Why Suboxone treatment is difficult to obtain!

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Some parts of the country report a shortage of physicians who are DATA-2000 certified, i.e. able to prescribe Suboxone and other buprenorphine products. The shortage of buprenorphine-certified doctors parallels shortages of mental health practitioners in general, including psychiatrists and addictionologists. Larger cities and areas near the east and west coasts are less likely to have shortages of doctors than are smaller and more-rural parts of the country, particularly across the Midwest. Suboxone-certified physicians did not come to light in the United States until October of 2000. The difficult part of finding treatment comes from the 100 patient cap each doctor has to follow. Only 30 patients allowed for first year. This number has remained unchanged since 2000. Also, many physicians are downright frightened to become DATA-2000 certified. To become buprenorphine-certified, doctors must sign an agreement that allows random inspections by the DEA without cause.  Other doctors enjoy privacy rights similar to other businessmen, where search of the premises and review of records would require probable cause and issuance of a warrant by a judge.  But in order to treat with Suboxone or buprenorphine, doctors must waive that right of privacy and allow inspections with no notice, even if such inspections require closing the clinic doors for the day.

And now that most doctors are employees of large health systems, the requirement for inspections is a greater hindrance.  Most major health systems are not as interested in treating addiction— an area of medicine with low reimbursement rates, and patients who are more likely to be impoverished by their illness– as in attracting orthopedic or heart patients, the ‘cash cows’ of modern medicine.  If you were CEO of a multi-physician network, would you permit random DEA inspections of your physicians’ offices in exchange for the ability to treat more patients that are addicted to drugs including opioids? I can’t blame those CEOs and doctors for the decisions they make.  The result is a shortage of buprenorphine-certified doctors, and the attraction of businessmen-doctors who find a way to turn buprenorphine treatment into a profitable enterprise, by signing doctors to increase their patient-limit, and seeing as many patients in as short a time as possible.  Other doctors tend to be physicians who enjoy working in the field of addiction because of their own experiences with addiction and recovery.  To those physicians, treating a fatal disease, in a disrespected and stigmatized patients, can be very a very rewarding way to practice medicine. My personal opinion to those seeking Suboxone treatment is that you receive better therapy ie. talk-therapy from a private practice physician.

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