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 Post subject: New doc
PostPosted: Fri Jan 11, 2013 4:14 pm 
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Hello, I am joining a new practice and will be prescribing Suboxone. I have been to several forums and liike this one best. This is my semi-retirement plan. I have read many of your stories and appreciate the sharing that goes on here. I am picking up lots of tips that are not covered in the 8 hour course or textbooks. Hope it is ok if I pop in and ask questions occasionally. My prayer is that I not end up in one of the dr horror stories. Not in substance recovery but have been on both sides of the therapeutic relaionship having dealt (dealing) with PTSD.
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PostPosted: Fri Jan 11, 2013 4:56 pm 
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Don't prescribe 32mg a day. Or 16. You're ready to be a doctor! ;)

Where are you going to be practicing, why do you want to prescribe suboxone? If you feel uncomfortable being around drugs from PTSD I might suggest not prescribing suboxone as a retirement plan.

That's only my opinion though!


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PostPosted: Fri Jan 11, 2013 7:49 pm 
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Want to be Free:
Thanks for the tip, the current training is to start induction with 8 mg the first day and expect stablization at 12 - 16 mg a day.
Well supported here from what I have read.
My PTSD is from my time on deployment with the Army, ironic as I was the Division Psychiatrist. Over the years I have appreciated the challenges and personalities of patients also in recovery. Many of you dealing with issues of pain also must deal with depression and anxiety. I will be associating with a pain clinic, managing the psychotropics and sub for referred patients. The docs in the clinic are procedure oriented and hope I can fill a need in their practice. At this time the clinic does not have any people on sub for dependence only but dependence and pain. I am hopeful we will be able to expand in the future to do this, we will see in a few months.
I realize this is a suboxone forum and will look in old threads to see if it is covered; but has anyone found therapy, particularly CBT helpful in reducing dosage or managing symptoms? In my regular practice I have found it to be key to getting to full remission and wonder what the experience here has been.
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PostPosted: Fri Jan 11, 2013 8:54 pm 
Hey docm. I was diagnosed with PTSD just a couple months ago. I served in 1/16 Infantry division.. Big red one! I got honorably discharged last september and just got a 30 % disability rating to. So i was happy to get that. Also, i am on suboxone and the VA gives me ativan every month. So i know what it's like to deal with PTSD. But, i take a low dose benzo aswell. So i am tolerate to both. My advice is to not freak out and turn away patients who are on benzos. Damn afghanistan wrecked my nerves when it comes to fireworks, loud booms, hell even doors slamming close give me serious jolts and waves of panic and almost like a adrenaline rush and tunnel vision. Kinda like being programmed to respond a certain way. (muscle memory?) Hehehe. You must have been a officer in the Army? What unit where you with? What is your rank at seperating? I was a specialist/E-4. Thanks doc. And i bet prescribing suboxone will make some quick cash... Sadly, at the expense of people who are desperate and on the verge of O.D'ing, suicide, or other serious mental illnesses. It's going to be tough.


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PostPosted: Sat Jan 12, 2013 12:54 am 
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Will430 THANKS for your service. 30% sounds kind of low, I would get with your county service officer and try to get it bumped. CBT (cognitive behavior therapy) was the most helpful treatment I have had dealing with the fight/flight response. Meds have helped but I think create a platform for therapy to be more effective. Time has helped as well. I was a remf except a couple of times got caught up in business I shouldn't have. I was with the 34 I.D., a National Guard Division. I was in 23 years and had many great experiences but also some challenges. People tend to be soft and squishy around helicopters and tanks that crash. But back to my original thought, if you are on suboxone, I assume for chronic pain or post trauma dependence? If that is the case you should be able to make a strong appeal for 100% which opens the door for other benefits.
Oh, the fireworks get better, I went this year and didn't end up in a fetal position like I did 7 years ago.
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 Post subject:
PostPosted: Sat Jan 12, 2013 2:43 am 
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Welcome docm to the forum.

I think it's great you are researching suboxone and not just going with the 8 hour class. Thanks for choosing to work with us addicts. We are not an easy bunch.

I am an RN being monitored by my states impaired nurses program. I am grateful my state (WA) allows me to work as a nurse while taking suboxone. So I know from both sides how difficult it is to treat addicts.

My sub doc is great. I like how he does not rush me in and out. I take a UA every time I go and he requires me to attend some type of support group. He believes sub is a tool, not the cure. He also allows me to have input on how long I want to be on sub. He is not rushing me off so he can replace me with a new patient.

