How do you order Suboxone for dispensing?

Buprenorphine Post
drpasser
Posts: 1404

Postby drpasser » Fri Aug 07, 2015 12:28 pm

Makes good sense.....

compchat57
Posts: 35

Postby compchat57 » Fri Aug 07, 2015 12:28 pm

IMHO,

It's not the number of years of training that are so different between physicians and NP/PAs but it is the last two years of residency or fellowship that make all the difference in the quality of the physician. That time frame is when we docs really hone our skills and continue to do so after out formal training.

NoDrugs4u
Posts: 198

Postby NoDrugs4u » Fri Aug 07, 2015 12:28 pm

fishdoc, your logic is irrefutable! And they get nearly the same pay with none of the liability. They truly are dumb like a fox!

HAPPY NEW YEAR!

fishdoc
Posts: 111

Postby fishdoc » Fri Aug 07, 2015 12:28 pm

Now how can you deplore NP/PA's practicing medicine? They are much smarter people than are most physicians. The proof? Using myself as an example, I went to undergraduate school for 4 years to get a B.S. degree. 4 more years in medical school for an M.D. and then 4 more years internship and residency. Had I been as smart as a nurse practitioner, I could have gone to nursing school for 2-4 years and nurse practitioner training for another 2 years. Physician****istants have the same 6 years of training. This proves to me that physician extenders are at least twice as smart as I am since they were able to learn in half the time what it took me 12 years to learn. To top it off, we physicians are stupid enough to hire them and expect them to do the same quality work we do!

In over 5 years I have yet to see a single opioid addicted patient successful after a rapid detox program. By definition it is a chronic RELAPSING disease, so detox is always going to fail.

Happy Holidays to all!

Dave
Posts: 187

Postby Dave » Fri Aug 07, 2015 12:28 pm

NoDrugs, I agree with you about the "rapid detox" and non-physicians practicing medicine.

NoDrugs4u
Posts: 198

Postby NoDrugs4u » Fri Aug 07, 2015 12:28 pm

In follow-up, the DEA troopers as well as the state inspectors came, saw and went. Clinic passed with flying colors, and I wasn't even there! FYI, the clinic is a branch of a well known inpatient addiction facility and is located in the local big regional medical center. There was a lot of fanfare when it opened and I doubt any inspection agency is going to poo-poo it. I'm sure there is a lot of politics involved, as well.

That said, I also don't believe in the "Rapid Detox", and I deplore NP/PA's practicing medicine. I also don't appreciate administrators making my schedule and meddling with my treatment decisions. Once my private practice gets busier I think that I will be leaving this position.

miket
Posts: 15

Postby miket » Fri Aug 07, 2015 12:28 pm

I have been doing OBOT for 8 yrs now and this protocol just seems highly suspect. My question is this clinic owned by a physician at all let alone a wavered physician. What sort of "counseling" are they doing , and what is the drug testing used for and how often is the testing done. In the state I practice in Ive heard of "lay persons" opening addiction practices, and this seems to me like a clinic cutting every corner possible. Also what is the purpose of the "5 day detox"..The great majority of my new patients are coming in these days already on buprenorphine either from another physician or "off the street".

adavid
Posts: 64

Postby adavid » Fri Aug 07, 2015 12:28 pm

Hi NoDrugs4u,
there appears to have been a misunderstanding regarding the words "dispensing" and "dosing". What I meant by "dosing" is that on the patient's first day, and only on the first day do I dose the patient in the office. Subsequently only prescriptions are given.

PS. These "rapid detox" schemes are a major racket. You are not going to resolve addiction in a five day detox. These programs are nothing short of stealing candy from a baby. In fact its worse. They take money from desperate people and their families, give them falls hope and deliver nothing.

drpasser
Posts: 1404

Postby drpasser » Fri Aug 07, 2015 12:28 pm

DATA 2000 clearly spells out the requirement that only Physicians who are waivered, may participate in Outpatient Based Opiate Replacement therapy using Suboxone or Subutex, as follow:

"The practitioner is a qualifying physician."

DATA 2000 goes on to describe what is a "qualifying physician."

"The term `qualifying physician' means a physician who is licensed under State law and who meets one or more of the following conditions:"(I) The physician holds a subspecialty board certification in addiction psychiatry from the American Board of Medical Specialties."(II) The physician holds an addiction certification from the American Society of Addiction Medicine."(III) The physician holds a subspecialty board certification in addiction medicine from the American Osteopathic****ociation."(IV) The physician has, with respect to the treatment and management of opiate-dependent patients, completed not less than eight hours of training (through classroom situations, seminars at professional society meetings, electronic communications, or otherwise) that is provided by the American Society of Addiction Medicine, the American Academy of Addiction Psychiatry, the American Medical****ociation, the American Osteopathic****ociation, the American Psychiatric****ociation, or any other organization that the Secretary determines is appropriate for purposes of this subclause."(V) The physician has participated as an investigator in one or more clinical trials leading to the approval of a narcotic drug in schedule III, IV, or V for maintenance or detoxification treatment, as demonstrated by a statement submitted to the Secretary by the sponsor of such approved drug."(VI) The physician has such other training or experience as the State medical licensing board (of the State in which the physician will provide maintenance or detoxification treatment) considers to demonstrate the ability of the physician to treat and manage opiate-dependent patients."(VII) The physician has such other training or experience as the Secretary considers to demonstrate the ability of the physician to treat and manage opiate-dependent patients."

No other healthcare professional may subtitute of a physician for the process of Rx bupe. I have heard of drs getting themselves in hot water with the DEA, trying to circumvent this requirement. There are no stipulations for a Nurse Practioner, or anyone like that.

Sorry. I am not trying to be harsh or contrary. More like, trying to keep you out of hot water, that's all.

Best
Kevin

:-)

kcairns
Posts: 571

Postby kcairns » Fri Aug 07, 2015 12:28 pm

Fishdoc I think is giving some tough good advice and leads me to post too , in spite of financial hardships, for building even if slowly ones good safe correct practice rather than possibly finding oneself stuck in a less than safe for patients costcutting money making thing where a good doc might have to endure some agonies....also 5 day detox is really not where the evidence is for bup doing its good ....ps also just this moment learned that e-psychiatry now has telepsychiatry suboxone rx on line in the comfort of your own home, googleitout...I learned that from someone I had to turn down for my practice d/t no openings, so he will probably soon have all the help that tele-suboxone can give


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