Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The other side of Suboxone

Dennis Wichern
Meds
July 28, 2018
67 Shares
Share
Tweet
Share

A lot has been written about Suboxone, the buprenorphine treatment drug. For many, Suboxone acts as an effective medication to treat opioid addiction. For others, it’s a highly-valued street drug that is commonly diverted and misused. To understand and acknowledge the darker side of Suboxone we have to look back at its history over the past 16 years.

History of Suboxone

Suboxone was first approved by the FDA in 2002 to treat opioid addiction in office-based opioid treatment programs. Prior to Suboxone, the only opioid treatment drug available was methadone, which could only be obtained from an opioid treatment program or methadone clinic. Suboxone was initially manufactured in tablet form but was subsequently changed to a dissolvable oral filmstrip in 2010.

Currently, over 35 states have filed lawsuits against the drug’s manufacturer alleging antitrust violations regarding the tablet to film reformulation.

Prison heroin

Suboxone smuggling into correctional institutions is a significant issue across the nation with the drug oftentimes hidden in books and letters because of its filmstrip form. The New York Times in 2011 was the first to report that law enforcement was witnessing the abuse of Suboxone inside prisons from Maine to New York.

In a subsequent 2013 Times article, Suboxone was referred to as “medication and dope” and “a treatment with considerable successes and also failures, as well as a street and prison drug bedeviling local authorities.” The same article dubbed the drug “prison heroin” because inmates were using it to get high, instead of its intended helpful use.

Unfortunately, the smuggling of Suboxone into jails and prisons continues to this day but several states have taken action.
On July 1, 2016, Maryland’s Medicaid program stopped allowing Suboxone strips in an effort to stop the illicit flow of the drug into jails and prisons. According to a NPR article, the amount of diversion was “staggering.” Zubslov, a tablet containing buprenorphine and naloxone was added to the program’s formulary as an alternative treatment drug.

And in April of 2017, the Wisconsin Sheriff’s Association asked the state’s medicaid director for assistance in reducing the smuggling of Suboxone into the jails of Wisconsin. As a result, Zubsolv was added to the formulary in the hope that the tablets become used more than the strips.

A new type of pill mill?

The emergence of Suboxone has also brought unscrupulous providers into the opioid treatment profession who operate cash-only prescription clinics with some calling this phenomenon, “the second coming of the old pill mills.”

The states of West Virginia, Kentucky and Tennessee have all recently implemented oversight regulations concerning treatment clinics in their states due to concerns about inadequate treatment and the rise of Suboxone “pill mills.” In Kentucky, one provider had his receptionist and maintenance man handing out Suboxone prescriptions when he was absent.

Why is this happening? Street value.

Suboxone is a valuable drug on the street and is used by those with an opioid use disorder to experience its euphoric effect, prevent opioid withdrawal, profit off its sales or to self-medicate.

A 2017 Dayton Daily News article detailed the street value of 60 Suboxone film strips rings up at $1,200 per month, and in a correctional facility, a strip of Suboxone is worth $100.

So, how big an issue is this?

According to DEA statistics, there were 446 crime laboratory reports involving buprenorphine in 2005 which rose by over 4,000% to 18,077 in 2016, the most recent data set available.

Buprenorphine is now the fourth most encountered opioid drug analyzed by nationwide crime laboratories trailing only oxycodone, fentanyl, and hydrocodone.

A doctor in Tennessee found a 60% decrease of statewide prescriptions for Suboxone during 2016 when the state changed the Medicaid formulary to Bunavail, a lesser dose alternative to Suboxone.

And in 2017 the University of Kentucky published a study which found that out of 1,675 substance users, 985 reported taking Suboxone at some point, with only six percent receiving it by prescription, 62% by illegal means and 32% both ways. Nearly 80% of those who received it both illegally and by prescription admitted selling, trading or giving away what they were prescribed. More than 75% admitted mixing Suboxone with other drugs or alcohol to get high.

What should a MAT provider do to mitigate diversion while still helping those in need?

Follow a national guideline like SAMHSA’s TIP 40, SAMHSA’s TIP 63 or ASAM’s 2015 National Guidelines which include diversion plans that include weekly office visits until the patient is stable, urine drug testing including testing for buprenorphine, recall visits for pill counts and limiting the dose to decrease the risk of street sales. These same guidelines also emphasize the importance of psychosocial treatment in conjunction with medication-assisted treatment.

Suboxone and other buprenorphine medications are important tools in a treatment provider’s toolbox but prescribing only medication— without any other treatment support — is short-changing those in need.

As ASAM’s sample patient treatment agreement states, “I understand that treatment of opioid addiction involves more than just taking my medication. I agree to comply with my doctor’s recommendations for additional counseling and/or for help with other problems.”

Dennis Wichern is a retired DEA agent.

Image credit: Shutterstock.com

Prev

Technology ought to save lives. So why aren't we using it better?

July 28, 2018 Kevin 4
…
Next

What personality type fits your medical specialty?

July 29, 2018 Kevin 13
…

Tagged as: Pain Management, Psychiatry

Post navigation

< Previous Post
Technology ought to save lives. So why aren't we using it better?
Next Post >
What personality type fits your medical specialty?

More by Dennis Wichern

  • CBD: What is it? A former DEA agent explains.

