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PostPosted: Fri Feb 12, 2016 10:56 pm 
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I hope I'm posting this in the right sub-forum...

I'm 20 weeks pregnant, and I've been taking Suboxone (Subutex since getting pregnant) for a few years now. I see my doctor once a month, and she writes me a script for 30 days worth. Generally she'll schedule my appointments on the 29th day so I won't run out (I'll then be able to fill the script the following day - the 30th day - without having to wait to see her - which is super helpful since she only has evening hours.)

I have not had any problems with my doctor or prescription - until now.

I saw her on the 14th of January. She wrote me a script for 30 days... and I assumed that as usual she rescheduled me for the 29th day (which would have been today). However, upon checking my appt card for the time this morning, I noticed that she rescheduled me for Monday the 15th.

Obviously this is more than 30 days... Monday will be 32 days since my last visit/prescription.

I think there was a mixup, perhaps the receptionist wrote the wrong date down on the card or just gave me the wrong appt day... because I received a voicemail (automated) this evening confirming my appointment for YESTERDAY - which would've been almost right on time... Once I realized that something was funky w/my appt date (and that I was going to run out of Subutex early) I started calling her office.

I reached her answering service twice, they said they'd relay the message to her. She only keeps evening hours, so this evening I actually drove to the office only to find that they were closed - and I still have not heard back from my doctor.

I will have no Subutex for the weekend, through Monday evening at 7pm... I'm concerned about stopping abruptly like that, especially while pregnant. I'm worried that withdrawal will harm my baby (not that I'm particularly looking forward to it myself!)

My question is - if I were to go to the hospital, could they write me a prescription to hold me over until I see my doctor Monday evening? Is this a good idea/bad idea? Any thoughts/advice would be greatly appreciated.


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PostPosted: Sat Feb 13, 2016 1:49 am 
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Welcome Lissarae,

This is another reminder to all that are reading this to ask your prescribing doctor who to go to if they are unavailable. Sorry, not picking on you but this has come up several times in the past. And I know you're kicking yourself for not looking at the appt. card right off. My guess is she's on vacation and put that date down to correspond with her absence. Or like you said, a mistake by the receptionist. Who cares now? What you need is your Subutex.

You didn't mention how much you are taking. About the only thing you can do is to reduce your dose enough to get you through to your next appt., that is if you have any left at all. Hopefully your Dr. will call back and fix it before you have any trouble.

The problem with asking the ER at the hospital is just not knowing if they will do it or not. We've heard it go both ways. I really wouldn't count on it until you're up against the wall. If they do, you'll only get one days worth and will need to return for the remaining two days.

Yep, you're between a rock and hard place. Call again and ask them to call the doctor because it is urgent. I can't say if it's going to be bad for the baby or not. Dr. Junig would need to answer that one.

Let us know what happens,

rule

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PostPosted: Sat Feb 13, 2016 3:04 am 
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Thank you so much for your response/advice.

Quote:
This is another reminder to all that are reading this to ask your prescribing doctor who to go to if they are unavailable. Sorry, not picking on you but this has come up several times in the past.

This is very good advice - I wish I had thought to do so when I first started seeing this doctor! (I'll be sure to do so in the future, that's for sure!)

Quote:
And I know you're kicking yourself for not looking at the appt. card right off. My guess is she's on vacation and put that date down to correspond with her absence. Or like you said, a mistake by the receptionist. Who cares now? What you need is your Subutex.

I am *absolutely* kicking myself for not looking at the appt card sooner. I've been going to this doc for so long, with the same procedure each month, that it never occured to me that my appt wouldn't be when I expected it to be. I'm guessing that she is on vacation, since her office was closed last night - but as you noted, it doesn't really matter why she's MIA or why my appt was mixed up - I just need to solve this problem!

Quote:
You didn't mention how much you are taking.

I'm taking two 8mg tablets of Subutex daily. Because I didn't notice the appt snafu until so late, after I had taken my second dose of the day in fact, I'm almost completely out (tomorrow - er, today, now - is 30 days since my last visit/prescription... when I would normally refill.)

Quote:
About the only thing you can do is to reduce your dose enough to get you through to your next appt., that is if you have any left at all. Hopefully your Dr. will call back and fix it before you have any trouble.

I'm hoping that what I have left (about 8mg's) will be enough to stave off withdrawal until I can get my doctor on the phone.. hopefully before Monday evening!

Quote:
The problem with asking the ER at the hospital is just not knowing if they will do it or not. We've heard it go both ways. I really wouldn't count on it until you're up against the wall. If they do, you'll only get one days worth and will need to return for the remaining two days.

Thank you for this information. I had read up a bit online, about the 3-day rule, etc... but wasn't sure if it actually worked in practice or only in theory. The only positive I have going for this potential plan of action is that I live literally down the street from the local hospital - going there daily wouldn't be a problem, but I don't want to have to go at all if I can avoid it. Just wanted to know if they would help me out if I continue to strike out with my doctor.

Quote:
Yep, you're between a rock and hard place. Call again and ask them to call the doctor because it is urgent.

The last time I spoke with the answering service and I explained that this is an emergency and that I needed to reach my doctor, they advised me to "call 911 with any medical emergencies" - which obviously was not really that helpful. I'm going to try again as soon as the answering service picks up in the morning, and just keep my fingers crossed that I can get through to my doctor - and that if not, my baby will not be adversely affected by withdrawal.

