FearYourFaces

I’m a pharmacist at an independent retailer. Within the past year or so, our local clinic, which uses buprenorphine for opioid addiction, began prescribing (concurrently with suboxone) amphetamines (adderall), benzodiazepines (usually klonopin) and gabapentin almost universally to its patients. Two board-certified addictionologists oversee the clinic’s operations.

Am I missing something? Is there a place for multiple scheduled substances in treating opioid addiction? Or, if not for addiction, is it reasonable to use these medications so liberally in this population? My impression is that this practice is ensnaring a large patient population susceptible to developing addiction to ensure the clinic’s long-term viability.

If this practice is wholly inappropriate as I truly believe it to be, what is the best course of action? Should I notify the board of medicine? I’d feel like a snitch. Also, isn’t someone reviewing prescribing practices?

I haven’t considered that. I can appreciate that this could be an unconventional yet pragmatic approach with real-world benefits. Thanks for the insight.

It’s a schedule 5 substance in my state, but I don’t understand why it’s not a controlled substance on the federal level. I guess the FDA is just slow to move on it. It wouldn’t surprise me to find out it makes the list very soon.

School was years ago. I’m rusty so consider the source, but as I recall… That’s the pharmacologic difference between affinity (binding strength) and efficacy (activation) of a receptor. Consider an agonist which binds strongly and activates the receptor vs an antagonist which binds strongly but blocks the receptor. There’s a spectrum between of partial agonists or antagonists. The difference in affinity determines a drug’s ability to displace another from a receptor.