Can Any Doctor Prescribe Suboxone?

Buprenorphine is a controlled substance. Doctors must go through a few extra hoops to prescribe it, and pharmacies must take additional steps before filling your prescription.

While all of this added preparation can be annoying, it's also important. Some people try to steal Suboxone or misuse it. By ensuring that the medication is dispensed properly, we can lower diversion risks.

Here's what you need to know about Suboxone prescriptions. 

What License Does a Doctor Need to Prescribe Suboxone?

Controlled substances are tightly regulated by the Substance Abuse and Mental Health Service Administration (SAMHSA) and the Drug Enforcement Agency (DEA). To prescribe Suboxone, doctors must complete a few additional steps.

Typically, a doctor needs to follow these steps:[1]

1. Notify SAMHSA. The doctor must tell SAMHSA's Center for Substance Abuse Treatment Division of Pharmacologic Therapies that they want to offer Medication for Addiction Treatment. 
2. Prove their credentials. The doctor must have a valid medical license within the state and be registered with the DEA.
3. Take training. The doctor must take an eight-hour training course about buprenorphine and addiction.

The DEA gives doctors a license beginning with an "X," and the doctor writes this on any buprenorphine prescriptions. Anyone following all of these steps has a so-called "X-waiver," and it allows doctors to treat:

• 30 patients in the first year
• 100 patients in the second year
• 275 patients in the third year

This program has some drawbacks: first it limits the availability of Suboxone to those that need it, due to a shortage of providers. Researchers found that only 7% of providers could treat 275 patients, and almost a third of people in rural settings had no X-waivered doctor in their county.[1]

As the impact of the opioid epidemic became clear, experts started looking for ways to give more people needed access to Suboxone. They have done this in a number of ways: Some states have eliminated the X-waiver so that any provider with a DEA number can prescribe Suboxone without needing additional training. Other states have increased the number of patients that a Suboxone prescriber can treat to more than the original 30 patients [2] Despite some of these positive changes, shortages of Suboxone and Suboxone prescribers persists, particularly in rural areas [3]

What Do You Need to Get a Prescription for Suboxone?

You must visit a doctor who is licensed to prescribe Suboxone, and ideally one who treats a number of patients and is experienced in prescribing this medication. [4]

Some pharmacies don't stock Suboxone. You and your doctor should call them in advance to request the medication you need and ensure that it is in stock.[5] Coordination like this can ensure that you get your medication in a timely manner. 

Who Can Fill a Suboxone Prescription?

Only the person whose name is on the prescription can fill that Suboxone prescription. This ensures that the medication is received and used only by the individual for whom it was intended.

If your doctor writes a prescription that you can't get filled due to issues with teh pharmacy, insurance, etc, talk to your doctor and ask for help. Your medical team can investigate and make sure you get what can often be a lifesaving and necessary medication for those with opioid use disorder.

Sources

1. Policy Shift in the Opioid Epidemic: An Update on the X-Waiver. EM Resident. https://www.emra.org/emresident/article/x-waiver-update/. February 2021. Accessed June 2022.
2. FAQs About the New Buprenorphine Practice Guidelines. Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/medication-assisted-treatment/become-buprenorphine-waivered-practitioner/new-practice-guidelines-faqs. April 2021. Accessed June 2022.
3. Become a Buprenorphine Waivered Practitioner. Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/medication-assisted-treatment/become-buprenorphine-waivered-practitioner. April 2022. Accessed June 2022.
4. Pharmacist Verification of Buprenorphine Providers. Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/medication-assisted-treatment/pharmacist-verification. April 2021. Accessed June 2022.
5. Pharmacist Information: Buprenorphine and Buprenorphine/Naloxone Sublingual Tablets. VA Pharmacy Benefits Management Strategic Healthcare Group. https://www.pbm.va.gov/PBM/clinicalguidance/faqsheets/BuprenorphinePharmacistInformation.pdf. July 2003. Accessed June 2022. 
6. DEA Takes Aggressive Stance Toward Pharmacies Trying to Dispense Addiction Medicine. National Public Radio. https://www.npr.org/sections/health-shots/2021/11/08/1053579556/dea-suboxone-subutex-pharmacies-addiction. November 2021. Accessed June 2022.