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.
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