In my last post, I wrote about how stigma affects our ability to blunt the opioid crisis in ways that we don’t usually consider. For example, almost a quarter of the pharmacies in the worst-hit counties in the nation do not dispense Suboxone. A few days after my article, NPR published this article:
The article explains that the DEA requires drug wholesalers to flag orders from pharmacies for Suboxone and Subutex above an undisclosed set amount that it considers suspicious. The wholesalers guess the amount considered suspicious based on DEA’s enforcement actions. Pharmacies know this. So they try to keep their orders to the wholesalers below what they think is the amount that will trigger a flag. As a result, they are always at risk of now having enough Suboxone/Subutex in stock. No wonder almost a quarter of the pharmacies don’t want to dispense Suboxone. If they get flagged and become subject to DEA action, they could go out of business — like the pharmacy highlighted in the NPR article did.
Imagine a person who has an opioid addiction. After years of struggles, he decides to give treatment a real chance. With great difficulty, he manages to find a doctor who will prescribe Suboxone. Unfortunately, this doctor is out-of-network for his insurance. So the patient pays out-of-pocket for his doctor’s visits. At least, he can go to an in-network pharmacy to get his medicine. But no, the pharmacy he usually goes does not stock or dispense Suboxone. So he goes to another pharmacy nearby. That pharmacy dispenses Suboxone but, due to fear of the DEA, never accumulates enough of it. The pharmacist tells him to come back three days later. The patient decides to drive to a couple of different pharmacies to see if someone will fill it. Now, they flag him for “pharmacy-shopping,” which is considered suspicious behavior.
No one fills his medication on time. So he keeps on misusing opioids.
This is how we perpetuate stigma and barriers to treatment.
[Suboxone and Subutex are brand names and registered trademarks for preparations of buprenorphine, one of the proven medications for the treatment of opioid addiction. Featured image by NickyPe from Pixabay]
