Today I had a follow-up visit with a patient who takes Suboxone, a 55-y-o married woman.  I remember when I first ‘met’ her during a frantic telephone call to my practice about 5 months ago.  At the time, she was on a high dose of pain medication from her doctor for a variety of ailments, and more worrisome she was on high doses of benzodiazepines– Valium-related medications like Xanax, Klonopin, and Ativan.  As I have mentioned before, benzodiazepine withdrawal can be fatal… but with opiate withdrawal, you only wish you were dead!

Foolish Pharmacist
Some Pharmacists are Better than Others

She had been through traditional treatment several times;  had attended meetings over the years, and worked a program as hard as anyone… and yet she had little sobriety to show for her efforts.  She was crying, afraid, depressed… and for good reason, because from her perspective life appeared to be over.  I have met many people in the same condition over the years, and have been in her condition myself– as have many of the readers of this blog.

A few years ago I would have been afraid for her and would have given her poor odds of surviving ten years, let alone finding sobriety or any degree of happiness.  I would have offered her residential treatment, but she would have had trouble coming up with the $4000 required to get in the door to a 30-day center, and the open-ended treatment center where I went years back wouldn’t even be on the table, as costs there run to $30,000 and more for three months of treatment.  Insurers don’t usually pay these bills, as the treatment is considered ‘residential’, and not ‘inpatient’.  I could have offered her psychotherapy– which doesn’t work particularly well for opiate dependence.  I could have recommended NA or AA meetings… something she was already doing.

I set up an appointment, and we discussed the options, including Suboxone.  She warily agreed to give it a try.  Three months later she sat across from me in my office, smiling and grateful.  She was employed for the first time in years;  she was exercising and had lost over 15 pounds;  she was attending NA meetings once or twice per week;  her relationships at home were improving;  most importantly, she felt something that she hadn’t felt for years: that life was worth living. Cost for three months of treatment?  Several hundred dollars after her insurer (the cost for a person without insurance would have been about $1200 for medication and appointments).  She looked great and felt great.  Everyone who knew her was surprised by the sudden change in her demeanor, and most were happy for her.  \

Most, but not all.

Today she was crying at the start of her appointment.  Everything had fallen apart– ever since she took the advice of the people at NA who told her to ‘get rid of her crutch’ and stop the Suboxone.  The doctor is (gasp!) making TONS of money off you!  You aren’t REALLY sober!  And so she took their advice and stopped.  She had passed through the withdrawal– not the worst she has had– but things kept getting worse.  She was on the verge of losing her job– the job that she was so proud of a month earlier.  She was at odds with her family, and her son had announced plans to ‘write her out of his life’.

During our discussion, she told me about the advice she had been given.  I usually attend AA meetings myself, and am not familiar with the NA meetings she attends– and plan to keep it that way!  Taking each other’s inventories, giving medical advice counter to a person’s physician without knowing anything about her history, accusations of ‘inferior recovery’…  what a bunch of self-righteous jerks!  They had taken this trusting woman and turned her into a basket case.  We discussed the difference between ‘honesty’ and ‘inappropriate self-disclosure; we discussed boundaries.  And we got her back on Suboxone.
A bit later in the day, I get the usual message from some idiot– only this time, the idiot is a pharmacist.

His message:

Perhaps you charge differently than my local docs do that prescribe this junk, but they charge $200 to $300 every 2 weeks. Thirty patients times $400 a month is $12000. Sounds like a nice chunk of change to me.
I’m a pharmacist in recovery now for 8 years.

I think Suboxone could have a place in treating addicts if it were prescribed and managed properly and ethically. What I’ve seen doesn’t fall along these lines. What I’ve seen is doctors taking the place of the dope dealers. Do you get them off narcotics so that they can be on narcotics? OK…? That would be okay if the Suboxone were used for a short period and then tapered. I have yet to see anybody get tapered. Why is it necessary to keep these patients on this new narcotic for so long? Put them on it, let the fog clear, point them to some AA/NA meetings, and taper the junk so they can learn to live.

