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PostPosted: Thu Aug 08, 2013 12:37 am 
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I have been with my suboxone Dr. For years and he said the DEA is making all his patients sign new contracts. We are no longer able to change a monthly appointment time once it is scheduled. We also can not see the doctor before 28 days from our last appointment . I travel with my job do these new rules will devastating . Has anyone heard of the idea cracking down on appointment scheduling or is my Dr lying???


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PostPosted: Thu Aug 08, 2013 2:53 am 
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It is a shame that that the physician would still require a long term maintenance patient to continue with monthly appointments. For what? This is a chronic disease. If I choose to stay on buprenorphine to maintain dopamine tone the rest of my life, then why in the world would I need a monthly appointment? I have this crazy disease that isn't miraculously going away because "I don't like being addicted to Suboxone". My physician knows this and I schedule an appointment once or twice a year a most. His nurse calls in the prescription otherwise. It's frustrating when these physicians only do this for the money.


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PostPosted: Thu Aug 08, 2013 6:04 am 
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"not see the doctor before 28 days"

Thats a weird one. My doc just put me at every other month appointments now that I've reached my 1 year mark. I hope that doesn't change since I am a cash paying customer.

I haven't heard anything, though if these are real changes i'm sure I will. Sorry to hear its going to add unneeded stress in your life.


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PostPosted: Thu Aug 08, 2013 8:35 am 
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The DEA, to my knowledge, doesn't regulate appointment practices of dr offices. Can you imagine what it would be like to take an agency that is already taxed to death in workload, and add even more workload to them? This approach by a doctor's office is their way of being too coward to say "we got new rules, but we don't want you to know they are our rules we made up, so we're gonna say the DEA has implemented it."

The next time I go into my doctor, I'm going to call them on their approach to using the DEA for their rule-making. My doctor posted signs all over the office, saying that starting immediately you are required to keep your suboxone empty wrappers and bring them back in with you to be counted every month. WTF? The DEA? The DEA doesn't care what I do with my trash. The DEA could care less if, out of 90 Suboxone wrappers, I can only account for 86 of them. Are they going to fine my doctor because I accidentally threw 4 of them away? No...not hardly. This rule was made by the doctor who owns the place, and instead of having BALLS, he said "Print a sign that says the DEA has a new rule saying patients must bring back their empty wrappers."
They aren't too cowardice to ask for my money, not too cowardice to ask me to piss in a cup...but they don't have the balls to say "we want to make sure you're not selling them, so we gotta have you bring back your empty trash"...

Ask them why they are saying the DEA made this rule, if you are confrontational...I for one, am...and I plan on asking why the doctor didn't just say that instead of putting DEA in there...does that make me more "scared" of throwing one away by accident? Not hardly. I'll never have the DEA knocking on my door, saying "sir, I'm Agent Fox Moulder and I'm with the DEA...you threw away a couple of Suboxone wrappers last month, and I wanna go dumpster diving in your trash to see what else you might be throwing away...we have had an alarming number of people throwing stuff away lately, like empty clorox bottles, empty ammonia bottles, and empty fertilizer containers...all of which, if added together in the city dump, could possibly be mixed together if we had an F5 tornado and create a massive explosion, twice the size of an M-80 firecracker."

Oh, the doctor's office will get a visit from a disposable-suit wearing DEA agent who sifts through their garbage because there has to be a conspiracy with all these people throwing away empty Suboxone wrappers..and it's gotta have something to do with the doctors who prescribe it.

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PostPosted: Thu Aug 08, 2013 8:47 pm 
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belvin wrote:
I have been with my suboxone Dr. For years and he said the DEA is making all his patients sign new contracts. We are no longer able to change a monthly appointment time once it is scheduled. We also can not see the doctor before 28 days from our last appointment . I travel with my job do these new rules will devastating . Has anyone heard of the idea cracking down on appointment scheduling or is my Dr lying???


Sorry, but your doctor is lying about DEA prohibiting seeing your doctor as often as you mutually agree. That's pure malarkey and "28 days" makes no sense whatsoever unless your doctor is too lazy to adequately serve his patients and has arrogance to think patients won't see it as sign he's running a pill mill.

