Search found 11 matches

by miket
Wed Sep 02, 2015 6:42 am
Forum: Clinical Use of Buprenorphine
Topic: New female patients & contraception
Replies: 6
Views:

Thanks Ken....Oh believe me its not me so much as the " Volunteer State", that treats these/ my patients like 2nd class citizens for their reproductive decisions whether they are using street opioids or in proper OBT. There are literally hospitals here in my area that immediately place every child b...
by miket
Wed Sep 02, 2015 6:42 am
Forum: Clinical Use of Buprenorphine
Topic: New female patients & contraception
Replies: 6
Views:

Grateful for your input, Ken, Sam, & C. Thank you C very much for the quick start algorithm link......Mike
by miket
Fri Aug 07, 2015 12:28 pm
Forum: Clinical Use of Buprenorphine
Topic: How do you order Suboxone for dispensing?
Replies: 18
Views:

I have been doing OBOT for 8 yrs now and this protocol just seems highly suspect. My question is this clinic owned by a physician at all let alone a wavered physician. What sort of "counseling" are they doing , and what is the drug testing used for and how often is the testing done. In the state I p...
by miket
Tue Jun 02, 2015 1:04 pm
Forum: Clinical Use of Buprenorphine
Topic: Patient Prefers Subutex
Replies: 53
Views:

Greetings Kevin, The TN law applies to all MAT Bupe patients that need greater than 16 mg daily for more than 2 months. Tenncare max coverage is now set at 8 mg daily after 6 months even with my consult unless I choose to spend over an hour on the phone in what I call the "tenncare loop". As far as ...
by miket
Tue Jun 02, 2015 1:04 pm
Forum: Clinical Use of Buprenorphine
Topic: Patient Prefers Subutex
Replies: 53
Views:

I am in total agreement with FinkelMD., TN law just established any dosing over 16 mg needs referral/ consult w addictionologist for evaluation. I think this is a good start. I also feel that prescribers not boarded with ABAM, ASAM, Etc should open a dialog on some level to consult with someone that...
by miket
Wed Feb 19, 2014 11:14 am
Forum: Clinical Use of Buprenorphine
Topic: The last milligrams issue
Replies: 26
Views:

There are several meds that I use to help with the last doses of Bupe.. I start by changing them to Subutex, as I believe the Naloxone may impair endorphin/ enkephlin release and uptake at this critical time when needed most.. I also check Testosterone levels as they run chronically low in our patie...
by miket
Thu Sep 15, 2011 10:08 am
Forum: Clinical Use of Buprenorphine
Topic: Multi Physician Addictions Practice Question
Replies: 3
Views: 201

Anyone else have experience with this? Thanks
by miket
Mon Nov 02, 2009 5:37 am
Forum: Clinical Use of Buprenorphine
Topic: DEA On-site Inspection
Replies: 129
Views: 3856

I had DEA audit yesterday...very respectful agents (2). Asked if we provided counseling, conducted drug screening, and what drugs patients were using on the streets prior to coming in for treatment. Were not interested in seeing patients protected information. They were interested in seeing a log of...
by miket
Thu Jan 22, 2009 9:33 am
Forum: Clinical Use of Buprenorphine
Topic: erectile dysfunction
Replies: 24
Views: 969

Any and all opiates have a natural tendency to decrease free and total serum Testosterone levels. I have checked these levels on several of my patients and found this to be true. After administering testosterone replacement injections both the libido and ED improve. Viagra and similar meds are nitri...
by miket
Thu Jan 22, 2009 9:33 am
Forum: Clinical Use of Buprenorphine
Topic: erectile dysfunction
Replies: 24
Views: 969

Controversy still surrounds HRT with T and goes back to Lyle Alzado as best as I can recall. My issue has always been that T is converted by aromitization to E2. I continue to prefer injectable Test Cypionate over compounded creams as patients just don't care for the cream as much and state their en...

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