Wednesday, January 20, 2010

DEA Suboxone Audit: Worst Experience of My Career as a Physician

Continued from: DEA Suboxone Audit Update VI

You prescribe Suboxone. You know a DEA agent will "unexpectedly" appear in your waiting room to audit your records of treatment of opiate addicted patients under DATA 2000. You figure you have done nothing wrong, so why worry? It couldn't be too bad. I'll deal with it when it happens.

That's what our colleague assumed, until a woman and a man claiming to be DEA agents appeared in his office.

It wasn't the first time they had staked out his office. Since they hope to catch physicians in the act of committing unspeakable narcotics crimes, these dedicated public servants eschew appointments. This also affords them the luxury of a morning or afternoon where "work" on the taxpayer's dimes consists of traveling to a doctor's office, discovering the doctor is out, and then what? Maybe a doughnut and a cup of coffee. Hazardous duty in law enforcement. Of course now and then these intrepid guardians of public safety will face an evil physician, risking life and limb to audit records of buprenorphine prescriptions.

Having already wasted one trip these lions of law enforcement pounced on this wayward health care provider with claws bared. First they sat in the waiting room discussing his case in front of his patients. One of the patients left without seeing the doctor. Then they asked him to sign a form permitting them to proceed with the "audit."

"You don't have to sign it doc. We can come back with a search warrant."

He signed.

They cleverly engaged him in casual conversation, ensnaring the unwitting villain. Then they showed him the water board. Just kidding.

The doctor described the agents' approach as hostile and intimidating, treating him like a criminal. He told me it was the worst experience of his career. Good work, agents. We can all sleep better knowing these guardians of public safety will protect us from all those dangerous docs trying to help people recover from substance use disorders.

The physician has hired an attorney and was told to expect an "exit interview."

The DEA has little cause for worry. Most doctors are too afraid to rock anybody's boat to even speak out, much less take action, and besides, if they put the other guy out of business, it means more patients for the rest of us!

Above all, remember that treating opiate addicts with buprenorphine results in less diversion of pharmaceutical opiates and in a reduced market for heroin, both major threats to job security for DEA workers. And some of us addiction docs actually were naive enough to think that law enforcement was on our side in the war on drugs.

If you believe our law enforcement agents can make more of a difference by chasing criminals instead of doctors, demand that professional associations like ASAM, AMA, AAAP and APA take action. Write your legislators and your local DEA field office.

DEA Suboxone Audits: The Video


  1. I am not sure where the bad experience stems from? I always understood those who handle controlled drugs are subject to audits. Are doctors above that? it says they sat in the waiting area? do you know a better place. If I want to speak with someone but not in the waiting room, I invite them into my office? I beleive I have read on more than one occasion that prescriptions drugs are a problem in this nation, does that concern you? Perhaps you should suck it up. In regards to your comment about the luxury of traveling to the doctors office, I am just curious would you have preferred going to the DEA, and if that was the case wouldnt all doctors patient files be just perfect when you turned them over? would that make an effective audit.

    1. Your an agent aren't you?

  2. Anonymous:

    Your idea of inviting the agents into the office might work on a slow day, but put yourself in the patient's position. Scheduling is difficult as it is. I don't want to make my patients an extra hour just because DEA want to play cops and robbers. I'm not sure about all doctors who prescribe controlled substances being subject to audit, but in fact it rarely happens and has never happened to me in 30 years. I do not object to the audits, provided they are scheduled.

    I absolutely agree that diversion of prescription drugs kills people every day, but DEA should focus it's investigations on the drugs that kill, like oxycodone, rather than buprenorphine, which is much safer, and less likely to lead to addiction. This misplacement of resources will hamper treatment of addiction while allowing more diversion of the most dangerous drugs. You bet that concerns mean.

    You ask what would make an effective audit. Depends on what you mean by effective. My understanding is that many if not most docs audited may not have been found fully in compliance even knowing that the audits will happen. DEA is mostly just educating them. The same ends could be accomplished with less waste and disruption by scheduling the audits.

