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PostPosted: Wed Sep 09, 2015 3:09 pm 
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I have more than 20 enrollment slots available as of Sept, 5, 2015.
Additional information, fee schedules, and clinic dates can be accessed at http://sajmdtx.com
Some conditions, and limitations of my practice:
1. Must be resident of Dallas-Fort Worth, and surrounding area (generally within one hour driving distance)
2. I am not an addiction specialist or psychiatrist, and will not prescribe any medication other than Suboxone, Zubsolv, Bunavail, and induction medications. I do not prescribe Subutex.
3. I am not an approved provider for any insurance. I do not see Medicare, Tricare, or Medicaid, patients. Others are enrolled as Self pay patients. I can not assist you with your claims or preauthorizations.
4. This is an outpatient program, patients are seen once a month.
5. I do not see IV drug users, they need a much more intensive program, and need to be seen more frequently; I do not have such resources.
6. Patients are required to enroll in an ongoing counseling program with a licensed counselor of their choice and under their own arrangement. Counseling is not included or provided at my clinic. Counseling is required for 12 months/12 sessions, after that it is optional. Counseling is also optional once patients taper their dose to 4mg/day or less.
7. Treatment protocol: New patients 16mg/day, first month, 12mg/day for 2 to 6 months. Target is 8mg/day within 2 to 6 months. Patients control as to how soon they can complete the program. Transfer patients are started at 12mg/day or lower.
8. Part time clinic, operates only on specified dates.
9. Enrollment is started with a phone interview.
10. Not accepting IV drug users, pregnant patients, patients allergic to Naloxone or Suboxone, and patients with severe medical problems, ... such patients are better served in a program that has the resources needed to provide additional services.
11. No expensive urine drug screens. Random urine drug screen included in fee.

Treatment is cheaper than addiction. If you have the motivation and self discipline to conquer your addiction ... then an outpatient program can work for you. You can do it while you work or attend school. Cell / Text 469-693-2020. Phone calls from outside area code 214, 469, 682, 817, and 972 are ignored.


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PostPosted: Fri Sep 11, 2015 2:56 pm 
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I can't tell from your post whether patients are required to taper off buprenorphine after they get to 8 mg per day. Do you pressure your patients off the medication after a certain amount of time? Have you read the studies that indicate that long term maintenance can be preferable to tapering clients off before they are ready? There is a tab at the top of the page called "Talk Zone". It's got really great informative material on buprenorphine.

I have to say that your fee schedule seems fair. $325 for an initial visit ($275 for transfer patients) and $145 for subsequent visits for the first 12 months and $95 per visit after 12 months. That seems fair since you don't accept insurance.

What I'm wondering is why you are prescribing buprenorphine to begin with. Are you in it to truly help addicts, or is your practice designed to bring additional funds to you. You only take the easiest bupe patients, you have no problem kicking them out if they mess up even one time, and you don't want to take on the responsibility of improving the lives of addicts unless it is simple for you.

Do you recognize that addiction is a chronic brain disorder characterized by relapse? The changes in an addict's brain are permanent. We will always be at risk of relapse, especially after going off of a maintenance medication. It often seems to addicts that some doctors are only in this for the money they can make off desperate people. Your fee schedule is fair, however. I would urge you, no matter how "one strike and you're out" you seem, that you give your patients some slack. Relapse is a characteristic of our disorder, and sometimes it takes a couple of tries to live in recovery.

Good luck with your practice.

Amy

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PostPosted: Tue Oct 20, 2015 4:36 pm 
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Amy- do you have any suggestions for doctors? I live in Wichita Falls and am willing to travel to see a doctor for maintenece. I am on subutex


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PostPosted: Tue Oct 20, 2015 10:34 pm 
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I don't know any Kansas doctors. I do know, unfortunately, that most doctors will not prescribe subutex, especially not right at first. You can use our "Find Suboxone Doctors" tab at the top of the page. Another suggestion is to contact local pharmacists and ask them if anyone is being prescribed subutex locally and who is prescribing for them. They may not tell you, but they may. It's worth a shot!

Good luck!

