Who Can Write for Suboxone?

Tonight’s question:  who can write for Suboxone:

To explain this situation requires a bit of history.  In the early 1900’s, morphine and other opiates were sold as ‘tonics’ (along with other drugs that are now ‘controlled substances’).  In the 1920’s doctors treated addicts by prescribing narcotics to relieve their withdrawal.  Clinics existed with the aim of treating and/or preventing opiate withdrawal.  Public outcry consistent with the attitudes of the time eventually led to the closing of these clinics, and a ban on prescribing opiates to treat opiate withdrawal.  That was the state of affairs until the early 1970’s, when congress passed the law allowing methadone clinics to operate.

Most people don’t realize that doctors are allowed to prescribe pretty much anything for anything.  There are very few rules that regulate medical care;  the way doctors practice is kept in line mostly by physicians’ desire to do help patients, coupled with physicians’ fear of being sued for malpractice.  One confusing issue for patients is ‘FDA indications’ for medications;  a pharmaceutical company will seek FDA indication for a medication so that they can advertise the medication for that use, but doctors can use the medication whether or not it is ‘FDA indicated’.

Buprenorphine is indicated for treatment of opiate dependence.  But this use is at odds with Federal law, which bans the use of opiates to prevent withdrawal.  So in 2000 a law was passed allowing the use of buprenorphine to treat addiction under certain conditions;  doctors had to pass a course and be ‘certified’, and they had to follow certain guidelines, including treating a max of 30 patients the first year and 100 patients after the first year.

But buprenorphine was available long before 2000.  It has always been available in IV form, dissolved in a liquid for injection in microgram dosages.  Reckitt-Benckiser found a way to administer buprenorphine as a dissolvable tablet, and patented the product as Suboxone.  There is nothing to prevent a doctor from prescribing buprenorphine, either in liquid injectable form or in the form of Suboxone, to treat acute or chronic pain.  It is illegal to treat opiate withdrawal with buprenorphine or any other opiate, unless the doctor has a waiver– in which case he can treeat it with buprenorphine.  But there is no law against treating chronic pain with buprenorphine.

Unfortunately, most doctors do not know about all of this, and neither do most pharmacists.  If you are able to talk your doctor into prescribing Suboxone for your chronic pain, you are likely to have a problem with getting your pharmacist to dispense it (especially if your pharmacist works at Walgreens, whose pharmacists seem to have problems with every other script that they fill for my patients).  There has been a suggestion made (not sure where it came from originally) that doctors prescribing Suboxone for pain write across the top of the prescription ‘for pain treatment’– then the pharmacist is supposed to fill the script without needing the ‘x number’ that is used by by doctors with the waiver.

So in summary the answer to the question, who can write for Suboxone, is… anyone with a medical license and a DEA registration for Schedule III narcotics.  But getting your doctor to write for it, and your pharmacist to fill a script for it, is another matter entirely.

4 thoughts on “Who Can Write for Suboxone?”

  1. What is it with Walgreen’s anyway? Some time after I had my surgery, the doctor wrote a script for Darvocet which ended up to be not appropriate, so he wrote another for Norco about 2 days later. My insurance company didn’t like that, so they wouldn’t pay. So (since it is so cheap and I was in pain), I said I would just pay for it. They actually told me that it is illegal for them to do that. Now, at the beginning (right after surgery) I had 2 percocet scripts 1 day apart which I filled with another pharmacy for convenience sake. The insurance wouldn’t pay, I asked to just pay for it, and they said OK and filled it. The same thing happened with another pharmacy regarding the Norco (the one that Walgreen’s wouldn’t fill). Why would 2 other pharmacies do something illegal? I believe Walgreen’s is just full of sh*t. If they said it was against their policy, that is one thing. But to just blatantly lie is another. I am still considering writing them a nasty letter about their employees lying to people. It is unconsionable! If I had believed them, I would have had to go to the ER for the pain while I waited for the insurance company to believe enough time had passed between pain scripts. At that point, I might have sued them for the cost (and pain & suffering of course – ha ha) if I found out later that they were LIARS!

  2. This is probably not related much to your post, but is there any real difference between Subutux and Suboxone? I’ve read that Subutux can be abused if you shoot it up, although I can’t imagine why anyone would do that. Other than that, though, does it matter which one you take? My doctor gave me Subutux to take after I stopped taking the pain killers after surgery. It was about time for a refill of Suboxone, but I didn’t realize it at that time. When I looked at the Subutux script, I noticed that it was for 60. I don’t want to ask for a Suboxone refill since I have 60 of these. Is it OK to just take these instead?

  3. I stupidly ran out of my suboxone a little to early. In the 3 years I’ve never done that before. I went to the ER and the doctor wrote me a proscription for 12 days worth. Enough to last until I see my doctor again because he’s out of town. I took it to Walgreens and he wouldn’t fill it. Then he kept the prescription. So now I’m out until my doctor gets back which is now 9 more days. I don’t want to relapse. But I’m really scared. My husband is deployed and I have a 4 and 3 year old. I know it’s my own fault. But it’s not like I do this all the time. I’ve never failed a drug test and I’ve never misused. I wish there was more of an option for emergency situations. I also called every suboxone doctor in the area. No one can see me this soon. I’m really scared. By the time I see my doc I will probably be almost over the w/ds. I’m wondering if I should just quit.

  4. Ouch—- the doc should have SOME provision, for covering when he’s out of town…. there is nobody taking calls for that doc?

    I wonder what the pharmacist’s problem was…. any doc can prescribe Suboxone for PAIN, with or without special certification. I question whether that pharmacist had the right to keep the script; I would consider looking into the matter– perhaps with the pharmacist’s boss, to at least see what right he/she thinks he had to do that.