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PostPosted: Sun Dec 11, 2011 4:57 pm 
I will log different/multiple perspectives on the question as a series of posts in this thread.


Last edited by docnusum on Sun Dec 11, 2011 5:30 pm, edited 1 time in total.

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 Post subject: The Problem...
PostPosted: Sun Dec 11, 2011 5:29 pm 
Simply put... There are NOT enough Prescribers of Buprenorphine.
There is a nationwide shortage and it doesn't seem to be changing anytime soon.

The Drug Addiction Treatment Act of 2000 (DATA 2000) was passed, which allowed qualified physicians to obtain a waiver from the requirements of the Narcotics Addict Treatment Act to treat opioid addiction with Suboxone and other approved opioid medications in their office-based practices. The law allowed these physicians or group practices to treat only 30 patients with opioids at one time. In 2006, the law was updated to allow approved physicians to treat 100 patients at a time with these medications.

Quote:
A survey, conducted three years after buprenorphine was approved and marketed for office-based treatment, was the first to include both physicians who have received waivers to prescribe buprenorphine and those who have not. The goal of the survey was to understand barriers to prescribing this new addiction treatment. Results indicate that most addiction specialists have adopted it, but beyond addiction specialists, few other clinicians have incorporated it into practice.


The training can now be done online but there still isn't enough providers.
Twice a yr, we help/co-sponsor and co-teach a Long acting Opioid class that also meets the criteria for the attendees to get a data waiver to prescribe Buprenorphine for Opioid Dependence. The class is ALWAYS filled to capacity (with a waiting list) but few go the next step to actually apply for the waiver... and of those who do... even fewer go on to care for a substantial number of opioid addicts. Why...????

Some have cited fears of censure for irresponsible prescribing (pill pusher stigma), others have cited their concerns about dealing with the often co-occuring disorders, and behaviors that accompany substance use disorders and some had concerns that having a waiting room full of substance misusers will put off other patients and require the majority of their resources.

There seem to be this prevailing notion amoungst patients that most/many of these providers who invested $100k-$200k, and 8-12 yrs of their post bachalors lives becoming providers are all just greedy docs, looking to prey of the ills of the patients so functioning from that premise:

100 patients = 100 monthly medication visits x the typical rate of ~$100 cash = average income for a doc: $120,000 per year for this portion of practice alone and requires no additional equipment, staff, facilities, etc.

So Why aren't there many more physicians applying for data waivers and caring for opiate dependent patients to get that "easy money"....???


Last edited by docnusum on Sun Dec 11, 2011 7:06 pm, edited 2 times in total.

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 Post subject: Physician Training...
PostPosted: Sun Dec 11, 2011 5:53 pm 
Substance abuse and substance abusers stir up complex responses in society in general and in medical providers in particular. On the one hand, for the "typical" person to become a licensed healthcare provider, they had to buy into the common stigma, rejection, and punitive responses to “addicts” and “alcoholics.” For the most part, they wouldn't have passed the tests, gotten the grades, gotten selected for training if they didn't "tow the sociatal line" and adhere to the customary morals and norms concerning substance abuse. On the other hand, after decades of indoctrinal brainwashing about the ills, wrongs and immorality of substance abuse/dependence and "choice theory", they are then told to toss that out the window and suddenly become non-judgemental, sympathetic/empathetic and understanding of the addict.

The often encountered negative attitudes of physicians and providers seem to reflect their experiences with addicts in medical school/clinical training...

Quote:
All physicians-in-training believe that alcohol and drug-abusing patients have challenging medical and social issues that provide educational opportunities. They also believe that they have been well educated in the techniques and approaches to diagnosing and managing patients with abuse problems. Despite feeling that they have an appropriate fund of knowledge and skills and despite believing these patients offer challenging opportunities in care, a significant decline in satisfaction achieved in caring for these patient populations is observed between the third year of medical school and the fourth year of residency training.

Students and residents-in-training agree that alcohol and controlled substance-abusing patients can be salvaged and provide meaningful contributions to society.

Over the years of training, frustration with these populations appears to rise, leading to enhancement of beliefs of over utilization of the health care system resulting in compromise to the care of other patients.

Despite increased awareness of the effects of negative attitudes and enhanced education of students and residents in caring for these populations little impact has been achieved in reversing the deterioration in satisfaction in caring for these patients.

See study here...


I can say that from MY 25 yrs of experiences in training and employment in healthcare... as a Paramedic picking up addicts in the ambulance, as a ER Nurse caring for addicts in the ED, as a FNP/PA treating addicts in cardiology, emergency medicine, primary care, addiction medicine and psychiatry... it hasn't be easy and/or pleasent most of the times.


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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

  • Board Certified Psychiatrist
  • Asst Clinical Professor, Medical College of Wisconsin

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