duration of treatment with buprenorphine

Buprenorphine Post
NoDrugs4u
Posts: 198

Postby NoDrugs4u » Mon Mar 17, 2014 11:24 am

Thanks peter & ken, for acknowledging my post. I was beginning to think that I was relegated to the invisible "Not Moderated" realm!

Ken, wow, a load of great ideas. Thank you very much. I have spoken to a regional inpatient rehab facility, but they are strictly an abstinence program and will not even consider referring anyone for OBOT. I am in the process of making up brochures to mail out to local addiction support groups. My RB rep (Suboxone) has kindly informed her other physician clients who are at capacity that I am here and taking new patients. Like others here on the board, I run a legitimate program rather than a pill-mill, so I won't tolerate any funny business. Hopefully sincere clients will appreciate that. Perhaps some New Year's Resolutions will bring me more souls seeking to get well?

Thanks again for the good wishes, and I too wish all of my colleagues here on the board a joyful Thanksgiving!

kcairns
Posts: 571

Postby kcairns » Mon Mar 17, 2014 11:24 am

NoDrugs doggone it just when i swear i will shut up something else always comes up--You have an exciting and enriching immediate future - clearly you are the only enlightened person in your area and therefore the torchbearer to others....do not advertise, analyze, analyze and educate....analyze your 9, and analyze and educate -- area providers, and ER docs, what are they doing w their problem drug seekers? -community addiction agencies?, nearest detox ctr? (at ours, despite many reminders and their numerous failed admits/readmits for clonidine detox, they still do not think to offer callers the outpt option of OST)...pregnant women (unless from TN where they are criminalized for being in treatment) , around here they know better than all the docs that bup is better for pregnancy outcome and for keeping their babies (IN FACT IN JOURNAL OBGYN 5/14, RE 1 MILLION MEDICAID WOMEN, PREGNANT, 1 IN 5 HAD RX FOR OPIOIDS DURING PREGNANCY -THEY CALL FOR MORE STUDIES RE SAFETY OF SUCH IN THE DEVELOPING FETUS --PS THESE STUDIES ARE LONG DONE --- O YES THERE IS PLENTY OF WORK OUT THERE FOR US ALL TO DO!!!) ...is there one enlightenable ob doc in your area that you could talk w?, ...maybe do community meetings with posters in prominent places for the ill and their families, (for such you could put a small notice in a local free paper and word will get around)...?your nearest besides you , regional big expert in addiction --maybe could come for educ teaching for area docs,,,? of local pain mgmt ctrs, they are always kicking pts out who might do great on bup ...or best not listen to me as i am so outrageous as to give out my cell # to help seekers i see and such gets passed around like crazy and i get calls and texts all the time of people needing help and am like a local free referral and talk resource and do not mind as it is really no trouble at all and a great help to people and even if i cant get them in i can guide them to other help...?your nearest OTP they will from time to time have clients who need obot flexibility and will travel for it...above all also have a good Thanksgiving w family, ...ken

peterorrin
Posts: 267

Postby peterorrin » Mon Mar 17, 2014 11:24 am

NoDrugs4You: Be patient. Im sure you have a good program. That will get around.

Peter R.

drpasser
Posts: 1404

Postby drpasser » Mon Mar 17, 2014 11:24 am

Hey all y'all:

So, when I am at my 100 pt limit, I stop taking new pts. That is a shame, but it is what it is. When a slot opens, a usually fill it backup right away. I do not maintain a waiting list.

I do have some pts which are on bupe but are being txed for pain management, and I do not count them as part of my 100.

Pts do quit coming, change doctors (esp. when they have some new insurance that they want to use, as I do not accept any insurance), get weaned completely off, violate their contract and are terminated; so, I actually often have a few spots left. Like currently, I have 97 pts, 3 open spots. As I usually field 3-4 calls per week, I will likely fill the open spots very soon. Then, another will open up and so forth.

If there was no limit, I could easily have 200 pts, or even more.

Best,
Kevin

fishdoc
Posts: 111

Postby fishdoc » Mon Mar 17, 2014 11:24 am

We also have different clinical settings in which we work. A physician seeing bup patients in his own office cannot give the same intensive therapy as another doc working in a large inpatient-outpatient multidisciplinary clinic. There are some patients we just need to send to programs better equipped to handle their problems and we must depend on the patients to follow through with our instructions to go to the more intensive therapies. For some, who may be unwilling or unable to comply, this may be a "death sentence" while for others being discharged from a specific doctors care could be a prescription for life.

jmosby1469
Posts: 104

Postby jmosby1469 » Mon Mar 17, 2014 11:24 am

Of course!

MChaplin
Posts: 183

Postby MChaplin » Mon Mar 17, 2014 11:24 am

jmosby- but when we cull, even if it for a justifiable reason, is it also "akin to a death sentence" as Dave said in the benzos are bad thread....I have had two patients leave my practice due to my refusal to treat them with benzos who are now dead. I can't help wondering if buprenorphine would have kept them alive....this thought probably belongs in the bz thread- but it is here because terminating patients whether because they are doing well or doing poorly is risky....i come back to the insulin/diabetes analogy- imagine saying, we are going to teach you the skills you need to live without insulin....or since you are continuing to come here with high blood sugars, we are no longer going to provide you with insulin.....or so we are really pleased that your sugar is now under control, but your blood pressure is still high and you are still overweight, so we just can't justify continuing your insulin- we have given you several months to control this yourself, and you haven't so we are forced to discharge you from our clinic. and finally would we be having this discussion if there were no 100 patient limit....I think you would see a lot more leeway if there were no limit- now we get caught up thinking we are "wasting a slot"- they are not "slots" they are human beings suffering from a potentially lethal illness.....

jmosby1469
Posts: 104

Postby jmosby1469 » Mon Mar 17, 2014 11:24 am

I look forward to those answers. My impression has been that the more rigorous rules some of us apply allows us to cull the client population rigorously to remove all the less likely compliant and successful, making room for new comers.

NoDrugs4u
Posts: 198

Postby NoDrugs4u » Mon Mar 17, 2014 11:24 am

If I may interject a different dilemma. Unlike most here on the board, I am having trouble getting patients. I have only had a total of 9 patients (not at the same time) in my first 6 months of operation. And I see all the time in the local news stories about the "epidemic" of heroin addiction in this area.

The RB rep says it is because of my rural location, but this is where the addicts are. I am listed on most of the internet 'bup docs' websites, but I do not advertise. I guess I will have to have to start (advertising).

MChaplin
Posts: 183

Postby MChaplin » Mon Mar 17, 2014 11:24 am

Thanks Kevin-
Are you saying you are pretty much not taking new bup patients at this time? do you maintain any kind of wait list in the event that you do have an opening? I think this raises another interesting query- how many of us are now "saturated"? ie can't take any new patients except very sporadically??? Seems to me we are all facing an agonizing ethical choice- since we are all getting more referals than we can legally treat, we must choose between turning away those in need or tapering stable folks knowing that their outcome may not be good and if it is not that we may not be able to restore their treatment......
thoughts?
M.


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