Updated: Dec 4, 2018
This can be one of the most frustrating obstacles that patients face when trying to find treatment for their opioid use disorder. After years of abuse, they may have finally come to a point in their life that they are ready to quit but then have no where to turn to so they just give up and keep on using. And what makes this particularly frustrating is that there are several well studied, evidence-based treatments available such as Suboxone that work extremely well at controlling cravings, reducing overdoses, and maintaining sobriety. However, medications like these are highly regulated and very few physicians have the required training to prescribe them making finding a Suboxone treatment center very difficult, especially in rural communities.
Who Can Prescribe Buprenorphine
Buprenorphine became available for physicians to prescribe under the Drug Addiction Treatment Act of 2000 known as DATA-2000. At first, only physicians (MD or DO) were able to treat 30 patients at a time. However, this law was amended in 2006 to allow for prescribers to increase their limit to 100 patients after a year. Due to the worsening opioid epidemic plaguing the country and the increased demand for treatment, the Comprehensive Addiction and Recovery Act (CARA) was passed in 2016 which was a huge improvement and allowed for certain advanced practitioners such as Nurse Practitioners and Physician Assistants to apply for their Suboxone waiver. Also in 2016, the patient cap for physicians increased from 100 to 275 if they met certain qualifications such as board certification in addiction medicine or addiction psychiatry or if they practiced in a qualified practice setting. Most recently, the SUPPORT for Patients and Communities Act was signed into law in October 2018 which permanently allows NP/PAs to prescribe Buprenorphine, allows additional practitioners such as certified nurse-midwives, clinical nurse specialists, and certified registered nurse anesthetists to apply for their Suboxone waiver, and also codifies the increased patient limits of 275 patients for physicians.
So Where Are The Treatment Clinics
This issue is a bit more complicated. Just because clinicians have the ability to prescribe Suboxone doesn't mean they necessarily want to. In fact, it is estimated that less than 5% of all physicians have done the required training to be able to prescribe Buprenorphine and even amongst those who do have their DATA-2000 waiver, only about 1/3 actually utilize it. As a result, nearly half of all counties in the United States don't have anyone that can prescribe Suboxone which is again magnified in rural counties. There are several resources available to help locate one of these rare providers such as the Substance Abuse and Mental Health Services Administration (SAMHSA) treatment center and provider locator but as mentioned the majority of the individuals listed in the directory are not actively prescribing Suboxone. The National Alliance of Advocates for Buprenorphine Treatment (NAABT) has created a website that attempts to match up patients seeking treatment with providers or treatment centers that are actually open but again you may run into the issue of having to travel great distances to find a clinic accepting patients. And the concept of a walk in Suboxone clinic does not exist so even if you are lucky enough to find a clinic accepting patients and is within a reasonable distance you may not be able to be seen for several days or weeks which can feel like a lifetime if you are actively withdrawing. Here at Lucina, we understand the importance of needing to be seen as soon as possible and can usually get you in either the same day or next day. We've recently hired numerous DATA-2000 waivered providers so rarely have a waiting list and can work around your work hours to get you seen. Click here to schedule an appointment today.