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Addiction Treatment: Congress Allows Certified Physicians to Take On More Buprenorphine Patients

On December 8, Congress moved for the second time to increase the number of patients to whom a doctor can prescribe buprenorphine, an opiate agonist used to treat heroin dependence. Under an amendment to the Controlled Substances Act, certified physicians will be able to prescribe for up to 100 patients.

When Congress passed the Drug Addiction Treatment Act of 2000 allowing for the first time medical office-based opiate addiction treatment, it limited the number of patients who could be treated in any one practice to 30. Last year, Congress changed the cap to 30 patients per physician. To qualify for the new, 100-patient prescribing limit, doctors must have been certified to prescribe buprenorphine for at least one year.

"Of the estimated six million people in the United States who are dependent on opioids, many of them have been forced to wait for the medical treatment they so desperately need simply because of a mandated 30-patient 'cap' on how many people a doctor may treat," said Edwin A. Salsitz, MD, of Beth Israel Medical Center in New York City. "Enactment of the legislation will begin to address this inequity."

Salsitz was quoted in a press release from Reckitt Benckiser Pharmaceuticals, the company that manufactures Suboxone and Subutex, the formulations of buprenorphine approved for opiate dependency treatment by the Food and Drug Administration.

"This is the best-kept secret in opioid addiction and it shouldn't be," said Timothy Lepak, president of the Connecticut-based National Alliance of Advocates for Buprenorphine Treatment. "I'm puzzled that there's any limit whatsoever."

The amendment passed as part of the bill reauthorizing the Office of National Drug Control Policy (ONDCP), the drug czar's office.

Permission to Reprint: This article is licensed under a modified Creative Commons Attribution license.
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what the law actually says

Actually US Sup Ct precedent says doctors can maintain addictions without any special license, and the Controlled Substances Act does not say it is illegal to do so without special permission.

Suboxone Saved My Life

I am an opiate addict and suffer from chronic back and leg pain that at times I just want to die because the pain is white, blinding and never stops. What to do to stop the pain?? I have many times wanted to give up, no one will listen, no one understands. I have gone to dr's for the last 5 years, one minor back surgery did not stop the pain, made it worse in fact. Then I am left with the pain, I have to beg doctors for pain medicine, sometimes I will get 30 vicoden, if I am lucky. Well, the vicoden does not last and the pain comes back. Try to refill my prescription, treated as a freak, treated like I am trying to get a fix. Try to tell them the vicoden doesnt work. I beg for answers, I beg and cry for someone to fix my pain, fix the problem, make the pain stop, please... Sent away with no answers, no pain pills......what am I to do??? Kill myself to make it stop, that seems the only answer. Or go to the streets, the internet pharmacies......Well I did both, can you explain to me why I have to pay $60.00 for an 80 mg Oxycontin, for one pill, or $10.00 for one percocet...... So what happens when I cannot find pills to kill my pain, someone says I cannot find you pills, but here, try this, next thing I know, I am a 42 year old, with a pretty good middle income job in the suburbs, smoking crack for the first time of my life. Does it make the pain go away, yes.......however, big problems come then, 4 months of more hell, addicted to crack cocaine and all I wanted is for a Dr. to listen to me and help me fix my pain. Can I get a prescription of Oxycontin, percocets, something a little stronger than vicoden, hell no.....where do these criminal drug dealers get these more potenant opiates. It is a miracle I never tried herion, I am sure that would fix my pain. I have never stuck a needle in my arm, however I reduced myself to 2 years of buying illigal pain pills off the street, 4 months in a hell of a crack addiction... Almost lost my husband, who also likes his opiates for his pain issues. Almost lost my home because I am so in debt in buying these illigal drugs that cost $60.00 a pill.... Or $400.00 for a supply of vicoden over the internet. If only a doctor would help me I would not have gotten $30,000 in debt to the drug dealers of the USA. Would it not be better to buy my medication I NEED through legal ways instead of being forced to buy from the criminals. So now I am on Suboxone, it helps my pain somewhat, not as good as the real opiates do. But it dulls it to where I might not commit suicide. Thank God my health insurance pays for my medication, however to start me and my husband into the Suboxone program cost us a good $2500.00. $250.00 the first visit, then $100.00 a week, a peice for the next several weeks, now, thank God again, we only have to go to the "Suboxone" doctor once a month, at $100.00 a piece. We still have to pay a pretty high copay for the medication, but it beats the drug dealers prices by far. I could easily either be dead from suicide, crack od, drug dealer violence and in very risky areas to seek drugs or in jail. And I am a very good American citizen in very bad physical pain. I am only 44 years old, I am still trying to find out what is wrong with me and seeking doctors to help fix my never ending leg pain. Why is it so hard to get the help I need??? I do not know. The depression that goes along with all of this is overwhelming, but I am a strong woman and I will continue to seek the truth and the answers. We need to legalize drugs to keep all this money away from the dealers and put it where it can help people like me. I am a Christian, tax paying American, that needs some decent medical care, is that too much to ask??? I just want the pain to stop, I want answers, I want medication when I need it. It is not my fault that I suffer physically and it is not my fault that I am addicted to opiates, I need them to survive, does that make me a bad person, I think not, I just don't want to hurt from the time I wake up, until I go to bed and then can't sleep because of the pain, it makes life kind of hard to live, but I do my best, one day at a time.

