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PostPosted: Thu Feb 23, 2017 1:28 am 
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Hi,

On Jan 11, I got a phone call saying my pain doc/sub doc would be out of the office for a month, which was day my appointment was. I knew something was up right away because he never takes a moment off. I was referred to a psychiatrist with a Suboxone waiver a week later. My pain doc also prescribed Percocet in a low dose (Yes, I know all the pharmacology, and the controversy, but it helps me), and other non narcotic meds and did nerve blocks regularly.

I anticipated a problem at the psychiatrist's office with the percocet, so stopped taking that 48 hours before. That office said they were not able to help me because they only treat people who aren't on other medications causing dependency. I am also on Lunesta for intractable insomnia, phenobarbital for epilepsy, and fioricet for migraines. We tried everything else, it doesn't work.

I started getting concerned he wasn't coming back, and started trimming my dose so I went from 16mg to 8mg over a month.

My pain doc's office got a prescription signed by my sub doc, by staff travelling to his house. They said they'd do the same this month, and have me see his partner (Who doesn't have a Suboxone Prescribing Waiver) for my other meds and UA. They forgot to ask sub doc for script and mailed me one.

The office said today they can't help me next month, because its not legal for the sub doctor to keep signing the suboxone script without seeing me. My understanding is the sub doc, can call subxone in five times in six months, without seeing me. Does anyone know the law on this?

I'm miserable on the 8mgs, in pain and losing ground in my mental health (Have PTSD too). I'm considering tapering still because its better than the alternative. It angers me that I have to choose what diseases get treated.

I know none of you can give great solutions but I wondered if anyone could clarify the law as to how often the doc can prescribe Suboxone without seeing me. I get the impression the office wants to be helpful, just doesn't know what to do, or is sure of the law.

Thanks.


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PostPosted: Thu Feb 23, 2017 2:28 am 
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anonvet

I cannot answer your question with any authority but I can give you my opinion. Yes, according to federal law a doctor can write refills for 6 months after your face to face appointment. Be aware that clinic rules, state regulations or insurance rules may be more restrictive.
Personally I had no difficulty adjusting to 8 mg of buprenorphine. I suggest that you think about splitting your dose and reading the posts about maximizing the absorption of buprenorphine. I have had four different doctors, two psychiatrist, one primary care and one cash only provider. Neither of the psychiatrist were listed on the physician locators apps. You could try calling large mental health clinics and treatment centers in your area. In my area there is a surplus of cash only providers if you are desperate enough. I take a benzo RX by sleep clinic and this was an issue with the cash only doctor but I wouldn't be intimidated and took the attitude that we would just have to agree to disagree and he relented. Clonazepam , at least in small doses, does not show up in drug screens but will show up in the Prescription monitoring system. Good luck.


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PostPosted: Thu Feb 23, 2017 3:05 am 
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The law likely varies from state to state, but I'm getting a couple of scripts overt the next few months
while I'm traveling to another part of the country, by means of telephone appointments with my local
sub doc. He told me the DEA requires that for him to write. If that doesn't quite cover it, perhaps a FaceTime appointment via Internet.

Likely something you've checked out, but if not worth a try I think...

Best wishes...

Godfrey


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PostPosted: Thu Feb 23, 2017 11:36 am 
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Hello Anonvet, Welcome! I know here in NJ, a doc can not call in a refill for suboxone. You must be seen. We have many Sub Docs in this area and yes, some are with the local clinics, definitely worth trying! Also, the methadone clinic here has a wonderful Dr that prescribes suboxone and has extensive experience with mental health issues so she knows all about prescribing psychotropic meds and addiction meds together. You have also received excellent suggestions here! Splitting the dose does wonders for me as I deal with pain from osteoarthritis in my knees. Good luck and please keep us posted!


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PostPosted: Fri Feb 24, 2017 8:19 am 
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Location: Rocky Mount, North Carolina
State laws will vary but here are the federal laws:
CI: Herion, no medical use, no prescribing.
CII: Oxy, Fentanyl, Morphine, etc. Must have hand signed prescription with no refills delivered to pharmacy although there is talk of allowing CII drugs to be sent electronically.
CIII-CV: everything else including Suboxone, xanax, ativan, lunesta, codiene cough syrup, etc. These can sent via fax rather than hand delivered to the pharmacy. The script is good for up to 6 months so can have 30 days with 5 refills. Most offices won't give that many, and again it'll also vary by state. But those are the federal drug laws regarding scheduled (controlled) substances


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PostPosted: Fri Feb 24, 2017 11:51 am 
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Quote:
although there is talk of allowing CII drugs to be sent electronically.


It has been available for awhile now. It has taken time to get the EHR's compatible with the pharmacies, an extra layer of security and encryption is required. We have had e-scribing for several years and finally adding the controlled substances.
I go live sometime within the next two weeks.


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PostPosted: Fri Feb 24, 2017 2:44 pm 
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Docm2 are you going to have to carry some little PDA type thing that communicates straight to the pharmacy?


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PostPosted: Fri Feb 24, 2017 3:50 pm 
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Last month when I was getting my script, the doctor had a new looking script thing lol. It was like electronic and I had the impression that it was sent to the pharmacy or something because they'd made a mistake and put 7 strips instead of 28, the nurse said she'd call the pharmacy and clear it up. Which that could have been because they didn't want to make a second one or something....... but it was different and no hand writing, all electronic and printed. Maybe that's something like ur talking about.

I don't know, I just do what I'm told and don't ask many questions, I probably should from now on :)

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PostPosted: Fri Feb 24, 2017 4:32 pm 
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docm2 wrote:
Quote:
although there is talk of allowing CII drugs to be sent electronically.


It has been available for awhile now. It has taken time to get the EHR's compatible with the pharmacies, an extra layer of security and encryption is required. We have had e-scribing for several years and finally adding the controlled substances.
I go live sometime within the next two weeks.


My doctor does it this way. Doesn't it require some type of biometric component?

Amy

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PostPosted: Fri Feb 24, 2017 11:58 pm 
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With non controlled prescriptions the EHR can send the Rx to the pharmacy, similar to a fax but via computer. With controlled substances, I have a fob, gives me a password for each Rx that is sent, still through the EHR and internet but with another layer of security. To get the fob I had to set up a special account with two notarized ID's. I would not be surprised if there are some systems that could use biometrics, actually would be nice to just swipe a finger instead of a different code each time.
What is really nice for both patients and doctors is that now we can communicate via an electronic medical record portal, text or phone and I can send a prescription to the pharmacy. They don't have to come to the office and pick up a hardcopy to take to their pharmacy.


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