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

Buprenorphine Post
Posts: 137

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

I have the same policy, but I just can't bring myself to enforce it on pregnant patients. But I do discharge them after delivery if they are not solidly entrenched in recovery.

Posts: 1404

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

New Office Policy-as of March 16, 2014

To All My Patients:

Due to an increased number of requests to call in additional medication between appointments, for buprenorphine products, such as Suboxone Film, Zubsolv and Generic Suboxone and Subutex; I will NOT call in to a pharmacy any additional medication, for any reason.

The medication you receive is your responsibility. You must keep it in a safe and secure place at all times. Lost medication will NOT be replaced or called in to a pharmacy, for any reason.

If in the future, you lose your medication or you forget your medication or your medication is stolen or your medication is accidentally destroyed; you will NOT be able to obtain a prescription or have any medication called in to a pharmacy between your appointments with me.

There will be no exceptions to this policy.

You will only be able to receive a written prescription for your buprenorphine medication during your visits with me in my office.

I, the undersigned, agree to and understand this New Office Policy of Dr. Passers, as above and as indicated by my signature below:
Signature:________________________________ Date:_____________

Posts: 137

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

I also have a strict policy of not replacing lost/stolen meds. I ALWAYS review this in the first visit. I also have a handout listing some of the key, and most often broken, rules of the agreement. Also, I'd be careful about calling it a "contract". It's really an "agreement".
By the way, if a patient is pregnant, I will replace lost meds, but I generally discharge the patient after delivery unless they have shown a strong committment to recovery (attend mtgs, therapy, clean urine, etc.). And, I never never ever write for meds without an office visit and urine tox.

Posts: 187

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

It depends on your email software or how you get your email. There should be some way to mark mail from certain addresses as not spam. Short of that ability, you have to check your spam mail more often.

Posts: 1404

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

I will try to remember to post the contract tomorrow.

For some reason, my alerts that there's a new post here have been going to spam instead of to my email inbox. I have tried sending messages from my spam box to my inbox, but it has not yet fixed the problem. Any suggestions.?

Posts: 198

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

Yes, Dr Passer, would love to see your contract. Is it copyrighted or may we plagiarize from it?

Posts: 84

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

Please post your contract! Thanks

Posts: 1404

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

I have, (I think anyway), heard so many excuses about what happened to my bupe, it's pathetic.

I have always had a policy to, rarely, cover someone who has lost their bupe-in what seemed like one legitimate way or another. If it didn't seem like the pt's fault, I would only call them in no more than 8 mgs/day (regardless of their Rxed dose), to last until the pt RTC.

Now, my recent new and improved recent policy is to not cover anyone who has lost their bupe, without first seeing them in my office. for a drug screen and a conversation.

No exceptions. Enough is enough. (whatever that means)

It's "funny" how pts seem to only lose their bupe, and not anything else.

I have thought, in the past, and now too, that it might be entertaining to have a thread with all of the wild excuses we've heard about what the pts say happened to their bupe.

So, I've changed my ten or so year policy. No bupe until seen. No exceptions.

If anyone is interested, I am happy to post my new contract regarding this.


Posts: 32

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

Thanks all for the excellent suggestions. Here is how I handled the situation.

First off, the patient is in late 20s and I've seen him for 4-5 months. I typically request a patient bring in a supportive family member so I can make them part of the recovery process. However, this patient had been unwilling to do so. Yet he reported that his parents were holding on to his suboxone and they misplaced it. So, I insisted he bring them in or I would simply be unwilling to provide any****istance as he broke our agreement by not adequately securing his meds. Parents did come in. They are relatively high profile people and admitted they they have no clue where the medication went. I explained to them why I couldn't refill it early. They seemed to understand. I also did an observed U/A that was positive only for suboxone. I opted to provide him clonidine and gabapentin pen, and will see him over the next few weeks until his scheduled appointment.

Posts: 267

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

I have contracts too, so the first question I would ask is for me. There is so much going on during the first visit, maybe the contract was given cursory attention...a signature is easy but understanding takes longer..'sorry we are out of time!'. Did I stress enough the importance of obtaining a lock box. In general, its takes 2-3 weeks for my bup patients to have 'earned'a monthlong rx. By that time, Im beginning to see enthusiasm, humor or at least more smiles, AA attendance (not easy to start) and attendance and engagement in our required groups. As for what to do with this patient, I would ask who s/he lives with, who could have taken the meds, where would they be lost. What to do going forwards, I often depend on the more intense treatment approach mentioned above by edibill...that's a REAL test of motivation (and finances).

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