Amy

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PostPosted: Thu Nov 26, 2015 12:09 am 
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Amy-Work In Progress wrote:
I can't tell from your post whether patients are required to taper off buprenorphine after they get to 8 mg per day. Do you pressure your patients off the medication after a certain amount of time? Have you read the studies that indicate that long term maintenance can be preferable to tapering clients off before they are ready? There is a tab at the top of the page called "Talk Zone". It's got really great informative material on buprenorphine.

I have to say that your fee schedule seems fair. $325 for an initial visit ($275 for transfer patients) and $145 for subsequent visits for the first 12 months and $95 per visit after 12 months. That seems fair since you don't accept insurance.

What I'm wondering is why you are prescribing buprenorphine to begin with. Are you in it to truly help addicts, or is your practice designed to bring additional funds to you. You only take the easiest bupe patients, you have no problem kicking them out if they mess up even one time, and you don't want to take on the responsibility of improving the lives of addicts unless it is simple for you.

Do you recognize that addiction is a chronic brain disorder characterized by relapse? The changes in an addict's brain are permanent. We will always be at risk of relapse, especially after going off of a maintenance medication. It often seems to addicts that some doctors are only in this for the money they can make off desperate people. Your fee schedule is fair, however. I would urge you, no matter how "one strike and you're out" you seem, that you give your patients some slack. Relapse is a characteristic of our disorder, and sometimes it takes a couple of tries to live in recovery.

Good luck with your practice.

Amy


----

My current fee schedule as of Sept, 2015, is ... $375 for the initial visit, and $275 for transfers. The follow up visit is $195 ... I take off $50 from it if the patient brings their workbook and evidence of counseling. Once the patient reaches 8mg/day then the fee is $145, and $50 off for counseling. Counseling is made optional after patient has completed 12 months/12 sessions. Counseling is also made optional when patient has achieved the target dose of 4mg/day or less. Patients who are on 2mg/day need to see me once in two months.

I bring patients down to 8 mg within 3 to 6 months, and yes I do pressure patients to taper their dose to less than 8 mg, and come off it completely.
That is the goal of the treatment ... complete recovery. There are practices who are satisfied with "harm reduction", and in some cases that is completely appropriate, but not in all cases, ... and anyway I do not have the resources to run such a program.

Most patients dropout from my practice ... because they do not want to recover. I have no wish to serve them. Some patients openly ask me how much will I prescribe, and when I tell them my treatment protocol ... they do not want the treatment ... they are not patients ... most likely they are drug dealers. A genuine patient is one who would like to make a complete recovery.

Yes some people need long term treatment ... may be even life long, but at what dose? And if they do need life long treatment then probably I am not the right person for them ... they need to be treated by the addiction specialist ... in the advanced treatment center ... they also need other forms of behavioral therapy ... not just Buprenorphine ... and they have to be held accountable ... not blindly be prescribed what they want.

You need to read up on Michael Jackson, or Elvis Presley ... these people were rich enough to employ their own doctor and dictated to their doctors what they wanted; ... the rest is history.

I used to participate in the Suboxone program run by the manufacturer for low income patients ... they clearly have a vested interest in promoting high doses ... they used to allow two patients per doctor ... patients got for free up to 4X8mg films/day. None of the patients wanted to reduce their dose ... "Oh Yes doc I need those four films ... it is the only thing that keeps me away from the drugs" ... and no! it did not keep them away from drugs ... they had a higher rate of relapse than other patients ... because they were selling this free Suboxone and buying other drugs. I assume that being "low income" they could not afford Cocaine. I had to discharge all of them ... with the advise that they need a more intensive program ... if 32 mg of Buprenorphine per day is not going to hold them ... nothing will.

... and I have another philosophy ... if you can afford to buy drugs ... you can afford treatment. Treatment with Suboxone is cheaper than buying drugs. In my program the treatment cost is $30/day or less (including doctors fee, counseling, and medication costs ... most patients who seek treatment are spending $40/day or more on drugs).

It is true that some patients have difficulty in coming off medications ... but even they are able to reduce their dose to less than 8mg/day. Currently I have only one patient who has been on 8mg for more than two years. People who stay in my program beyond two years are on 4mg/day or less. I have one patient who has been on it for five years, his current dose is 2mg once in 2 to 4 days.

