Originally Posted 9/16/2013. Thankfully, I haven’t heard about the type of behavior described below in the past few months. Maybe things are cleaning up a bit…
I’ve mentioned the problems with heroin use and buprenorphine/Suboxone diversion in Wisconsin and the UP of Michigan. There are rumors circulating about a doctor prescribing Suboxone in that area—an area where street Suboxone is easier to find than a buprenorphine-certified physician. I’ve called a few pharmacists, but haven’t fully verified the story. But the people I’ve spoken to assert that the doctor used a motel room as an office, and quickly saw a number of people seeking help for heroin or pain pill addiction. According to rumor, he prescribed 90 tablets of Suboxone or buprenorphine to each patient, and then quietly left town.
That’s one way to deal with the cap.
But seriously…. The doc at the center of the rumor may have had valid reasons for his behavior, and I apologize if my comments are misdirected. I was thinking about nasty it would be to treat desperate patients in such a way. But then I realized that addiction is about the only disease where patients are discharged to the curb for being TOO sick—so it is difficult to accuse the practice of ‘patient abandonment’. In fact, doctors are probably more likely to get in trouble for NOT abandoning a struggling patient than for keeping one.
Induction-only practices give everyone connected to buprenorphine a bad name. A year ago there was a doc from Illinois who would come to Northern Wisconsin, induct large numbers of patients with buprenorphine or Suboxone, and tell them ‘now go find a doctor to prescribe it to you.’ That type of practice fuels diversion, and does nothing to help people suffering from opioid dependence. I strongly encourage people to report those types of practice to law enforcement, and to the agency in your state that regulates misconduct– such as your state’s medical licensing board.
A couple other odds and ends…. Zubsolv was recently approved as a menthol alternative to Suboxone Film. I’m not buying company stock; the ‘advantage’ to Zubsolv is a greater dosing efficiency, so that 5.7 mg oral dissolving tabs create the same blood levels as 8 mg of Suboxone film, something the manufacturer suggests may reduce diversion. But for patients who have a say in their prescribed buprenorphine product, which do you think they would favor—- a tablet with 5.7 mg of buprenorphine that is promised to act like it had 8 mg…. or a tablet of 12 mg of buprenorphine that is promised to act like it had 8 mg? The scientific and marketing people should have a discussion with the docs in the trenches.
If you missed my point…. How many of your zubsolv patients, after reading that they are taking 20% less buprenorphine, are NOT going to complain about needing their dose raised? Then again, they have some cool slogans (like Evolv, Resolv, ZUBSOLV) and their own version of ‘Here to Help’, called RISE. Maybe that will make the difference…