At the end of her story, Laura Ungar describes the 27 cases of
doctors who have been disciplined for mishandling Suboxone.
"Rogue Suboxone doctors across Kentucky have allowed the opioid drug to seep onto streets already saturated with illicit prescription drugs and heroin," Ungar writes. "In the hands of these doctors, the much-touted medicine designed to curb opioid cravings and ease withdrawal is instead fueling the scourge of addiction in one of the nation’s hardest-hit states."
Attorney General Andy Beshear called it "the second coming of our pill mills," which dispensed opioids with little control until the General Assembly cracked down on them in 2012. Ungar reports:
"The Courier-Journal compared a federal list of Kentucky doctors authorized to treat opioid addiction with buprenorphine, the main ingredient in Suboxone, against state medical board records on physician discipline. The CJ also examined regulators’ reports on doctors, reviewed government rules about Suboxone prescribing and interviewed doctors, drug experts, officials and patients. The investigation found:Suboxone has become more prevalent as medication-assisted treatment for addiction has become more common. The Obama administration increased the number of Suboxone patients a doctor can have to 275 from 100, and "In Kentucky, the amount of Suboxone dispensed statewide rose 28 percent in less than two years," Ungar reports.
►Buprenorphine doctors were more than three times as likely to have current disciplinary orders against them as doctors overall — the majority stemming from inappropriate prescribing of controlled substances. Six percent of the 465 buprenorphine-prescribing doctors were the subject of disciplinary orders for any reason as of mid-May, compared with 1.8 percent of all doctors registered in Kentucky. Officials acknowledge other rogue doctors may be operating under the radar, since they only come to the board’s attention through complaints — a system that limits the state's ability to crack down on them.
►Suboxone clinics can be lucrative for doctors and owners. Some only take cash for office visits. Some pay doctors by the patient, giving them an incentive to see as many as possible. Former Lexington doctor David Swan, whose license was revoked in February, said the clinic where he worked paid him $130 for each patient he saw, 'far more than I ever made in my life.'
►Kentucky's buprenorphine regulations require regular drug screens, pill counts and other measures to prevent medication abuse, but contain loopholes rogue doctors can exploit. Patients must participate in “behavioral modification” such as counseling or 12-step programs — but the rules don’t say how often, so it can vary from several times a week to less than once a month. And if patients fail drug screens, it’s up to doctors to use 'appropriate clinical reasoning' to support changes in treatment such as increased screening or more frequent visits. Rogue doctors sometimes make no changes.
►Doctors can prescribe buprenorphine with very little training — just an eight-hour course required nationally, which can be done online, and another 12 hours of continuing education every three years in Kentucky. Critics say this isn’t enough for well-meaning doctors to learn what they need to know, and makes it too easy for unscrupulous doctors to put up a shingle."
(C-J photo by Laura Ungar)
A study at the University of Kentucky’s Center on Drug and Alcohol Research is looking at experiences with buprenorphine among addicts at The Healing Place, where Blanford is being treated. It "suggests that diverting and abusing the medicine are common," Ungar writes. "Of 1,674 addicts interviewed, 985 reported taking Suboxone at some point. Six percent said they got it only by legitimate prescription, 62 percent by illegal means and 32 percent both ways. Nearly eight in 10 who got it both ways admitted selling, trading or giving away what they were prescribed. More than three-quarters admitted mixing Suboxone with other drugs or alcohol to get high."