People need to become aware of this treatment option

My Name is Timothy Lepak. I am President of The National Alliance of Advocates for Buprenorphine Treatment (naabt.org) and was quoted in the article above. Buprenorphine is the greatest leap forward in opioid addiction treatment in the last 40 years, however too few people are aware of it. Part of the reason is the terrible stigma that plagues patients with addiction disorders. Right now we have 245 people on our matching system who can’t find a doctor to treat them. These are people who want to change their lives but cannot find a doctor certified to prescribe near them. Only 9,089 (as of Dec 6th) doctors are certified to prescribe buprenorphine for addiction. Of that number an estimated 40% are actually treating patients.

One thing that makes buprenorphine different is that it can be prescribed in a doctor’s office, like with other diseases. This is a big step forward that will ultimately help fight the stigma. Now that doctors can treat addiction as they do diabetes or depression the perception of who the addicted patient is will change for the better.

Most people still don’t see addiction as a disease despite recent medical proof of physical changes to key structures of the brain. Understanding addiction and being able to explain to skeptics why it is a disease and why treatment must be available will lay the groundwork for changing the views of many in this country. It is one thing to call addiction a disease, it’s quite another to actually treat it as one. The outdated tactics of the 35 year old drug war of demonizing drugs and the people who use them has caused undue stigma for people who use drugs (medications) appropriately to treat their legitimate medical conditions, addiction included.

A nurse told me that some of her terminally ill patients refused opioid pain meds, because they didn’t want to die an “addict”. This medical condition is so stigmatized and misunderstood that someone would actually choose excruciating pain in their last hours rather than the thought of being addicted, as if it were somehow worse.

The stigma associate with this disease is deep. Even physicians that treat addiction are sometimes treated differently by colleges because of it. Changing people’s perceptions about what addiction is, through education is the only thing that will reduce that stigma. Scientists and doctors know addiction is a treatable chronic medical condition, not a moral failing or something that can be cured with good advice or tough love.

Using appropriate respectful language when speaking or writing about this condition is one thing we all can do. Slang words like “junkie, addict, clean, dirty” have no more place in the medical lexicon than “retarded or crippled”. People with addiction disorders are patients. Teaching the public why addiction is a disease, showing them how the brain is altered by addiction, and explaining how the treatments work will reduce the stigma and along with it, much of the suffering.

Educating is the only thing that can erode the stigma, which has been cited as the biggest barrier to treatment.

Timothy Lepak
President, NAABT.org

suboxone for addicted nurses

While working as an RN i developed an addiction to percocet due to an ongoing painful medical condition. Once taken off the pain meds, I was left with horrible withdrawals, and in lieu of diversion, I went on methadone, stayed at 30 mg and functioned great with absolutely no problems. However, I tested positive on a UA for a pre-employment screening and was told by the board that I had been scheduled for a hearing on this matter and would undoubtedly be found guilty of illicit drug use and my name would then be smeared all over the internet sites as an addict, etc. As an effort to avoid the above, I turned my license in, and in fear, I did not attend the hearing. One week later, I received an Order following my hearing stating that since the methadone was prescribed legally for me, that no actions would be taken. BUT, if at any time my "license was interrupted" (knowing that I had turned it in), that I would be required to attend 5 years of monitoring by an addicted nurses organization. I had alot of difficulty in maintaining sobriety off methadone, not to mention HELL, so I ultimately went to suboxone. MY QUESTION IS, have there been any moves toward the legalization of suboxone for use by nurses? It works so well and has no side effects of any type of intoxication. Please let me know if there have been any talks in this regard. I appreciate hearing from you! lynda

Suboxone for impaired nurses

Can you please tell me if it is ok to be on suboxone and still practice as an RN in Pennsylvania. I have not been in any trouble with the board...sought treatment before it came to that point but on a whim I started to research nurses and suboxone. I am getting conflicting information. I never dreamed there would be a problem. I figured if I was asked to submit a random drug screen, suboxone would not be included on the screen. Is it like a don't ask don't tell type of thing or is outright not permitted. Suboxone has saved my life, my children, my marriage, my home...everything. Now I am thinking that despite all that I may lose my career. If I did not have suboxone I would lose everything. Do I give up my career for my life? This is a hard question to answer.