Quote:
I can't say if it's going to be bad for the baby or not. Dr. Junig would need to answer that one.

I would very much like a Doctors advice/opinion on the matter, if possible, as it's my chief concern at the moment (I had a miscarriage over the summer, and I am terrified of something happening to this baby).

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Let us know what happens

I will. Thank you again for the response and advice!


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PostPosted: Sat Feb 13, 2016 2:18 pm 
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Have you started seeing an OB yet? They can prescribe three days of sub without the waiver if they are willing.


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PostPosted: Sun Feb 14, 2016 6:39 am 
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Unless you are metabolizing the sub very quickly because of your pregnancy, you should be fine until Monday! Sub is a long-acting drug that stacks up in your system and you shouldn't feel any withdrawals before you get your next dose on Monday. Good luck and let us know how you do!

Amy

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PostPosted: Sun Feb 14, 2016 1:53 pm 
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Clarification: Several years ago I joined suboxforum ...I was dealing with an issue with my doctor at the time and needed to vent/get advice. When I came back to the forum on Friday, I registered *again* as I had forgotten that I already had a login name. My browser apparently has a far better memory than I, and must have logged me in automatically under the original screen name, which is why my last reply was posted under the name Sospirae. I will stop using that name and continue using only Lissarae - my apologies for any confusion!

docm2
Quote:
Have you started seeing an OB yet? They can prescribe three days of sub without the waiver if they are willing.

I do have an OB, and realized that they could have prescribed my subutex under the 3-day rule, however I was unable to reach them over the weekend.

Amy
Quote:
Unless you are metabolizing the sub very quickly because of your pregnancy, you should be fine until Monday! Sub is a long-acting drug that stacks up in your system and you shouldn't feel any withdrawals before you get your next dose on Monday. Good luck and let us know how you do!

I actually have been metabolizing the sub more quickly since the beginning of my second trimester, which was causing me concern that what I had remaining would not hold me until my next appointment. As it turns out, it was not an issue...

Update: I called my doctors answering service again, and was once again told that they would relay the message and that if it was an emergency, to call 911. I then searched online to see if I could find a different telephone number for my doctor, and while I was unsuccessful in that endeavor, I did, however, find an email submission form to contact her. To my surprise, she called me within an hour of receiving my email message (she had not, however, received my messages from her answering service).

It was indeed a mix-up, I was supposed to be seen on Thursday, but the receptionist accidentally put my appt in on Monday. My doctor called in a partial prescription to hold me until my appt Monday evening.

When I see her, I will be sure to take the advice given by rule62 and ask my doctor who to go to if she is unavailable. I will also be sure to check and double check my appointment cards from now on! Lessons learned!

Thank you all for your responses and advice!


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PostPosted: Mon Feb 15, 2016 11:55 pm 
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Wow-- it is good to read about something working out the way it SHOULD work out.

I can see how the mistake could happen, and I'm glad things worked out-- and I don't mean to point blame at the original poster for what happened. This post is just a good story for a few reasons, so I want to keep it 'active'... and I'll add a couple thoughts from the doc's perspective.

It is important for patients to have a general sense, as they near the end of a script, whether they will be 'OK' or not. We don't want patients hoarding meds--- but if a person ends up with an extra couple doses, for example from having an occasional day where a dose is forgotten, those extras should be locked up in a safe place, where no children (or adults) can access them, for use in such an emergency.

One of the most frustrating things is when a person has something happen that causes the meds to run out early... but instead of contacting me immediately, the person waits until they are all gone and THEN calls. At that point, there is little or nothing I can do. In almost all cases, if they called immediately I would have told them how to make them last longer and stretch out until the next appointment. Or if not that, I could at least have scheduled an appointment earlier. But so often I get the call late Friday afternoon, that 'they were taken from my car two weeks ago, and I just finished my last one.' That is not a good thing to do.

I see how the 3-day rule would work for buprenorphine, but most docs won't know about it, and won't use it. It's hard enough to get them to simply treat pain appropriately in buprenorphine patients, that I don't think many will have a clue about the DATA waiver, how to prescribe the medication, proper doses, etc. At some point THAT MUST CHANGE. I keep hoping for a couple high-profile lawsuits by patients on buprenorphine who sue ER docs for not knowing anything about buprenorphine products. After all, if a patient on coumadin was treated with the same ignorance, there would be consequences to the wallets of the docs involved, and also to the hospital system.

There are many rumors floating around about harm to newborns, neonates, or fetuses (feti?) caused by opioid withdrawal. If someone has a real study, leave the reference. Most of the concern about untreated opioid dependence during pregnancy stems from the risk of hepatitis, sepsis, hypoxemia (from near-overdose), and use of other drugs like cocaine (which is clearly linked to early labor). But I doubt that the mild opioid withdrawal associated with early buprenorphine clearance would pose a great risk to late pregnancy. There would be no risk, for example, to organ systems or brain function, provided the mom didn't take other drugs in an attempt to tolerate withdrawal. Again, I don't know if opioid withdrawal has truly been linked to early labor in real studies (I know it is mentioned all the time, in pseudo-scientific articles--- but many of those stories are simply rumors that get passed on from story to story). And even if opioid withdrawal IS linked to early labor, that would not be an issue in term infants, or in infants born up to a few weeks early. If the mom is past 37 weeks, I don't know of any likely long-term problems. As the post originally said though, the labor would likely be pretty unpleasant. From a dad's standpoint, though, can it really get much worse?!!

Glad things worked out!


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