Missing appointments and rescheduling without valid reason OTOH can be signs of hiding drug abuse and fear of positive drug screens, or being high during the visit, or like wearing long-sleeve shirts in hot summer. Maybe he's had a problem with that, but DEA definitely has nothing to do with it unless he's already being investigated by DEA Diversion for some misbehavior of his or his patients'.

There are however some new rules (haven't yet seen from where) requiring a new doctor certification that long-term Suboxone patients are actually RECEIVING psycho-social support of some kind. Previously, per DATA 2000, X-prescribers were required to "have the capability to make referrals" for such. But so many of them would just hand a patient a phone number and be done with it, leaving the patient with nothing even if they have been begging them for things like a Sub Support Group for years. In my case, I've been doing that very begging for years and only learned about this new rule after I received a letter from my insurance company stating that my doctor needs to provide them a written certification of my ongoing psycho-social support or else they would stop covering my Sub. I only learned about the new requirement after a false positive drug test for amphetamines caused by the selegeline MAOI that he recommended. Same insurance co. letter also stated that I had to promptly urine-test negative for ALL tested substances or else my covered treatment would end in 30 days.

The false positive for amphetamines didn't require any retesting because he found a journal article saying selegeline is metabolized to amphetamine at almost 100%, and they took his word that I get Deprenyl tabs from U.K. ($1 each) because the Emsam skin patch is $700/month and i'm already in doughnut hole from Sub.

After seeing that they needed this new certification of receiving psycho-social support I called his office to tell them that I had been begging for that very same psycho-social support for YEARS to little avail and doctor knew I was not receiving it and I'd even offered many times to do the leg work with a student of his to help get a local support group going but he never did anything about it until I told his nurse that he was filing a false certification about me receiving behavioral support. A month later this university hospital where he teaches addiction medicine on faculty of medical school started a support group; i'm the only one who attends! Squeaky wheel gets the grease but when I told him I needed help tapering down and that Sub was killing me he wasn't helpful. PITA is the other side of squeaky wheel, huh?

I wonder how many people just kill themselves when they realize that after the honeymoon of the first few years, Suboxone can kill any chance of happiness in their lives and that after quitting it two times and relapsing twice over a period of almost ten years, that quitting it a third time is simply not a practical option.

A support group of just one member is really no help at all, apart from it being a sort of free therapy session with about 30 minutes of talk time and a zero copay, with three people sitting in on the meeting to further their education--hardly optimal for therapy.

I've tried everything, including 4 months of very recent hell trying to survive on just one (very split) film a day with treatment-resistant depression and PAWS and just last week decided it's not worth suffering any more trying to taper down especially if my doctor has no interest in helping me. So i'm back to almost my full two films a day which now gives me a small respite from misery in not waking up wishing I was dead every day.

The only way out of this prison seems to be death.


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PostPosted: Thu Aug 08, 2013 10:57 pm 
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Thanks for all your replies. I have been with this Dr for 5 years. A few months ago the nurses and doctor said the"DEA is cracking down on us and we can no longer see long term patients before 28 days from their last appointment, and no more than 35 days from last appointment. This made scheduling appoi ntments very difficult given my job requires out of state travel often 1 to 2 weeks a month. Now they are saying because of the DEA they appointments can no longer change or you get kicked out of the program.
I have never done anything that has damaged the trust with my Dr, who I like and respect, but I can not put these new rules into any sort of rational context. Given the DEA does not make policy...they simply help enforce it. I am going to confront him on the DEA excuse but before I do I need to know if there is any truth to these silly rules. These rules will force me to find a new doctor.


