In the past, opioid addiction treatment had been restricted to certain approved facilities only. Under Drug Addiction Treatment Act of 2000, physicians who meet certain qualifications are allowed to prescribe controlled substances that are specifically approved by the FDA to treat opioid addiction.
Currently Buprenorphine, marketed as Suboxone, and Subutex, are the only medications approved for this purpose. Methadone can only be dispensed for opioid addiction treatment by approved Methadone Clinics.
The availability of Suboxone and Subutex by prescription through community based physicians has brought down the cost of opioid addiction treatment, and made such treatment accessible to patients within their communities, in the familiar setting of their physician's office, and without seriously disrupting education or work schedules.
What is Suboxone Therapy?
Suboxone and Subutex are brand names for Buprenorphine, which is a medication that is used for the treatment of opioid addiction. This medication is placed under the tongue from where it gets absorbed in ten to fifteen minutes. It completely stops withdrawal symptoms, and is needed to be taken only once a day.
How does it work?
Patients who have become addicted to opioids like Hydrocodone, Oxycodone, etc, find it very difficult to stop using those drugs.
Whenever they try to stop further use of those drugs, they go into withdrawal. It is a state marked by uncomfortable symptoms beginning with a sense of lack of energy, a flu like feeling, generalized muscle pain, and progressing to joint pains, shivering, sweating, tearing, nasal stuffiness and discharge, irritability, abdominal cramps, diarrhoea, nausea, and vomiting. These symptoms are intolerable to most people, and it will prevent them from working, or studying, ... and they will not be able to rest, or sleep. This leaves them no option but to seek opioids again, and use it to feel normal. Once opioid addiction sets in ... it is very difficult to break the cycle without medical help.
Buprenorphine is also an opioid, but it has some properties that makes it very suitable for use as a substitute for other opioids. This is a very long acting drug, a single daily dose is enough to prevent withdrawals. This drug does not cause much euphoria, what the addicts call a "high", and so there is no reward to use it unnecessarily. One can progressively go on reducing its usage, with very minimal uncomfortable symptoms. Eventually people may use it every other day, or every two days, then as needed, and finally discontinue it altogether, and be completely free of opioid use.
Buprenorphine comes as a tablet or film, it is placed under the tongue from where it gets absorbed, it starts working within 15 to 20 minutes, and is very effective in completely stopping the symptoms of withdrawal. This medication is given as a prescription, this is available from most pharmacies, ... patients administer the medication themselves in the comfort of their home, and follow up with their doctor as directed.
How long does the treatment last?
That depends on the patient. It depends on their level of motivation and self discipline. They can complete their treatment in as little as one month, most take much longer, some take more than a year. In general, the longer a person has used drugs ... the longer one will take to successfully complete the treatment.
Are there any risks from using this drug?
Buprenorphine is an opioid, and so it carries the same risks as other opioids, and if consumed in large quantity, ... or with other drugs like xanax or diazepam, or used along with alcohol ... it can cause death.
It can rarely cause an increase in liver enzymes, most of the times the increase is minor, and the treatment does not have to be stopped.
What is the difference between Methadone and Buprenorphine?
Methadone is not used to treat drug addiction. It is offered by Methadone clinics (with Government assistance) at a low cost, as a maintenance program. The reasoning behind this is that if addicts can get opioids in a safe way, through legal channels from a Methadone clinic, then this will reduce criminal activity. It also gives the clinic an oppotunity to offer counseling and education, and do blood tests to diagnose and treat communicable diseases that are common in this population, ... and thus reduce the health hazards to the community. The program requires that the patient go to the Methadone clinic every day to get this medication. This is a problem for people who work or study, or live too far away from a Methadone clinic, or lack transportation. These requirements also pose problems for women who are pregnant. These clinics are only in major cities; the procedure appears somewhat demeaning, ... standing in a que to get drugs, ... and many people do not want to be seen going to such clinics.
