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PostPosted: Sun May 01, 2016 12:31 am 
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So, I finally figured out the whole "government said you need counseling to get this medicine!" thing. After leaving one place that didn't take state insurance, only private or check/cash, I was on track to begin with a different place that said I'd need to go to two hour groups three times a week in addition to hourly monthly one-on-ones. At my last Suboxone doctor's appointment I spoke with one of the doctors about my situation, mainly that I've had so much counseling complete with certificates of completion without relapsing between that, even though there's some great tools to take from each experience, after awhile it's just regurgitated info over and over, and that I believe I'm doing fine with what I've already learned, etc. She advised me to come see their counselor they just hired and said they won't make me come all the time or jump through hoops, etc. So, this past Thursday I went to my 'assessment' and the guy was very cool. He recognized that it's silly to have a long-term, stable Suboxone client come to counseling so often, especially when those clients have no trouble with the law, or with friends or family and have a good job that they make okay money at and are pretty satisfied with how their lives are going as-is. One of the questions they have to ask is 'What do you want out of treatment?" I was like, "You know, that question would have been a lot easier to answer like seven or eight years ago. Now, I'd have to honestly say I just don't want to backtrack. I like my course going steady as-is, but, maybe just knowing there's someone to talk with if my life boat gets rocked too much, you know? That would be very helpful." Anyway, my assessment was only thirty minutes with most of as a 'get-to-know-each-other', and he told me that they understand how inconvenient it can be to ask long-term, steady clients to come to counseling throughout the week and month and said that as long as I'm continuing to do well that he has no problem with seeing me for a general check-in once every six months, which will keep the insurance people happy, and my doctor happy since the counselor works out of his clinic under his guide, so everyone's on board and happy. Another great thing about this is my insurance is paying for the doctor visits, the meds and the counseling and it's all out of one clinic, (save the meds part, they don't have their own pharmacy, but, that would be very nice; then I'd only need to go to one place every two weeks and every six months! lol!)

Anyway, I understand a lot of people might need more counseling, or less, everyone is different, but, I'm really happy not to have to worry about it; money, transportation, time, anxiety over speaking in groups, anxiety over not having anything new to 'work on' that week, etc, etc. If I do need to speak with someone I know I can just see my counselor any time. So, anyway, that's my good news.

Thank you!

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PostPosted: Sun May 01, 2016 11:33 am 
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I've met more addiction doctors who would benefit from counseling than many of my patients...

You are being gracious, Skayda, by saying that you've gotten something from each of your counseling experiences. I'd be surprised if most people felt that way. People tend to benefit from counseling when they have made the decision to change something about themselves-- not when the counseling is a hoop to jump through in order to get a much-needed medication.

Again, I think that your own attitude is healthy-- sort of like making lemonade out of lemons. But a more cynical view (like mine) holds that the people requiring counseling for all buprenorphine patients are either intellectually lazy or worse-- i.e. motivated by the need to fill appointment slots for their counselors. I'm even more suspicious of the latter in cases where they are all under one roof, as in your case. That seems like a huge conflict of interest to me. STARK laws prevent doctors from referring to any services that they have interests in-- and everything would look cleaner if patients were told to find their OWN counselor, not associated with the prescriber.


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PostPosted: Sun May 01, 2016 12:27 pm 
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Hi Skayda, that is good news and I hoped something like that would work out for you! I wish I had someone to "check in" with. I too feel the same as you do, I was in weekly counseling for years with someone I trusted and loved. I was at the point of checking in once a month when she relocated out of state. Since then, I have not seen anyone on a regular. When I was active in my pill popping, I started with someone and was lying to her about how much I was taking. We really did not click so I just stopped seeing her. That was about four years ago. Now, aside from my sub Dr. and here, I don't talk about my journey with anyone. Well, my amazing husband of course! NJ requires that the prescribing doctor discuss counseling and my doctor considers my being connected to this site and the occasional na meeting to be meeting the requirement. It is all working for me today! Thank goodness! Enjoy your day!


