A reader writes:
I have been taking Suboxone for 2 months now and it has changed my life! I finally feel a freedom I haven’t felt in over 30 years! I am a nurse and am able to work around and administer narcotics with absolutely no thoughts, urges, or cravings…a miracle for me. BUT, the hospital I work for has just informed me I cannot be taking suboxone while employed there.
I am just in shock. Is there any recourse for me? Are there any laws protecting my disease/disability medical management?
I feel it’s like being told I can’t take my insulin if I were diabetic.
Any suggestions?!
I have been watching to see what position the various Licensing Boards take on suboxone. I did not expect to hear of such a silly demand by an employer– particularly an employer that supposedly has an interest in keeping people healthy.
If you read some of the forums out there you will come across this statement: “We need our doctors and nurses to be 100% on their toes– would you want your surgeon to be on suboxone?” My answer, of course, is YES– particularly if he/she has any history of opiate dependence. I want his/her mind 100% on my surgery… not on the last meeting they went to, not on the meeting that they need at the end of the day, and not on the narcotic prescription that they will write after the surgery If they are taking suboxone, then I know that they are essentially ‘normal’– they are not having cravings, they are not sedated, they are not ‘high’– they are the person that they would be, if they were able to dissect out their opiate addiction.
For our nice nurse, I wish that you could go and hire the best employee-rights attorney in the country, and sue the hospital for wrongful termination. In fact, as I think about it, I wonder if they can even make such demands. Can a hospital threaten to fire a patient for taking antidepressants? If not, how can they threaten to fire you for taking suboxone? They would have to claim that it somehow impairs you from your job– and how could they do that? As anyone taking suboxone knows, once you are used to the medication there is no significant effect from taking it.
I actually DO have a great attorney for this type of work. The problem is that lawsuits cost money. I will send him an e-mail and see if he has come across this issue before. In the meantime, don’t do anything drastic. You may want to consider drafting a letter that threatens to go the the EEOC over the issue. They cannot fire a person for having a protected disability, including addiction (they can fire a person for behavior, or even risk of behavior, related to the addiction– but if the addiction is only a ‘past’ issue they can’t hold it against you).
Stay tuned…


tic · June 3, 2015 at 11:18 am

Ten days of methadone taper seems to be the standard around here, even for babies born to mothers on relatively low maintenance doses of 2 mg buprenorphine a day. All my patients have also gotten an automatic referral to a high risk pregnancy specialist. They come back to me concerned about why they need a maternal-fetal medicine referral if the buprenorphine I am prescribing is really not going to hurt their baby.

mirimar · March 4, 2016 at 11:14 pm

Well, I guess when they cannot make tens of thousands of dollars, any other form of Continued, Practical, Private Remission from active addiction just doesn’t work. I am here to tell them, Horsepuckey ! ! I live and have been living a Normal, Productive, Asset to My Family and the Community Lifestyle for several years now thanks to Suboxone and a Dr. I like and respect. Mr. Clearbrook can keep all the BS they feed you in treatment facility’s and then Boom…..You have to get back in the game of life, and believe me it’s hard after years of addiction. More power to all that strictly adheres to 12 Steps and it’s principals, just don’t tell me there aren’t safe, reliable, private alternatives.

tic · March 21, 2016 at 9:45 am

We do use a reference lab routinely for patients with insurance. We also have point of care (POC)12 substance cups that cost us about $6 each. While the lab does bill some crazy amount for the drug panel that we do, insurance usually only reimburses $100 or less, and the lab has usually taken that as payment in full, although rarely patients will owe a small copay, usually under $20. Uninsured patients and patients with high deductibles are never charged more than about $85. Every billing problem was resolved with a patient call to the lab. We routinely use a reference lab when we trust the patient (because results take about 5 days), if there is a discrepancy between the POC test and what the patient is telling us, and if the patient has insurance. We do not bill insurance for doing POC tests because it is a huge administrative pain in the neck, so if a POC test is done we charge the patient $15. Patients can use their HSA for POC testing. Patients sometimes prefer to use the reference lab and have no copay as opposed to an additional cash charge of $15 at the office. A fair number of our patients have medicaid, and pay cash for their visit, since we do not take any medicaid plans. Medicaid for example pays 100% of the patients lab, and I do not have to charge the patient $15 a visit for a POC test.
I agree completely that drug screens are not to catch people doing wrong, but to allow them to “prove themselves” and to find out who might be struggling and afraid to admit it, or keeps thinking they can handle it on their own. Some patients like regular urine tests since they say it helps keep them honest, and especially if they have struggled on buprenorphine in the past, they feel helps it proves to me and sometimes their families that they are going well, like an A+ or gold star on a report card.
This crazy billing strategy is not just something that happens with urine drug screens, but with other labs, procedures, medications, and testing as well.

mirimar · May 4, 2016 at 10:15 am

Perhaps the reason they are so hyped up on counseling is because that is where the better money is. I’m not knocking treatment centers, but they are pricey and if the persons insurance doesn’t pay for it. The taxpayers do. I doubt seriously the Treatment Center cares who pays them, as long as they get paid. Having been through both traditional treatment and one on one Dr treatment/maintenance, I personally prefer the one on one Dr. route. It’s all in the numbers if you ask me. If you own an operate a conventional treatment facility, I would wager that the objective is to Keep it Full as best as possible. Doctors such as yourself, take away from the available pool of addicts/abusers, thus lowering the head count ie MONEY. It quite possibly may be no more of an argument that.

tic · May 9, 2016 at 9:20 am

A patient recently asked me if giving suboxone to a person who was overdosing would save them. I think the question was precipitated by Prince’s death. I answered possibly not because the the time of onset for suboxone SL is about 20 – 40 min, and someone who is already unconscious may stop breathing before the suboxone has started working. IV, IM, or nasal Narcan is a better choice because of it’s more rapid rapid onset of action.

    Jeffrey Junig MD PhD · February 14, 2017 at 9:51 pm

    Absolutely– plus there are risks from injecting anything that is not specifically intended for injection. I have known of reversals with buprenorphine given by injection– but that would only work if the heart is still beating, as otherwise the drug will stay in the arm. But yes– naloxone is a better option!

mirimar · May 16, 2016 at 10:17 am

Why can’t Dr’s standardize the rates we pay monthly for treatment ? According to Dr Burson, 80 to 100 dollars per 20 min visit is sufficient. Especially when one is paying in cash every month, why do some Dr’s charge 250 an 350 per month ? This is where you start to piss people off. Do not charge me more than you charge everyone else, so you can make up some money you are losing on John Doe. You may justify this by saying, oh so n so has a good job and can afford it, Bullshit already..One wonders why some people have such low opinions of Dr.’s in general. This is dam sure one of them…Please write an article yourself on this matter and be honest about it. Thank you

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