In the past only approved addiction treatment facilities were allowed to dispense opioid medications for maintenace and weaning, and most of them started with an inhouse, residential treatment program. Buprenorphine treatment is now available from a doctor in your community, and it does not require an admission to a facility, and does not require daily trips to the clinic. You can use this method in the comfort of your home, and continue to work, or attend school. You do not have to explain any long absences, because this is not an inpatient treatment, and only the people closest to you will know about it.
Can any doctor give me a prescription?
No. This prescription can only be given by those doctors who have chosen to participate in this progam, who have gone through a brief educational course, have filed an application with the Drug Enforcement Agency, and obtained a certificate of waiver.
Does the doctor have to be an addiction specialist?
No. Any doctor who goes through the above process, meets the qualification, and has obtained a waiver can prescribe these. Many are primary care physicians. However most doctors who go through this process are psychiatrists, or addiction specialists, or pain management physicians. Increasingly obstetricians are also acquiring this waiver, but they tend to prescribe this medication only for their pregnant patients.
Insurance carriers provide this service thropugh their behavior health services. They have contracted with and approved a small number of providers for these services.
Why is it difficult to find a doctor to prescribe this medication?
Most doctors do not want to deal with drug addicts. They do not want them to be coming anywhere near their clinic. Other doctors in the building do not want these patients to be coming to their clinic. Then the current law has placed a limit of a maximum of 100 patients per doctor, ... many doctors have already reached their limit. Lastly your insurance does not cover it, or has no clear policy, or has too many if's and but's attached to the coverage, something that keeps changing. This discourages doctors from participating in this program.
Is this treatment confidential?
Is anything confidential these days?
Theoretically yes ... your doctor will not disclose your treatment to others, or provide medical records containing this information. However this is a controlled substance, and every prescription is transmitted to the state board of phramacy. The state adds it to the controlled substances database monitoring program which has been in effect in Tennessee since 2006. Neighboring states also have similar programs and record keeping requirements. Your name and address, doctor's name and address, pharmacy name and address, medication quantity, and method of payment ... are all recorded. This information can be accessed by any physician or pharmacist. This information also is available to your insurance company, and prescription program.
How do I chose a facility?
That will depend on what is available to you in your community, and what kind of coverage your insurance provides. Most insurances do not cover addiction treatment. Even if you had coverage ... most doctors are not approved by your insurance carrier as a provider for this service. They require the provider to be an addiction specialist or psychiatrists and have addiction counselors on staff. For insurance companies, the less doctors they have, the less benefits they have to pay, and higher will be their profit, so why enroll providers?
You have three medical choices, and two non-medical.
- The lowest level, the most convenient, and least expensive is to get this from an approved provider within your community. They are usually not an addiction specialist or psychiatrist; most are family practice doctors. They do not provide counseling in their offices, and require you to arrange for one on your own, which is better for some people as it gives them more flexibility, and they can chose one that fits their work, or study schedule. The down side is that these doctors have very low tolerance for relapse, and you get discharged for using any opioid. Most doctors will not keep you in their program for more than one year. These doctors will see you may be once or twice a month.
- The next level is going to an addiction specialist, or a psychiatrist who provides this service. This is more likely to be approved by your insurance carrier. They generally have the personnel familiar with the preauthorization process and paperwork required. How do you find them? Ask yor insurance for a list of providers "contracted" to provide this service. These provide all services under one roof. These programs see you more frequently, have counselors available in their office, are more tolerant of relapses, and can treat you for longer periods, ... that is longer than a year. Expect to be seen every week in the beginning, and as you make progress ... somewhat less frequently. For people who do not have insurance ... these programs do cost more.
- Next is the business class ... these are residential programs ... you will be isolated from the temptations of this world, and will have no access to drugs. You will be attending lectures and workshops most of the time. You will receive an accelerated detox method, will be tapered faster than you like, and at the end will be declared cured and discharged with a certificate of achievement. Average cost of these programs is $1000 per day. Do not think about it unless you are a congressman, or a country music star. Some insurances cover it.