As for CBT.......We have just started to talk about it in my outpatient group. I will report what I think after our next meeting.

Feel free to pop in here whenever you want. We love to have new people and I'm sure many will be interested in your opinions. We don't hear from prescribers often. And Dr. J who owns this forum is super busy saving the world from addiction!


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 Post subject: Treatment of Addicts
PostPosted: Sat Jan 12, 2013 3:02 pm 
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Hi Docm,


Welcome to our forum! The only thing I would add is to not just go by the training you received but by the experience you have read here from our own addicts. A lot of them have complained about being prescribed too large of a dose after induction. The only people who warrant 16 mg's of Buprenorphine would be those that have very high tolerances to opiates like heroin users, oxycontin, etc.

My own Dr. prescribed 24 mg's for me when I only took Hydrocodone as my drug of choice. Yes, my tolerance was high but I would have been very happy with 4-8 mg's. Within a month or two I had dropped down to 8 mg's on my own accord. So please look at what they are taking. The best system of success we've seen is starting on a low dose and working up until the patient feels okay. The vast majority will function just perfectly on doses much lower than what you were told in training.

The best thing you can possibly do is to read as many members posts here on Suboxforum.com. If you have any medical questions regarding treatment I suggest you contact our own doctor, J. Junig, MD. We are only addicts and pain patients giving opinions.

Welcome once more,

Rule62

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 Post subject:
PostPosted: Sat Jan 12, 2013 5:23 pm 
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Thank you for coming here and considering what we have to say! I can tell that you won't end up in Dr. horror stories, because you already understand that you need more than just an 8 hour class to be a good suboxone doctor. I think you will be an asset to our community here!

I love my sub doc and here are the reasons why: He is a family practice doctor as well as a sub doc so it doesn't feel like I'm walking into some drug clinic, just a regular doctor's office. He accepts my insurance. He doesn't talk down to me. I can talk to him about current suboxone research like a colleague. He isn't pressuring me to stay on sub or taper off sub, but letting me take the lead. He is very knowledgeable about how to treat post-operative pain in suboxone patients. These are just some of the things I thought of. I'm sure there are more.

I wish you the best of luck in starting up your suboxone practice!

Amy

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 Post subject:
PostPosted: Sun Jan 13, 2013 6:08 pm 
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Rule62 I can't agree more. I was on a 200mg oxy a day addiction and 8mg was A LOT. Stabilizing at 12-16 is really high. Really high. Super high. Your doctor should lose his license for that 24mg a day script. Hah.

WTBF


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PostPosted: Sun Jan 13, 2013 10:31 pm 
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Thanks for the replies and warm welcome. I have read a lot of threads in the induction area and others. The complaints about high doses have been heard by the people setting up the training. Now we are to start with 2/.5 and maybe work up to 8/2 in the first 24 hours. One of my standard questions near the end of a med check has been to ask what do You think we should do? How about family? Then see if my plan can mesh with their needs. I have seen a much higher failure rate when we are not on the same page. Most psychiatric drugs, particularly for depression/anxiety have a high placebo rate and I want to tap that as well.

I really liked the thread where several people responded on why they like their sub doc.

During my training I managed the intake/inpt detox/treatment unit. We were given the option of full participation on top of our duties. So in addition to the evals, daily checks and whatever else went with managing a unit as a second year resident I also went to the groups and had a CD counselor. I took all my meals and slept on the unit as well. It was quite helpful. I met with my personal therapist daily that month to deal with the boundary issues, transference/countert that came up. It was enlightening, fulfilling and a great growth experience. I was dancing with alcohol, defiantly binging but had not progressed to dependence and perhaps I never would have but it sure helped. It definitely sensitized me to the stigma, no longer would I let my colleagues call it the 'wine cellar'.
PAX


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 Post subject:
PostPosted: Mon Jan 14, 2013 11:42 pm 
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docm wrote:

I really liked the thread where several people responded on why they like their sub doc.




