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PostPosted: Tue Jun 28, 2016 10:19 am 
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My doc has been trying to get me into his IOP but I am not interested. When I first started taking the zubs, he made it sound like I had to do IOP in order to get zubs. The next day he said he was sorry for the confusion and that I do not have to join his IOP to get zubs. Now that I am one day from finishing his induction program, he talked to me about the IOP again. I told him I wasn't interested AGAIN.

He said, "You know, federal law requires that you do IOP to be on this medication." I feel duped b/c I can't get off this stuff without his help, and I don't think he's telling the truth.


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PostPosted: Tue Jun 28, 2016 12:28 pm 
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Hey Serenity.

I know I'm gonna have a "duh" moment when u tell me, but what exactly does IOP stand for? Is it like an outpatient thing or group thing or what? Sorry I know I should know what ur talking about but I don't lol.

If it is an outpatient thing, why are u against going to it (if that's what it is)? My clinic requires suboxone meetings, which are held at the clinic's meeting room. If ur weekly then u have to attend meetings once a week, if ur biweekly then u attend a meeting once every two weeks and if ur monthly u have to go to at least one meeting a month (u can attend as many as u want but those are the required amount). It's actually a great thing and gives ya a chance to discuss with others just like urself. I don't know if it's a law or what though, hopefully Dr J or someone can answer that for ya.

I won't go into anything else until u tell me exactly what IOP stands for lol it could be something completely different than what I'm thinking it is :)

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PostPosted: Tue Jun 28, 2016 12:36 pm 
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It is Intensive Outpatient Program...3 nights per week @ 3 hours each. M,W,F. I can't do that b/c I work some nights and my spouse is ill and I am the sole caregiver.

I just think the doc is lying when he says federal law requires that I do this. I do 12 step and I am open to counseling, but not 9 hours a week in addition to my job and my caregiving responsibilities.


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PostPosted: Tue Jun 28, 2016 1:04 pm 
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I've never heard of having to go 3 hrs a night 3 nights a week. The old program my ex went to was once a month one hour group session. And the dr did say he was required to do this, not sure if that's true or not tho.


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PostPosted: Tue Jun 28, 2016 1:11 pm 
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Omg 3 nights a week at 3 hrs each?? I've never heard of that much honestly! I'm not person that's familiar with the laws on suboxone, but I'd go out on a limb here and say no...I can't see it being a federal law. If it was a federal law then why isn't everyone required to do it? Yeah that's a lot so I totally understand that being an issue. Even ppl who don't work would have a hard time with that kinda schedule. I hope Dr J or docm2 can shed some light on that "law".

Regardless if it's a law or just ur doctor's rules, it looks like ur going to either have to go with it or find another dr. Because even if it's not a law, he's still gonna enforce the rule so what are ya gonna do? Is there another dr in ur area that u can switch to? Maybe u can go to the dr u have now until u can find another one. Maybe it's like my clinic and the longer ur there, u get to go longer between appointments. I can't imagine someone who's been there for a yr still going 3 times a week at 3 hrs a pop....dang that's way too much and I can't blame u for not wanting to deal with that.

I was so desperate by the time I entered suboxone treatment that I'd probably went ahead and done all those days but not if there was another option or doctor in the area. So I guess my question for u is, what're u gonna do?

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PostPosted: Tue Jun 28, 2016 1:59 pm 
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It is not Federal Law. It can be a clinic rule. We do that. IOP for 10 weeks, then LOC (low intensity) for 10 weeks. But, it is made clear during orientation prior to seeing a Suboxone provider. You may choose to seek care elsewhere if we don't meet your needs.
Please don't castigate me for the clinic rules, I don't write them, but I do abide by them.


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PostPosted: Tue Jun 28, 2016 4:38 pm 
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Serenity,
I can totally understand your scarce time availability w work and care giving. You have a lot going on. I am glad you made the decision to start bup. It made all the difference for me - was the only way I could get my life back. Would your bup doc be open to a less stringent schedule? I have to wonder if all bup folks can really adhere to 9 hrs/wk for weeks and weeks. I guess if you have a choice to go to anther bup doc then you might have to consider that...

To Dr. J, docm2 and other posters both here and on other threads, we often discuss whether counseling helps. Wondering if this recent study might pertain. 42 mos long w 653 bup users. It says counseling IS effective for people receiving office-based buprenorphine treatment. It does not say how the counseling was delivered. Perhaps it includes folks that completed the short term IOPs or required ongoing counseling like jennjenn's clinic does? Thoughts?

http://www.psychcongress.com/article/in ... quit-27836

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PostPosted: Tue Jun 28, 2016 10:17 pm 
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Serentity, the first Bup ( psyche ) doc I went to was like yours. He insisted I go to an IOP program much like the one your talking about. 3 months, 3 nites, and 3 hours. Not only that, I would have to pay for it, or the co-pay. I was crushed because I needed the meds and he held them over my head saying he would not dispense them unless I complied. I told him I'd been through countless IOP's and did not feel it was what I needed but he would not bend.