    As for "going to the DEA": That might work for me since I do not keep buprenorphine at my office, but the agents conducting the audits probably want to see the supply and how it's locked up. They could not do that at DEA field offices. I will also want my staff with me, and "going to the DEA" is hardly part of their job description.

  3. Just completed my 3 hour inquisition and still shaking from it. But does this make sense to anyone else ? Who profits most from these Suboxone harassments, scaring doctors into not prescribing Suboxone, requiring special certification and the additional X-DEA license to prescribe a medical treatment to get people off opiates ? The opium industry ! Suboxone cuts into their bottom line, profits. Can't keep people hooked and buying opiates if they are treated and cured of their opiate addiction. Take a look at Purdue Pharma, importer of Opium, and makers of Oxycontin and other opiates. Or, Mallinckrodt who not only makes opiates (imports cocaine), but buys 80% of the world opium from Afghanistan and 20% from Turkey. Wouldn't it have been more appropriate to have a special X-DEA for prescribers of Oxycontin, which is the major opiate my patients are addicted to, then to harass doctors and make them jump thru additional hoops to provide a great treatment ? Always follow the money trail...If in doubt, read up on your Opium history.

  4. Anonymous: thanks for enlightening us about the opium trade. But the drug companies are not behind the audits. It seems clear to me that DEA needs to justify its existence, and has failed miserably at what it should be doing, so doctors who prescribe buprenorphine become an easy, even willing target. And our professional associations have done next to nothing to help. I have now turned away between 30 and 40 buprenorphine patients because of this irrational policy. Maybe if all buprenorphine doctors stop accepting new patients, and let this been known to public officials, we can pressure DEA to at least schedule the audits.

  5. The majority of the agents that work for the DEA and Medical Licensure Boards are worse then the people they investigate. They hope to maintain their jobs by harassment and intimidation, and prosecute enough people to make it look like they are actually providing a service. There will be more enlightenment of the public regarding these issues in the months to come as professionals take the steps to contact their associations, and legislators.

  6. Whatever Govt. touches, it sucks.

  7. I'm a Texas area insurance executive (unconnected to the medical field), and I am a suboxone patient. I became dependant on the opiod vicodin while boxing in college. This DEA crackdown is terrifying. I can understand the half of the argument pertaining to controlling scheduled drugs, but it seems like the DEA is much to far to the right on this issue. Suboxone is like insulin to a diabetic. Maximum levels of patients serves no purpose I can descern (seriously, can someone enlighten me on who or what a cap on the number of patients per doctor protects?), and I am terrified of the results should just one vote in a legislatie body result in a negative outcome for the prescribing of this drug.

  8. Thanks Texan. Insulin is a great analogy. The idea was for your own physician to prescribe buprenorphine rather than to have physicians set up "mills" in which that's all they do. I like the idea, but the consequence of depriving patients of a great treatment is not OK.

  9. DEA has realized in recent decades that their expensive efforts of international interdiction and chasing cartels has had little effect on supply or demand - It's much easier, and much safer pursuing well-educated citizens whom they can paint as 'Doctor FeelGood'. In addition, it appears to the uninformed observer that they are now eliminating dangerous threats which are 'in our own neighborhoods', giving folks the impression they are heroes, and that drug use is evolving, when in reality not much has changed. As long as prescription opioids exist, dependence, overdose and diversion will be an issue. The sooner our culture accepts that, and the responsibility that goes along with it, the better. DEA agents, politians, etc, have no place in protecting adult citizens from a function of their own free will. And they especially have no place reaching their hands into the practice of Medicine, making decisions which they are nowhere near qualified to make. On the other hand, Physicians must be held accountable (not by law enforcement) but by their respective Medical boards for their practices - To put it simply, opioids coming from a board certified MD/DO who is respected and trusted, should be supplied appropriately and dligently, with full disclosure - Those using narcotis recreationally on the other hand, should be left to buy their fix at the local supermarket; and be held responsible for their own consequences, rather than a Physician, who has actual patients to treat.

