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This past weekend, the front page of the New York Times featured “Addiction Treatment with a Dark Side”, an article which focused on the risks and benefits of a medication called Suboxone.

The article pointed to many positive benefits of Suboxone, including ease of administration in a doctors office, lower risk profile, coverage by most insurers. Included were several testimonials from Suboxone patients who described how Suboxone saved their lives and enabled them to move forward to highly productive and healthy lives.

However, the article also discussed a “dark side” of Suboxone treatment where unethical 166672553doctors prescribe large amounts of the medication without proper monitoring or counseling. Included were some testimonials from Suboxone patients who were able to get a euphoric “high” off suboxone and some examples of people who overdosed while using Suboxone.

So how can we understand this article? Should we embrace Suboxone as a miraculous medication that heals or should we reject Suboxone as a dangerous drug? As with most treatments for substance abuse, I believe the answer lies within the doctor-patient relationship. If the doctor runs their practice in an ethical, cautious, appropriate manner and develops a good relationship with their substance abuse patients, then Suboxone can indeed work wonders. If the doctor runs a sloppy, unethical, inappropriate practice, there will not be a good relationship with patients, and Suboxone will often fail as a treatment.

If you are thinking about Suboxone for yourself or someone you care about, do your homework. Educate yourself as to the risks and benefits of this medication and then find a reputable doctor who prescribes this medication to have a consultation visit. What should you look for in a doctor?

Look for a Suboxone program with the following:

  • Routine urine toxicology screens with detailed breakdown of substances, including but not limited to Suboxone.
  • Wrapper counts at each visit – the patient is held accountable for each dose of Suboxone prescribed.
  • Controlled substances database(s) are checked routinely (to avoid “doctor-shopping”).
  • Appointments with the doctor rather than a physician assistant.
  • Some form of counseling at the program and/or a referral system for counseling.
  • Length of visits – is the doctor spending at least 15 minutes at each visit to discuss.
  • Ease of scheduling – are urgent appointments available if needed?
  • After-hours coverage – is a doctor available for emergencies after hours?

 

If you find a program that offers these features, it is likely you will be working with an ethical, cautious, appropriate doctor.

More questions? Please contact us by email or phone at (919)636-5240. We would be happy to discuss Suboxone or other treatment options with you further.

Dr. Jennie Byrne, MD PhD
Cognitive Psychiatry