I’ve seen the guys coming into the pharmacy week after week for their Suboxone fix. They’re not changing anything but their dealer. They are living with this false suboxone and hope that everything is better. If they are taking only Suboxone and not using illicit drugs too, then I’ll admit that could be a step in the right direction. At least they aren’t involved in the illegal buying and selling of narcotics.

Why do I care? I care because I am passionate about recovery and guiding people there. I see these people weekly and I hurt for them because they are spinning their wheels by continuing on these narcotics while recovery is available. I care because I hate addiction and what it does to people and their families (I’ve been there), and I don’t want anyone else to be fooled by this so-called opioid treatment. There are better ways to live than being a slave to narcotics, including Suboxone.

Fairly civilized.. but keep reading:

Keep kidding yourself about Suboxone while you rake in the money from these people who don’t know you’re nothing more than a pompous ass pusher with a great degree that’s being wasted by greed. You offer these people an answer that’s not real- a fucking band-aid for a gaping wound.

How much do you charge these people to write these prescriptions for them? Is it a regular office fee? Or do you rape them like the con artists around here? Just curious.

Jared Combs

My comments:

I don’t know where this idiot works, but I feel for you folks out there who have to see such a self-pretentious jerk fill a prescription.  I urge you to count your pills closely– someone who thinks on this level– who has such disdain for doctors who prescribe Suboxone– can justify who-knows-what for the ‘good’ of others!

I have talked about all of his ‘cussing points’ over the past year;  I have never met a doc who charges the fees he quotes (I suspect he made the numbers up), and you would hope that a pharmacist would know at least some basic biochemistry– such as the difference between an agonist and a partial agonist.

What bothers me the most, though, is the attitude.  I left out the part of his message where he boasted about his 8 years of recovery and (for some reason) belittled my own– as I have written several times, I found recovery through the steps in 1993, relapsed in 2000, and have done well since 2001– but like the others, at my meetings, I consider myself as ‘sober’ as anyone else in the room!  And yes, I am angry– angry because of patients like the one I saw this morning who listen to idiots like this guy.  Some of those patients die.  An idiot like this pharmacist caused a great deal of pain for a woman in my practice, and that makes me angry.

As for the woman in my practice who has ‘inferior recovery’ according to this guy?  I would put her level of honesty, decency, and respect for others far above his!  If that is the difference between ‘true recovery’ and Suboxone, I know which one I like better!


armme · January 6, 2009 at 7:14 am

I think you should ask the pharmacist if he works for free? I mean, maybe he doesn’t make the very GOOD living that most pharmacists make by charging money for prescriptions that sick people need to live? How can a PHARMACIST possibly not see the hipocrisy in demeaning your work by calling you “money grubbing” when all he is required to do is stand around in a white coat and hand out pills all day?!
Yes, I know, I am being catty. But nothing makes me more angry than someone in “recovery” who thinks they know how everyone else in recovery should find their way! I put quotes around the “recovery” [about this pharmacist] because I think anyone who spends so much time worrying about how other people navigate recovery can’t possibly be as healed as they would like everyone to believe they are!
The absurdity and irony of this NA group telling this woman to get off meds just proves to me (once again) why NA harms far more addicts than it helps. I hope if she’s attending a group it’s AA now!