Thankfully he was not the only psyche doc that had the DATA cert. under my health plan. I quickly found and went to see a different doctor and he was like night and day compared to the other. He just gave me what I needed and didn't ask me to do anything. He doesn't make me come in every month either. He'll write for refillls and I only have to go in every few months.

This tells me that it's not the law. It's not federal policy. It's at the doctors discretion and many don't understand addicts or treat us well.

Find a different doctor!!! Ditch that other loser!! best of luck.....megster...san diego, ca.


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PostPosted: Thu Jun 30, 2016 8:51 am 
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I went to Arrowhead Behavioral Health in Maumee, OH and is where I still go for my suboxone. It is the best rehab/mental health facility in all of Toledo area. It is expensive but a nice place and their programs are so great and helpful. When you get out of inpatient stay (only if you are on suboxone) you HAVE to do IOP... at least by the clinics rules, idk if its a law but I doubt it. It is SOOO expensive but if you are lucky your insurance will cover some or most. Mine covered I think 4 weeks only, out of 6, so they let me stop after those 4 weeks because of how expensive it is. We did Tuesday Wednesday & Thursdays, 6-9pm for 6 weeks straight. Then you have to go to relapse prevention meetings every Monday for 2 hours, for 12 weeks long. That one was free. Even though it was 2 years ago, IOP helped me SO much. You learn soo much and it really is beneficial for anyone in recovery, regardless of how many days, months or years you have clean. I'm sure u have heard this plenty of times before, but you have to put your recovery first... I know it sucks sometimes but it has to come before everything if u expect to stay clean, even before your loved ones sadly. So if that is what your clinic requires to stay on subs, and it is going to help you, then u just gotta suck it up and go. Good luck to you!

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PostPosted: Thu Jun 30, 2016 8:54 am 
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Oh yeah and end of august will be 2 years clean/on subs for me, and in order to stay on suboxone it is required by the clinic that you must go to three 12step meetings per week! So it could be worse.

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PostPosted: Thu Jun 30, 2016 12:28 pm 
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I'm so glad that I can be a little bit absent for a couple weeks and know that you all are doing just fine without me! Great responses everyone!

Amy

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PostPosted: Thu Jun 30, 2016 1:31 pm 
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Jess1208 everyone is not like you. Serenity, and myself are talking about being forced to do IOP's when it's not something we feel necessary " anymore". After 25 years of addiction which includes going to IOP's often, sometimes the IOP's or 12 step programs in general become "triggers" to bad feelings rather than helpful. I've heard this a lot and I myself have this experience. Whenever I go to meetings it triggers traumatic memories of a long painful protracted fight against this disease. Those memories can't be controlled so often the 12 step ( big part of IOP's ) programs become an uncomfortable unsafe place to be.

They absolutely saved my life in the beginning of my journey to sobriety. But I realized after several years of forcing myself to keep going to them even though I was clean, that they were having a negative more than a positive effect on me. I spoke to my addictionologist and she said this is common so I didn't feel bad about giving the meetings up. I found other things to take their place.

I don't think it's smart of healthy to try to fit all of us in a one size fits all programs. We're not all the same.

Glad it works for you.......


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PostPosted: Thu Jun 30, 2016 2:18 pm 
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That's not what I was saying, I just said if its something that is required by ones clinic to stay on suboxone, then they should probably just do it... its not worth getting kicked out in my opinion. I used to like NA meetings at first too but now not so much and yeah it sucks being forced to get stamps but if its something I have to do to stay out of active addiction then I will do it. It is so easy for addicts to slip back into our old familiar ways I think the clinics that force meetings are just trying to weed out the people who are not serious about their recovery/selling their subs.. things like that. Some places accept programs from a church service, Individual/family/spouse counseling or seeing a psychiatrist instead of a 12step meeting stamp so if one of those interests you more than meetings you should ask your doctor/nurse if you can do those things instead. In a way I feel the meetings help to remind me of how shitty active addiction really was. and seeing other recovering addicts regularly can make some people feel hopeful.

