Patient Prefers Subutex

[drpasser]

I would never actually advocate having bupe be otc. I didn't think, that by wondering about it being otc and posting my thoughts here, that qualifies as 'toying' with the idea.

So, for the record-IMO- buprenorphine should NOT be OTC, ever.

:-)

[entjwb]

Fink elms, I am a Suboxone prescriber who after a year of prescribing deceived to learn more and have taken the needed courses and studying to take the boards in October. I have a patient who came to me who was addicted to hydrocordone and went to a Methadone clinic and they started her on Methadone. Would you agree with that. If she came to see me, I would first talk about trying to wean off the Hydro and if not successful use Suboxone forc5-6 months. She was on Methadone for two years when I saw her.
Not all patients are Methadone candidates as well.

[MChaplin]

our agency has been meeting with our state senator who is very interested in what can be done at the federal level to reduce the "heroin epidemic" in COnnecticut. The concensus was for said senator to work towards both doing away with the 100 patient limit and to allow aprn's to prescribe buprenorphine for MAT. I have mixed feelings about the aprn- i like the idea of increasing access to buprenophine- and I of course bup is considerably less dangerous than the full opioid agonists that they already prescribe however, i do think that treating opioid addiction is extremely challenging- being able to treat the disease with all of its medical complications, and it's subtleties- when to push through and when to terminate treatment and when to refer to either obot or higher loc....well I am not convinced that APRN training is sufficient to handle all that....what do people think? i know there are folks that toy with the idea of making buprenorphine OTC - obviously i don't- I treat a large number of people that were gettting their bup "on the street"- i really like to beleive that now that they are under our care they are doing much better. we provide counseling, psychiatric screening and carem infectious disease screening, referal to primary care; could i be replaced by an aprn? curious what others think...

[drpasser]

I thought so too. Don't we agree, we need less government oversight and redtape.

There should be no restrictions on bupe. At the very least, it should be easier to Rx than oxycodone, not more difficult.

:-)

[Dave]

If finkelmd's advice were to become law, there would be even less OBT available than there is now. Not a good idea. Never trust the "powers that be", who are the ones who got us all into this predicament.

[jmosby1469]

Here, here!!, kc
I know the oversight suggestion is very well intended, but wait a minute...

[kcairns]

above makes me hopeful also for ways to similarly decrease iatrogenic mistakes and diversion re bzd and opioid pain"killers" both of which have much greater documented morbidity/mortality than does bup and also how to mandate Psychiatry oversight of all rxed stimulants....but now for the fun, a consideration of what other strengths, focus, experiences , (? personal hx of addiction recovery) , attitudes, manner of being, -- (ie qualities like demonstrated by many many colleagues on this forum ) might be of at least equal value to Boarded-Oversight in helping addicts recover...this must have been studied w data available somewhere...and who would be the overseers
Guidance - A Play...scene , office of lil'doc (ld)...nurse, "yes client , I know u r in ppted wdrl but ld is awaiting guidance from BIGDOC (BD) who will call us by end of next business day"...Client "wtf, I am switching to BD", calls BD office, "hi , this is client, I need guidance , I am switching to BD"..., BD' nurse, "sorry BD has no openings" ...client phones..."hello Heroin Pusher, this is client, I need your guidance"

[finkelmd]

With regard to being able to prescribe suboxone after a 9 hr course I am submitting the following for consideration :
Being able to prescribe contraceptives does not qualify me as an OB/GYN specialist.
Being able to prescribe testosterone does not qualify me as an Urologist
Being able to prescribe suboxone does not qualify any MD as an addiction specialist.
My suggestion to the people in power positions is that any MD with a license to prescribe suboxone who does not have added qualifications in addictions, should do so under the supervision of a qualified addiction specialist ie: board certification by the ASAM, AAAP.This should improve outcomes as well as decrease iatrogenic mistakes and diversion.

[kcairns]

article in Drug Alcohol Depend 2014 dec 1, daily observed rx w methadone and bn both found to decrease illicit use of buprenorphine

[peterorrin]

There need not be a time limit for patients to remain on MAT (medication****isted treatment); I have medical patients who have been methadone clinic patients for many years; I have some buprenorpine patients who tell me they want to remain on it indefinitely.

Methadone patients get better too. Not all, of course, but many. First, they live. Then their lives stabilize. They become reliable employees. They are no longer barbarians at your door. You get the picture. Federalized treatment environment is not ideal. "It is what it is."