Induction

Buprenorphine Post
fishdoc
Posts: 111

Postby fishdoc » Mon Apr 27, 2015 10:55 pm

Sorry about that. My error as TIP 40 only advises in-office induction. Like you, I am unable to find official home-based induction protocol.

I have sent my induction protocol to you via e-mail

Jeremy K
Posts: 109

Postby Jeremy K » Mon Apr 27, 2015 10:55 pm

Thanks fishdoc; I've perused TIP 40 and I can't find any specific guidelines for out-of-office induction; do you know which section/page it's on?

quote:
Originally posted by fishdoc

Jeremy, I believe the SAMHSA-recognized or ASAM-recognized home-based induction protocol" you are seeking is contained in the SAMSHA TIP 40 which is now out of print but available as a download:
http://store.samhsa.gov/product/TIP-40-Clinical-Guidelines-for-the-Use-of-Buprenorphine-in-the-Treatment-of-Opioid-Addiction/SMA07-3939

Hopefully it is being updated as it is dated 9/2004


drpasser
Posts: 1404

Postby drpasser » Mon Apr 27, 2015 10:55 pm

I also only schedule in office inductions first thing in the morning. It usually takes 2-4 hrs. I am fortunate to have several rooms in my office set aside for this, with a recliner and blankets for the pt and a sofa for the family to watch TV. At those times, as I then have a "captive audience," I have them all watch videos from the HBD series, which I have on DVD about Opiate Substitution Treatment.

There must always be a designated driver, or I don't do the induction in office.

I then, try and see the pt back for follow up four times, over the next 2-3 wks. Once the bupe dose is stable, I start txing other problems, like with mood, anxiety, sleep and pain.

Best
Kevin

fishdoc
Posts: 111

Postby fishdoc » Mon Apr 27, 2015 10:55 pm

Jeremy, I believe the SAMHSA-recognized or ASAM-recognized home-based induction protocol" you are seeking is contained in the SAMSHA TIP 40 which is now out of print but available as a download:
http://store.samhsa.gov/product/TIP-40-Clinical-Guidelines-for-the-Use-of-Buprenorphine-in-the-Treatment-of-Opioid-Addiction/SMA07-3939

Hopefully it is being updated as it is dated 9/2004

NoDrugs4u
Posts: 198

Postby NoDrugs4u » Mon Apr 27, 2015 10:55 pm

I only schedule inductions in the morning and advise the patients ahead of time that they must be in partial withdrawal or I won't do it and they must reschedule. If the schedule permits I will offer to bring them back after lunch to re-azzezz, still allowing time for induction before closing time. So far they take me seriously and I have had no issues. I don't do methadone conversions yet, I want to get more experience with regular inductions first.

deegee
Posts: 137

Postby deegee » Mon Apr 27, 2015 10:55 pm

I don't do in office induction. My new patient protocol is similar to most. Weekly visits x 4 and gradually increase to 28 days once urine tox is appropriate, pt is in regular counseling, and pt LOOKS better.
agree that we need to work around work as much as we can.

If you do in office inductions, how do you handle patients who are "almost" ready for induction at 5PM? Do you stick around all night? Send them home for induction? Or are you somehow able to schedule these things with precision? What about patients switching from methadone? They might be ready in a day or in a week! I'd be interested in the logistics of scheduling in-office inductions as I do believe they are probably superior to home inductions.

drpasser
Posts: 1404

Postby drpasser » Mon Apr 27, 2015 10:55 pm

I do about 90% in office induction. It both insures the pt is doing it right and helps our dr-pt bonding :-)

Best
Kevin

Jeremy K
Posts: 109

Postby Jeremy K » Mon Apr 27, 2015 10:55 pm

New recommendations/guidelines from KY Board of Med include the following statement:
"If an in-office observed induction does not occur, the prescribing or dispensing physician shall appropriately record the circumstances in the patient chart and shall implement a SAMHSA-recognized or ASAM-recognized home-based induction protocol."
A quick search has not yet disclosed such protocols; anyone familiar with them?

NoDrugs4u
Posts: 198

Postby NoDrugs4u » Mon Apr 27, 2015 10:55 pm

I only do induction in the office. Call me cynical (because I am), but I don't trust this population to follow any instructions on their own. Plus, I want to see how they respond to each dose. I give them the induction Rx at their evaluation visit and tell them to bring it with them to induction. At induction first I do the COWS to make sure they are in mild to moderate withdrawal, then give a 4mg dose, bring them back in an hour, do COWS again, give them another 4mg dose if indicated (it almost always is), bring them back in another hour and do a final COWS. I don't go beyone 8mg on the first day.

How do you do a COWS if they are at home?

mack86
Posts: 70

Postby mack86 » Mon Apr 27, 2015 10:55 pm

Regarding the increased cost of more frequent visits, I charge a flat rate per month. The first month I call them the first day or two, then see them in 1 week, 2 weeks and 3-4 weeks. I also allow them to pay by the week in the beginning: most of them don't have the ability to put money aside for a whole month until they have stopped buying drugs on the street for a while.


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