My nephew used to trade his suboxone for heroin.
In Virginia, many drug clinics dispense daily and the drug taken in the presence of the nurse. They went to this several years ago because of selling and trading methadone and suboxone. Virginia limits the number of suboxone scripts a psychiatrist can order, general practice medical doctors don't want to order because of Board of Pharmacy oversite .
In Virginia, every script for any narcotic is tracked by area, pharmacy AND physician and fed into the BOP. When you hit a certain threshold the Board of Medicine come knocking for chart review, if there is not clear documentation of test, Xrays, medical diagnosis they are written up and required to take a class on medical documentation. Most are monitored for 2 years. If you don't stop writing scripts then they come with a warrant and they go straight to jail.
We had two local Dr's. where the DEA came to the office with guns drawn. Both are in jail. When this program started years ago, we would have several Dr's a month, now its taper down. Many Dr's left Virginia to practice in greener pastures. Governor Allen, went on the Today show and said... We have people moving to VA to obtain drugs thru our Medicaid program, we are stopping this. Over the next few years Medicaid from out of state enrollment dropped and many moved to other states.
Medicaid in Virginia requires pre approval for all narcotics. You must be in a state approved drug clinic to obtain methadone or suboxone, thru Medicaid. Long term pain patients and clinics require the patient to bring the pill bottle at each monthly visit to be counted and the drug test PRIOR to writing next script. In VA all narcotic script are good for 30 days only, must be original, no call in and NO refills.
Our big problem now is street drugs. Last week, it was announced that VA is now added to the Federal Opiod Strike force, so we must still have a problem.
It started with the doctors and now its the illegal drugs from China and Mexico.