luzzi308 · January 8, 2009 at 3:36 pm

I had an experience somewhat similar to this one. Tuesday I had an appointment with my pain management specialist that I had been referred to by my orthopedic surgeon. This was my third or fourth prescription for suboxone. I left the prescription there on my way home from the Dr (10:30 AM). When I went back at 6:30 PM the pharmacist told me he couldn’t let me have the prescription because he called the Dr and he was not able to give him some secret number that only certain doctors were allowed to have to write prescriptions for . He started to lecture me. He said that he knew what these drugs were used for. There was a huge line of people behind me. I just decided that I wasn’t going to let him humiliate and embarrass me like that. I replied that he obviously didn’t know what he was doing. He really lost his composure then and started shouting at me. I just let him go on and make a fool of himself. I wasn’t going to let him get away with treating me like some kind of criminal or dope addict. I asked him what am I supposed to do now. He said “do you want me to call the Dr again” . I said “what good is that going to do it is almost 7:00 P M”. Besides you said he didn”t know the secret number”. I told him again that he really was going to cause me a lot of pain. He said “all I can do is call again maybe they will let me give you some other narcotic”. This is still all loud enough for everyone in the store to hear. I just said “no you could have done your job in the first place”. Then he blows up again. He said ” that prescription layed there all day long no one called me back”. I said if you knew as much as you said you do you could have called me. I could have gone right back to his office and gotten this all cleared up. Let me point out this is not just some little fly by night Dr office. The Dr runs a large pain treatment clinic in San Diego Ca that takes up an entire floor of a large office building.
Sorry to ramble on but the good doc mentioned something in his comment above about counting your pills. I had this happen to me at my previous pharmacy. I got shorted 10 pills. I don’t know if we have any recourse but I didn’t notice till the following day but went back right away but the pharmacy manager told me there was no way he made a mistake. I would think that if this stuff is as tightly controlled as they say it wouldn’t be that hard to check his inventory and see that they possibly did make a mistake. He wouldn’t even do that. According to him there was just “no way he made a mistake”. He just turned his back and walked away and I was just standing there in disbelief. I actually thought he would check at least. As if this weren’t enough I told my physician about it at my next appointment (I just bit the bullet as to the shortage of medication) he goes “that’s one”. I ask him what does that mean? He replies that he gives his patients 3 strikes before he cuts them off.
If weren’t so true it would be funny.

SuboxDoc · January 8, 2009 at 9:39 pm

Your comments really make me angry. There is ignorance, and there are rude people, and there are pompous people… but ignorant, rude, and pompous people really shouldn’t be allowed to work in any area of health care.
Your pharmacist was simply wrong– the ‘x number’ is the ‘secret number’ that those of us treating addiction with Suboxone use– we are given the number when we get the ‘waiver’ to treat addiction with Suboxone. BUT– you do NOT need an ‘x number’ to prescribe Suboxone for pain! Doctors can use their regular DEA number to prescribe Suboxone for pain, and that is probably written on the prescription that you took in. The pharmacist also could look it up– although if this is a big pain clinic it would surely be on file at the pharmacy.
It is actually even sillier than that– I don’t want to give away too much info, but the ‘x-number’ is very easily determined from knowing the DEA number. In other words, unless the pharmacist is a complete fool he should know the x number, and shouldn’t even have to look it up. I wonder if all of that was just a bunch of garbage to hassle you– hard to imagine, but I can’t imagine why else the pharmacist would say what he did.
I strongly encourage you to follow this through. If the pharmacist said something about your medical care that was heard by others, that alone is a violation of your privacy. And to then essentially humiliate you, and then deny you service– I would be writing a very detailed letter about the pain I experienced as a consequence of being denied service, about how it felt having your health information broadcast to strangers, about how it felt having a health care ‘professional’ (pharmacists do less and less to deserve that title these days) put you down for something you cannot control… I would make several copies of the letter, and send them to the head of the pharmacy dept of the store, the store manager, and the various VPs of the chain or parent company. I would write that I wanted a reply, including an explanation of how this was appropriate, and an explanation of what they were going to do to correct the problem. If I needed a hobby I would call again a week later if I had not heard back, and I would keep calling or writing until I felt that someone had noticed.
I’m not done yet!
I get a bit worked up sometimes… I would send e-mails to the local newspapers and see if anyone wanted to do a story on the privacy of patients standing in line in drugstores, as you have an interesting story to tell.
Then… I would see if there is a place to file a complaint with your state’s dept of regulation and licensing– in my state you can go online and fill out a complaint.
That is what I would do… but I’ll probably die young from all that anger. Or sort of young– it might already be too late to die real young… but you get the point.
That really does make me mad though…

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