Why Aren't More Doctors Prescribing Suboxone?

By Zachary Siegel 04/05/16

There are around 900,000 physicians in America and only 32,000 of them have certification to prescribe buprenorphine.

Not Enough Doctors Can Prescribe Buprenorphine
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At the National Rx Drug Abuse & Heroin Summit in Atlanta, Ga., President Obama announced that under a proposed rule, the number of patients a doctor can treat with buprenorphine will double, from 100 to 200. While that is a major step forward, one looming problem remains: there are not enough doctors out there who can prescribe the drug. 

Buprenorphine (the active ingredient in Suboxone and Zubsolv) is a semi-synthetic opioid, but it is a partial agonist, meaning it does not fully activate opioid receptors such as drugs like heroin and methadone. Because of this property, it is uniquely designed to treat opioid use disorders, keeping the patient sated while not producing intense euphoria. And unlike methadone, which has largely been limited to being distributed through clinics, buprenorphine can be picked up at a pharmacy and taken home. 

There are voluminous data in the scientific literature supporting buprenorphine’s effectiveness as a form of treatment. The drug has been demonstrated to significantly reduce cravings, mortality, blood-borne disease, and illicit drug use. Stacked up against traditional, abstinence-based treatment, those who have access to buprenorphine are more likely to remain in treatment long enough to see the benefits. 

Because the science supports the use of buprenorphine, Obama proposed spending more than $1 billion over the next two years to expand its use. However, there is currently a chasm in America’s treatment industry, where 80% of people who need treatment do not get it. Furthermore, those who do receive treatment are often limited to abstinence-only treatments, where drugs like buprenorphine are not on the table.  

The number of people who need medication-assisted treatment is only growing, yet the number of doctors who can offer it remains stagnant. There are some 900,000 physicians in America and only 32,000 of them have certification to prescribe buprenorphine. "What is a concern to me is that more physicians don't feel the responsibility to step up" and get a license to provide the drug, Melinda Campopiano, chief medical officer at HHS's Center for Substance Abuse Treatment, told the Chicago Tribune

One impediment might be that in order to prescribe the drug, a doctor needs to take an eight-hour training course, then acquire a special license from the Drug Enforcement Administration. 

Kelly J. Clark, president-elect of the American Society of Addiction Medicine, told the Tribune that no other medication requires special licensing, and no other medical condition has a patient limit. Such rules are symptomatic of the nation's long-standing prejudice against the disease of addiction, she said. 

It should be easier to get the drug that treats addiction rather than the drugs that feed it. But that’s yet to be the case.

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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.