We’re in the midst of an opioid epidemic here in the United States. It’s worse here in Northwest Tennessee than most places across the country — not the worst, but it’s certainly not great.
There are a few central reasons why opioid use here is so likely to result in overdose, if not death. First off, the lack of regulation in the market means batches of opioids can’t be screened for contents or purity. Put simply, opioid users, like me, don’t know what we’re using.
Second, there’s a lack of resources necessary to healthy, fulfilling lives here in rural Tennessee. Many of us struggle to even find transportation to get to mental health practitioners or physicians, let alone pay for them in the first place.
Third, although this fits into the “resources” problem mentioned above, it’s difficult for long-term, dependent opioid users to seek out and secure opioid replacement treatment, also called medication-assisted treatment (MAT), in the form of buprenorphine (Suboxone, Subutex) or methadone.
A Personal Aside
I am a long-term drug user. Opioids have been by primary drug of choice since, give or take a month, June 2014. Not for pain — just ‘cause they’re hella fun. #ItsLit
But seriously, drug use isn’t cool. #ItsNotLit I self-medicated depression and anxiety with opioids before opioid dependency caused — well, worsened is the proper term — mental health issues on its own accord.
I began injecting heroin about two, maybe two-and-a-half or three years ago. I first snorted heroin for a few months or a year prior to graduating to injection drug use. I moved from street-sourced pharmaceutical opioid tablets to heroin, and later from sniffing heroin to injecting the drug, for cost’s sake.
Earlier this year, after an arrest, I was tired of the legal issues associated with illicit drug use. Thus, I sought out treatment at a buprenorphine prescriber in Jackson. I went as far as Jackson, an hour or more away from me, because there aren’t many prescribers in Northwest Tennessee. More on that below.
Things That Make It Difficult for Opioid Users to Get on Suboxone or Methadone
This article solely focuses on the area-specific challenges that plague long-term illicit opioid users such as myself here in Northwest Tennessee, though these issues aren’t just specific to Northwest Tennessee — they’re rampant all over rural Tennessee, if not the entirety of the state.
Due to the fact that the federal government upholds excessive regulation around buprenorphine prescribing, these things also hold true throughout the United States.
I’m not particularly a fan of airing my personal information out into the ether, but I want everyone to know just how expensive Suboxone really is.
The prescriber I go to charges $275 monthly for just one visit. The physician prescribes 28 days’ worth of Suboxone for that price. If you go weekly, it’s $100 per week. Everybody at this clinic has to start off going weekly for at least 6 weeks.
These excessive costs make it difficult for people to get their foot in the door — and $275 isn’t on the higher end, either; once people do gain entry to medication-assisted treatment programs, they’re still going to get their heads busted by facilities that specialize in opioid replacement therapy.
56 generic Suboxone films cost $388 at the pharmacy I go to. They don’t take discount cards. I don’t have insurance. None of the 11 health insurance plans I was offered by Healthcare.gov this year covered Suboxone.
Right now, it costs $663 per 28 days. It initially set me back $788 per 28 days.
Like, fuck — might as well stick to heroin!
Pharmacies Aren’t Willing to Fill
Pharmacies don’t like filling prescriptions for controlled substances.
Especially for Suboxone.
The idea is that people on Suboxone and other controlled substances are more likely to abuse their medications than run-of-the-mill medications and pester pharmacies for early fills and cause a scene.
Is this true? No idea. On the surface level, I totally understand the merits behind this ideology. Is it right? No.
The pharmacy I use is an hour away from my house. It’s a small mom-and-pop pharmacy that doesn’t take discount cards. I’m forced to pay cash. At least I get treated like a human, though.
I tried to fill at Walgreens in that city, but they said since I didn’t live there, they weren’t willing to fill. My prescriber is a quarter-mile — a five-minute walk — away from that Walgreens. Whatever.
