We applied to the FEDS to have our OTP license modified last week. They ok'd it today! The state says they don't care. So all we have to do is figure out the pricing structures and protocols.
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I work in a methadone clinic, but have not used buprenorphine under the OTP license, ie under Federal Regs 42CFR part 8, nor under California's state regs. I have used buprenorphine in the clinic under DATA2000, with my x number. AS noted above, this gives patients and physicians more flexibility to make clinical decisions, however the 30-patient limit applies, of course. It's great to have the counselors on site, and the lab that knows how to do tox screens, etc. We had to set up a separate billing path, and the charts are a different color and filed separately to keep track of census. I have colleagues who work in the VA setting who are using buprenorphine under 42 CFR regs (VAs don't have to deal with state regs). What one of them does is: stabilize the patient, and once the proper dose is found, change them to MWF dosing, which is like LAAM used to be. Waivers could be obtained for 'early take-homes'. I believe some dispensing stations are reluctant to do what it takes to keep track of solid pills. Otherwise I have not heard any problems with use in OTP. The main glitch seems to be that state regs haven't really caught up with the federal.
In my area of southern Mass, a practioner attempted to use Bup in the methadone clinic and was not allowed to. I have two converts from Meth clinic and their reason was to not have to go daily to Meth clinic with many mandatory attachments. These people are working people and cannot met the standards of attendance that the clinic demands
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