For many, they mean nothing. But they are at the heart of a disturbing trend which has seen people move to the area just to obtain them, caused doctors to leave other jobs to prescribe them and left hundreds of drug addicts with an endless prescription.
It is a problem law enforcement has seen explode in the last five years.
“We routinely arrest people for drug offenses and find them in possession of both buprenorphine (Suboxone or Subutex) and some other powerful narcotic (heroin, opiate-based pain pills, etc.) that buprenorphine is supposed to be weaning them off of. This phenomenon directly contradicts their intended purpose,” said Kingsport Police Department Public Information Officer Tom Patton.
“In an ideal world, buprenorphine could arguably serve a legitimate purpose. But we do not live in an ideal world, and we are probably seeing more harm than good out of these drugs at this point.”
The intended use of buprenorphine, the main ingredient in Suboxone and Subutex, is to help people addicted to pain pills achieve sobriety by providing an alternative to their drug of choice. Counseling and therapy are supposed to be provided along with the prescription.
Over time, the dosage should be reduced gradually until the patient is completely drug free.
That is not happening.
“I started going to a doctor in 2006 or 2007, somewhere around there,” said a Suboxone patient who wished to remain anonymous. “The first time you take it and the second time you take it, it feels great. Then it just turns into maintenance.”
He said he is disappointed because he was told by a healthcare professional that a tapering off would occur, but never did.
The patient, who is currently homeless, said he spends $160 a week to visit a doctor and fill his prescription. He readily admits he could spend that money on an apartment if he were not on Suboxone.
It is a cash-only business because his doctor, like many buprenorphine prescribers, does not accept insurance.
And cash only not only applies to patients, but to everyone, including law enforcement agencies that buy the drug for use as health maintenance for prisoners.
“All clinics do cash only,” said Christy Frazier, the health administrator for the Sullivan County Jail. “The ones I worked with here only take cash, even from us.”
Frazier said in just one week, approximately 75 percent of those coming into the jail had abused Suboxone or Subutex. She said at least two inmates told her they moved to Northeast Tennessee for the express purpose of obtaining the drugs.
Sullivan County District Attorney General Barry Staubus said almost every single drug case before a recent grand jury involved the selling of Suboxone or Subutex.
“It’s a real danger to the community,” he said. “I attribute that to overprescribing.”
Patients are not the only ones getting in on the act. Doctors are reportedly leaving their current work to start prescribing buprenorphine.
“Greed is taking over,” said Dr. Randy Jessee, senior vice president of specialty services for Frontier Health. “We are hearing stories about doctors quitting their ER work, quitting their practice and going into the Suboxone business.”
According to the Department of Substance Abuse and Mental Health, there are 94 buprenorphine prescribers in the greater metro areas of Johnson City, Kingsport and Bristol. And that number could be an underestimate because prescribers decide whether they want to be listed in the DSAMH locator, according to the 2015 DSAMH “Medication-Assisted Treatment Substance Use Tool Guide.”
It would never be obvious to anyone driving around town that so many buprenorphine prescribers exist. There is a reason why.
Many of the clinics or prescribers do not advertise the prescribing of Suboxone or Subutex. They also have unassuming names, calling themselves a rehabilitation center or family treatment center. Many users find out by word of mouth.
The Suboxone patient who talked to the Times-News was handed a card directing him to a clinic by a friend nearly 10 years ago.
“My friend at work gave me a card that was $25 off the first visit,” he said. “At my first visit, he (the prescriber) gave us cards to give out. We were pretty much advertising for them.”
He said he’s gone from being able to see the doctor at any time to having to wait up to two hours for a visit. Suboxone and Subutex are being prescribed so much in the area that pharmacies are either running out or reaching their federal limit on buprenorphine.
The patient said he’s had to drive to every Walgreens to try to get his prescription filled, only to be declined. Many smaller pharmacies refuse to accept new patients who are being prescribed Suboxone.
Once someone is given a prescription for these drugs, it becomes very hard to stop using them without tapering off because the withdrawal symptoms are worse than with regular opioids.
The Suboxone patient is stressed out because he was robbed of some cash and his entire prescription four days ago. He has not had Suboxone in three days and is starting to feel the effects. He has experienced withdrawal before and is not looking forward to going through it again.
“I feel like I woke up with the flu,” he said. “For 11 or 12 days, I feel really, really bad. Then I won’t feel right for about 30 days.”
He said he is currently $35 short for his next doctor’s appointment, meaning he needs to find the money so he can get his prescription. That means borrowing money from someone, usually with the promise of giving a pill or two in return.
Subutex is more popular on the street than Suboxone because it does not contain the overdose drug Naloxone. Users can take Subutex and get higher than they could with Suboxone.
Suboxone is going for about $25 to $30 per dose on the street while Subutex is selling for between $40 and $70.
The Tennessee General Assembly passed a bill in 2015 that said only pregnant women and those allergic to Naloxone can get it. Frazier said this had led to women getting pregnant on purpose just to obtain Subutex.
Subutex and Suboxone use on the street has become a huge problem and many blame the prescribers. The patient interviewed by the Times-News called it legal drug dealing.
“We’re giving doctors the money instead of drug lords,” Frazier said.