I tried to fill at a CVS where I live, but the pharmacist said they were at capacity for buprenorphine prescriptions, meaning they couldn’t welcome any more. That’s a lie. There’s no such thing as an upper limit of Suboxone prescriptions — or any prescriptions — that a pharmacy can fill. Whatever.
I tried Walmart. They said they’re not licensed to dispense buprenorphine. That’s a lie. “While qualified practitioners are required to have waivers to prescribe or dispense buprenorphine under the Drug Addiction Treatment Act of 2000 (DATA 2000), pharmacists and pharmacies are not required to have any credentials for dispensing these medications beyond those for other Schedule III medications,” SAMHSA’s official website says. Whatever.
I tried the closest Walgreens to where I live. They don’t stock buprenorphine. Whatever.
Is it their responsibility to fill my prescription? Not at all. I shouldn’t have gotten myself into this situation in the first place. I should eschew drug use in favor of a better life.
All long-term opioid users should do the same — stop using drugs — unless given a prescription for chronic pain or something. However, this doesn’t work, in practice.
SAMHSA Limits the Number of Prescribers Who Can Legally Prescribe Suboxone
I’m not going into the specific limitations that SAMHSA, the Substance Abuse and Mental Health Service Administration, places on buprenorphine prescribers.
Just know that there’s a reason why less than 4% of all licensed physicians in the United States are able to prescribe Suboxone to chronic, dependent opioid users. That reason is SAMHSA.
Yeah, I get it — what if doctors started misprescribing Suboxone? I get it.
However, one thing’s for sure: not helping the already-underserved populations of people suffering from opioid use disorder by making buprenorphine and methadone, the two go-to opioid replacement drugs, widely available harms us. Family members, friends, and communities lose people to the opioid epidemic left and right, especially in rural Tennessee.
Statistics About This Lack of Prescribers
In the nine-county area that makes up Northwest Tennessee, there are about 254,000 people. There are only 19 buprenorphine prescribers licensed to prescribe Suboxone or Subutex for opioid use disorder.
The United States Department of Health and Human Services designates certain parts of the United States as “federal shortage areas,” which, obviously, have shortages of health professionals based on various criteria.
7 of NWTN’s 9 counties have medically underserved populations (MUP) in terms of primary care physicians. The other 2 are medically underserved areas (MUA). MUA refers to the entire county’s geographic area, whereas MUP refers to the people in the area. To make it simple, all of the counties here don’t have enough doctors.
9 of NWTN’s 9 counties are considered to have a shortage of federal mental health professionals and are deemed “Whole County Geographic” shortages. That means no matter where you live in NWTN, the entirety of this region has a shortage of federal mental health professionals.
What You Can Take Away From This
Suboxone and Subutex both contain buprenorphine, a long-lasting, relatively safe opioid that satisfies long-term, physically-dependent opioid users’ brains’ opioid receptors. That means no withdrawal symptoms, physical or mental.
When I didn’t have opioids over the past 3+ years, when my opioid use really started to progress, I laid around, did next to nothing, and my depression and anxiety symptoms worsened.
Now, since I started Suboxone in mid-September, I haven’t felt depressed at all. I don’t have to worry about overdosing because I don’t use heroin. I don’t have to worry about the legal issues associated with illicit drug use.
Other long-term opioid users largely report the same: their mental health improves and stabilizes, they don’t have to live highly-dangerous lifestyles with short life expectancies, and they don’t have to worry about the legal issues arising from daily drug use.
We need to make buprenorphine and methadone more widely available. The single most effective means of doing this would be severely loosening the existing regulations supported by SAMHSA.
As more practitioners could prescribe buprenorphine, the cost of getting a Suboxone prescription would decrease big time. Filling the prescription would still cost a lot, but as demand for Suboxone increases and stigma associated with Suboxone users decreases — a direct result of loosening government regulation on buprenorphine prescribing — I feel that costs incurred by end-users of Suboxone would drop.