I didn't say all addicts are the same and that we all like/dislike the same thing... no two recovery stories are exactly the same. I was just saying that if its what he has to do in order to stay prescribed to suboxone it should probably be done.. for the sake of staying out of active addiction. Suboxone doctors are really hard to come by most of the time, not accepting new patients or only doing detox/induction I imagine it would be really hard to find a new suboxone doctor if I ever wanted to get a different one.. And I would assume most suboxone doctors require things like this, for our "own good". I consider myself very lucky to be on suboxone. I will clarify again by saying this is all just MY OPINION :)

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PostPosted: Sat Jul 02, 2016 5:57 pm 
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IOP is not mandated by law. You Dr. has to decide what if any counseling or IOP you need, and will not RX if you do not comply. Many Drs just make all of their suboxone patients do IOP. The only way I can see to avoid IOP is to come up with your own plan and present it to your doctor, maybe something like 12 step meetings plus individual counseling and perhaps seeing the Dr a little more frequently for a while. If you have been through treatment before, some outpatient tx providers offer a less intensive relapse prevention group. Those programs are typically once or twice a week for maybe two hours. Personally I liked IOP, but I understand that you have other obligations. Good luck.


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PostPosted: Sat Jul 02, 2016 8:25 pm 
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Pelican, I read the article about the counseling study several times-- and I cannot find any results! Am I missing them? The study suggests that people getting counseling do better.... but that data is not in the story. I'm looking for a comparison between people WITH counseling vs. people WITHOUT counseling.. I would go to the study itself, but the article is from a poster session.

What are the results?!

As for the original post, there is NO FEDERAL LAW that requires counseling for buprenorphine patients. Doctors have to be able to provide or refer for counseling if it is indicated-- and that is up to the doctor to decide.

I describe Obama's executive order to raise the cap on buprenorphine: http://suboxonetalkzone.com/obamas-lousy-suboxone-offer/

Under Obama's 'lousy offer', all people on buprenorphine products would have to be in counseling. I will just keep the 100 patients I have, rather than jump through all of the hoops that he requires.

There may be a state that requires counseling.... but there definitely is no Federal requirement.


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PostPosted: Sun Jul 03, 2016 4:32 pm 
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Dr J!!

Thanks for your question. I think we need your expertise to suss this out. I provide info below to help. After reading it all, I don't see where there IS any data to show counseling is effective and I can not explain the Reuters Health news release that prompted my earlier post. Here is the news release which I saved but cannot provide a link to it bc when I go back and search Reuters to link it here, its not there. If you are a registered member on medscape, it does show up there.

Reuters Health Information
Individual Counseling Helps People Dependent on Prescription Opioids Quit
By Lorraine L. Janeczko June 22, 2016

June 22, 2016 NEW YORK (Reuters Health) - Patients dependent on prescription opioids are likely to quit if they get individual drug counseling with their prescribed medications, according to long-term follow-up results.

"Medication-assisted treatment for opioid dependence benefited people who were dependent on prescription opioids. Good standard medical management, medically based counseling, can be effective for these people if given in conjunction with buprenorphine treatment," said lead author Dr. Roger D. Weiss, professor of psychiatry at Harvard Medical School in Boston and chief of the Division of Alcohol and Drug Abuse at McLean Hospital in Belmont, Massachusetts.

"Over time, with treatment, these patients have relatively optimistic outcomes, but there are a number of risks involved, including people shifting from prescription opioids to heroin who had never injected drugs, injecting them, and a higher death rate," he told Reuters Health by phone.

Dr. Weiss and colleagues examined the outcomes over a 42-month follow-up period among adult participants in POATS (the Prescription Opioid Addiction Treatment Study), the first long-term multisite randomized trial to investigate whether outcomes for patients dependent on prescription opioid analgesics can be improved with standard medical management by adding individual drug counseling to prescribed buprenorphine (combined with naloxone to prevent withdrawal symptoms).

The researchers enrolled 653 participants at 12 medical centers in nine states through the National Institute on Drug Abuse (NIDA) Clinical Trials Network. They examined the results at four and 12 weeks and conducted follow-up assessments of opioid and other substance abuse through telephone interviews with 375 patients at 1.5 years, 2.5 years, and 3.5 years from study entry.

At 1.5 years, most follow-up participants no longer depended on opioids, and at 3.5 years, fewer than 10% of them were opioid dependent. Patients who reported a lifetime history of heroin use at study entry were more likely to be opioid dependent at 3.5 years (odds ratio 4.56, p<0.05).

At 2.5 years, 61% of patients reported that they had abstained from opioids for one month. The roughly one-third of the sample who received opioid agonist treatment during follow-up were more likely to be abstinent at month 42. Even so, 27 (8%) of 338 patients used heroin for the first time during follow-up and 10.1% reported that they had injected heroin for the first time.

The results were presented in a poster May 16 at the Annual Meeting of the American Psychiatric Association (APA) in Atlanta, Georgia.

