Probuphine

[MChaplin]

more risks- what happens when a patient abuses benzos or alcohol??? what happens if she becomes pregnant? and as stated above, what happens, if the device proves difficult to remove??? what if the patient relapses and the implant dose no longer "holds" them???

[MChaplin]

I passed on the training for many of the same reasons outlined by deegee- i don't have all that many patients on 8mg or less and those are not the people that are a big diversion risk- I also worry what happens if I can't locate the patient when it is time to remove the implant- i consider my stable low dose patients to be "successes"- and so I tend to follow that wonderful mantra- don't mess with success!
what I would find much more useful is a delivery option that is available for high dose high risk patients that are still testing positve for both bup and opi- are they skimming and selling? are they taking buprenorphine inconsistently...a depo formulation would help...

[peterorrin]

No see for 6 mos while on MAT? Only astronauts & military starting 6mo tour of Afghanistan.

Here's a better idea for the rest of our patients: 6 one-month prescriptions preceded by UDS & a small cash service fee...followed by a getting re-acquainted office visit.

Peter

[peterorrin]

this is a test.

[sslonim]

2 quick thoughts: 1) one place where I think it clearly would help is patients who will be in jail and not allowed to take Suboxone; 2) cost: if I've got this right its for patients on 8mg/day or less and good for 6 months; so at $4995 for 6 months that is around $830 per month and while Suboxone 8/2mg is expensive its not anywhere near $800 for 30 strips (8mg/day) - am I missing something? Sam

[Bruni]

I await the first reports of diversion by kitchen-surgery and retrieval of the implants, recipes for melting the implants, directions for re-implanting them, how-tos on dividing and eluting the active ingredient, etc. It will happen.
I think a 30 day implant or depot injection is workable, but everyone in this diagnotic category needs a director to steer them into recovery centered treatment and lifestyles. I don't just write scripts at monthly visits, I review, question, evaluate, suggest, direct, adjust, and encourage.

[mattkeene]

More than anything I struggle with the labeling of "stable on 8 mg or less". I do have several patients who are stable on 8 mg or less. But the operative word here is "stable"! If they are already doing well on their current regimen, why would they wish to subject themselves to a surgical procedure? And if they are "unstable", then they may well need more than 8 mg, or perhaps they are avoiding opiates, but still struggling with BZDs or AMP. And in that case, why would I want to give them a 6-month implant with the potential for this unstable patient then choosing not to return for appropriate f/u or counseling?

[deegee]

I've been to the training for rx'ing and implanting. I've reviewed the studies and they are reasonably convincing. I like the idea of no diversion and no pediatric exposure. I worry if behavioral medicine will be neglected as well as followup appointments. Also, after implanting both arms and a year has gone by, what do you do? There's no indication for implanting another site.
How many people have stable patients on 8mg/d or less? I'm guessing that' a huge minority of patients overall. And,what if the pt is on 4mg/d, vs 6mg/d, vs 8mg/d vs 2mg/d? Are you increasing the dose, decreasing the dose? I guess I love the technology but am having a hard time finding a use for this iteration of it. I'd love to hear others' thoughts on this.

[peterorrin]

Psychiatrists and primary care docs should check with their insurance carriers to find out if probuphine implantation will increase rates.

I will not be a pharmaceutical mfg's bank. Im not going to pay for a drug, then wait for uncertain reimbursement. For example, because of Prevnar 13's high cost, I write scripts for it rather than provide it in office.

I do provide 2mo Rx's for Suboxone to a few patients. I do not call them in between visits for UDS. Guess what, sometimes they are found to be pos for drugs at their scheduled appointments. Those patients must increase counseling sessions and come in more often. But,this policy may need to be revised.
Peter

If a patient is on buprenorphine for 6 mos without seeing you, what is the doctor's leverage?

[drpasser]

I stand corrected and removed my post. Sorry. (c;}