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PostPosted: Thu Jan 14, 2010 10:19 pm 
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My last Suboxone appt. my doc informed me that the government was going to enforce a limit of TWO 8/2 suboxone per day. He said that at a conference he was just at a study was presented that said out of maybe 59 ER admissions for opiate abuse/addiction/overdose, something like 50 of the 59 had Suboxone on them that was not prescribed to them. I guess I am naive. I never got a "buzz" from Suboxone and never really thought there even was a street demand for it. But I guess if the alternative is getting dope sick or coming up with a few bills for a binge, I can see a street value. He told me that the gov't is going to strictly enforce a 2-tab/day limit to reduce diversion of Suboxone to the street. I was wondering if anyone else has heard of this? It won't personally effect me but I'm sure there has to be people on a higher amount than 16 mg. I personally have not found any info on it and my doctor didn't state when this would go into affect, so Im wondering how accurate this info is? Maybe Im just hoping its not true. Thanks ALL!!!!


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PostPosted: Fri Jan 15, 2010 11:57 am 
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Let me do some research on this.. I will be back shortly.

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PostPosted: Fri Jan 15, 2010 12:13 pm 
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I have found nothing in regards to this statement.What dose are you on currently? Just curious.
I do have a contact that I asked about this, so if I hear anything I will post it.

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PostPosted: Fri Jan 15, 2010 12:57 pm 
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I don't know the specific amount but about a month ago everyone at the clinic I go to was in an uproar because the doc had reduced the number of sub he was prescribing them. I only take 1 8mg a day so it was not an issue with me. Apparently there were quite a few on a lot higher dose and they said with no warning that day he reduced their prescription due to new guidelines.


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PostPosted: Fri Jan 15, 2010 1:22 pm 
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After conferring with my colleague, I am able to tell you that this is FALSE. He may have said this to justify his dosing regime.

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PostPosted: Fri Jan 15, 2010 1:37 pm 
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I understand why people may be concerned about Suboxone being diverted but think about this for a second is someone more or less likely to OD after taking Suboxone? I've come to the conclusion that it's much safer to have someone taking diverted Suboxone over diverted oxycodone. Even those non opiate dependant individuals who would try Suboxone for a "buzz" are much safer because of the higher safety profile of bupe compared to any other opiate that they might try and abuse. If a heroin addict buys a few Suboxone from someone that is legally prescribed the medication and takes a half a 8mg tab or more it greatly reduces their risk of OD-ing over the next few days. As a taxpayer would you prefer to have alot of diverted Suboxone out there or diverted oxycodone/hydrocodone/morphine that can very easily kill an addict or land them in the ER? ER visits are obviously not cheap and considering most addicts no longer have healthcare if they've been using for a considerable time we as taxpayers end up paying both more to uncle sam in taxes along with increased hospital fees. I guess I just don't understand the logic of trying to really clamp down on Suboxone diversion while there's still so much diversion of more deadly opiates....I certainly don't support someone diverting medication but I'd much rather a using addict get ahold of Suboxone over opiates that can easily kill them or land them in the ER at our expense. I've even heard people here share that even after just taking 4mg of Suboxone it's pretty much impossible to get high over the next 2-3 days. Ultimately I hope legislators are not trying to play doctor and tell actual doctors treating addicts what to do and how much of what to prescribe. If people are actually worried about diversion of medication then my god why would you target Suboxone? I've never seen Suboxone sold on the street here but I could make one phone call and have several grams of oxycodone in a few minutes.... Instead of looking at how many lives have been saved by Suboxone they choose to make diversion the bigger issue? How many people have ODed now with Suboxone and depressants a few? Over the last what 6 years that Suboxone has been prescribed? Alright now lets compare that with the tens of thousands of opiate addicts that OD every year......but maybe that argument is too logical. Maybe the lives of opiate addicts simply aren't that important to those individuals that comprise our government....'
Anywho I'm done venting for now I think....

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PostPosted: Fri Jan 15, 2010 2:14 pm 
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Shelwoy,
I am currently taking 16 mg per day. I have searched and searched and searched some more about this topic and found NOTHING concerning his statements to me. Thanks for all the replies, As soon as I heard this I wanted to come straight to you guys to see if anyone else had heard this.


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 Post subject: Diversion and sub
PostPosted: Fri Jan 15, 2010 2:23 pm 
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I think my Doc may have had some issues lately. I noticed around the same time (about 2 weeks before) he reduced the number of subs he prescribed to patients, he drug tested almost all patients that were there that day. I got the impression they were looking to make sure we had sub in our system. In the group session we are required to attend before we can see the doc the counselor gave a speech about what will happen if we are caught selling the pills. I know that one lady in the group said someone had called and reported her to the doc for selling hers (which she said was false). Maybe they are cracking down on specific doctors or maybe you're right. He apparently had a lot of patients on a high dose I thought they were going to riot! I mentioned to the Doc he had some upset patients and he told me himself he had new prescribing rules. I like the Doctor okay but I hate the way he runs the clinic. You sign in first come first serve. So you can be there for up to 2 hours. He will not file insurance. Charges $100 a week. If you are a good patient he will let you come every 2 weeks for $200. While you wait you have group and are counseled to go to NA or AA. About every visit I hear the "you're trading a drug for a drug speech". The counselor never had sub he did it the NA way.