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PostPosted: Sun May 01, 2016 2:02 pm 
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Excellant subject and glad to hear you're finally figured it out. I'm not at all sure I have but am elated that I no longer have to. The first sub doc I went to was a lame brain by the book robot type that said he'd "help" me by getting me off the methadone and onto the subs but before doing so he rattled off a list of things he expected of me first. It was ridiculous. He wanted me to do the induction in a hospital setting which I didn't need. I as only on 10mg. methadone for about a year so it's not like I needed total round the clock care.

Then his wanted me to start doing out patient group therapy three times a week for the first 3 months and see how that goes.

I told him that I'd been in and out of rehabs, detoxs, NA. AA, sober living homes and groups, inner child workshops, retreats, and a gazillion other assorted other new age workshops in an effort to overcome my life long behaviors that are ultimately at the root of my life long drug seeking. I told him in all honesty I've done so much of it that it does more harm than good. I said to him, where it once was a life saver it now is a trigger.Which is absolutely true. Unfortunately he was unfazed and unwilling to compromise. If I wanted the meds I had to do the treatments; Needless to say I got up and walked out of the room in tears;

Thankfully I found a much better doctor a few weeks later. He's a gem and has saved my belief in humanity. He's not interested in making me do anything other than what I feel I need to do and it's clear to him I'm not in there to play games. When I told him I didn't like the films he was happy to change my script to the strait bup tabs. He doesn't need me to come in every month and so we're already at every other month and I'm sure eventually I'll be like queenie, every 6 months. As it should be for folks like us that can control our intake and not screw around with old drug seeking behaviour.

So yeah, if you get a doc that wants you to jump through hoops, if at all possible, find a different one right away. I know they're scarce but they are out there. Good luck to all.......megster

ps: sorry so long, I'm just very passionate about this particular subjext.....I hate it when doctors do more harm to us than good which is more ofthen than not!


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PostPosted: Sun May 01, 2016 5:37 pm 
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Hi, just wanted to chime in. I agree with some people not needing the counseling that is forced down our throats.

One of the reasons I stopped seeing my sub Dr was because of the endless meetings that seemed to do more harm than good for me. I did learn coping skills and how to deal with cravings. But when I left, all I could think about was pills and cravings. I couldnt move past it because I was always forced to talk about it. Every meeting was the same thing. How do you feel, any cravings, any triggers? Yes, these meetings are becoming a trigger lol. At one point we were actually coloring, cutting and pasting like we were in kindergarten. These meetings were a mandatory 2 hours, plus waiting for the dr after. Sometimes I would be there for close to 4 hours. Then I started to hear about the people there selling pills and I knew I couldn't go there anymore. That, and they would only fit me into one meeting a week, and it was right in the middle of work, and if I didn't make the meeting they held my script back. It was a constant struggle. If I don't go, I risk relapse...if I skip work, my family loses everything.

It got to the point where the clinic director screamed at me and belittled me for going to work. I have oil heat in my house and had to work, we were out of oil and freezing (it was december) and she made me feel like a first class piece of shit for it. She had me bawling in front of everyone. My dr there was wonderful and heard everything, so she understood why I had to leave. Great doctor, horrible staff and directors. Dr gave me a script for 2 weeks to taper and I stretched that out to 3 months and jumped. No other a office around me was accepting new patients and the ones that were had mandatory therapy...some up to 3 times a week. It's so frustrating.

Anyways, that's my terrible therapy story. Glad to be out of there.


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PostPosted: Mon May 02, 2016 1:02 am 
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suboxdoc wrote:
I've met more addiction doctors who would benefit from counseling than many of my patients...

You are being gracious, Skayda, by saying that you've gotten something from each of your counseling experiences. I'd be surprised if most people felt that way. People tend to benefit from counseling when they have made the decision to change something about themselves-- not when the counseling is a hoop to jump through in order to get a much-needed medication.

