Search found 65 matches

by mack86
Wed Nov 30, 2016 10:39 am
Forum: Clinical Use of Buprenorphine
Topic: Non-Doctors Taking Over - Out of a Job
Replies: 4
Views:

It's their loss. Go out on your own. See patients in a private office. You will enjoy the autonomy!
by mack86
Wed Nov 30, 2016 10:39 am
Forum: Clinical Use of Buprenorphine
Topic: Non-Doctors Taking Over - Out of a Job
Replies: 4
Views:

Agreed. happened to me years ago in ER and urgent care. PA's and NP's are cheaper and they don't make waves, because they just follow hospital approved algorithms. Now I mostly do functional medicine (that's bio-identical hormones, natural wellness, etc), cash pay only. I had a patient who needed gr...
by mack86
Mon Oct 24, 2016 2:58 pm
Forum: Clinical Use of Buprenorphine
Topic: suboxone/subutex and testosterone
Replies: 3
Views:

Opiates, including buprenorphine, suppress testosterone. Many patient's fatigue is due to low testosterone and you can really help them by replacing.
by mack86
Thu Oct 20, 2016 7:01 am
Forum: Clinical Use of Buprenorphine
Topic: Iron law of Prohibition
Replies: 2
Views:

Interesting. Thanks!
by mack86
Fri Oct 14, 2016 8:44 am
Forum: Clinical Use of Buprenorphine
Topic: 'online' counseling
Replies: 7
Views:

I have been doing this for prescribing. I call or fax Rx to their pharmacy. North Carolina medical board accepts this as a way to reach people in rural, remote, or otherwise underserved areas.

There is also a format for online counseling, but I have not used it yet.
by mack86
Fri Oct 14, 2016 8:11 am
Forum: Clinical Use of Buprenorphine
Topic: Max Dose Suboxone
Replies: 9
Views:

I have an elderly patient with severe arthritis on 12/3 mg bid plus 1-2 tabs 8mg subutex. I don't like it, but haven't been able to wean her down. Somehow, her insurance covers these meds.

Had a patient with glossopharyngial neuralgia. Went under gamma knife in Chicago and is off all pain meds now.
by mack86
Fri Oct 14, 2016 8:06 am
Forum: Clinical Use of Buprenorphine
Topic: Guidelines for Extended Take Home Doses
Replies: 9
Views:

I take a different approach depending on the patient. For new inductions, I give them a prescription for 3-7 days at 24mg a day. Sometimes I will also give them clonadine, and very rarely, an Rx for 2 tabs of 5mg valium to get them through the first day. I give them a cell phone number. I talk or te...
by mack86
Fri Oct 14, 2016 7:21 am
Forum: Clinical Use of Buprenorphine
Topic: Induction Advice
Replies: 6
Views:

Have had a few cases like this. Possibly they were also getting long acting opiates, after all, they are getting their opiates usually from unreliable sources. In that case, waiting longer is needed. I have heard of doctors writing Rx for short term opiates to transition off MTD. I usually give them...
by mack86
Wed Jun 29, 2016 11:57 am
Forum: Clinical Use of Buprenorphine
Topic: Skype or Factime ?
Replies: 7
Views:

Telemedicine is also accepted by the North Carolina medical board. (I think accepted is a better term than legal, because medical boards make their own rules and they don't necessarily have anything to do with law). I used Telemedicine to see my NC patients when I moved to another state. Agree with ...
by mack86
Wed Jun 29, 2016 11:57 am
Forum: Clinical Use of Buprenorphine
Topic: Skype or Factime ?
Replies: 7
Views:

Also, I have always used phone and texting for my patients. I like texting because it gives me a record, also.

I don't do insurance at all, so I'm not sure what "meaningful use" is or if I have to worry about it.

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