TRI-CITIES, TN (WJHL) – It’s no secret prescription drug abuse is an epidemic that has a chokehold on our region.
But consider this. News Channel 11 discovered three of the top 10 doctors in the country who prescribe Suboxone to people on Medicare, practice in Johnson City. For more than a year, News Channel 11’s Kylie McGivern dissected the impact of prescription drug abuse on our region, and the role replacement drugs like Suboxone, used to help wean people off opioid addiction, play in recovery.
It is among the nation’s 18,448 prescribers of Suboxone and its generic counterpart, buprenorphine-naloxone, that three Johnson City doctors rank in the top 10. One, is ranked second overall when it comes to medicare claims for the drugs. The Centers for Medicare and Medicaid Services released the data this year, and the non-profit investigative reporting website ProPublica compiled the information.
Johnson City is home to 65,000 people, breathtaking mountain views, and we now know, and the highest concentration of top Suboxone prescribers for Medicare in the nation.
So why are the numbers so high? We asked the top doctors themselves.
Beyond the bold prescribing numbers, the most recent from 2013, it is a prescription drug abuse problem as tall and wide as the Appalachian mountain range itself, deemed by many, as “ground zero.”
We went to a local pharmacy in Johnson City, who showed us a stack of narcotic prescriptions written in May 2010. Five years later, in May 2015, that pile of prescriptions is doubled.
To him, the high rate of Suboxone prescribing makes sense.
“Three of the top 10?” Dr. Pack questioned, making sure he understood the data correctly, before shrugging his shoulders. “That doesn’t surprise me.”
After all, the most recent data available, from 2013, indicates the most prescribed drug in the state for “Medicare Part D” is hydrocodone – a highly addictive opioid painkiller.
Suboxone is a drug used within medication-assisted treatment (MAT), meant to be combined with counseling and therapy to treat opioid addiction.
“I believe that there are places that prescribe Suboxone that are doing it with the very best of intentions. They’re doing it with an orientation toward healing the addict and helping them with respect to – job placement, for example, and counseling and family care, and more of a holistic approach. There are places that are attempting to go in that direction that cost more money, that cost more resources, etc. I think that there are OTHER places that are prescribing Suboxone… In a way that is less supportive, and that would concern me more,” Dr. Pack told News Channel 11.
“There are lots of places in the country that don’t have a problem at all,” Dr. Edward Crutchfield said, talking about the region’s battle with prescription drug abuse, “We just happen to be a really bad place.”
Treating that high level of addiction with Suboxone, is what brought me to Dr. Crutchfield’s office.
Kylie: “You are the top prescriber of Suboxone in the state. Does that surprise you?”
Dr. Crutchfield: “Very much so. I just have a small clinic… That surprises me.”
As for Dr. Bomar Herrin, the second highest prescriber in the nation and one of the first in the Tri-Cities to prescribe Suboxone (buprenorphine-naloxone), “It does not surprise me that there are a lot of docs that have written a lot over a 10, 12, 15-year period.”
Kylie: “Now, the numbers that we were looking at were just for 2013.”
Dr. Herrin: “Well – and I don’t know if they look at total doses or whether they look at total number of patients, and I’m not really gonna be too concerned about that.”
The numbers, drawn from Medicare Part D data and compiled by ProPublica, take into account both patients and claims filled.
“I don’t even think Suboxone is the treatment of first choice. It’s just the one that you’ve got right now,” Dr. Herrin said.
President of Watauga Recovery Center, Dr. Tom Reach, ranks 43rd in the state for Suboxone prescriptions.
Of the top 25 Suboxone prescribers in Tennessee, 19 are in the Tri-Cities.
“With the federal restriction on the number of patients that you can see, you wouldn’t think that any one physician would be significantly higher than another,” Dr. Reach said.
That federal limit is 100 patients for every licensed prescriber of buprenorphine products – commonly known as Suboxone or Subutex.
“You’d have to ask yourself, are they in violation of the law?” Dr. Reach said, admitting, “This is a very, very difficult limit to adhere to, considering the scope of the problem in East tennessee and in Appalachia.”
Dr. Reach knows the difficulty firsthand.
Kylie: “there WAS an investigation into Watauga Recovery Center for going over the 100 patient limit. And you really stood behind, “We felt like we couldn’t turn those patients away.’ Anything else you want to say about that now, since at one point you all were seeing over 100 patients yourselves.”
Dr. Reach: “Well, what we did is worked with the DEA and provided them with a plan of action where we were going to get in compliance with the law. That included removing patients from our list that were not compliant with their therapy, increasing the number of physicians, dispersing those patients to other physicians who had access to care who were able to take them. And it took some time, but the government was kind enough to give us the leeway that it took to get that situation correctly.”
“A physician has a moral and ethical responsibility to care for patients have have been coming to him for care. And when we lost physicians because of this 100-patient rule, there were literally hundreds of patients that we couldn’t provide access to care. And what were we to do? Turn them back to the street? Tell them to go back to heroin? Tell them to go to methadone clinics?” Dr. Reach said.
Included in the top 10 list of Suboxone prescribers, is Dr. Reach’s former employee, Dr. Tracy Goen. Dr. Goen is also board certified in addiction medicine. He would not go on camera, but told us his numbers point to a severe lack of access to care and strong desire to treat those who turn to him for help.
For clinical pharmacist Sarah Melton, an associate professor at ETSU’s College of Pharmacy, the biggest concern in the data is the record of dangerous co-prescribing of Suboxone with benzodiazapines, like Klonopin.
Melton explains that the combination of drugs increases the risk for respiratory depression, problems with cognitive function, overdose and death.
“We’re seeing that a lot in this area, and it’s very concerning,” Melton said. “The pharmacists that are filling these prescriptions are very concerned because of the increased respiratory depression and other side effects that you get from that.”
Crutchfield and Goen are among the top 25 prescribers in Tennessee for klonopin as well.
According to ProPublica, Tennessee ranks 4th in the country for the number of doctors who prescribed at least 1,000 prescriptions of benzodiazapines and narcotics.
Herrin, like Crutchfield and Goen, remains confident in his prescribing practice and says that given the rise of narcotic addiction and a severe lack of inpatient bedspace for chemical dependency, Suboxone is the best available option.
“If I’m crossways with somebody, I’m just going to say look, if I’m not an asset to the patients in the community, just tell me. You don’t have to fill out any paperwork, you don’t have to do anything, I’ll just go to the house,” Dr. Herrin said. “But I know what we have to ask of patients to get into recovery.”
If you want to learn more about your doctor’s prescribing practices, all the information we used in this report is available online through ProPublica’s prescriber database. There, you can find out where their prescribing trends fall both statewide and nationally.
Below is video of a previous story on this topic from back in 2014:
Copyright 2015 WJHL. All rights reserved.