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

Buprenorphine Post
Posts: 198

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

BLEEPING COMPUTERS! When I posted this there were no other replies showing on this page, and yes, I refreshed the page! Oh well.

Hi Matt, I am surprised that you haven't had any responses to your question yet. Everyone here must have had a big weekend! You will get some answers soon from very experienced Physicians on this web board. This board is a great resource for Bup information from the "real world".

Personally, I am new at this and have yet to have my first bup patient. I'm thinking that if I were in your situation, I would get an immediate lab test for norbuprenorphine (lab only, no POC test available) to see if the patient is actually taking it at all, or just diverting. Also, check for the usual other abusables.

If he comes up clean and positive for norbup, then I would maybe issue weekly refills for a while (provided this is his first offense) with testing each time. If he appears reliable, at some point you can go back to monthly Rx. If this ever happens again - Buh-Bye.....

Posts: 19

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

If you have a signed treatment contract, the answer is simple: NO.

Posts: 101

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

For me it depends on the patients past history and the scenario. There's no hard and fast rule. I make them sign a contract saying I won't replace medication but I have replaced medication in the past. Never 3 weeks worth though. I've never been happy about doing it even for a few days worth and made it clear I would never do it again. If it was someone who just started treatment I don't think I would at all. Even if it was someone I trusted and the scenario believable, I would make them come in weekly for drug screens and get a weeks worth of meds at a time so they would at least have a negative consequence for their carelessness and to cover my butt with documentation.

Posts: 180

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

In Ohio the pharmacies are not supposed to refill Rx until 48 hours or less before patient should be out of med. our policy is a one time writing an Rx early. We then give one or two week supply and they have to return to office to get another Rx. The second time it may happen they are dismissed without any weaning Rx. I would have this gentleman returning each week for Rx for 11 weeks.

Posts: 571

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

do not rx him more bup or keep him under your care regardless of how much wdrl he feels he needs help w, he can seek out clonidine and comfort meds for same... advise him that when such occurs, it shows that for the care he requires and per standards of care -- needed care = daily observed dosing in a setting where such can be done, preceded by re-eval in re readiness for change...no compromise for his sake and yours, you have limited openings, you can do much better for yourself and someone else in his slot

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