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PostPosted: Fri Aug 09, 2013 2:02 am 
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My old sub Dr is still my general proctitioner so I still get all the info on the sub drama. And he tells me every time I see him he's getting fucking sick of all the drama and rule changes that come with prescribing suboxone. And the patients are getting worst everyday. But to the rule changes its almost becoming as hard as prescribing methadone for pain. Drs are having to do much more paper work and so on. He said and I quote "suboxone will most likely be a schedule II drug in less than three to four years". Meaning it will be just like methadone were suboxone will only be available in the clinic setting were you'll have to go every day. Due to the rules are only getting stricter and stricter and it's going to get to the point were private Drs aren't going to want to keep up with all the new rules and restrictions. Do I agree I honestly don't know I'm just relaying what was told to me by a actual suboxone Dr so who knows.

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PostPosted: Fri Aug 09, 2013 2:53 am 
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I was told the same thing by my doctor that I have been seeing for about 3 yrs now. I see him monthly and will continue to do so because of some relapses I have had with in this 3 yr period. My doctor told me the DEA came in and went through all their records and did an overall check to make sure everything was being done by the book. He also told me they were trying to prevent giving any patient over 16 mg a day because the DEA said anything over that was more than likely being sold on the streets because 16 mg should be enough for a patient to cover all the receptors in the brain. He told me not to even call the office if I lose or misplace my medication because he will have to terminate me from the program. They are really cracking down to try and stop it from getting to the streets but that will happen anyways just like any other drug in my opinion.

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PostPosted: Fri Aug 09, 2013 3:15 am 
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What I am looking for is something in writing that states "these rules". The DEA can not make policy, so where are all these new rules coming from and where ate they referenced? I called the DEA and theydid not know shit....the manufacturer said their reps would never tell docs how often they must see a patient...I can't find anything on the net that discusses changes in prescribing practices....I truly baffled. If somebody is a long term patient and never has the ability to change the date on his monthly appointment the program collapses.


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PostPosted: Fri Aug 09, 2013 6:25 am 
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That's just it..you aren't going to find anywhere that says the DEA has made some sort of rules because they just enforce them....according to what schedule they are placed in.
Schedule II narcotics aren't just solely given in a clinic setting. opiates are schedule II and they prescribe them monthly every day..

http://en.wikipedia.org/wiki/List_of_Sc ... s_%28US%29
9250(methadone), 9801(fentanyl), 9193 (hydrocodone)

http://en.wikipedia.org/wiki/List_of_Sc ... #Narcotics
9064, the bottom of the list of narcotics. Doesn't look like it's in the right place, does it.

Just because Suboxone may be labeled into Sch. 2, won't make it where they have to do it in a clinic setting, not by schedule alone. As you can see by the Wiki, SEVERAL drugs are in Sch.2 and they are prescribed in 30-day doses.

Now..for some facts....
I just left a doctor's office who began saying he could no longer do 1 script with 2 refills (meaning, a visit required every 12 weeks)...
He said this was according to DEA. Nope. I went to a doctor who's doing 1 script with 2 refills right now....once you've been a patient for 6 months without a problem, you get 1 script with 1 refill. Another 6 months, you get 1 script with 2 refills.
The previous doctor also said he couldn't write more than 28-days worth of meds at a time.
Nope...I went to the doctor after I left him, and lo and behold, the doctor wrote me a 30-day supply.
So instead of getting 84/monthly, which is 28 days at 3 subs per day...they write 90. which is...3/daily for 30 days.
It's all in how the doctor wants to approach the matter of deterring illicit or street use. Some know their patients well enough to know they are doing right, and trust they won't endanger the doctor's entire practice...but then again, we're all addicts...and I can understand a doctor having trust issues with someone who's NEWLY in the suboxone program...and that "want" to return to old ways.
Far as the prescribing habits, if they change Suboxone to a Sch. 2, then you'll still have a few doctors who continue to see patients and possibly may change those patients to write Suboxone to be a pain medication instead of an opiate treatment drug.
It ALL depends on WHAT it's written for...
Methadone can be written for a month's supply in a pain medication setting, by a General Practitioner. But, as a treatment drug, it can only be given in a clinic setting. So it depends on the daig code they use for your treatment at the office. If they use a code for pain relief..they can write anything in the entire schedule that falls into the proper category...as long as it's written for pain...
but for opiate addiction...different rules.

