Suboxone Prescribing Under Scrutiny in Tennessee

By Zachary Siegel 07/31/15

Why are doctors in a small Tennessee city prescribing the most Suboxone in the country?

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Suboxone, the semi-synthetic opioid maintenance drug, continues to attract press in Southern states where the rate of opiate abuse is reaching a tipping point.

The most recent story is out of Tennessee, which details a report from a ProPublica database which found three of the top 10 doctors who write the most prescriptions for Suboxone currently practice in Johnson City, home to a population of only 65,000 people.

In the U.S. there are currently 18,448 doctors who are allowed to prescribe Suboxone and its generics. One prescriber in Johnson City is ranked second overall when it comes to medicare claims for suboxone.

The question being asked is why in such a small town are suboxone prescriptions so high?

“We have a tremendous problem here,” Dr. Robert Pack of East Tennessee State University’s College of Public Health told WJHL.

For Dr. Pack, the high rate of Suboxone prescribing makes perfect sense. “Three of the top 10? That doesn’t surprise me.”

Dr. Pack continued on to speculate on some of the prescribing practices of doctors in his state. “I believe that there are places that prescribe Suboxone that are doing it with the very best of intentions. They’re doing it with an orientation toward healing the addict. I think that there are other places that are prescribing Suboxone ... in a way that is less supportive, and that would concern me more.”

Pack is likely referring to pill mills that continue to be a problem in the South. Now that drugs like hydrocodone and oxycodone are being cracked down there are inevitably others to fill their place. The Fix recently covered such unethical practices happening in Kentucky.

Currently, a licensed prescriber of buprenorphine is limited to 100 patients. Many are suspicious of this federal rule because doctors have an unlimited number of patients they can prescribe addictive opioids such as OxyContin to.

One doctor interviewed for the story said, “A physician has a moral and ethical responsibility to care for patients. And when we lost physicians because of this 100-patient rule, there were literally hundreds of patients that we couldn’t provide access to care. And what were we to do? Turn them back to the street? Tell them to go back to heroin? Tell them to go to methadone clinics?”

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Zachary Siegel is a freelance journalist specializing in science, health and drug policy. His reporting has also appeared in Slate, The Daily Beast, Salon, Huffington Post, among others. He writes often about addiction, sometimes drawing from his own experience. You can find out more about Zachary on Linkedin or follow him on Twitter.