Prescription drugs, like Suboxone, are addictive and need monitoring.
Vermont implemented a Suboxone drug therapy program for the treatment of opiate addiction in 2003, prior to a 2006 report by Vermont health officials. Concerns about the diversion of Suboxone (buprenorphine HCl and naloxone HCl) for illegal trade, peddling pills on the street, injecting the pills rather than taking them sublingually, and smuggling them into the state's prison instigated further controls of the drug. FDA laws regarding Suboxone regulate access by trained physicians as well as their maintenance dosage.
Access to Treatment
Vermont served in a case study to determine diversion and abuse of the drug Suboxone. Vermont state treatment officials found that diversion and abuse of opiate treatment medications has occurred. Medicaid policy in Vermont reflects the appropriate use of Suboxone for patients diagnosed with an opiate dependence. It also addresses the inappropriate use of Suboxone as prescribed for pain management. Suboxone was primarily used by white males with a history of substance abuse. A third of these patients indicated their use as a form of self-medication to decrease symptoms of heroin withdrawal. The incidence of diversion may indicate an opiate addict's efforts to self-medicate. In this situation, the addict, who would enter formal opioid treatment if such treatment were made available, begins seeking out Suboxone through illegal markets.
Physician Training
The use of Suboxone in the treatment of opiate addiction requires specialized training for prescribing physicians. Not all physicians can prescribe this medicine. The Vermont case study suggested specialized physician training prior to authorized prescription of Suboxone. This specialized training coupled with efforts to link physicians with addiction specialists involves topics such as induction/stabilization, maintenance treatment, detoxification/dose tapering, special treatment populations (pregnancy, adolescence, pain), and case studies in selecting an appropriate level of care. Consultation and referral among addiction specialists and physicians is one strategy for addressing diversion and abuse of Suboxone. Other medical staff should support prescribing physicians with their monitoring activities. Recommendations for prescribing Suboxone included the role of pharmacists in patient education and monitoring. These recommendations address gaps in the law to eliminate "doctor shopping" where opiate addicts collect multiple prescriptions from several physicians. Physician training includes patient education on the successful maintenance of their Suboxone treatment.
Maintenance Dosage
Physicians are allowed to treat up to 100 patients with Suboxone. Despite this control method, several areas of misuse occurred within the Medicaid system in Vermont. The Vermont state's Medicaid program was being billed for prescriptions from doctors not authorized to prescribe Suboxone. A patient working with an authorized treatment physician is required to attend counseling and other non-drug therapy treatments. Their target dose of Suboxone is 16 mg per day, although doses can range from 4 mg to 16 mg per day. Each dose is effective for at 24 hours. A physician's assessment of psychosocial and psychiatric co-morbidity issues determine additional dosage for the Suboxone patient, along with any take home medication.
Tags: diversion abuse, addiction specialists, case study, opiate addiction, patient education, physicians with, prescribing physicians
