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?’
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Sign in nowCan my doc prescribe Subutex? SHOULD he?…
I found your article interesting thus I’ve added a Trackback to it on my weblog
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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.
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
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.
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?