The opioid epidemic has been detrimental to many families in the United States, ever since drugs such as Oxycontin came onto the market.
One treatment option available to opioid-addicted individuals is Suboxone, a prescription medication that primary care providers can prescribe to patients. However, there are certain regulations and specific steps that need to be followed. So, how is Suboxone prescribed to those who need it?
This article will outline:
- What Suboxone is
- Regulations surrounding Suboxone prescription
- How to get a Suboxone prescription.
Let’s begin.
What is Suboxone?
Suboxone is a prescription drug used for patients suffering from Opioid Use Disorder (OUD). It is part of a long-term MAT or medication-assisted treatment.
Opioid Use Disorder is a medical condition that is characterized by opioid dependence. This results in an intense need to use opioids, an increased tolerance, and intense withdrawals when discontinued.
Suboxone contains Buprenorphine and Naloxone. They work by reducing withdrawal symptoms and cravings, as well as combatting the effects of overdosing on opioids.
Buprenorphine acts as a partial agonist to u-opioid receptors, and it is what reduces withdrawal symptoms. Naloxone acts as an antagonist to u-opioid receptors. This is what reduces the effects of opioid overdose.
Regulations Surrounding Suboxone Prescription
Federal Regulations
Suboxone has a Schedule III controlled drug classification by the Drug Enforcement Association. Since 2000, the Drug Addiction Treatment Act (DATA) has allowed physicians with schedule III authority to prescribe medications for OUD in compliance with the state law.
Specific training requirements for physicians
From June 27th of 2023, it became a requirement that doctors applying for a new DEA license or renewing their old ones had to meet specific requirements. This includes 8 hours of training focussed on OUD.
However, a physician can also get a license through board certification in addiction medicine. Additionally, graduating from a program with a curriculum containing 8 hours of OUD content within the last 5 years is also applicable.
Limitation of physician prescriptions
The patient limit for physicians to prescribe Buprenorphine has risen from 100 to 275 since 2016. This applies to those that had at least 100 of their patients using it per year.
How to Get a Prescription for Suboxone
A person should consider the several aspects of a Suboxone prescription when reaching out for treatment. It’s not as simple as walking into a healthcare provider’s clinic and getting a script.
Below is what you should expect:
Initial Medical Evaluation
In the initial consultation with a medical provider, an evaluation will need to be undertaken. This is to assess what the needs of the patient are, and how the treatment plan should be tailored to that individual.
A medical evaluation will include things like drug testing via urine, questions about medical history and substance use history, and checking vital signs.
Finding a DATA-Waived Physician
In section 1262 of the Consolidated Appropriations Act, ‘X’ waivers have been removed from the requirements to prescribe buprenorphine in 2023. All practitioners now need a DEA registration and Schedule III authority to prescribe. However, in some states, physicians still need a waiver.
Substance Abuse and Mental Health Services Administration (SAMHSA) has a website that allows you to verify a practitioner’s DATA waiver using their first and last name or DEA registration number. So, in the meantime, if a state requires a waiver for a prescription, patients can look up physicians in their area and confirm whether they are DATA-Waived or not.
Ongoing Monitoring and Consultation
Physicians will continuously monitor and set up consultations with their patients who take Suboxone. This is to ensure they are safe and not responding badly to it. It is also an opportunity to adjust doses.
One of the main reasons for monitoring these patients with OUD is to prevent hazardous or harmful use of the medication. This is because misusing the medication is possible when taking Suboxone. This is due to the Buprenorphine component of the drug which is a partial agonist for opioid receptors in the body.
Other reasons for ongoing appointments include:
- Monitoring severe side effects such as respiratory depression, liver damage
- Keeping an eye on the patients who use other non-opioid medications
- Neonatal monitoring in mothers
- Being a child who is more vulnerable and requires close attention.
Steps on How to Get a Prescription for Suboxone
Here are the multiple steps that will be taken before getting a Suboxone prescription:
Firstly the patient needs to find a licensed Suboxone treatment provider.
As mentioned earlier, the physician they go to needs a DEA license and Schedule III authority to prescribe this medication.
Without these qualifications, Suboxone can’t be prescribed. To find a clinic, patients need to simply google search Suboxone clinics in their area and prepare to call them.
Secondly, an appointment needs to be set up. This is so a medical evaluation can be conducted to assess what the patient’s specific needs are and how a treatment plan should look for them.
Thirdly, the patient needs to actually be eligible to receive Suboxone. For instance, if they have no physical dependence on opioids or heroin they may not be eligible for treatment. Suboxone use is for the treatment of OUDs.
Fourthly, to get ongoing prescriptions, follow-up appointments are necessary. This will allow physicians to monitor progress and adjust dosages.
Conclusion
Overall, getting a Suboxone prescription does require going through some strict and specific steps, from initial medical evaluation to finding a verified physician and continuing consultations with them.
It is evident that getting a prescription is not overly straightforward. The regulations and rules around getting a Suboxone prescription are to ensure that patients do actually need it and that the medication is not prescribed without careful consideration.
This is important due to the potential side effects Suboxone may cause. Nevertheless, it is important to acknowledge that in the majority of cases, Suboxone is an effective and lifesaving treatment for those suffering from OUD.
References:
- https://www.addictioncenter.com/treatment/medications/suboxone/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10023135/#:~:text=In%202016%2C%20two%20additional%20policy,100%20patients%20for%20at%20least
- https://www.bicyclehealth.com/suboxone-faq/prescribing-requirements
- https://store.samhsa.gov/sites/default/files/d7/priv/pep15-fedguideotp.pdf
- https://www.addictionresource.net/mat/buprenorphine/suboxone/how-to-get-prescription/#process-of-getting-a-prescription
- https://www.samhsa.gov/medications-substance-use-disorders/pharmacist-verification/data-waiver-lookup
- https://www.medsafe.govt.nz/profs/datasheet/s/suboxonetab.pdf
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