It is coming!

Buprenorphine Post
drpasser
Posts: 1404

Postby drpasser » Thu Jul 14, 2016 10:19 am

There are those two things Ken, which are confusing for sure. That's why I have signed up for the Webinar ASAM is putting on next month, to try and get clarification for those issues you raised.

I posted a link for this on another thread.

Best
Kevin

kcairns
Posts: 571

Postby kcairns » Thu Jul 14, 2016 10:19 am

There are 2 different things, HHS raises doc limits but doesn't address midlevels, CARA adds midlevels but doesn't address doc limits ...

drpasser
Posts: 1404

Postby drpasser » Thu Jul 14, 2016 10:19 am

I know. I saw that as well (or didn't see that as well).

I am at this point, trusting ASAM as they are diseminating the information about the cap being raised to 275.

It is confusing though.

Bruni
Posts: 49

Postby Bruni » Thu Jul 14, 2016 10:19 am

Joint Explanatory Statement of the Committee of the Conference
Senate Bill 524: Comprehensive Addiction and Recovery Act.
http://docs.house.gov/billsthisweek/20160704/114-CRS524-JES.pdf

I went through this quickly and I do not see any expansion
of the patient limits for waivered doctors.
Does anyone else?
I do see provisions for waivering of NPs and PAs, but
the House version of the bill (Section 303) reads
"this new authority... would sunset three years after
the date of enactment" (whatever that means).

drpasser
Posts: 1404

Postby drpasser » Thu Jul 14, 2016 10:19 am

Isn't that great! One pt says he or she appreciates us and that makes such a positive feeling.
It can kinda reverse the bad feelings of the complainers. One may have 10 fussy pts and then one
with real gratitude can lift the spirits and remedy those bad feelings from the others.

Sometimes you get the bear, and sometimes the bear gets you...

Best
Kevin

kcairns
Posts: 571

Postby kcairns » Thu Jul 14, 2016 10:19 am

in my experience the more experience I have w bn the better I am able to do, thus curious their expansion of less experience and obstruction of greater....also doggone it what it takes to be an md is just greater than for mid level...ps years ago to be pc I chose as my provider a pa who was a nice guy and rode horses but his med care was so out of it I have forgone for me further healthcare ... and finally I arrived at work today worried re this issue and saw a young pregnant iv heroin user whose very name had been a cause for chills, but whom I had gotten on rx in the hospital, her gains are overwhelming and she has singled me out for a card of thanks...I don't need anything more

mattkeene
Posts: 32

Postby mattkeene » Thu Jul 14, 2016 10:19 am

The NP/PA prescribing is worrisome, but I am not sure how to prevent it now that CARA seems set to be signed. States have the authority to step in and make changes, but many will not, as there is a large movement to have unfettered access to buprenorphine based treatments. The trouble I have with this is that I find the opioid dependent patient to be one of the most challenging populations to treat. It requires great clinical dexterity to provide quality treatment, while navigating the all too frequent aspects of diversion/deception that can come with these patients. I've lectured to leading ASAM trained physicians who still don't "get it".
- One Doc will only prescribe Subutex as he is convinced that oral naloxone will cause withdrawal
- His partner will only prescribe 32 mg of bup/nal as he is convinced that anything less causes relapse.
Both are well-meaning and genuine in their belief...but both are likely having a fair amount of their RXs being diverted to the streets.
I find it troubling that providers with even less training and experience will be able to now prescribe these medication. It likely makes sense from a pure harm reduction standpoint. But I worry that a few years from now, we will have inpatient clinics who see bucketloads of "suboxone addicts" as bup replaces today's opiates.

drpasser
Posts: 1404

Postby drpasser » Thu Jul 14, 2016 10:19 am

Really? Honestly, I hadn't seen that part. Thanks for bringing this to our attention. I will ask around for clarification, if there even is any.

No, Noctors should not be in this arena, especially not before including all MDs and all DOs first.

NoDrugs4u
Posts: 198

Postby NoDrugs4u » Thu Jul 14, 2016 10:19 am

Except the part about allowing "advanced practice providers" to prescribe buprenorphine. If they would not previously allow all physicians to prescribe it, why now is it alright for any nurse with extra letters after his/her name to prescribe it?


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