- Finally there are programs who claim to cure your addiction without the use of drugs like Suboxone or Subutex. After all using drugs is a behavioral problem ... and they get down to make you behave right. If you can stand it ... go for it. These are also the least expensive, all you pay for is boarding and lodging.
- And ... finally ... there is one more ... go to jail ... you will not get any drugs, and no treatment ... and will come out cured. Unfortunately many people waste this opportunity, come out, and relapse immediately.
Is Suboxone prescription covered by Insurance?
Insurance covers your visit to doctors and hospitalization. Your prescriptions are covered by your prescription plan. Sometimes these are run by the same plan, but many times they are run by different organizations. Some prescription plans cover it, all of them require preauthorization. You and your doctor have to follow that procedure before you can get the medication.
Call your prescription plan and ask them if it is covered, what is required for preauthorization (download forms), for what duration it is covered, the quantity limits on it, and your out of pocket costs. Most importantly follow the rules of your program, because if you get discharged for violation of their policies, your preauthorization also terminates. You will have to apply again, and it is unlikely that you will get it.
How much does Suboxone cost?
Suboxone film costs $8 to $10 per 8mg/film. Generic Buprenorphine (what people call Subutex) costs $4 to $5 per 8mg tablet. Brand name Subutex costs same as the Suboxone film. Patients generally start at two to four tablets/films/day. On the average patients take one to two tablets/films/day and gradually reduce it, ... so your medication costs will be $10-$20 per day, ... much less than what you spend on obtaining dugs illegally.
Are the visit to doctors covered by Insurance?
There are generally no clear policies, but mostly not. Medicare and Tricare does not cover outpatient addiction treatment. However, they do provide coverage for behavioral health/psychiatry, and more and more insurance policies are covering these services. These have to be provided by a psychiatrist, so look for a Suboxone provider who is a psychiatrist.
Other doctors bill these services as routine doctor visits, but they risk the payment being recaptured, ... and worse, being accused of fraud ... if they are not a contracted provider for these services.
What are the doctors fees?
As a self-pay patient ... on the average you can expect to pay $300 to $500 for the initial visit, and then $100 to $200 per visit after that. There might be extra charge for urine drug screen which is likey at every visit.
What are the counselors fees?
Private counselors charge anywhere from $75 to $150/session. You are required to see them once every one to two weeks in the beginning. If your policy provides for behavioral health services then it may be covered with some limitations ... total number and frequency of sessions may be limited. Some provide group sessions, but are hard to find. Private option provides you much more flexibility in getting a person with whom you can have a rapport, a choice of location, and time etc.
If you go to a contracted treatment facility then this is generally included in the package. They usually provide a mix of individual and group sessions. You do not have a choice here ... you will attend the counseling sessions that is provided at this location, and is part of the treatment package.
About my practice
I am accepting new patients.
- Insurance not accepted. I am not a Suboxone provider for any Insurance plan.
- Self-Pay patients only. Payment is required at the time of service.
- Insured patients should call their insurance carrier for a list of contracted providers.
- I am not an addiction specialist, or a psychiatrist. My clinic is not a detox facility.
- My primary speciality is Anethesia and Pain Management.
Addiction can not be treated by a pill ... the person must be self motivated to treat their opioid addiction ... Suboxone and Subutex prevent withdrawal symptoms, and reduce the craving for opioids; thus making it easier to modify addiction behavior at a gentler pace.
Currently I am only accepting self-pay patients. I am a solo practitioner in a part time-practice. I do not have the time ... personnel ... or the inclination, to deal with your insurance ... or prescription plan. Insured patients must seek a provider within their network. I no longer assist in filing their claims. You can check my fee schedule here.
*Buprenorphine can also be used to treat moderate pain for those patients who need opioids but have difficulty maintaining discipline on opioid usage. The preparation for that is Butrans (Buprenorphine transdermal patch, a single patch lasts for seven days). Butrans is also a controlled substance but can be prescribed by any doctor, ... it does not require special certification. Butrans is not approved by FDA for treatment of addiction.