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PostPosted: Fri Aug 09, 2013 7:12 am 
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I guess I am surprised that many doctors are giving refills on suboxone, and allow some patients to be seen every 2 or 3 months. I have stuck to the rules for years with no relapse, no dirty urine samples and I can only get a 30 day supply. And now I have absolutely no flexability with scheduling my monthly appointments or I will be booted from the program. I am guessing my doctor is trying to get out of the suboxone business and is using new DEA crack downs as an excuse....I am down to 4/mg per day and dropping. I want to be off of this stuff by December. I am so sick of the Bullshit...If any of you wonder what Obamacare is going to ultimately be like...just ask a suboxone patient....they can tell you how fun it is to have the government telling your dr what they can prescribe, how much, when, under what conditions. I tell you...Things are going to get really bad. The Suboxone experience is a perfect example of what U.S. Government Health Care will ultimately evolve into.


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PostPosted: Sat Aug 10, 2013 10:10 am 
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It's not so much the government as it is the doctors not wanting to be confronted with controversy over how they prescribe suboxone. The DEA doesn't tell doctors how many refills to give or how often to see patients. Addiction specialists have differing opinions on what's needed with Suboxone patients, and some feel as though longevity without issue should be rewarded...some feel as though no matter what a patient should be kept to monthly visits for as long as they continue in Suboxone treatment...it really just depends on the doctor and how much they want to involve themselves.

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PostPosted: Sat Aug 10, 2013 1:28 pm 
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Jonathan has said it much more eloquently than I could. I have had my waiver for 8 months and have had no further communication from the DEA except the piece of paper with my additional DEA #. We can have our own 'rules' or guidelines but should 'own' them. PAX


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PostPosted: Mon Aug 12, 2013 10:35 am 
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docm2 wrote:
Jonathan has said it much more eloquently than I could. I have had my waiver for 8 months and have had no further communication from the DEA except the piece of paper with my additional DEA #. We can have our own 'rules' or guidelines but should 'own' them. PAX



Exactly. I'm in discussions with a doctor via Facebook about their practice...though it's not the doctor I see monthly. I think I've had some positive influence on a doctor (did I really just say that?)....I at least hope I have.
When I first started talking to them, via their Facebook page, the guy posted something about Suboxone treatment. And another poster on the same page asked how long it was, and the doctor replied with "an 8 to 14 month program"...so I made my comment, with proof. I told him that I didn't feel someone should be limited on the amount of time they could be on it..as everyone is different. And that people on Suboxone are much less likely to relapse than people on nothing with cravings and temptation still lingering around 14 months after stopping a 10-year habit...
I told him for me, I was content staying on Suboxone for life if I had to, because the 12 years I spent in pills was more than enough to show me that I never wanted that lifestyle again, and if I needed Suboxone as a failsafe to insure that, so be it. He actually agreed with me, and I posted some videos to his page, like a few of Dr. Junig's so he could see another prescriber who had a different belief system in using Suboxone for a long-term disease, instead of short-term "fix".
Suboxone hasn't, and won't ever fix me...no matter what I do, I'll still have the hereditary nature that I have for opiates.

And I'm dealing with my mom, who I only wish I could get into treatment...and now it's time to move on my feelings because the family is calling and wanting to go ahead and have her involuntarily committed. I hate to do that, but she has no where to live as of the end of the month, and I'm not moving her from Mobile, AL to my home in central AL, especially with her chasing the dragon like she does. And no other family will take her in either...that includes her sister, brother, and a cousin ...she's already calling and getting pissy with people who tell her "no, you can't come here doing the things you do."...

So what do I do? Google isn't my friend in this, as it's not answering me when I ask "WTF do I do, and where do I turn?"