Again, I think that your own attitude is healthy-- sort of like making lemonade out of lemons. But a more cynical view (like mine) holds that the people requiring counseling for all buprenorphine patients are either intellectually lazy or worse-- i.e. motivated by the need to fill appointment slots for their counselors. I'm even more suspicious of the latter in cases where they are all under one roof, as in your case. That seems like a huge conflict of interest to me. STARK laws prevent doctors from referring to any services that they have interests in-- and everything would look cleaner if patients were told to find their OWN counselor, not associated with the prescriber.


Hey, Doc, thanks for replying! Anyway, I was pretty tired when I posted this, happy yet tired, having just worked three ten hour shifts in a row, so, I might not have been as coherent as I'd hoped, (that and often my mouth, or fingers if typing, have a hard time catching up with my brain. Lol. What I meant by getting something out of my past counseling experiences wasn't that each and every session brought with some jewel of unknown wisdom, I actually meant that the two six month periods altogether were pretty helpful at the time because at that time I'd never actually completed an outpatient treatment program on my own from my own choice. Honestly, I could have just stopped after I completed one program, but, it was close to the time after my younger brother committed suicide and I had a lot stuff to work out with that so I asked if it would okay to do another six months, basically do the entire program again, but the facility I went to at the time said that was that, I finished, goodbye. So, I sought out another program. In retrospect I probably should have sought grief counseling instead. After finishing the second one I started to realize it's all stuff I'd just learned before with maybe a few new little wisdom tidbits thrown in. The majority of my time in those counseling programs was pretty much a waste after I'd pretty much learned all the stuff about coping skills and triggers, etc. etc. I joked about it with the counselor I met with last week by saying that I have boxes of chemical dependency paperwork from old group sessions, etc. After awhile it feels like they're trying to either trigger you to use with all the talk about triggers and cravings, (like one person here put it!), or brainwash you into a new addiction; counseling/therapy addiction. There actually is such a thing!

It's true about making lemonade out of lemons. I had no idea about that law, but, I don't know, after going through so much trouble to find something that makes everyone happy; insurance, doctors, myself, I'd hate to rock the boat, so to speak. I just hope it will continue to work out. A session with a counselor for thirty minutes every six months is exactly perfect for me at this time in my life and recovery.

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PostPosted: Thu Aug 04, 2016 1:40 pm 
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Since when are we suppose to go thru counsoling in order to continue this drug?

I read the rules once in my doctors office...and it didnt say anything about counsoling untill you had failed on or two drug tests.
I think the first fail is that you must do 2 a month and no 1 like usual for 6 months....then second fail you must get counsoling. and then the 3rd time you need to go to counsoling and get into a drug program, and then if you fail again you are kicked out of the program and a report is sent to the DEA.

I been with the same sub doc since september, and I got in trouble with the law and relapsed.
so the judge is the one or ordered me to go to counsoling and drug treatment program..
but i now realize the the doc always asks me where im going for treatment....and he hadnt asked before....so this rule has to be recent


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PostPosted: Thu Aug 04, 2016 8:11 pm 
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It isn't a rule, but if some people had their way, it would be. In order to get certification to prescribe buprenorphine for addiction, doctors have to attest to being able to provide or refer for counseling 'if counseling is indicated'. But nobody seems to put much thought into the type of counseling that might be helpful-- or if 'counseling' means seeing a person each day, each week, or each month!

I'm generally against having the government regulate medical practice. When the government becomes involved, illnesses like addiction are the first to fall under regulation--- because no news anchors are going to interview opioid addicts who are angry about the limitations on their physicians. If the government started by regulating women's health-- for example saying that oral contraceptives cannot be prescribed unless women have mammograms--- there would be a huge outcry.

It is interesting that historically, the first attempt of the Federal Government to control medical practice was the Harrison Act-- which went all the way to the Supreme Court. I just realized the irony right now--- the Feds prevailed in the Harrison 'Tax' Act decision by claiming they were not regulating medical practice-- they were passing a TAX. The Harrison Act taxed doctors out of existence if they treated opioid dependence using opioids-- pushing physicians out of addiction treatment for the next 100 years. How ironic that the Supreme Court decison about Obamacare passed on the basis of the ACA being a 'tax', within the Constitutional rights of the Federal Government.

History certainly repeats itself!


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