    Dennis Wichern
  • Telemedicine should be easy. Here’s why it’s not.

    Dennis Wichern
  • How to avoid negative press and fines during the opioid crisis

    Dennis Wichern

Related Posts

  • Suboxone for pain makes sense. Why don’t more doctors prescribe it?

    Hans Duvefelt, MD
  • Stop stigmatizing medication-assisted treatment

    Brandon Jacobi
  • A drug problem in rural Georgia

    Ashish Advani, PharmD
  • How hospitals can impact generic drug companies

    Mark Kelley, MD
  • Drug ads are a campaign against physician trust

    Judy Salz, MD
  • Crippling drug costs: the role of insurers

    Janice Boughton, MD

More in Meds

  • The deadly consequences of a shortage: The Pluvicto crisis leaves metastatic prostate cancer patients in limbo

    Matt Drewes
  • The real story of Xylazine contamination in street fentanyl and how we can manage it

    Julie Craig, MD
  • The cannabis education gap: Why patients are left in the dark

    Timothy Byars
  • Are doctors ready to discuss psychedelic therapies with patients?

    Thaís Salles Araujo, MD
  • The rise and dark side of fungi: Exploring health benefits and pathogenic threats

    Sandra Vamos, EdD and Deanna Lernihan, MPH
  • Advocacy and collaboration lead to major patient safety benefits on sterile pharmaceutical compounding: a review of USP’s revisions to Chapter <797>

    Elizabeth Rebello, MD
  • Most Popular

  • Past Week

    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Why affirmative action is crucial for health equity and social justice in medicine

      Katrina Gipson, MD, MPH | Policy
    • Unlocking the secrets of cancer conferences: an end-of-life counselor’s journey among pharmaceutical giants

      Althea Halchuck, EJD | Conditions
    • Why doctors aren’t to blame for the U.S. opioid crisis [PODCAST]

      The Podcast by KevinMD | Podcast
    • Nose-brain connection: The surprising link between allergies and mental health revealed

      Kara Wada, MD | Conditions
  • Past 6 Months

    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Breaking point: the 5 reasons American doctors are dreaming of walking away from medicine

      Amol Shrikhande, MD | Physician
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
  • Recent Posts

    • The importance of listening in health care: a mother’s journey advocating for children with chronic Lyme disease

      Cheryl Lazarus | Conditions
    • Medical errors and the power of apologies [PODCAST]

      The Podcast by KevinMD | Podcast
    • Finding your ideal work-life balance: tips for prioritizing personal life and achieving professional success

      Zahid Awan, MD | Physician
    • Boxing legends Tyson and Foreman: powerful lessons for a resilient and evolving health care future

      Harvey Castro, MD, MBA | Physician
    • 7 ways to beat burnout: a guide for health care professionals to reduce stress and reclaim their passion

      Marie Livesey, DO | Physician
    • The unjust reality of racial disparities in pediatric kidney transplants

      Lien Morcate | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 11 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Long COVID Cognitive, Depressive Symptoms Tied to Brain Inflammation Marker
  • 'Practice Changing' Trial on Activity Recs After Prolapse Surgery
  • What's With the Buzz Around NAD+ Injections?
  • Standing, Walking After Major Surgery Tied to Less Risk of Post-Op Complications
  • Tenapanor Improves Abdominal Symptoms in Patients With IBS-C

Meeting Coverage

  • Tenapanor Improves Abdominal Symptoms in Patients With IBS-C
  • Benefits Found for Hand OA Drug Treatments
  • MRI-Based Screening May Detect Prostate Cancer Earlier
  • New Model Aims to Study Intestinal Fibrosis in Crohn's Disease
  • Hypertension Tied to Worse Survival After Surgery for Upper Tract Urothelial Cancers
  • Most Popular

  • Past Week

    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Why affirmative action is crucial for health equity and social justice in medicine

      Katrina Gipson, MD, MPH | Policy
    • Unlocking the secrets of cancer conferences: an end-of-life counselor’s journey among pharmaceutical giants

      Althea Halchuck, EJD | Conditions
    • Why doctors aren’t to blame for the U.S. opioid crisis [PODCAST]

      The Podcast by KevinMD | Podcast
    • Nose-brain connection: The surprising link between allergies and mental health revealed

      Kara Wada, MD | Conditions
  • Past 6 Months

    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Breaking point: the 5 reasons American doctors are dreaming of walking away from medicine

      Amol Shrikhande, MD | Physician
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
  • Recent Posts

    • The importance of listening in health care: a mother’s journey advocating for children with chronic Lyme disease

      Cheryl Lazarus | Conditions
    • Medical errors and the power of apologies [PODCAST]

      The Podcast by KevinMD | Podcast
    • Finding your ideal work-life balance: tips for prioritizing personal life and achieving professional success

      Zahid Awan, MD | Physician
    • Boxing legends Tyson and Foreman: powerful lessons for a resilient and evolving health care future

      Harvey Castro, MD, MBA | Physician
    • 7 ways to beat burnout: a guide for health care professionals to reduce stress and reclaim their passion

      Marie Livesey, DO | Physician
    • The unjust reality of racial disparities in pediatric kidney transplants

      Lien Morcate | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

The other side of Suboxone
11 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...