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PostPosted: Tue Aug 13, 2013 12:36 pm 
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belvin wrote:
What I am looking for is something in writing that states "these rules". The DEA can not make policy, so where are all these new rules coming from and where ate they referenced? I called the DEA and theydid not know shit....the manufacturer said their reps would never tell docs how often they must see a patient...I can't find anything on the net that discusses changes in prescribing practices....I truly baffled. If somebody is a long term patient and never has the ability to change the date on his monthly appointment the program collapses.


belvin,

Your question has been answered correctly many times here. DEA has absolutely no authority, much less any rational interest, in preventing a patient from seeing their doctor as frequently as they both deem to be necessary.

Your doctor is clearly lying to his patients in blaming the DEA for his decision not to see patients more than once every 28 days. Any doctor with such a policy is probably running a pill mill with little regard for the health of his patients.

Any new "rule" or guideline from the DEA should be accessible from here:

https://www.federalregister.gov/agencie ... nistration

Reading more of the details about your doctor's Suboxone practice only confirms my initial impression that he's running a pill mill designed to maximize his profits with little regard for his patients' health.

You seem to be surprised that Suboxone scrips are issued with refills. Suboxone and Subutex, and Butrans, are all C-3, with nothing I can find suggesting that anyone wants to move it into C-2, which would prohibit refills. But maybe because of all the diversion going on mentioned at the end here, maybe it's being suggested in some states. States can have more stringent scheduling than federal, so if a state made Suboxone (or Subutex) a C-2, it would cause huge problems for the patients, doctors, and pharmacists in that state because the labels and inserts on the drug bottles and boxes are defined federally, not by states.

Suboxone and Subutex were placed in C-3 (when they are used for ORT) by an act of Congress in the DATA 2000 law that authorized ORT by any licensed M.D. or D.O. authorized to prescribe controlled substances who, further, completed an online 8-hr web training course and who obtained a special X-number (or "DATA 2000 waiver") allowing ORT with Sub from the DEA. Scrips for ORT using Sub are supposed to have that special X# in order to signify to the pharmacist that Sub is being used for ORT in that patient per DATA 2000. Suboxone and Subutex were unique in being dual-scheduled, where when DATA 2000 became law, buprenorphine became a C-III when used for ORT (in FDA approved form ... but C-5 otherwise, with Buprenex ampoules being the only FDA-approved form sold in US back then. Temgesic (Schering-Plough worldwide, generic made by Siam Pharma Thailand) 0.2-mg sublingual tabs if illegally imported were C-5 and some states don't even have a C-5 schedule. I don't know if Buprenex mostly used by veterinarians is still the C-5 it was under DATA 2000 or if it's been rescheduled by DEA into C-3 like the new Butrans film is now in C-3. It doesn't really matter for anyone but a drug lawyer or a drug dealer selling the stuff--get this!

Under the original DATA 2000 dual scheduling, LEGALLY PRESCRIBED Suboxone and Subutex with the DATA 2000 waiver/X-number were classified as C-3, with the according penalties for illegal possession set for C-3 drugs. But black market Suboxone/Subutex was (?) no longer a legally prescribed drug, so it reverted to C-5. Talk about unintended effects. LEGAL Sub was classified with stricter penalties than those for ILLEGAL Sub, which was, arguably, C-5. And argue is what lawyers do ...

DEA has authority to reschedule any drug as long as they follow the rulemaking procedures of the Administrative Procedures Act by publishing a Notice of Proposed Rulemaking in the Federal register, soliciting public comments on the proposed rule, "considering" those comments, and then publishing a Final Rule that has force of law unless it's overturned somehow.

When Congress came up with dual-scheduling for buprenorphine in DATA 2000, there was no need for the usual FDA-DEA inter-consultation on scheduling that usually works out any problems in meeting their different mandates, where FDA is primary on scheduling new drugs as controlled substances under the FFD&C, while DEA is primary on scheduling under the CSA. Raw pharmaceutical buprenorphine HCl powder back then would have been a C-5 and possibly not even considered a controlled substances under the laws of states that didn't have a C-5 category.

I don't know if DEA moved buprenorphine completely into C-3, but having it scheduled differently depending on how it had been prescribed was probably a huge confusion in legal cases charging illegal possession of buprenorphine. Maybe that's why Butrans is a C-3 and not the C-5 that Buprenex (and any illegally imported Temgesic) had been.