buprenorphine saved me too

hi, I was once an opiate addict too. Still am I guess, but only addicted to bupe. I used to do heroin, oxy, morphine, etc. No needles or abcesses, no pockmarked gaunt face, but still a junkie nonetheless. A middle class kid, addicted by age 17 to diluadid and oxycodone, and it progressed. I have a horrible stomach problem, so when I'd try to kick my nausea and cramping would be so goddamn awful that even when I wanted to quit I couldn't. I'd be so sick I'd have to go to the ER to get fluids so I wouldn't die from dehydration, and the only thing that made me be able to reclaim my life was a stupid ass fix. Mentally I've been ready to get off for years(at least I think so, I hope so), but the physical consequences are so severe I don't know how I could get past them. Suboxone has stabilized my condition for the past year and a half- for the 1st year I had to get them on the street, because I wanted to be normal and couldn't find another way. Now I get them thru my doc, and its great to be legit. I just wish that I could get off this shit forever, it sucks to be a slave to chemicals. However, suboxone is WAYYYYYYYY better than methadone, because at least its possible to get off suboxone. Methadone makes you its slave for life. Anyways, buprenorphine helps junkies become responsible, good citizens again, and for that I'm forever thankful. I just wish that I could eventually detox for good, but at least bupe got me away from my old friends and habits, and thats 98% of quitting anyways. I'm forever grateful.

HELP

I AM LOOKING FOR A DR IN THE CHARLESTON WV AREA WHO WILL PROVIDE MAINTENANCE TREATMENT FOR SUBOXONE INSTEAD OF DETOX. MY BOYFRIEND HAS BEEN TRYING TO DO THE DETOX FROM SUBOXONE BUT IS HAVING DIFFICULTY WITH THE DECREASE. HE IS DOWN TO 2 MGS A DAY AND IS DUE TO BE WEANED OFF THIS MONTH. HE HAS EXPRESSED TO ME THAT HE DOES NOT THINK IT IS GOING TO BE POSSIBLE FOR HIM AND IS ALREADY HAVING CRAVINGS. HE HAS BEEN ADDICTED TO OXYCONTIN FOR 7 YEARS NOW. I HAVE DONE RESEARCH ON THE INTERNET AND FROM WHAT I HAVE READ THE SUBOXONE SHOULD BE USED FOR MAINTENANCE. THE DR'S HE HAS GONE TO DON'T SEEM TO AGREE. WE DON'T WANT HIM TO HAVE TO GO BACK TO DOING/BUYING OXY'S FROM THE STREET. IF WE CAN JUST FIND A DR IN THE AREA THAT WILL PROVIDE MAINTENANCE WE WOULD NOT HAVE TO WORRY AND HE COULD LIVE A PRODUCTIVE LIFE AGAIN. PLEASE HELP! IF ANYONE KNOWS A DR THAT WILL PROVIDE MAINT. INSTEAD OF DETOX YOU WOULD ANSWER OUR PRAYERS.

Being addicted to oxycontin

Being addicted to oxycontin myself I can tell you I feel for you and your husband. I am about to transition from methadone to suboxone very soon. The methadone clinic I attend has expressed the importance of continuing some kind of counseling or meetings as well as the suboxone.(methadone clinics where I come from, It is the law that patients have to attend therapy and groups meetings provided by the clinics on a regular basis,) No pill, not suboxone or methadone alone will cure addiction. Addiction is a disease and it sounds like since he got down to 2mgs. of suboxone, maybe he should increase therapy or meetings. Sometimes talking it out helps. I know some people feel like they dont need it, but it is a known fact that nothing alone can cure cravings. there are other things he could try too. Like take up a new hobby or find something positive to take up his time and keep him occupied. If he is experiencing physical discomfort from withdrawel then keep looking for a new doc. and good luck! But if it is cravings I know from experience there is no easy way out. The doctors that prescribe suboxone dont express this enough. Good luck to you both.

