Are initial LFTs, etc. still necessary

Buprenorphine Post
rickbennettmd
Posts: 90

Postby rickbennettmd » Fri May 13, 2016 9:05 am

The Kentucky Medical Board now mandates annual HIV and hepatitis screens as well as a Comprehensive Metabolic Panel.

Fortunately we are often able to simply acquire these lab test results from the patients' other care providers.

Rick

drpasser
Posts: 1404

Postby drpasser » Fri May 13, 2016 9:05 am

I do not routinely obtain any labs, especially for folks who seem otherwise healthy (and not too yellow :-)

But seriously, it's amazing how much acetaminophen is apparently tolerated, at least in so far as a person not dying from an acetaminophen overdose.

And then, what can realistically be done for elevated LFTs? IMO-the best we can do for pts is to get them on to bupe sooner than later. Delaying initiation of tx for labs creates too much of a hurdle and an unnecessary delay which could become life-threatening secondary to OD. Often, once a person decides to get treatment; they wanna go out with one last big hurrah. Can't let that happen.

Gotta strike while the iron's hot.

Best,
Kevin

fishdoc
Posts: 111

Postby fishdoc » Fri May 13, 2016 9:05 am

The clinics in which I work get no labs except those required by the state of Ohio for buprenorphine patients. The methadone clinic does more extensive testing.

NoDrugs4u
Posts: 198

Postby NoDrugs4u » Fri May 13, 2016 9:05 am

Great Question Dr. Pierce. I have often wondered myself. I personally do not do labwork. I rationalize that whatever they are abusing is doing more damage to their liver than the buprenorphine that I will give them.

Bruni
Posts: 49

Postby Bruni » Fri May 13, 2016 9:05 am

quote:
Originally posted by BrianPierce


Should we be getting the initial labs recommended by the guideline? Does an exam and history suffice?


Since I don't bill insurance, I don't delve into bloodwork on anyone, yet, at least. If they are without PCP I strongly insist they find one. I ask repeatedly about their contacts with other providers and keep track of their major problems by asking questions. If they have used injection drugs and don't know their hepatitis (C,B,A) or HIV status, then I push harder. If they are sick I refer them to their PCP and then follow up with them usually by phone to make sure they got it fixed.


Bruni


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