Search found 30 matches

by Jeremy K
Thu May 12, 2016 7:00 am
Forum: Clinical Use of Buprenorphine
Topic: Variations in monitoring and therapy requirements
Replies: 0
Views:

Wow. I don't know with confidence what the 'norm' is in eastern KY where I am, but the few that I do know something about do similar to what I do: weekly for the first 4 wks, every other wk for 4 wks, then every 4 wks thereafter. A similar schedule is 'recommended' by the state Board; not 'law', but...
by Jeremy K
Tue Apr 12, 2016 8:22 am
Forum: Clinical Use of Buprenorphine
Topic: New rules in WV
Replies: 13
Views:

jmosby: I agree that such regs are well-intentioned. As a Constitutionalist/Libertarian, I deplore any gov't involvement in medical care at all, including treatment for addiction. As a realist, I know they're in there to stay for the foreseeable future. Therefore I am actually glad, somewhat, for th...
by Jeremy K
Tue Apr 12, 2016 8:22 am
Forum: Clinical Use of Buprenorphine
Topic: New rules in WV
Replies: 13
Views:

"In order to receive cash payments from a pt with Medicaid, you must not be a Medicaid provider for this or any other service"... Unless you are employed by someone who does not have a contractual relationship with Medicaid; then your services can be charged to the patient on a cash basis. E.g.: a f...
by Jeremy K
Tue Apr 12, 2016 8:22 am
Forum: Clinical Use of Buprenorphine
Topic: New rules in WV
Replies: 13
Views:

Well, that's what we get for letting the government have anything to do with it. I am in KY on the border with WV; I already see a substantial number of WV patients; I expect that demand to grow...
by Jeremy K
Wed Mar 30, 2016 5:50 am
Forum: Clinical Use of Buprenorphine
Topic: buprenorphine levels
Replies: 23
Views:

Dr Colleen: Fellow KY'ian here. Just wanted to mention (you probably know this but...) while the actual level of Buprenorphine in the urine may vary based on many factors, the Norbuprenorphine level will usually be higher than the Bup. Also, if one sees a Bup level 'off the chart' and a very low or ...
by Jeremy K
Tue May 26, 2015 11:57 am
Forum: Clinical Use of Buprenorphine
Topic: what is enough "behavioral medicine"
Replies: 20
Views:

Good topic, thanks for everyone's input. Like other posters, most of the welfare third party payors in KY require specific counseling documentation. I tell my patients they have to see a licensed addiction counselor at least monthly, more if the counselor requires it. I require documentation of thei...
by Jeremy K
Mon Apr 27, 2015 10:55 pm
Forum: Clinical Use of Buprenorphine
Topic: Induction
Replies: 30
Views:

New recommendations/guidelines from KY Board of Med include the following statement: "If an in-office observed induction does not occur, the prescribing or dispensing physician shall appropriately record the circumstances in the patient chart and shall implement a SAMHSA-recognized or ASAM-recognize...
by Jeremy K
Mon Apr 27, 2015 10:55 pm
Forum: Clinical Use of Buprenorphine
Topic: Induction
Replies: 30
Views:

Thanks fishdoc; I've perused TIP 40 and I can't find any specific guidelines for out-of-office induction; do you know which section/page it's on? <blockquote id="quote"><font size="1" face="Verdana, Arial, Helvetica" id="quote">quote:<hr height="1" noshade id="quote"><i>Originally posted by fishdoc<...
by Jeremy K
Mon Apr 27, 2015 10:55 pm
Forum: Clinical Use of Buprenorphine
Topic: Induction
Replies: 30
Views:

Thanks fishdoc and Dr P, and everyone. Good info and guidance. Due to KY guidelines I'm initiating 4 mg first dose in office observing for precip'd w/drawal (highly unlikely as they have to be in w/drawal before I start, of course) then sending them home with max 8 mg total first day, see them next ...
by Jeremy K
Thu Apr 24, 2014 6:21 am
Forum: Clinical Use of Buprenorphine
Topic: 100 years of solitude/opioid public health crisis
Replies: 8
Views:

Well, you asked for my advice for the nation, here it is: You can't eliminate it; since there have been people and addictive substances, there has been abuse of addictive substances, that's human nature. But with just a few legal changes in my opinion we could reduce the narcotic problem to the 'nui...

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