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PostPosted: Thu Sep 22, 2016 10:41 pm 
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Hopefully Dr J can opine on this study as I'm not for sure its well done but thought I'd put this new research out here for all's thoughts. Maybe this is why we hear of so many folks needing bup yet have such a hard time finding a bup Dr.?

Rand Corporation
"Many physicians who prescribe buprenorphine (multiple brands) for opioid addiction treat far fewer patients than allowed under the law, a new study from the RAND Corporation shows and are prescribing substantially below the patient limits historically allowed under the law." This link is a press release of the article: http://www.rand.org/news/press/2016/09/20.html

JAMA September 20, 2016. (Journal of the American Medical Association)
"This retrospective cross-sectional analysis of pharmacy data indicates that most buprenorphine prescribers’ patient censuses are considerably below current limits". 22% of prescribers treated three or fewer patients per month, 49% treated four to 30 patients monthly, 20% treated 31 to 75 patients per month, and only 9% had 75 or more patients. This was over a 3 yr time period with physicians who were prescribing buprenorphine and therefore were assumed to be more experienced with using it, yet the study surprisingly showed that the median duration of a treatment episode was 53 days (altho imo, this could be patient fall out and not necessarily related to the Dr.) particularly since studies are increasingly showing that longer treatment episodes are associated with better outcomes for opioid use disorders. This link is only the abstract and NOT the full article because the full article requires paid subscription access. https://jama.jamanetwork.com/article.as ... id=2553439


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PostPosted: Fri Sep 23, 2016 11:40 am 
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Good topic Pel,

I can only speak for my doctor who I asked that exact question. He said he keeps it at 85% just in case someone who gets off Suboxone can get back on again. That made me feel better knowing if and when I walk that road I have an out.

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PostPosted: Mon Sep 26, 2016 10:35 am 
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From Pew research foundation:

http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2016/02/11/waiting-lists-grow-for-medicine-to-fight-opioid-addiction

Quote: So far, fewer than 32,000 doctors have received the license and the vast majority who have one seldom, if ever, use it.

I have an x number, haven't used it in a couple of years. At the time I was in a small group practice and could set aside time to do it right (ie, working in an actual full-service clinic, meaning counseling and alternatives are available, and I was working with colleagues willing to share their wisdom and experience.) Now I'm in an employed position, so if I get back into addictions it will be a pretty serious business and personal decision.


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PostPosted: Mon Sep 26, 2016 3:05 pm 
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DrDave,

Not trying to be a smartass, but how do find the time to post here? I've been trying to get my own physician to log in but he says he's too busy. The owner of this site maybe can log in a few minutes each month if we're lucky. Then we have one more who posts about 1-2 per month as his time allows. You must be a very good time manager.

Just curious.

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PostPosted: Mon Sep 26, 2016 7:14 pm 
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Have u practiced in addiction before? U said if u get bk into addiction again...just wondering since u said in an earlier post u were a neurologist.

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PostPosted: Mon Sep 26, 2016 8:20 pm 
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Dragging this back to Pelican's original post. I was hoping Dr. J would weigh in as he is a better word
smith and parses statistics well.
This study was a 'Research Letter' published in the JAMA. My understanding is these can be published with less peer review vigor. If you follow Pel's link you get most of the article, not worth purchasing to see their discussion and citations.
The data is for the seven most populous states and cover the period 2010-13. To be included a practitioner had to be prescribing at the beginning and the end of the study.
After reading it I did a general face palm, there's 10 minutes I'll never get back. Anyone with even a peripheral view of the current state of affairs would find nothing surprising. Many doctors get their waiver, then use it for just a few of their current patients or not at all.
One surprising nugget was the 53 day median course of treatment, so only 1/2 the people treated got to at least 53 days.
They do state this was lower than expected 'given current clinical recommendations of maintenance treatment for up to 12 months and evidence linking longer treatment to better outcomes.' Just getting that statement in a journal such as JAMA is a step in the right direction. I wish they had said 'at least' instead of 'up to.' PAX


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PostPosted: Tue Sep 27, 2016 7:21 am 
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Well, one way of looking at the question is, was lack of access baked into the cake when the law was written. Maybe so, in some respects.

- It seems to be based on the neurological hypothesis of addiction, the idea that the drug itself should be sufficient for treatment, and the only training required, then, should be "dosage and how supplied." Ironically, I don't buy it.

- The original cap of 100 patients pretty much guarantees that a buprenorphine practice can't be a viable business model. I've often wondered if there's an element of self-sabotage there; it's definitely the mark of a polarized, or ambivalent legislature.

I'm actually probably qualified to speak to the business model; as for the theoretical basis of training, Dr. J and the other docs here are way more qualified than I am. All I can say is, I had good support in both respects (mentorship and business model), and I was always right at the cap.


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