pls help

Hey i came across your comment on here and was wondering if you ever found a doctor to prescribe suboxone? I was in the methadone clinic for 2 yrs at 100mgs a day and they kicked me out because i was having a hard time paying for it. They took me down 5 every other day and then kicked me out at 0 and ive been so sick i cant function. I cant live like this. I have 2 beautiful kids that i cant care for the right way because of being ill. I looked up and found about 10 doctors that supposedly prescribed it then when i called them they either quit doing it or it was an error on the internet. I cant find any doctors.The prestera Center even stopped their program!! They was the only ones that ive known of that had a suboxone program.This is horrible. PLS tell me you had better luck. Thanks so much

suboxone is a gift from god

Im a former heroin-opiate addict.Ialso had a very bad crack and iv coc habbit.No one but another junky knows what sheer HELL your life becomes once u cross the line from beeing a"weekend warrior" to full blown heroin addict.Not only was my life DESTROYD,it effects every aspect and angle of your existince.I lost everything,my family,the women i loved,my freedom,and,"i dont know how," allmost my life".I od 8 times in 1 year.thank GOD i found a doctor that does suboxone maintanance,Im now just turned 32 and been clean for 18 months i live in greenville sc if any one out there in my area is strungout and ready to"through the towel in" and is seriouse about getting-andSTAYING clean with suboxone maintanance email me you dont ever have to keep living in hell just give it a chance jolson

Dear Anonymous

I live in Spartanburg, SC and I would like any info you can give me in reference to the Dr. in Greenville who is treating you. His name would really help and also his address. I have been trying for the longest to locate a Dr. for my chronic illness. Thanks a lot! My email address if [email protected] if that helps.

suboxone

i would like to know why i was able to be introduced to suboxone by my psychiatrist that i had been seeing before suboxone became so popular. and although i saw her every month she would even give me refills which is absolutely legal. i still saw her every month for 30-45 min. she closed her practice in my town and went to a clinic where she works full time. she shut her office down because she didn't agree with all these drs. popping up and dispensing bupe u have to sign a waiver saying ur insurance will not be charged. the program consist of a 5 minute office visit and 200, a month just to get that piece of paper.that's what they r calling a program a piece of paper. is that legal ? last month i was out of town (my mother passed away) and i had a refill left from my old dr. and got it filled. just got back in town and went for a visit and told them i didn't need the suboxone that i had a refill and got it filled in WV and they told me at the new drs. office that it was still going to be 200. plus my reg,visit charge and he probably wouldn't be giving me suboxone script because i had just got that refill? this is the part ur going to love she also informed me that he waived my 200.last month because of my situation, i told her how could he waive it when sh ii didn't even make an appt. c him. she said i was on the suboxone program so it's 200. a month even if i don't see the dr. the"program" is a piece of paper. is all this legal? kp1153

This is true but, to my

This is true but, to my understanding it is only deadly when mixed with certain medication. You have to be careful what you mix with it. For example I know it is a fact that if you mix suboxone with meds. like xanax, it can be fatal. We must make sure all the facts are out there. Just like with methadone, yes it most certainly can be deadly if mixed with alcohol and xanax etc. or if too much is ingested. But if taken like prescribed from a methadone clinic, not a pain clinic or a family doctor, it can be very manageable and effective. It seems suboxone needs to be more regulated because the docs that are prescribing it dont seem to care about the other aspects of recovery. like good old fashioned counseling and meetings if need be.

Suboxone

Suboxone saved my life. I didn't have any side effects and my cravings are gone. I felt that opiates were the only thing that would ever make me feel normal but I was wrong. Being able to make it through a day without the craving for pain medication is a miracle. If it wasn't for Suboxone I truly feel I would be dead, in jail or turned to something I could get off the street. There is side effects to all medicine and I would take nausea, headache, vomiting and drowsiness any day over Death or prison. Anyone who is reading this and are in active addiction to please reach out to a Doctor and get help before its to late. I was so deep in my addiction and so down and depressed because I no longer wanted to be consumed on how I was going to get more pills if I ran out. I planned my daily activies, vacation, and simple things like cooking dinner around if I had pain pills and if I didn't it was terrible for anyone who came close to me. If I had pills I was a wonderful wife, Mother and Friend but if I didn't everyone's life was HELL. Please Please at least try this medicine what have you got to lose?

suboxone risks

I have been a heroin and general opiate addict for ovre 10 yrs.methadone for 5.quit methadone cold from240 mgs daily .got clean for 2 years then fell back down..tried suboxone in a clinic enviornment and started having seizures.i feel like if i dont get help im gone..i need a dr near gville sc to wean me down.or help me cold quit.whatever.drs prescribe these things and know no more than what they read in their dr suboxone starter kit (yes they do have those)wow i probably know more than these drs.its a damn shame we get treated like dirt for pain.loss.anxiety.ect...anybody??

Help! Please!

