Induction

Buprenorphine Post
mack86
Posts: 70

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

Does anyone do induction in-office?
Most patients already have some experience with bup and prefer to begin at home. I go over instructions very carefully and they appear very motivated to do this right. I have offered, but no one wants to pick up their prescription and return to the office sick. I call them that evening or the next day.

entjwb
Posts: 180

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

We see a new patient on the first visit and then in one week or two weeks at the physicians option. This depends on the patients situation. Our patients pay for their visits and for the most part very motivated to reaching recovery. We do have policies in place for discipline non compliance.

drpasser
Posts: 1404

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

Sounds very excellent as well, fish doc.

Best,
Kevin

NoDrugs4u
Posts: 198

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

Thanks, Dr Passer!

fishdoc
Posts: 111

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

We see patients 7 days after the first visit, 14 days after the second visit and every 28 days after that if everything is good. Any problems, including unexpected UDS results, cause more frequent visits. I work in 3 buprenorphine clinics presently and previously another. They are not connected in any way, but all follow the same procedure with new patients.

drpasser
Posts: 1404

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

That all sounds very excellent to me, nodrugs.

Best,
Kevin

NoDrugs4u
Posts: 198

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

i61164, I'm not quite a year in the buprenorphine practice and here are my policies -

New patient - evaluation visit, schedule induction asap, f/u visit 2 days after induction (I'm only open every other day), then weekly x2 weeks, then every 2 weeks through second month, then monthly if they stay clean and wrapper counts correct.

New patient already on buprenorphine from street or another practice (with records) - evaluation visit and continue same dose, f/u one week, then 2 weeks x2, then monthly as above.

Wrapper counts every visit. Urine drug screen at least monthly, more often if indicated.

MChaplin
Posts: 183

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

i work in a cmhc (community mental health clinic) so all our patients have co-occurring disorders- we have reached the point where we will only take new patients if they are willing to start by completing a 6 week iop program which runs 3.5 hours daily for 4 days a week- i see them at least weekly during those 6 weeks and then they step down to 3 one hour groups weekly and weekly medication visits and then 1 weekly medication visist and one weekly group and then biweekly and then monthly- if at any point we have cause for concern we can bump back up. the reason we went to this, is that we were having compliance problems with folks that weren't doing such a rigorous program. the only exception is patients who have an established record transfering from another provider- we do require weekly urines from these folks the first month, but not weekly visits. ....also if someone is employed, we work around their employment as that is an end goal and treatment should never interfere with employment!

drpasser
Posts: 1404

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

I try and see new pts five times within the first two or three weeks, then q month (or sooner, especially if they test positive at any point. Then back to weekly, until things turn back around. I speak by phone with new pts, everyday after their initial appt, until their dose is stable. I never give a Rx for more than should last until the next visit. I never give an entire one month supply after only one visit. The pts know that up front. All that is for brand new, never been on bupe before pts, or, pts who may have been on bupe at one time, but relapsed.

For pts who have been stable on bupe and are transferring their care to me, for one reason or another; I may give a one month supply after their first visit with me, it just depends. Here is Mizzippi, we have a Prescription Monitoring Program, so I always check out that. Pts must test positive only for bupe and negative for everything else, if they are transferring in. Otherwise, I tx em like a brand new pt.

Best
Kevin

i61164
Posts: 10

Postby i61164 » Mon Apr 27, 2015 10:55 pm

Thanks for your reply. Did you come up with this based on your comfort level or based on other info? I think I started doing the weekly visits for the first month because another doc in the practice was doing it that way. I also got the idea that monthly check ups were the bare minimum, but I'm not sure where I got this. In residency I do remember seeing a suboxone patient and the attending was giving her a refill (in other words a two month supply). I think she had been stable for a while. Does anyone know if there is a minimum standard that we have to follow? Is it the same for Bunavail vs. Suboxone?


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