I look at social, professional, and, personal achievements as markers of recovery, and determine whether I will retain patients in my practice ... or suggest to them that they find a better doctor.

8mg/day effectively stops withdrawal symptoms in the majority of patients, prescribing more than that ... over long periods, does not appear to me as sound medical practice. You can look at the data from Government run programs in other countries and compare that to how much Buprenorphine US doctors prescribe, and more important how much Buprenorphine US patients demand.

Addiction is a behavior problem ... it can not be cured by a pill. The role of Buprenorphine is to prevent withdrawal symptoms and the lowest dose that prevents withdrawal should be used.

Yes, I understand that addiction is a brain disease characterized by relapse, but if Buprenorphine could prevent relapse then no one would ever have relapse.

The medical fact is Buprenorphine does not prevent relapse ... it prevents withdrawal. As yet we do not have any medication that prevents relapse.

And it is beyond my power to improve the life of patients ... I can only assist them if they want to improve their lives ... it is a struggle, but it is they who are willing to put in the effort that will recover ... addiction is not cured by a prescription.

And No ... I do not kick out people just because they had one relapse ... I look at the overall clinical scenario ... most people are given a chance ... but some are not.

It is poor service to the patient, and, inappropriate to go on prescribing the same high dose without a demand for tapering ... or prescribe the medication to patients who disregard instructions and continue to relapse. It is my job to push them to taper ... if I am not pushing them I am not doing my job.

My philosophy is if I can not make a difference to you ... then go to some one who can.

Everyone is entitled to their own opinion ... and I am entitled to mine. And I base my opinion on current literature, physiology, pharmacology, and clinical experience ... of five years now ... and I used to do pain management before that, so I have a fair idea why some one refuses to taper.

There are very few patients who can make a complete recovery on the very first attempt. It takes multiple attempts ... but I am not willing to prescribe this medication to someone who is obviously not serious about making this attempt.

There are programs that run on the principle of "harm reduction" ... partial success is still success ... and is better than no success. But, I have found it very difficult to offer such a program as a solo practitioner. Those programs are better run by state agencies, or by organizations which have more resources.

It does not matter which doctor you go to ... the doctor's role is very limited ... it is to prescribe Buprenorphine ... and any doctor can do that. But just as a good coach can push you to achieve more ... a doctor who pushes you to take the lowest dose ... and demands a change in behavior, ... will be good for your health, and your recovery.

And yes I do charge a fee for what I do and it brings me additional funds ... I do not get any funds from the government or charitable institutions ... and No, I do not do it just to get money ... if that was the reason, I would have followed your advice and prescribed high doses for ever and ever. You need to look into your own conscience and examine why you are promoting high doses that have no pharmacological basis.

At this point I am satisfied in what I am doing, and the way I am doing it, ... and I will change it, ... if there is evidence that there is a better method.

It is gratifying to see those few patients who are willing to follow my advice ... and make a complete recovery, or at least achieve the lowest possible dose, ... and I am here to serve them.


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PostPosted: Thu Nov 26, 2015 12:50 am 
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Sonny6584 wrote:
Amy- do you have any suggestions for doctors? I live in Wichita Falls and am willing to travel to see a doctor for maintenece. I am on subutex


---
Buprenorphine is a controlled substance that has more rules and regulations than other opoids ... only a brave few prescribe it, and they do so inviting increased scrutiny. Most will stick to the FDA recommendations. Subutex is Buprenorphine alone, while Suboxone, Bunavail, and Zubsolv are Buprenorphine+Naloxone preparations. Subutex is no longer manufactured or marketed as Subutex, but a generic Buprenorphine tablet is available and is commonly referred to as Subutex.

Subutex is only recommended for:
1. Induction
2. For pregnant patients.
3. For patients who are allergic to the combination preparation of Buprenorphine+Naloxone, (presumably to Naloxone).

For the above reasons doctors do not wish to prescribe Subutex. Patients demand it because generic Subutex is half the cost of generic, or branded forms of Suboxne.

