family doctor prescribing

Buprenorphine Post
Posts: 29

Postby mgh63 » Sat Jan 24, 2004 6:14 pm

What is that old saying about visiting a barbershop repeatedly you will certainly end up with a haircut. No question that non-psychiatrists miss a lot of disease but also that psychiatrists find too much in this disease which so easily mimics psychiatric symptoms.

Posts: 26

Postby ryounkin » Sat Jan 24, 2004 6:14 pm

My concern with my psychiatric colleagues is a fear that they won't recognize the medical issues that these patients always have. (grin)

This is a collaberative effort. Those of us who provide "medication assisted treatment" understand that we need to call on the skill of others, particularly early in the process. Just throwing drugs at people isn't "treatment". You will need to have a certain skill dealing with psych issues or ready access to someone who does. If you choose to treat the addict in the first stages of recovery, you will need couselling skills (and time) or access to someone who does.

Addicts seem to go out of their way to make themselves unlovable at times, but you have to be able to love them anyway.

Posts: 106

Postby rbr1 » Sat Jan 24, 2004 6:14 pm

I share your concern and agree with the high frequency that opiate dependent patients benefit from psychotropic medication. The incidence of depressive disorders, anxiety disorders and borderline personality disorder are high and opiates are often used in a patient's attempt to relieve psychiatric symptoms.

There are several self-administered psychiatric symptom rating scales that can be helpful in evaluating the need for psychiatric intervention. Four of them that I routinely ask patients to complete on the initial visit are: 1) Beck Depression Scale; 2) Hamilton Anxiety Rating Scale; 3) 53 items of the Symptom Check List-90; and 4) a ten item OCD screening instrument. Two of these rating scales (1 & 2) can also be used for follow-up evaluations of patients who receive psychiatric intervention. Nonetheless, it would take an extraordinary non-psychiatrist to make an appropriate diagnosis and understand the nuances of treatment. I would suggest that individuals who have high symptom ratings be referred for psychiatric evaluation and treatment recommendation.

Posts: 15

Postby jack28nm » Sat Jan 24, 2004 6:14 pm

My concern with non-psychiatrists is how well they can recognize psychiatric conditions. At least half my patients on buprenorphine are now on a psychotrophic medication as well. Without this the percentage chance of relapse is much higher.

Posts: 29

Postby mgh63 » Sat Jan 24, 2004 6:14 pm

There is so much variation in dose and response because there is so much variation in patients and physicians. In both instances there are differing experiences brought together to produce an amazing variety of treatment plans. The same is true of asthma, hypertension, diabetes and most other chronic diseases in particular. Much of our learning after a certain baseline is by trial and error. The important point here is that you have tremendous leeway to err, i.e., the medication is very safe. And yes it will be very doable in the office setting. Go slow and you will soon find that it will be very easy and very rewarding. Find a mentor that you can reach fairly easily and that will give you a comfort level. You probably won't need to call very often but some in the beginning. You will need to have some tools such as: a bottle of Suboxone; some forms, examples of which are in the buprenorphine training manuals; some urine strip tests for opiates, cocaine, oxycodone, marijuana, and benzos; bottles (with temp strips) for urine collection; education of staff re procedures and attitudes about addicted patients and the use of buprenorphine; ready line of communication with a psychiatrist/psychologist who has experience with addiction; and finally and perhaps most importantly, connection with an addiction counselor/center for on going therapy if indicated (and it frequently is, especially if the person is struggling with his/her change from the previous behavior). Others should add to this as I am sure I left out some things of great importance.

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