"I lost my suboxone"...how to handle?

Buprenorphine Post
mack86
Posts: 70

Postby mack86 » Fri May 30, 2014 4:20 pm

Czelnick, I like your idea to write "FOR INTERVAL 12/1/15 thru 12/28/15 inclusive"

What is the powerpoint you use? Are you wiling to share it?

I hate doing it, but when a pt has lost or stolen Rx, I do sometimes prescribe week at a time, no more than 8 mg a day.

Thanks!

NoDrugs4u
Posts: 198

Postby NoDrugs4u » Fri May 30, 2014 4:20 pm

We agree once again, Dr Czelnick. Wrapper counts for every patient, every visit. No replacements for "lost" medication or Rx. Funny how no one ever loses their Lipitor or Glucotrol prescriptions? We dispose of the wrappers in our hazardous waste (needle) boxes so no one can get them out of our trash.

I also agree that if your patient can tolerate the lower dose then it is time for weaning.

czelnick
Posts: 3

Postby czelnick » Fri May 30, 2014 4:20 pm

I am clear in our agreement at the beginning. I have a Powerpoint I show every patient. They also get a copy of their signed agreement.
I never do ANY bup refills without an office visit.
Recently a stalbe patient that I see a lot in the community reported she left her purse in a hotel room wiht her bup and it was gone when she came back. Because she has been stable, I agreed to fill next months Rx early, BUT she only gets next months 28 days now, and has to make it last 43 days until the subsequent date comes up. we pulled up the calculator and figured if she did 2/3 strip daily instead of her usual one a day she would come out right. She thought this very fair, and it will keep her going into full withdrawal. will step up her counseling visits for support if cravings get worse, and if she does well we agreed we might stay at lower dose as part of long term taper.
Every case is different. I trust my gut, but also "trust but verify" the patient. Behavior will tell the story. Great thing about small town medicine, is we know who is selling in the grocery store lot!

BTW, i started putting "FOR INTERVAL 12/1/15 thru 12/28/15 inclusive" sig on all my scripts. We count strips at every visit and having the dates of start/stop for that script makes the counts easier and also helps patient figure out when they will run out, etc. I also collect strip covers form used strips- they are serial numbered, and if patients are going to sell, it makes it a hassle for them to have to bring in all the strip covers and keep counts correct.

entjwb
Posts: 180

Postby entjwb » Fri May 30, 2014 4:20 pm

I would only give additional if patient has a police report of the medicine being stolen. When they bring the report to office for Rx I inform them this is a once in a lifetime benefit. They also have to show the pharmacist to get meds.

kcairns
Posts: 571

Postby kcairns » Fri May 30, 2014 4:20 pm

I HAVE PT STABLE FOR 3 YRS, HE SISTER I AM SURE STOLE MEDS, DO HAVE SIGNED CONTRACT , UDS SHOWS BUP ONLY AND I AM SEING PT, SHE WOULD NEED REFILL 5 DAYS EARLY AND IS IN ABSOLUTE PANIC STATE RE FEAR OF WDRL, PLEASE ADVISE

mack86
Posts: 70

Postby mack86 » Fri May 30, 2014 4:20 pm

That is a good idea, MChaplin, repeating the urine sample the same day!

MChaplin
Posts: 183

Postby MChaplin » Fri May 30, 2014 4:20 pm

I would not base a discharge on a single test result. I would call him in between visits for pill count and****ess his mental status and repeat the urine. I would also confront him with the result and ask him about it. My hunch is that he did slip up and doesn't want you or mom to know about it so he got someone to give him a clean urine sample. When this happens I have the client repeat it the same day because clients usually don't have two samples prepared!! I always tell people that most important is to be honest and we will deal with the results- sometimes this means referring to a higher level of care within our facility and sometimes to a residential facility. If however it becomes clear that the person is selling their medication they are discharged.

i61164
Posts: 10

Postby i61164 » Fri May 30, 2014 4:20 pm

I have the same concern about pregnant patients. What to do if their sub is stolen or if they test positive for benzos or other egregious contract violations. I would taper and/or discharge any other patient, but I worry about harm to the pregnancy due to opiate withdrawal.

assadi11
Posts: 5

Postby assadi11 » Fri May 30, 2014 4:20 pm

How to handle situation like this? :
I have been seeing a patient for the past 3 months. He seems to be very motivated. He is on total of 6 mg of Suboxone pill. He came with his mom in his last visit. He always had positive urine drug screen for Suboxone but this time it was negative. His mom who is very concerned about his previous addiction, said she is the one who gives him the medication everyday. Can I call him and ask him to bring his bottle so I count the medication?
Thanks for any hint
Hamid

catschollmd
Posts: 16

Postby catschollmd » Fri May 30, 2014 4:20 pm

we do NOT replace lost or stolen Rxs..even when they bring in police report as it is their reponsability to safeguard their meds! and it is in the contract and posted in office.

(come on: how often have you ever lost your meds??)[


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