You will have a problem finding a Suboxone doctor who accepts pregnant patients, or is willing to see a patient who claims to have allergy to Naloxone.

If allowed, doctors would be glad to prescribe Subutex.

Tennessee has actually passed a law (effective July 1, 2015), restricting the prescription of Subutex to only the above conditions. If the doctor prescribes without endorsing the above conditions the pharmacy refuses to dispense it. Lucky for you ... you are not in Tennessee.

This recommendation has no pharmacologic basis. This recommendation was made to prevent drug diversion and its use by Intravenous route. A majority of patients who abuse opioids use it orally. This FDA recommendation, and the law in Tennessee forces patients to pay twice as much for the prescriptions.

Yes there is some logic behind it, but they should have considered the increased economic burden on patients.

1. Programs which offer a daily dose, where the medication is administered under supervision, should be allowed to dispense Subutex.
2. Patients who are on low dose and have no evidence of IV use should be allowed to receive prescription Subutex because the risk of drug diversion is much lower.
3. This medication anyway is not a desired drug for misuse, so intravenous users wanting to get a "high" would rather use something else.

May be you can write to your Congressperson/Senator.


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PostPosted: Fri Nov 27, 2015 8:17 pm 
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Sajmd, welcome to the forum. It's great to have another doctor chiming in here. I hope you will continue to post when you can. There are several other docs who do the same plus the owner of the website.

I agree with much of what you have written in your multiple posts. You are clearly n the upper half of MDs with regard to knowledge and understanding of opiate addiction and treatment with suboxone. Clearly your thoughts on dose are spot on. Most people do not need a dose of any greater than 8 mg. most also can do very well on 4 mg.

You seem to mostly get it. Unfortunately I then read some of your other statements and seriously question where these thoughts are coming from - especially since you claim your thoughts, opinions and practice are based on current research. You multiple times talk about a "cure" for opiate addiction, including stating that bup is not a cure. I would again agree with that, but with bump not not being a cure, what is? Do you believe there is a cure for opiate addiction? If so, that would go against just about all current understanding and research. Can opiate addiction be cured?

You stated, "the goal of the treatment...complete recovery" How would you define that? Again current clinical standards claim remission is about the best anyone can hope for. How would you define complete recovery from opiate addiction? In fact dies such an animal even exist? Can an opiate addict completely recover, and if so, are they then cured?

You also state that "addiction is a behavior problem". This again seems to contradict current standards of practice, current research and even current diagnostic criteria. How is it that addiction is a behavior problem rather than a chronic, relapsing medical disease. Is ADD and ADHD a behavior problem as well?

Finally, you stated multiple times that all Bup does is prevent withdrawal. That's all it does? Again, current literature and understanding very clearly show that in addition to preventing withdrawal, this medication curbs and sometimes removes cravings. For every patient, withdrawal symptoms will eventually go away completely. The same cannot be said for cravings which could last years after withdrawals have stopped. Please tell me if and how that is not a correct statement. Beyond that, how do you explain a at isn't who reports their cravings have disappeared after starting Bup? What removed these cravings? The mere fact that withdrawals have stopped?

Again. I want to be clear that you "get it" more than the average prescriber. I'm not trying to simple challenge you. It just appears there is still some room for additional growth in your level of understanding - especially with the items I've started with. I would enjoy reading your response - especially if I or others may learn something from you. I sincerely hope you'll continue to participate here as time allows.


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PostPosted: Sat Nov 28, 2015 11:38 am 
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I agree 100% and thank u donh for bringing that up. Patients are who're taking suboxone after all and if we're telling u that suboxone removes all cravings, then it removes all cravings. I used for yrs and yrs before suboxone and I tried everything u can possibly try to stop using before I found it. Rehab, detox, cold turkey, NA & the steps...u name it, and I could get clean but I couldn't make it past six months and that was because of the horribly intense cravings that never let up on me at all. My last resort was suboxone and it removed complete and total cravings. I am a firm believer in sub being used for yrs and possibly life.

I respect ur opinion and I'm glad that u care enough to post here, just remember that the ppl taking this medication and have personal experience with it knows that suboxone removes cravings.

