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Suboxone, a narcotic film strip used in medically-assisted treatment for opioid abuse, ranked number one in a recent list of Tennessee’s most prescribed drugs. But the finding may raise questions about data access and how Tennesseans fill the medication, said experts with different data sets.

Tennessee was the only state to have Suboxone as the top prescribed medication in GoodRx’s The Most Popular Drugs in America, State by State breakdown. In fact, Tennessee is the only state with Suboxone even in the top 10.

A thyroid replacement hormone, Levothyroxine, was the top prescription in 26 states.

The hydrocodone-acetaminophen combination sold as Vicodin or Norco ranked at the top in 10 states, according to the report released on March 22. GoodRx, a provider of medication discount cards, utilized data from partner pharmacies and insurers to compile a representative sample of prescriptions.

Tennessee’s rankings piqued the interest of Thomas Goetz, the director of research at GoodRx in California — as well as public health officials and researchers around the state.

Goetz looked into what could have boosted Suboxone’s ranking in Tennessee. He wondered if the data reflected more stringent prescribing practices under state guidelines that have doctors writing shorter scripts  — meaning patients have to come back more frequently to get the same number of narcotic strips than would have been dispensed under a longer prescription.

There’s a risk that people using Suboxone will misuse it, or trade or sell it for opioids, painkillers or other illicit drugs, said Stacey Grant, vice president of clinical operations at axialHealthcare.

It’s important for providers to monitor patients and assess efficacy and responsible usage, Grant said. Axial is a Nashville-based company using data and technology to help partners find solutions to the opioid abuse epidemic.

It’s the first year GoodRx did the analysis so it doesn’t have preceding years of data against which to compare, said Goetz.

The ranking looks at the the number of individual prescriptions written, not the number of people receiving them or the quantity of the drug dispensed, Goetz said. It represents the frequency of written prescriptions, not the most commonly taken drug.

Different data yield different results

Competing data is a byproduct of the splintered health care system because analysis is determined by access to information.

Axial researchers looked at their data after seeing the report and found the data sets from Medicaid and commercial patients didn’t match the GoodRx results.

Gabapentin — a medication for nerve pain that is increasingly abused — was the top prescription in the state using axial’s Tennessee Medicaid data, Grant said. Gabapentin made the top 10 list in several states, including Tennessee, per GoodRx.

The Tennessee Department of Health doesn’t have a list of all prescriptions in the state, said Shelley Walker, a department spokesperson.

Hydrocodone is “far and away the most prescribed controlled substance” in Tennessee for the same time period as tracked in the state’s controlled substance monitoring database, Walker said. According to state data, buprenorphine prescriptions like Suboxone were surpassed by several drugs, including Oxycodone, alprazolam (Xanax) and zolpidem (Ambien).

Buprenorphine and Suboxone are often filled and refilled in smaller quantities so could lead to a higher number of overall prescriptions, Walker said.

“Many patients also pay cash for this medication and get partial fills as they have the funds to pay for the medication,” Walker said in response to questions about what could lead to a high volume of Suboxone prescriptions.

Walker said the executive director of the Tennessee Board of Pharmacy, Reginald Dillard, “does not believe (the GoodRx ranking is) a reliable source of data” and noted that the representative sample “is not a reflection of all prescriptions filled.”

Even though axial’s data didn’t match, Grant said getting people talking about the frequency of suboxone prescriptions is a positive step toward normalizing treatment given the stigma around addiction and medically assisted treatment.

“I’m sure (the GoodRx data) is different so we can see different things,” Grant said. “For us it wasn’t even in the top 10 for either group. Regardless, it is great we’re talking about it. I think there’s some stigma around MAT (medically assisted treatment)  — even the term.” •

For an interactive map go to GoodRx.