C-3 allows up to 5 refills over a period of six months, but the SAMHSA guidelines, below, recommend that refills be limited to 2. But that's just a guideline and I can imagine a situation where a patient with many years of stable maintenance with no drug abuse and a stable mental condition could be on some extended work or vacation travel that justified more than the usual 2 refills. Of course the doctor would probably need solid documentation of that need for their files and they also should probably give the patient a To Whom It May Concern letter for any foreign country they might be traveling to that allowed entry of the drug, or to pharmacists and police in other parts of the U.S. where that patient might be going.

After a physician who has a regular DEA # completes that 8-hr training course and then certifies in writing (to DEA) that they will abide by the Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction, TIP 40, 2004, et seq., US Dept. Health and Human Services, http://www.samhsa.gov ... then the DEA at their discretion can choose to issue the X-number to that physician which is kept in a central registry so that pharmacists can verify the validity of those scrips if they don't know that doctor. Pharmacists also have guidelines to follow and pretty much all Sub prescribers these days require a signed Treatment Agreement from the patient where they're usually required to fill all their prescriptions want just one pharmacy so that they can be better monitored for doctor shopping.

I just checked and the original TIP-40 published in 2004 still seems to be the same as it ever was:
http://buprenorphine.samhsa.gov/Bup_Guidelines.pdf

There are lot of rumors and vague statements from both patients AND doctors floating around about some kind of "NEW RULES" for Suboxone/Subutex ORT.

Doctors are doing things like asking patients to bring in their pills and films for counting and there's also a new requirement from insurance carriers that prescribers now need to certify that each of their patients are ACTUALLY RECEIVING some type of behavioral support.

My local university hospital is trying to start a Suboxone Support Group and they say that it's because of these "NEW RULES" but when I asked the clinical psychologist/therapist who has sat with me two week in a row for a "open therapy session" he could not tell me anything about where these new rules came from.

It's all very vague and he didn't think it strange that he's supposed to get this group going because it's legally required, he thinks it's legally required, but I can't find out anything about where these supposed new rules have come from.

It's possible that they're part of Obamacare Affordable Care Act itself as a modification of Medicare or Medicaid rules, or maybe it's all just a hoax.

If I can't easily find where these supposed new rules are and who issued them and what they actually say and with what authority ... well maybe it's just anarchy now in the healthcare system which iss supposed to be highly regulated. An engineer friend of mine uses the term "anal extraction" to refer to things that people just "make up" and fool other people into believing them as truth.

I'll do some more digging to try to find out what's causing all this confusion and misinformation. It had to be something that started it.

I know that in my city with a lot of Suboxone patients receiving their drug for absolutely free under a variety of different programs, and with very little monitoring, that there is a tremendous amount of Suboxone tabs and films appearing on the street to help opiate addicts get by on less heroin or whatever. People are getting as many as #90 of the new generic Suboxone tablets for free every month and they're keeping at most 30 for themselves and selling the rest for $2 or $3 each, and using that money to buy brown tar heroin. Some of these addicts are only taking half a tab a day or even much less because the more they take the more it interferes with their heroin high.

Yes, we have a true epidemic of opiate abuse but flooding the streets with free Suboxone as is being done in my city could be doing a tremendous harm because new opioid users are starting to present for drug treatment when they became addicted to opioids with illicit diverted Suboxone, and then they started using heroin, and then they go for treatment of their heroin addiction and they hit the jackpot with free Suboxone from a pharmacy where because they now have a legal scrip for it and it's provided to in the local jails ... they won't have to suffer WDs in jail if the get arrested selling thee Suboxone they were getting for free.

History repeats itself. Heroin was supposed to bee less addictive and less harmful than morphine. Then methadone was supposed to be less harmful than heroin, but everyone knows that it's a lot easier to quit heroin than it is to quit methadone.

TIP-40 was is less than 10 years old. The long-term effects of Suboxone are only slowly being recognized as being a mixed bag of benefit as well as harm.