    I believe in a 'hands off' approach when it comes to drugs, and that the notion of 'Natural Selection' definitely applies in this situation ;)

  10. I am a Suboxone patient. It has been a miracle drug for me and my family. I have a wife of 16 years and 3 boys ages 3, 5, and 8 and I can't imagine what my addiction would have done to them if it had not been for Suboxone. I live in a tourist destination on the beach in Florida and there are only 2 doctors that prescribe Suboxone in this area. I found out what the DEA was doing last year when a local doctors office was raided by guys in full combat dress with machine guns! This local doctors office has been in this very small community for over a decade now. She had decided to get her "license" to prescribe Suboxone a few months prior to the raid and had a total of 16 patients she was prescribing it to. They stormed in and seized not only the Suboxone records, but all of the hundreds of other patients records also! They also seized the PA's checkbook who happened to be on duty who was a retired military PA. The reason I found this out was because my little old mother happened to have an appointment right as these supposed protectors of justice were leaving. She said that she was told she would need to reschedule because that had taken her file in the raid! Being a pill head allows me to look at this from a different perspective than most. It is an absolute joke that this drug is watched to the extent that it is, and I personally thought that it had the methadone lobbies prints all over it. Suboxone is the first therapy to ever be produced that actually works on opiate addicts! This fact will cause major problems for those in power that make their living off the seemingly endless supply of drug abusers because it threatens to stop the cycle of an addict getting off there drug of choice and going back to it a few months later. Suboxone and it's supporters must win this fight! This needs to make it into the main stream media outlets so normal people can understand what is happening and help pressure the government agencies tasked with the oversight of the DEA to stop what they are doing. By the way, the little doctors office that got raided dropped their patients and no longer prescribe Suboxone...But you can go get a big ole bottle of oxy's from them!!!

    1. Let me ask are you off them? Because once you try to get off them you might change your tune. These docs are supposed to use Subs as an in and out program: 1 month, tops! They see an opportunity to have cattle going through their office at X amount of $$ for life, most talk about how they are helping you, which they are, but not many have an exit plan for you, you are just a "pay the ticket at the door" kind of patient, trust me I was on 3 (8's) starting in 08, I have been trying to quit all year and finally dropped on July 1, the past 4 weeks have been hell. Now on the DEA side, these guys are not much better, it seems they go after docs that defy them, or mess with the wrong person, I would assume if they don't get paid their monthly fee, that the audit is coming soon. So everyone is making out great, the patient (not sick), the docs (ka-ching) and the Feds (most likely double or triple ka-ching) Nice world we live in, everyone stays happy, except when you want out of the matrix, then your FKD.

    2. If addiction was so easily cured in 1 month we would not need meds like Suboxone. Sorry but I disagree, this is not a short term fix but a life changing opportunity to have a life not ruled by pain meds, it is meant to help you get through and deal with cravings and safely come off opiates then with behavior changes and counseling taper off Suboxone. We find pts that stay on for 1 yr have the best success for long term.

  11. What the DEA is doing is wrong. It makes patients like myself sit up at night wondering if my last three years on suboxone (which have had me clean for three years and back in college) are comming to an abrubt end. I never thought I would have to think about the prospect of relapse on Heroin or any other opiod again. Now I have nightmares about relapse since my doctor was frightened out of prescribing. I have a new doc, how long will he help me before they destroy his life and the lives of his patients? I fully support original content of the video above. If anyone feels otherwise I would like to see how much succsess you would have without suboxone if you were strung out on heroin... and you would deserve to experience that yourself if you feel I deserve it.

  12. Well, I agree with the author. As a Suboxone provider I gave up my DEA suboxone prescribing number. I have been audited TWICE and both times have been horrible. I do not prescribe opiods other than this, I do my urine testing, my PMP reports, my contracts EVERYTHING is in order, and these "agents" still ruin entire schedules at a time, intimidate staff and patients alike and are complete assholes (typical little power trips of ignorant and undereducated government officials). I am a family physician who works in a community center for the underserved, I am not a criminal and will not tolerate to be treated like one. While thousands thugs flood our streets with narcotics everyday without even being questioned. Strange world indeed. But you have a point doc, no drugs=no DEA.