I've been seeing my suboxone dr. now for 21 months.... (today, is 21 mos actually) and at the end of every visit
he says,
"is there anything else i can help you with today, amber, anything on your mind?"

for the last 8 months, maybe more, I've said,
"thanks for saving my life, doc"

without skipping a beat, he always says, "well I couldn't do it without you here"

I can tell, it helps him though. to HEAR IT. it helps him in SOME small way be able to put up with
some of his "other" patients......
and I USED to be one of those "other" patients, in the start,,, in the begining, I used to think
"well this guys' the biggest asshole I ever met, this just ain't gonna work out"
LOL

it makes me so sad to hear the horror stories on here,of people being "dropped" or being turned down for
not having any money, or enough money..... it just sucks.
I'm really lucky to have such a great dr. especially since there are only TWO in about a 80 mile radius....

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its the easiest thing in the world to do, but to
hold it together, when everyone would understand if you fell apart
That's TRUE STRENGTH
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 Post subject: Get a cell
PostPosted: Fri Jan 18, 2013 11:51 am 
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The best thing about my Doctor is that he is AVAILABLE. He has a cell phone set up for his buprenorphine patients and checks the messages a few times daily, returning calls personally. He is a cash pay Dr. and his feeling is that for the amounts of cash people are paying him monthly he is essentially on retainer for them should any medical issues related to their suboxone or other medications he is managing come up. I'm sure there are some people who abuse it and hassle him if they stub their toe, or their 'meds fell in the river while fishing, ' etc. I personally have only used it a handful of times for serious emergencies or to simply leave an important message keeping him in the loop regarding important medical issues he needs to be aware of. If that's a possibility for you, I'd highly recommend it! Cell phones and plans are cheap and pay-as-you-go these days, just sayin.

Travis

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 Post subject: You Made My Day
PostPosted: Fri Jan 18, 2013 3:12 pm 
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DOCM,

Reading what you've researched and experienced in your quest to treat addiction totally makes my day. We don't often get a Suboxone physician on our site asking questions. More often than not when we talk to our doctors about something they should know we are mostly ignored or told that it isn't correct. Most of the time it's been about dosing quantities and just how strong this drug really is.

Years ago we were constantly told that we would feel very little discomfort if we stopped at 2 mg's. When I told my wonderful doctor that Suboxone makes me very sleepy I was told it must be something else. He knows better now.

It is delightful to know that future addicts seeking help just may find a doctor like you to correctly guide them into recovery.

Thank You for your compassion.

Rule62

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PostPosted: Fri Jan 18, 2013 7:06 pm 
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Thanks Travis, gave out my phone # to my first patient today. Will induct next week. My other was already on 32 mg a day, UA was + for cannibis, three different benzos and cocaine. Didn't except her and referred her to inpatient treatment. Out of our comfort zone.
I have read a lot of old threads. I am not docnusum in disguise. I think collectively you would have picked up on it very quickly but in spite of being burned you welcomed me. This is quite a community and much, much better than any PDR or textbook I have found.
PAX


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 Post subject:
PostPosted: Sat Jan 19, 2013 1:48 am 
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docm wrote:
Thanks Travis, gave out my phone # to my first patient today. Will induct next week. My other was already on 32 mg a day, UA was + for cannibis, three different benzos and cocaine. Didn't except her and referred her to inpatient treatment. Out of our comfort zone.
I have read a lot of old threads. I am not docnusum in disguise. I think collectively you would have picked up on it very quickly but in spite of being burned you welcomed me. This is quite a community and much, much better than any PDR or textbook I have found.
PAX


[marq=right] *******GOLD STARS FOR YOU!!!!!******* [/marq]


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its the easiest thing in the world to do, but to
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That's TRUE STRENGTH
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 Post subject:
PostPosted: Sat Jan 19, 2013 8:24 pm 
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Haha...I think everyone who was around for the Docnusum nightmare thought you might have been his new screenname when you first came around. I know I did! It's difficult to tell on a message board as people can be whoever they want to be.

So the client who was already on 32mg Suboxone, cocaine and three benzo's? Was she willing to titrate down from three to say one benzo? Assuming they're Dr. prescribed, I guess. RX Monitoring should help if she is getting them from different Dr's; depending on where you are that could be run. Then Cocaine use could be looked at from a harm-reduction angle. If she continues to test positive for cocaine then her visits to your office and doing UA's should become more frequent. Tell her that after a clean UA she can get X amounts of take home doses. If she fails again, same thing. Just because DATA allows for monthlong takehomes and refills it's at a phycicians descretian to determine what their clients needs are. If they need treatment somewhere between a methadone clinic setting and your office setting that could likely be arranged..

Travis

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540 Greenhaven Road #201|Anoka, MN 55303
(763)250.0702
http://www.facebook.com/TpnServiceCompanies
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