Inevitably, some patients relapse. Some become angry if they don’t get what they came for. A solo practitioner like Zong—who, by many accounts, had few employees, a tendency to work late on his own, and a high cash intake—faces security risks.
Zong was concerned enough to stow a gun in his desk drawer. “I keep a gun in my office for self-protection,” he said in his email.
In California, demand for buprenorphine has only grown with the opioid epidemic and recent changes to Medi-Cal, the state’s Medicaid program, which have made it easier and quicker for low-income people to get the drug. The program was expanded under the Affordable Care Act to cover more adults (3.8 million) and more drug treatment.
In addition, beginning in June 2015, doctors were no longer required to get prior approval from the Medicaid program each time they prescribed buprenorphine.
Within seven months, claims jumped 100 percent, according to the state.
Zong, an osteopathic physician who had trained in internal medicine in New York, opened his Bakersfield practice in 2007. Situated next to a marijuana dispensary, it was a one-stop shop for pain management, addiction treatment, and acupuncture. Though Zong’s medical training didn’t focus on those areas, he had the necessary DEA waiver to prescribe buprenorphine by 2010, records show.
Zong had a reputation for writing scripts cheap and fast, according to numerous interviews with former patients, drug-treatment professionals, and pharmacy employees in the area. Lines of sometimes agitated patients stretched from the waiting room into the parking lot, the street, and the dirt lot across the road, patients and neighbors say.
If the wait was lengthy, the appointments weren’t, the patients say.
“When I walked in the first time,” says Brian Adams, a former patient, “[Zong] said, ‘What’s going on?’ I said, ‘I’m a heroin addict. I need help.’ He said, ‘Okay, I’ll write you a prescription for Suboxone.’”
No intake. No drug testing. No counseling. “I was in and out in five minutes,” Adams says.
The price for the visits ranged from $80 to $100 cash to secure the medicine, patients say—far cheaper than anywhere nearby.
Federal regulators say buprenorphine should be “part of a comprehensive treatment plan that includes counseling and participation in social-support programs.”
There was an option like that within a few miles of Zong’s office: Aegis Treatment Centers, which runs opioid-treatment clinics closely regulated by the government. The clinics require services including intake, urine testing, and counseling for opioid treatment.
From a hard-up patient’s perspective, Aegis had another downside: It had not yet been approved to accept Medi-Cal for buprenorphine, which was dispensed on site as take-home pills. The range of services and medication cost nearly $700 per month for patients without insurance, with a limited number of discounts available to poorer patients.