question re patient

Buprenorphine Post
Posts: 38

Postby crmark » Mon Dec 15, 2014 10:22 am

Yep Dave, my question was actually rhetorical, and a little sarcastic. My contention is that marijuana abuse in an opioid addict is every bit as dangerous to one's long term recovery as is cocaine abuse!

Posts: 187

Postby Dave » Mon Dec 15, 2014 10:22 am

One would think so from the answers here.

Posts: 38

Postby crmark » Mon Dec 15, 2014 10:22 am

So, I am concluding that marijuana is safer for Bupe patients to continue to abuse than is cocaine-would that be accurate?

Posts: 1404

Postby drpasser » Mon Dec 15, 2014 10:22 am

I agree with others. I would give her an ultimatum. If she wants to see you, she can't use cocaine.
Her choice. That's it.

I had a patient recently, a 25 or so yo WF. I gave her lots of one more chances. When we screened her over the phone, she denied using any other drugs and then tested positive for cocaine at her initial visit. I had her sign my standard agreement at that time, stating she was would not take any cocaine while on Suboxone.

I had her RTC weekly. I gave her chance after chance. I kept giving her one more chance. I tried to not terminate her. It was only after she tested positive for cocaine for FIVE consecutive weeks in a row that I did finally terminate her.

I gave her a Rx for 30, 8/2 Suboxone, so she would at least have a chance of staying clean. I knew she would relapse immediately without bupe.

Anyway, that's what I did, to help her out AND to keep me from having a guilty conscience.


Cheryl Seaman
Posts: 11

Postby Cheryl Seaman » Mon Dec 15, 2014 10:22 am

Thanks for the thoughtful responses. I think it's helpful to hear from others to resolve my ambivalence about taking a hard stance. She has wicked bipolar depressions but because of the ECT(?) doesn't "recall" if cocaine was in use. I'm suspicious cocaine could kick off a depression. On the other hand she's a nice lady who is cooperative in all other ways. I will bring this up to her. I could also wean her off the Suboxone first.

Posts: 101

Postby edibill » Mon Dec 15, 2014 10:22 am

I would give her the choice, stop cocaine or lose her spot in your suboxone program and document it just like that. See her weekly or every two weeks for a while and witness her drug screens. Call her in for some random screens. Cocaine is cleared from the urine so fast she could easily use around her appointments. The first coc positive screen I'd write her a 10 day supply with taper instructions and refer her to a treatment program. That should cover all your bases.

Posts: 198

Postby NoDrugs4u » Mon Dec 15, 2014 10:22 am

I second adavid. I'm not a Psychiatrist, but that sounds like a train wreck! I admire you Psychiatrists, there is no way I could deal with real crazy people all day. The regular patients' craziness pushes me to the limits :-)

Posts: 64

Postby adavid » Mon Dec 15, 2014 10:22 am

Dismiss pt at once. Give her numbers of rehab facilities. She is not a candidate for In-Office treatment. In-Office treatment is for highly motivated individuals who want to work hard at recovery. She obviously is not and is playing you for a patsy.

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