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 Post subject: this doc is a scammer...
PostPosted: Sun Jan 17, 2010 8:20 pm 
You need to find a new doc, because and Doctor charging $100 dollars a week is just outrageous. He's obviously turned the miracle of Suboxone into a "pill mill" for his personal gain. I'm sure he came up with this "2 a day" limit only to limit his own liability in the case he is investigated for overprescribing and overcharging....after a few weeks of compliance, you should not have to see the doctor more than once a month. Hell, I only see my Sub doc once every 3 months, and he takes insurance. So I pay nothing out of pocket for just 4 visits per year to get all the Sub I need. You really should shop around. Docs that do it the way yours does are comletely immoral. Disgusting.
JD


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PostPosted: Tue Jan 26, 2010 11:53 pm 
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There are more and more guidelines 'out there', as the different addiction societies try to promote consistency between practices. There will always, unfortunately, be docs out to make a buck. Sometimes, though, docs are afraid of being audited (something that the DEA has threatened in several formats), and that someone will think they are not doing enough to monitor or 'counsel' patients.

I think that the efforts to make things more uniform will help; if people are interested, read about buprenorphine at places like SAMHSA, NIDA, ASAM, or the ATTC Network. The latter also has info for anyone interested in a career in addiction treatment!

One big frustration for me and I'm sure for many docs is the split between the different opinions about buprenorphine. If you look at information about addiction at NIDA (National Institute on Drug Abuse), NIH (National Institute of Health) or NIMH (National Institute of Mental Health) you will find that the future of opiate addiction treatment, on a national level, lies in buprenorphine or buprenorphine-related medications. I believe from my own findings and from the efforts of the national agencies that eventually opiate dependence will be 'just another illness' that is treated with a medication for the long term. But right now we have so much ignorance out there... it does not surprise me that the counselors at treatment centers do not read the literature, but shame on doctors who prescribe buprenorphine or who treat opiate dependence, who are not keeping up with the science. We know, for example, that starting a person on buprenorphine only to stop it after a couple months is STUPID, because virtually all of those people only relapse. The reason I wrote 'Fond du Lac County Health Resource Center psychiatrists' in the title of this post is because I am hoping that Google will bring this post to the attention of their psychiatrists, particularly Dr. Lothian (Hey Google Robot: Lothian m.d., dr. lothian, lothian psychiatrist, lothian fond du lac wisconsin, lothian psychiatrist fond du lac county). I heard recently that she was telling people in my area that 'Dr. Junig hands out Suboxone too long' or something even worse than that- she told the person I heard this info from that you should only take buprenorphine for a few weeks! Clearly, that person has no clue about the current science of addiction treatment-- which is fine. But if a doctor is going to remain clueless, it would be best if she didn't broadcast the wrong information and confuse people-- not to mention piss me off!

Then there are the insurance companies who seem to be resisting long-term buprenorphine more and more, even as we learn more and more that buprenorphine is most appropriately considered as a long-term medication. The motivations of the doctors who work as review officers for the insurers are obvious.

I recently exchanged a couple e-mails with the Immediate Past President of the American Society for Addiction Medicine (ASAM), Dr. Michael Miller. His practice is much like mine, but he has been using buprenorphine for a longer period of time; he has about 75 patients who have been on buprenorphine for 6 years who are doing well. I asked if he knew of any letters or statements by the addiction societies that clarified their position on buprenorphine, and he did not-- but he did say that he would take the issue to the society leadership.

There are things called 'TIPS' or 'Treatment Improvement Protocols' that come from NIMH. that describe proper use of buprenorphine. There are also guidelines about the proper time periods to follow-up with patients, which are generally a bit conservative in my opinion, given the cost of treatment and the poverty of addicts seeking help. I think there is need for flexibility in any guidelines, as some patients are at a higher level of 'true desperation', and I find that there is a relationship between desperation and success with addiction treatment-- with or without buprenoprhine.

One last comment on the original post-- that there is a limit on dosing of buprenorphine. There IS such a limit that has been informally announced. I have a copy of one of the letters on my blog Suboxone Talk Zone, and receive similar 'best practice' notices every month or so. The numerous studies of buprenorphine that looked at dosing have clearly shown that there is no need for doses greater than 16 mg per day in the vast majority of patients; any use of higher doses should be temporary and for unique circumstances. Out of my 100 patients, I have maybe 1 or 2 people who take more than 16 mg per day; the people who have been on buprenorphine for longer periods of time generally reduce their dose at their own request to 8 mg or so. When I see buprenorphine patients at their follow-up appointments I work on the psychologically parts of addiction that make people think that a higher dose of buprenorphine is actually 'doing something' when in reality the effect is only a placebo effect.

Doctors who prescribe more than 16 mg of buprenorphine per day are doing something that is outside of the 'standard of care' that has been established for buprenorphine. It is not illegal to prescribe more than 16 mg per day, but the frequent announcements to doctors and to pharmacies makes it more likely that a doctor prescribing those higher doses will at some point be asked why his/her practice is 'different' than the practice supported by the research. This is an important issue at a time when the whole buprenorphine program is at risk for being destroyed by a politician looking to score points over the diversion problem.


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