The United States is in the middle of an Opioid Addiction epidemic which doesn’t seem to be ending soon. According to the National Survey on Drug Use and Health, 4.3 million Americans age 12 years or older were engaged in the non-medical use of prescription painkillers. In addition, 435,000 Americans were using heroin.
If we examine the factors that contributed to this epidemic, we will quickly identify physicians’ prescribing habits as a leading cause. Between 1991 and 2011, the total number of prescriptions for hydrocodone and oxycodone products increased from 76 million to 219 million. The number of overdose deaths due to prescription opioid pain relievers have more than tripled during that time period. In 2014, drug overdose was the leading cause of accidental death in the US with 47,055 lethal drug overdoses. Prescription pain relievers accounted for 18,893 deaths while 10,574 overdose deaths related to heroin.
To combat this epidemic, federal, state and local government agencies have stepped up oversight of physician opiate prescribing habits. They’ve even gone so far to imprison physicians running “pill mills” while prosecuting others for contributing to accidental overdose deaths of their patients. However, a solution was needed to help the ever growing number of addicted patients who could not abruptly stop using opiates.
One such solution is the drug Suboxone, a combination of buprenorphine (partial agonist) and naloxone (mu antagonist). When taken, the opioid receptors are activated but produce a diminished response. The patients’ withdrawal symptoms are relieved while the rewarding effects of opioids are also blocked. Suboxone helps these patients be functional while ending the need illegally obtain opiates. Some patients may be appropriate for opiate detoxification in as little as 5 days, while others may need years of maintenance on Suboxone.
With the passing of The Drug Addiction Treatment Act of 2000 (DATA 2000), qualified physicians were permitted to treat opioid addiction with buprenorphine via Office Based Opioid Treatment (OBOT). A new market emerged to provide this service.
Economically, OBOT clinics charge an initial fee to cover the cost of the initial evaluation and titration of Suboxone (induction) and then a lower fee for routine follow up appointments. The induction costs range from $200 – $600, while followups may cost $90-$180. There are clinics that require weekly followup visits and others may extend visits to every other month. While some physicians accept insurance the majority only accept cash. Therefore, the revenue range of these clinics can vary widely and for a select few can be seriously lucrative.
Should you start a Suboxone clinic? My personal advice on this question is to “first do no harm”. Patients seeking OBOT with Suboxone are often desperate for help and they need physicians who are prepared to deal with the “addicted mind”. Remember, while all of these patients need help, you need to ask yourself if you are prepared to care for patients who may manipulate you, break the law, and relapse. In addition, the economics of a Montgomery County, Maryland clinic will differ from a Holmes County, Mississippi clinic. Some patients without insurance will have trouble affording the Suboxone prescription which can run $500 per month. Last, do not forget the 30/100 limit. The DATA 2000 law limits the number of simultaneous patients you can prescribe Suboxone to 30 your first year and then 100 the following years.
That being said, adding a Suboxone clinic to your practice can be financially, as well as emotionally, rewarding when you help patients end years of opioid dependence. If you are interested in obtaining Buprenorphine Training, please follow the link http://www.buppractice.com. A popular forum where providers and patients share their stories is http://www.suboxforum.com/index.php. If you have any questions about this or any article published on anesthesiastat.com, please complete a contact form.
