There was a time when Dr. Richard Soper thought Suboxone and the generic equivalents were almost miracle drugs.
Like similar therapies such as Methadone, it can help opioid addicts step down off of pain pills or heroin. But unlike those drugs, there is virtually no risk of overdose because of the formulation, which includes the overdose reversal drug naloxone.
Still, it does have street value. And Soper says that was confirmed to him when TennCare stopped covering Suboxone as a preferred medicine last October, and patients did everything they could to stay on it.
"Pretty close to two-thirds were requesting that they be allowed to stay on Suboxone and pay for it out of pocket, which just amazed me," he says. "I was just almost without words."
Soper, who is the chief of addiction medicine at the Center for Behavioral Wellness in Nashville, conducted a survey of Suboxone prescribers and also crunched the numbers from prescription data. He found that once the state's Medicaid program moved to a newer drug, which is supposed to be even less abusable, the number of statewide prescriptions for opioid addiction was cut by more than 60 percent.
A state spokesperson says TennCare cannot track how much Suboxone was being misused or sold on the street.
Soper says he doesn't want to suggest that Tennessee has a surplus of poor drug addicts selling their medication. Doctors are partly to blame for how freely they've been prescribing, he says.
He adds that the new preferred alternative, Bunavail, approved by the Food and Drug Administration in 2014, probably has some vulnerabilities too, they just haven't been discovered yet.
"I would never say that there is not some street chemist that is not able to find a creative way to abuse things," he says. "I thought when Suboxone first came out that that was pretty much going to be fool-proof."
Soper acknowledges that his study was small but says he hopes his findings can be replicated. In Tennessee alone, he expects the switch will save millions of dollars a year.