What Happens if a Provider Decides I’m Not a Good Fit for Suboxone or That I Don’t Need the Medication?

Far too many people struggle with substance use disorders (SUDs) without the help they need. Only 15% of people with opioid use disorders  get treatment, and even fewer get medications. [1]

If you meet a provider and they tell you you are not a “good fit” for Suboxone, you have choices. You can visit another provider, enter a different program, or try an alternate medication. 

Who Is a Good Candidate for Suboxone Treatment? 

Your doctor runs physical and mental health tests in response to a request for Suboxone. You must meet a few requirements to be considered a good candidate.

People who are good candidates for treatment fit the following criteria:[2]

• Interested: You want to get treatment for your opioid use disorder (OUD), and you think medications are right for you. 
• Compliant: You understand how the program will work, and you agree to follow the rules. 
• Educated: You understand the risks and benefits of Suboxone treatment. You’ve looked at other options with your doctor, and you think Suboxone is the right choice.

This list is short, and that’s an intentional decision. People who want to combat their addiction using science-based methods should get access to the care they deserve. 

Why Wouldn’t You Be a Good Candidate? 

While you might want to get sober with the help of Suboxone, your doctor might not agree that you are a good candidate for Suboxone for a number of other reasons. These might include: 

You Use Other Drugs - Either Illicitly or By Prescription

Combining drugs, particularly other sedating medications, can be risky while on Suboxone. In a study from Australia, almost 60% of unintentional overdoses were due to drug/drug combinations.[3] Some people attempt to enroll in Suboxone programs to quit opioids, but they intend to keep using substances like alcohol or marijuana.

Different doctors feel very differently about this. For example, some doctors refuse to prescribe Suboxone to patients who are using other substances like alcohol or cocaine.

Other doctors feel that this is patronizing and an outdated way of thinking about addiction disorders: Suboxone is a treatment specifically to help people avoid opioid use, not cocaine use. Therefore, patients should not be denied access to life saving medications like Suboxone just because they use other substances. We know that Suboxone can be prescribed safely to patients taking a number of other potentially sedating medications, so long as it is done cautiously and under medical supervision.

Unfortunately, at this time, the decision to prescribe Suboxone if you are using other substances is at the discretion of the doctor and the clinic at which you receive care. If this is the reason your doctor cites for not prescribing you Suboxone, you may want to seek care at a facility or from a clinician that has a different practice or policy regarding concurrent substance use. 

You Have Health Issues Exacerbated by Suboxone 

While it's rare, some people have allergic reactions to Suboxone or other health conditions that may preclude them from being able to safely take Suboxone. People with liver or kidney disease may also be poor candidates for Suboxone therapy. Your doctor should test your liver and kidney function and ensure your other health conditions do not preclude you from safely taking Suboxone. [4]

What to Do if Your Provider Decides You’re Not a Good Fit 

If you've asked for Suboxone and your doctor disagrees, you have a few different options. 

Ask for An Explanation

It is important to first understand why your doctor is recommending against Suboxone. Is it because of your health history, or because of another medication or substance you are taking? Make sure you advocate for yourself and understand your doctor’s rationale. This way, if you do decide you want to pursue treatment elsewhere, you can better understand the risks and benefits of your taking this medication. For example, if your doctor recommended against Suboxone for a health reason, it might make sense to avoid this medication. However, if he/she recommended against it due to your use of other substances, you might disagree and could pursue care elsewhere at a more open minded clinic.

Talk With a Different Provider 

Some doctors aren't willing to manage patients using Suboxone. If the doctor you visit doesn’t prescribe Suboxone in general, or won’t prescribe to you specifically for one of the reasons described above, it might be worth getting a second opinion or asking for a referral to a provider that does routinely prescribe Suboxone.

Try a Different Medication

Your doctor might decide that Suboxone isn't a good choice, but another medication could work better. Methadone works similarly to Suboxone, but it's provided in specialized clinics that provide drug testing.[5] Naltrexone is a third FDA approved medication for OUD.

If your doctor thinks your body can't handle Suboxone or you won't succeed in a program with low monitoring, Methadone or Naltrexone might be options for you.

Sources

1. Practice Guidance for Buprenorphine for the Treatment of Opioid Disorders: Results of an Expert Panel Process. Substance Abuse. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4470850/. June 2015. Accessed August 2022.
2. Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. U.S. Department of Health and Human Services. https://www.naabt.org/documents/tip40.pdf. 2004. Accessed August 2022.
3. Polydrug Use. Alcohol and Drug Foundation. https://adf.org.au/reducing-risk/polydrug-use/. Accessed August 2022.
4. Suboxone Prescribing Information. U.S. Food and Drug Administration. https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/022410s000lbl.pdf. August 2010. Accessed August 2022. 
5. Guide for Families: Medications for Opioid Use Disorder. Providers Clinical Support System. https://pcssnow.org/resource/guide-for-families-medications-for-opioid-use-disorder/. June 2021. Accessed August 2022.