Nobody knows how this story will evolve but when people are being called in for pill counts, it does not bode well for those such as me have been stabilized so long that my doctor now needs to see me only every 4 months for my Sub checkups ... but since he's my PCP I can see him earlier if needed.

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PostPosted: Wed Aug 14, 2013 5:17 pm 
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Thanks Trampy for all your input.
Well after reading the responses I have received here, after researching the net along with calling the drug manufacturer and the DEA, I am certain that there is no new law behind the new policies my Dr. is adopting, even though I was given the answer from my doctors office that the DEA is behind these new policies being adopted.

I see my doctor in about two weeks and hopefully will find out more about these new policies since I will be signing a new contract.

My doctor is a primary health physician but also takes on suboxone patients as well as doing everything from laser hair removal to facial microderm abrasion skin treatments. I dont see him running a pill mill as some have suggested given his policies. I think he likes the money he is making from the suboxone side of things but doesnt want any of the bullshit that comes along with treating addicts to jeapordize his DEA license in the event he gets audited. His business at this point may even be dependent on suboxone revenue for all I know.

As we all know SOME addicts may not take their medication as scheduled, may lie to get more meds, doctor shop, sell part of their scripts, my run out of meds early requiring an ealier appointment etc. I am guessing that caring for up to 100 addicts and the behavior associated with that can be stressful and so he is simply saying...."look...if you want to be a part of my program, you must see me every month, no ealier or less, take urine samples when you come in, and stick to the appointment you scheduled. A no tolerance policy will cut down on the B.S. and he can decide how strictly he wants to enforce it.

I have found a few doctors in town taking new patients that have policies much more compatible with my short/long term suboxone goals and my travel lifestyle and will simply arrange to be to switched to a different Dr. if mine will not be reasonable when a legitimate conflict comes up regarding my appointment date. Enough Said I guess. Thanks everyone for all of your input.


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PostPosted: Sat Aug 17, 2013 12:34 pm 
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Belvin,

I meant no offense to you in saying that your doctor seemed to be running a pill mill. As you acknowledged, it seems he's putting his profits and convenience ahead of his patient's interests in restricting how frequently he's willing to see his Suboxone patients outside of the monthly schedule he's set up as one-size-fits-all.

While it seems to make you a bit angry that he's lying in blaming his new policies on the DEA, I don't see how it could benefit you in any way if you confront or challenge him about the obvious misrepresentation and lack of care. Lack of caring is significant because it seems to run counter to accepted medical ethics.

I hope for your sake that you don't let your emotions about what is really shoddy medicine on his part adversely affect your ability to get ongoing care with Suboxone, hopefully under less onerous and and much more individualized approach. You doctor is running something very much like a methadone clinic for Suboxone patients. But if you want to change doctors they will almost surely want to contact him to find out what kind of patient you are. You don't want to get a bad rap.

After you find a new doctor and are happy with the new setup then if you're still angry you could write a letter to your state medical board describing his practices. It seems like a gross violation of medical ethics to tell patients that they cannot see him more frequently than every 28 days. Just stating that as a fact and citing the exact wording of those signs in his office (or taking some pics of them with a cell phone) should get him investigated and maybe eventually motivate him to pay more attention to the needs of his patients as opposed to the money he can collect from them for doing a minimal amount of work in assembly-line fashion. Maybe he's basically a good doctor but has gotten a bit money-hungry and is taking advantage of the dependency inherent in Suboxone maintenance. Here in my city, there are still very very few doctors who will accept Suboxone patients for indefinite "lifetime" maintenance. So don't burn that bridge even though it's decrepit.