I am addicted to Lortab. I just turned 28 last week & have already burned up $2,000.00 of my familys savings. I have a beautiful wife of 9 years & 3 wonderful boys. They deserve way better than what I've been doing for them lately. I'm past my wits end. I have to get help. I was addicted to Xanax for the last 9 years but have somehow wung myself off of those. The only problem with that is that I have replaced the Xanax addiction with Lortab addiction. I wish I could just go to sleep & all of this be a bad dream. I love my wife so much. I even told her yesterday about the money being gone,(guilty con.). We had a big argument. Not fun at all. I am scared to death that she is going to divorce me. I would do anything for this woman. She is my soul mate. I know I have to put God first & foremost in my life, but how am I going to shake this evil addiction while I'm trying to mend things with my wife & kids, all while trying to keep my job? If anyone has any suggestions as far as options in the Greenville, SC area, please let me know. I think that going to detox is what I have to do , but I can't afford to miss work. What do i do? I need help!!!!

You need to give up. If you

You need to give up. If you love your wife & kids, let them go. You are only holding them back. Screw work, it's just a job. I would rather be homeless than try & have all of these problems.

This message is for Help Please!

Hey, I can relate to your story. I've been in a long term relationship with someone that had an addiction problem and his addiction problem has affected our entire family. Addiction is very serious. Here is my advice: For your benefit, your wife's benefit, and even more importantly your children's benefit. Seek treatment in three parts: 1. Detoxification 2. Rehabilitation (this is absolutely key). Since you have been addicted for so long to things, it is apparent that this is something you struggle with. To fight your battle you need the right weapons. Get into rehab asap. You may need in patient rehab or perhaps intensive outpatient, but it is apparent that you do require this type of aggressive treatment. 3. Plan to be in NA or see an addiction counselor on your own after your treatment program ends for maintenence for awhile maybe a year or so. You love your family, so fight for yourself and them. Yes, pray to God ask for his help and then do something about it. I understand you are concerned for your job. Get creative about how to get away....i.e. someone is sick or use a medical leave act. Or take a leave of absence. This is important. If this is not taken care of you will eventually lose everything, including the respect of your wife and children even. You may even lose you job eventually from it. I hope this helps. Best luck. I prayed for you.

Suboxone the miracle drug in my life

I have been on suboxone around three months. I got carpel tunnnel right after that i think it was do to the subs but i am not sure. I was on 24mg but that was the only thing i could take for the pain. I even went up to 28mg. at the time of the carpel tunnel. The dr that saw me gave me cortisone shots and the pain was instantly gone. Another miracle.
Iknow i need to taper down so my dr told me to take 20mg (2 1/2). She also gave me neurontin which helps alot but my question is that i was told that i am supposed to go to taper down 1 mg a month
I am a 43 year old mom batteling with opiates for 20 yeara (had six years totoally clean,iand i was doing everything i was supposed to be doing). Then the monery jumped on me and i was off and running. I have been . I work and wonderful progrram I'm in AA and am very active and truly subs saved my life. At this point and time i know i have to go slow and eventually reach the 2mg stage. But what i feel today is i don't want to go off these any time soon I know it is a slow process i went shakey and full of anxiety when she brought me down to 2 1/2. I think at this point and maybe it will change but i think i may be on this for life and i am ok wi th that,. I know me. I am a binger. As soon as i have the thought i don't call my sponsor.....i just am off and running. So i think i will take this road. I love GOd and he is a HUGE part of my program but the BIg Book talks abouit seeking outside medical help if you have to ,.................well i have too.

Any thoughts???sorry about my spelling, i am educated but my 3 year olg got stickry stuff between the keys...lol

suboxone for health professionals

is there any progress being made toward allowing the use of suboxone by nurses in S.C.?

Subs are not the answer!!

My son who is not prescribed this stuff but his girlfriend is, he is serverley addicted and is in rehab at this very moment. They both started using/snorting lortabs and other similiar pain killers, thern one of her drug buddies directs her to a sub clinic. Here's the deal she keeps my son going on the subs while she trades some of her prescription for addreall and lortab. She is not even taking this stuff except when it's time for her docs visit to get more. She does that so it shows up in her system. I would had rather he stayed addicted to lortabs. In the end it's all a big money racket for the clininics. The girlfriend switched clinics because the first clinic was doing it the proper way by what they thought was weaning her off so she switched clinics, the new clininc lets you decide if and when you want to be weaned off of it. I just know there must be a special place in hell for the companies that manufactor this stuff and the doctors that treat people with it. In the end you would be better off feeling the pains of detoxing off lorotabs or other crap rather than this evil stuff. It has been hell for us to see our son suffer from this stuff. My advice is to get yourself detoxed off the stuff you are doing and avoid subs. The detoxing off subs is horrific. Please don't go from bad to worse, trust me!!

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