Guest Blogger: Thoughts on Roadside Suboxone Signs

This is not a picture of Daniel Rhodes. But if he were a dog, he might look like this.

 

It is with delight that I present a guest blogger who has volunteered to give his thought on the roadside Suboxone signs that I blogged about several weeks ago.

I’m also delighted that I get to take a week off blogging, and hope all my readers have a great holiday weekend.

Daniel Rhodes is an LCAS-A and LPC-A working in both an OTP and a private Office Based Practice. He had a background in Abstinence-Based treatment models, and has, over the years, come to believe strongly in MAT. He believes in the importance of both approaches and that each has much to learn from the other.

When I first saw a sign on the side of the road advertising Suboxone, I reacted strongly enough to take a picture to show at work and marvel over. I discussed the issue with Dr. Burson, and realized my initial reaction was incomplete.  My gut told me that there was something off about the situation, that there was something unethical or below-board happening, but I could not understand why that might be.  I believe pretty strongly in a Harm-Reduction approach to addiction treatment, first managing the dangers of overdose and disease then trying to help addicts address the issues underlying their disease. I think wider availability of the combination buprenorphine/naloxone product is a good step towards that goal of Harm-Reduction.  In fact, I have been known to argue for the combo product to be available in vending machines. While this is an extreme example and there are many reasons it is not a feasible option, I do think it illustrates a valid principle: Buprenorphine saves lives, prevents the spread of disease, and is a remarkably safe medication. Expanded availability is a good thing.

                So why did this mobile Suboxone van raise my hackles?  Surely, this would increase access to the potentially life-saving medication, and should therefore line up perfectly with my philosophy!  In part, of course, it does; however, I have been able to articulate for myself several ways it does not, several reasons for my misgivings.

                First, as Dr. Burson has said many times, it should be no more expensive for a doctor’s appointment addressing addiction than it is for any other appointment. In the affluent area of Lake Norman, were I to pay out-of-pocket for a routine follow-up visit with my primary care MD (without applying insurance), my cost would be $65. According to their website, the Mobile Suboxone practice charges $175 for an office visit, making their per-appointment charge roughly 270 percent what my primary-care MD charges. While there is certainly nothing wrong with making a profit, I have to wonder if the price differential is warranted, or if it is taking advantage of a relatively desperate population.

                Second, since their website does not identify the person (people?) seeing the patients, there is no way to assess the legitimacy of the practice. In my previous example of buprenorphine in a vending machine, there could be no pretense of legitimate medical practice. However, in a Mobile Suboxone unit, a patient might leave believing he or she had received sound medical advice when this was not the case. There is little on their own website that points to more than a veneer of sound medicine; there are many claims, but paltry sourcing (Wikipedia among them) and seemingly no accountability. As far as I can find, they make reference to a Physician Assistant and “physicians throughout the state,” but attach no names to their practice. In short, even though the practice might expand access to buprenorphine, it seems to be doing so in a way that potentially bills their service as more than it is.

                Third, and following on my point about the medical quasi-legitimacy, the website compares their service to Methadone clinics in a way that I do not believe is fair or even reasonable. They claim that Methadone clinics are too expensive, that they disrupt life too much. While it is certainly true that daily dosing in a clinic can be a burden, particularly if a patient lives far away, a clinic offers a vital component seemingly lacking in the model of the Mobile Suboxone practice: accountability. While they make claims of daily electronic interaction, the daily in-person contact of a Methadone clinic provides a much better picture of a patient’s progress than any electronic communication could. A Methadone clinic mandates and provides counseling for its patients, typically included in the daily fee. The website for the mobile practice offers counseling electronically, the frequency of which is “between you and the counselor,” at a cost of an additional dollar per minute. It seems like an apples-to-oranges comparison: Yes, Methadone might be more expensive than their service, but it comes with much more intense support.

                Finally, that the signs mention “micro-loans” is worrisome. I am not sure how this will work, and I find no mention of the loans on the site. “Micro-loan,” however, evokes images of payday lenders, pawn shops, and other outlets associated with active addiction. It is hard to imagine a scenario in which no one is taking advantage.

I believe the idea of the Mobile Suboxone practice risks losing the ground we have fought so hard to gain in the discussion of the “opioid crisis.” At last, MAT is something being discussed in political circles, and funding is finally opening up to expand access to treatment. Poorly run practices, profiteering, and anything that risks damaging the perceived legitimacy of MAT risks lives. If the practice is not well-run, I fear it might prove an impediment to treatment rather than the expansion it claims to be.

                In conclusion, I may be completely wrong. The Mobile Suboxone practice may be exactly what we need to help more patients get access to life-saving treatment. I sincerely hope my misgivings prove unfounded and that the people behind the roadside signs are creating a new way to combat the disease of addiction. At this point, however, I believe the onus of proof lies on them to show the rest of us how their treatment will work, and that they are not taking advantage of a population that so desperately needs the help offered by well-administered MAT.

 

 

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4 responses to this post.

  1. I’ve also seen many roadside signs and billboard advertising easy to get medical marijuana cards.

    Sent from my iPhone

    >

    Reply

  2. Posted by Nancy Friel on May 30, 2017 at 6:42 pm

    Thanks for this comment, and I agree 100%. MAT stigma is still incredibly pervasive, in my experience. Methadone clinics have been referred to as “juice bars”, and I still encounter highly educated and experienced professionals who think there is something wrong with methadone maintenance. I currently work with a psychiatrist who appears reluctant to do suboxone maintenance even though he has the waiver, knowledge and skills to do so. Anything that delegitimizes MAT is harmful, in that such services, if they result in poor outcomes, will be held up by abstinence ideologues as examples of why the stigma against MAT has a basis in reality.

    Reply

  3. Posted by anon on May 30, 2017 at 6:54 pm

    Let me explain why it gives me an ery feeling. We know that the “pill mill” gold rush to Florida killed many people and had far reaching effects. Many treatment providers worked hard to separate MAT from the stigma that came from shady pain management pill mills. When you do a google search for how to recognize a pill mill, these are a few of the signs that come up, over and over, again.

    1. No physical exams are given
    I am skeptical of how comprehensive a van exam in a church parking lot is.
    What get examined?
    Who does this exam?
    2. Only cash is accepted as payment
    Cash or “micro-loans”
    Are people in early recovery really known to be able to manage new debt?
    My gut says I could possibly have some triggers that feel like a drug deal in the parking lot and I get fronted the goods for payment later. Maybe that is just me.
    3. Pain (or addiction, in this case) is only treated with pills
    The website for the mobile practice offers counseling electronically, the frequency of which is “between you and the counselor,” at a cost of an additional dollar per minute.
    4. Congregating “patients” in the parking lot
    The waiting room IS the parking lot, in this case
    9. Patients are in and out of the doctor’s office in minutes
    I imagine things will move pretty quick, after all, their marketing clearly states they are against the burden and life disruptions of being in a treatment program.

    Reply

    • Actually, I did learn a little more about this organization. All exams are done at a physician’s office in Charlotte, according to them, at least for the first visit. And I heard they will do hair and nail drug testing, plus saliva, no pesky urine samples.

      Reply

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