"Prior to this study, there had never been a study of treatment in people dependent on prescription opioids. There had been many opioid-dependence treatment studies, but they had all focused on people who exclusively or primarily used heroin, and most were done in methadone maintenance programs. This was the first study done with people receiving office-based buprenorphine treatment," Dr. Weiss told Reuters Health.

"A real strength of this study is that it was very large and included a mixture of urban, suburban, and rural sites. No other study has looked at even 100 people," he added.

Regarding future related research, Dr. Weiss told Reuters Health that it would be good to learn exactly which people do well over time and how to increase their success rate."

The authors reported no funding or disclosures.
SOURCE: http://bit.ly/28MTqd6
APA 2016.

As a result of your data question, I looked up the Prescription Opioid Addiction Treatment Study (POATS). These 3 articles are what came up on pubmed, which, given all your research, you've already read, but for completeness sake, I'm including them here. I see no data to show counseling IS effective.

2011 POATS says "the addition of individual opioid dependence counseling to buprenorphine-naloxone plus medical management did not improve opioid use outcomes.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3470422/

2015 POATS 18 month follow up. Check out section 4. Discussion, paragraph 9 and 11 "Although drug counseling, as delivered in POATS, in addition to medical management, was not associated with either short-term or longer-term outcomes, alternate models of behavioral treatment may fare better."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4250351/

2015 POATS 42 month follow up does not mention counseling.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4407806/

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PostPosted: Tue Aug 23, 2016 12:01 am 
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docm2 wrote:
It is not Federal Law. It can be a clinic rule. We do that. IOP for 10 weeks, then LOC (low intensity) for 10 weeks. But, it is made clear during orientation prior to seeing a Suboxone provider. You may choose to seek care elsewhere if we don't meet your needs.
Please don't castigate me for the clinic rules, I don't write them, but I do abide by them.


Dang... I'm lucky I bypassed all of this! I did 40 days of inpatient, another period of time of outpatient treatment and I'm not willing to do more. NOW... if I kept relapsing or if it became necessary then I would.


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PostPosted: Thu Aug 25, 2016 11:35 pm 
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Pelican, not sure if you are still following this thread--- but I appreciate the info you chased down. I want to say, first of all, that I have great respect for the work of counselors, and I realize that a patient can benefit immensely from a good therapeutic relationship with an addiction professional.

But the results provided by Pelican are examples of the messy science that comes from addiction societies. If the American Society of Anesthesiologists had officers talking about the need to have a dead squirrel next to the head of patients undergoing anesthesia, anesthesiologists would create an uproar and demand to see the evidence. Maybe the comparison is a bit far fetched.. let's say that the anesthesia society experts claimed that nurse anesthetists teamed with anesthesiologists provide better care than anesthesiologists alone. If they did, there would be calls to 'prove it'. Frankly, other areas of medicine have academic rigor that would prevent any comments that were completely unsupported by data, so it is hard to find a good analogy!

In the addiction world, there is a constant mantra that 'of course counseling is necessary'. Yet the studies that I've read show the opposite-- that nobody has been able to show that the counseled group did any better than the med group alone (with buprenorphine). It is fine to keep the counseling available for people who want it. But withholding medication to people who don't get counseling is ridiculous. And along the same line, Obama adding language to the cap increase, requiring that the cap can be increased on if doctors are providing counselilng, is a feel-good measure that only limits the choices of doctors and patients. It reminds me of his smug comments 7 years ago about the now-failing Affordable Care Act, when he said that 'if the green pill works better than the red pill, the government is going to pay more to the doctors who use the green pill instead of the red pill.' All of those mid-level government staffers know better than your doctor, and will now be 'helping' your doctor make the right decision.

Wow-- must be getting close to an election.


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PostPosted: Sat Aug 27, 2016 12:13 am 
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Yes, still following this. I read the Reuters article and took it at face value, that counseling helps. I was satisfied w that until you asked for the data, so I went looking for it in the POATS studies.

I was shocked bc while the Reuters article says the POATS studies show counseling helps -- the studies actually said the opposite -- that it did not. My frustration then became why did the lead study author clearly tell the Reuters reporter counseling helps -- when his own studies show it does not... ....Head shaking...

Pelican

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PostPosted: Sun Sep 18, 2016 5:28 pm 
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Hi Serenity,

Depending on where you live (State if in the USA), then your doctor may be required by federal or state regulations to perform a follow up or to provide complementary services during and post the prescription of the suboxone.

Your doctor is required to adhere to several regulations in order to maintain his license or ability to prescribe suboxone. This is why there is such a variety of answers among suboxone patients on what their doctor requested of them. Then there are doctors who required nothing and simply prescribed...this could be that they may live in a state where there is no regulation for during or after care such as counseling.

C


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