  13. Someone needs to get the dea and samsha out of this business you said it 100 % correct I am a suboxone patient and of the only two doctors that had license in my county we now have 0 because of this stupid nonsense forcing me to drive two hours and see a doctor who seems scared to even see me. Suboxone Saved my life a seven year heroin addict the first year on suboxone I started a business bought my first home and have since had a baby boy and been on several vacations and off heroin life has been GREAT!!! if I had kept with old ways I would be in prison by now or dead. This is exactly what the afraid of a magical pill that turns long time junkies into productive members of society OVERNIGHT of course they need to stand in the way of progress its their job security at stake. THIS HAS TO END!!! I have lost freinds to opiate addiction/overdose and if suboxone was more readily easily available this may not have happened.It's hard to get on suboxone took me three times to Doctor and a lot of searching . I realize I may be in the minority here i do know theres a lot of idiots that will trade this drug for other drugs and ruin this for people honestly trying to stay clean. Simple solution make these people pay in cash for the prescription and the doctors visit its the people in the state programs that get these pills given to them that do this. The D.E.A 1 yr school maybe? are driving you doctors with an 8+ yr education into not helping people like me this is SO WRONG ive been stewing over it for a long time now what can we do what can i do as a successful patient? Doctors who read this Thank You for the trouble you go thru I cant imagine, you are making a difference to people like me and Thank You from the bottom of my heart I mean this I would be in Prison again or dead if not for you guys you are in the RIGHT THE DEA IS WRONG ON THIS!!!!

  14. I have just started the process of getting the waiver to prescribe Suboxone and after reading all of the above I am hesitating. On the one hand I see that there is even more of a need than I thought, at least in some locations. On the other, at this stage in my career, do I want to be subject to this kind of harassment? Is there anything I can do to protect myself, or make this worthwhile, better for patients and physicians/health care providers?

  15. Suboxone is safer than any other opiate because it is a partial agonist and cannot be mixed with other opiates. The requirements for an 'x' license and the DEA audit process are a major barrier in the treatment of chronic substance using patients. Patients who take suboxone have less morbidity and mortality than untreated patients. Other drugs which are much more dangerous than suboxone require no special hurdles to perscribe.

  16. Was visited by 2 DEA agents today for suboxone. They had many questions and wanted to know how many patients I had on suboxone and where are my segregated files, etc. They said that I could get into big trouble for not keeping my files properly. I told them that I would be happy to cancel my suboxone license. They said I could do it right then so I did. Because of DEA harassment and nonsensical, onerous regulations I am no longer subscribing suboxone for opioid addiction. I feel bad for the patients. Let the last subscriber turn out the lights.

  17. Suboxone saves lives period folks

    natural selection lol are you serious why don't you wait until your grandkids are dead from heroine or if you get in an accident and become addicted by natural selection !!

    It's science hello!

    9 out of 10 opiate addicts relapse in first year and multiply aids hep c and the loose of income from this disease it's astounding and a epidemic of biblical proportions

    dea should wake up and realise it's the best treatment practice we have now to combat addiction

    Btw dont let this epidemic change how we do medicine I know people dying and need to buy opiates for pain because the poor doctors are too scared to treat pain properly

    We are undoing many years of good medicine in pain management and shifting the responsibility to the doctors

    hello personal responsibility keep doctors treating diseases using best practices and doing differential diagnoses please our health depends on it

    making a doctor or pharmacist a cop too is crazy

    plus the dea wants addicts to use hello it's their job with out heroine flooding the country they go out of business

    personal responsibility

    read the book

    praise the Lord


  18. I am a doc and have been abused by the DEA before like some of the other physicians on this blog. I understand the emotions that you are going through but in the end if you want to win the war you need to forgive them and love them despite their bad behavior. They are like your children when they misbehave. You are angry at first but you get over it.

  19. I am a doc and have been abused by the DEA before like some of the other physicians on this blog. I understand the emotions that you are going through but in the end if you want to win the war you need to forgive them and love them despite their bad behavior. They are like your children when they misbehave. You are angry at first but you get over it.