to convince your Dr to give it to you for life? My saboxone Dr said the maximum time I would be on it was 6 months. If anyone out there has information that would be helpful to me it would be a God send.

  6. Hello, everyone. I am new to this website. I decided to sign up after reading Kari’s post. Kari1978, I don’t know if you still come back to this site, but I think I can help you. If you see this post, please respond to it so that I can give you my personal information. I can help you. I just hope that I’m not too late.
    You have nothing to be ashamed or emabarrassed about. There seem to be some wonderful people on this blog and all of us have something in common. As one person said in a previous post, “Addiction is NOT a character deficiency”! You are human, just like the rest of us. The fact that you were so honest and forthcoming about your addiction only makes me empathize with you more. You are NOT pathetic, but I can understand how you might feel that way. I too, used to feel that way when my addiction happened, but I taught myself to deal with it.
    You see, my addiction started simular to yours. Back in 2005, I went to the doctor for what I thought was a broken bone in my foot. In my martial arts class, I injured my foot during sparring. Shortly afterwards, I noticed a large, painful lump that stuck out on the top of my foot. After it wouldn’t go down and was so painful to the touch, I assumed my foot was broken and went to my family doctor. After nothing showed up on the xray, I was sent to a podiatrist, who determined that the lump was a hard tumor. Frightened, I pleaded that he give me surgery to remove it in case it was cancerous. Of course, the insurance company gave us hell, so until my surgery was approved, I was prescribed strong prescriptions of Lortab and Hydrocodone. Knowing nothing about narcotic dependence, I took them as prescribed. This went on for several months before and after my surgery. Then the tumor returned with several other tumors, and I had another surgery. Still, I was on the painkillers. Once I felt better, I stopped taking them immediately. I felt a sickness I cannot even begin to describe. Thinking I had some sort of post-surgery infection, I paged the doctor in a panic. After a series of questions, he determined that I was going through a “harmless withdrawal”. Once again, he advised that I continue the pain meds and taper off. Well, I did as I was told. It wasn’t long before I realized I had a problem. Scared and embarrassed, I tried to check myself into rehab. After hours of questioning, they decided that I was not a candidate for admittance. Instead, they referred me to a local doctor that prescribed Suboxone.
    I remember the first tablet I put under my tongue. Since then, I have been on Suboxone. I have my life back and have no urge to take another pill ever again. I’ve even had hand surgery and refused the prescription. I welcomed the pain. In fact, after the pain of withdrawal, a little pain from surgery was a god send, managed with Aleve.
    So you see, you are not alone. And your cravings are not your fault. Longterm use of those opioids have changed the chemical balance in your brain, and that is why you “need” those meds. You have taken the most important step by admitting you have a problem, and the second most important step is asking for help. A real addict refuses to admit or ask. You have done both. Finally, you have shared your problem with others; others being us. I call it AAS-Admit, Ask, Share. You admitted your problem, asked for help, and shared with others your problem. I’ve found that it’s easier to open up to strangers. You’d be amazed at how friends and loved ones will treat and judge you if you open up to them. Until I found this site, my doctor/therapist was the only one I shared my feelings with regarding my addiction. That is what they are there for. As for your doctor, you may need to look into finding another one. Even if he/she is in another city or state. The sacrafice of distance is always worth the help you will recieve. I remember when I moved to another state, I still drove up once a month to see my doctor because addiction will rule your life. I remember days when I ran out of my prescription, I couldn’t go to work until I got my prescription filled because the sickness is paralyzing. The muscle-aches, the stomach cramps, joint pain, restless leg syndrome, anxiety, nausea, restlessness, depression, and darkness is paralyzing. And when you feel that way, guys, all you can think about is getting that pill to make it through the day. Life like that is no way to live. I’ll admit that while I’ve had no desire to use, I would be frightened of the withdrawals if someone took my Suboxone. I have just learned to accept that as reality. As one person candidly state in a post I read earlier, I would rather have to put a pill under my tongue twice a day than take another painkiller as long as I live.
    That being said, I want to thank all of you for your posts. Your stories and your honesty are priceless. I don’t feel so alone, and I finally have found an outlet. And if my story only helps one person, it’s worth it. So, Kari, if you or anyone else wants to talk, please reply to my post and we can talk. I wish you all Godspeed and the best of health.

    Tonjia