There are all sorts of pill mills. Many of them cater to chronic pain patients with legitimate medical need for opiates and muscle relaxers with some benzos thrown in for comfort. I know of one local doctor who schedules all of those patients on certain mornings and afternoons of the week in order that his "regular patients" won't see a waiting room of patients who seem him exactly once a month all get the same scrips of hydro/apap, Soma, and Valium. They're all required to bring in their empty pill bottles because he doesn't want them floating around in city with his name on them. This doctor is literally a "croaker" because he's old and uses oxygen and even though everyone in twon knows what he does, he's not bothered by LEOs or DEA even though he's part owner of the pharmacy he sends all those patients to for fills after sending their scrips over by phone, with that mass of people all driving over at the same time to again sit and wait for their name to be called out when their drugs are ready. That croaker also has signs saying "no controlled substances prescribed, period" and other signs saying that patients who fail to follow the rules will no longer be treated. There are plenty of people with legitimate chronic pain who end up abusing their pills and he's one of the very few doctors who treats them. And MRIs showing tissue damage are extremely expensive if you don't have health insurance. And he's also a Suboxone doctor, of course.

I still haven't found anything about these supposed New Rules for Suboxone. It's very puzzling.

Please post here if you find out that there are such rules from someone or something somewhere.

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PostPosted: Sat Aug 17, 2013 5:59 pm 
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jonathanm1978 wrote:
...
And I'm dealing with my mom, who I only wish I could get into treatment...and now it's time to move on my feelings because the family is calling and wanting to go ahead and have her involuntarily committed. I hate to do that, but she has no where to live as of the end of the month, and I'm not moving her from Mobile, AL to my home in central AL, especially with her chasing the dragon like she does. And no other family will take her in either...that includes her sister, brother, and a cousin ...she's already calling and getting pissy with people who tell her "no, you can't come here doing the things you do."...

So what do I do? Google isn't my friend in this, as it's not answering me when I ask "WTF do I do, and where do I turn?"


You need to do what you think is the right thing, balancing all the interests of everyone involved, but mostly your own. It's a tough situation you're in, but since you can't have her living with you while she's still in active addiction and you obviously don't want to have her living on the street as a homeless heroin addict, maybe the best you can do is try to get her in the best possible type of treatment facility out of whatever is available and try to be there to do what you can even if she expresses anger, which is totally normal.

If I were you I'd start with a local suicide/crisis center where it's a common misconception that calling those numbers is like calling 911 for only suicides in progress. Not. Most of what they do is talk to lonely people with nobody else to talk to. After that, the next biggest thing they do is find referrals on community resources. I know because I volunteered at one for seven years with only one real suicide call in all that time and even then he told the responding police that the "gun at his head" was just a figure of speech. It sounds to me like YOU badly need to talk to someone about what you're going through, which is truly a CRISIS situation. Give it a try. http://www.suicidehotlines.com/

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PostPosted: Sun Oct 27, 2013 5:34 pm 
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Even if it was moved to #2 in the scheduling and no refills allowed, like my Doctor did with adderall is write me post dated paper scripts & writes "DO NOT FILL FOR 30 days FROM DATE WRITTEN" and gives me 3 of them. Never had issues.


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PostPosted: Wed Dec 18, 2013 2:03 am 
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Many good responses. The DEA doesn't get involved in the way docs practice; that is left to state regulations. Nothing at the DEA has changed; the doc is lying-- unless the state did something and the doc (or patient) confused who was behind the change.

A quick correction to the adderall note above... the DEA does spell out, very specifically, how docs can prescribe 90 days of a schedule II med like Adderall or Oxycontin. But the scrips CANNOT be 'post-dated'; that is illegal. It may just be semantics-- but the doc can give up to 3 scripts that each cover 30 days. The med and dosing on all three scripts must be the same (i.e. no titrations or changes). Each script must have the date the script was actually written, plus the date that the script can be refilled after.

There are some problems with the policy because schedule II scripts expire after 60 days-- so a script written today, to fill after two months, will expire on the day it can be filled (and the lousy pharmacies, i.e. Walgreens, will even take that one day away). For that reason, docs are tempted to post-date that third script by a week or two, so that it doesn't expire before it is filled. BUT-- that is not legal, and it is the type of 'small thing' that can and will get a doc in trouble. So instead, I either mail out the third script when the patient calls to tell me that the second one was just filled... or write the 'fill after' date to be a day or two early for that third script. The trick is to avoid writing it TOO early, because then insurance won't cover it-- and neither will the pharmacist.


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