By R Carter.
In Part 1 we looked at how the total number doses, or pills and the total MME for prescribed opioids, taken from Ohio PDMP database, has consistently dropped since 2010. In contrast to that the total number doses, or pills and the total MME for Suboxone has remained steady. Indicating chronic pain patients have been migrated to Suboxone in significant numbers.
The Migration to Suboxone
For some this has proven to be problematic as clinicians exited the practice of pain management or retired, a patient seeking a new provider was either forcefully terminated or refused treatment due to the stigma surrounding the use of Suboxone. The FDA has only approved Suboxone for Opioid Use Disorder and although physicians routinely prescribed medications for “off label” use, the stigma surrounding opioid abuse undoubtedly influenced physician decisions, assuming any patient on Suboxone was a drug addict.
As part of the changing perspective when reporting on prescribed opioids, the reader should take note that with the government’s effort to curb abuse, treatment for opioid use disorder is also a high priority. And with data such as this, MME and doses shown on maps, also includes those who are receiving Medication Assisted Treatment.
MME per Capita Q1 2010 with and without Suboxone
MME per Capita Q3 2019 with and without Suboxone
These four images show the impact of migrating chronic pain patients from mainstream opioids to Suboxone. While the difference is marginal in Q1 2010, by Q3 2019 you can see in the Southern portions of Ohio, the hardest hit areas in overdose deaths, Counties are turning red. Keep in mind these numbers also include individuals who are receiving Medication Assisted Treatment for OUD as well as chronic pain management.
MME per Patient Q1 2010 with and without Suboxone
MME per Patient Q3 2019 with and without Suboxone
As before, Figures 5 – 8 show the impact of migrating chronic pain patients from mainstream opioids to Suboxone. The key points in these figures are the Daily MME prescribed per patient, with tradition opioids and again when Suboxone is included. Keep in mind these numbers also include individuals who are receiving Medication Assisted Treatment from OUD as well as chronic pain management.
Doses per Patient Q1 2010 with and without Suboxone
Doses per Patient Q3 2019 with and without Suboxone
As usual mainstream media continues to focus on those reports which are most dramatic and shocking. While data such as this shows how the chronic pain community is marginalized by government regulation and patients are corralled into substandard treatments and then abandon by healthcare providers.
I think I can speak for most chronic pain patients when I say we are completely behind the government’s efforts to put a stop to opioid abuse and opioid deaths. We only wish our government was behind us in seeing that patients with legitimate medical need are not left behind while they work to make our country a safer place to live.