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PostPosted: Sun Nov 29, 2015 2:10 am 
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sajmd wrote:
Amy-Work In Progress wrote:
I can't tell from your post whether patients are required to taper off buprenorphine after they get to 8 mg per day. Do you pressure your patients off the medication after a certain amount of time? Have you read the studies that indicate that long term maintenance can be preferable to tapering clients off before they are ready? There is a tab at the top of the page called "Talk Zone". It's got really great informative material on buprenorphine.

I have to say that your fee schedule seems fair. $325 for an initial visit ($275 for transfer patients) and $145 for subsequent visits for the first 12 months and $95 per visit after 12 months. That seems fair since you don't accept insurance.

What I'm wondering is why you are prescribing buprenorphine to begin with. Are you in it to truly help addicts, or is your practice designed to bring additional funds to you. You only take the easiest bupe patients, you have no problem kicking them out if they mess up even one time, and you don't want to take on the responsibility of improving the lives of addicts unless it is simple for you.

Do you recognize that addiction is a chronic brain disorder characterized by relapse? The changes in an addict's brain are permanent. We will always be at risk of relapse, especially after going off of a maintenance medication. It often seems to addicts that some doctors are only in this for the money they can make off desperate people. Your fee schedule is fair, however. I would urge you, no matter how "one strike and you're out" you seem, that you give your patients some slack. Relapse is a characteristic of our disorder, and sometimes it takes a couple of tries to live in recovery.

Good luck with your practice.

Amy


----

My current fee schedule as of Sept, 2015, is ... $375 for the initial visit, and $275 for transfers. The follow up visit is $195 ... I take off $50 from it if the patient brings their workbook and evidence of counseling. Once the patient reaches 8mg/day then the fee is $145, and $50 off for counseling. Counseling is made optional after patient has completed 12 months/12 sessions. Counseling is also made optional when patient has achieved the target dose of 4mg/day or less. Patients who are on 2mg/day need to see me once in two months.

I bring patients down to 8 mg within 3 to 6 months, and yes I do pressure patients to taper their dose to less than 8 mg, and come off it completely.
That is the goal of the treatment ... complete recovery. There are practices who are satisfied with "harm reduction", and in some cases that is completely appropriate, but not in all cases, ... and anyway I do not have the resources to run such a program.

Most patients dropout from my practice ... because they do not want to recover. I have no wish to serve them. Some patients openly ask me how much will I prescribe, and when I tell them my treatment protocol ... they do not want the treatment ... they are not patients ... most likely they are drug dealers. A genuine patient is one who would like to make a complete recovery.

Yes some people need long term treatment ... may be even life long, but at what dose? And if they do need life long treatment then probably I am not the right person for them ... they need to be treated by the addiction specialist ... in the advanced treatment center ... they also need other forms of behavioral therapy ... not just Buprenorphine ... and they have to be held accountable ... not blindly be prescribed what they want.

You need to read up on Michael Jackson, or Elvis Presley ... these people were rich enough to employ their own doctor and dictated to their doctors what they wanted; ... the rest is history.

I used to participate in the Suboxone program run by the manufacturer for low income patients ... they clearly have a vested interest in promoting high doses ... they used to allow two patients per doctor ... patients got for free up to 4X8mg films/day. None of the patients wanted to reduce their dose ... "Oh Yes doc I need those four films ... it is the only thing that keeps me away from the drugs" ... and no! it did not keep them away from drugs ... they had a higher rate of relapse than other patients ... because they were selling this free Suboxone and buying other drugs. I assume that being "low income" they could not afford Cocaine. I had to discharge all of them ... with the advise that they need a more intensive program ... if 32 mg of Buprenorphine per day is not going to hold them ... nothing will.

... and I have another philosophy ... if you can afford to buy drugs ... you can afford treatment. Treatment with Suboxone is cheaper than buying drugs. In my program the treatment cost is $30/day or less (including doctors fee, counseling, and medication costs ... most patients who seek treatment are spending $40/day or more on drugs).

It is true that some patients have difficulty in coming off medications ... but even they are able to reduce their dose to less than 8mg/day. Currently I have only one patient who has been on 8mg for more than two years. People who stay in my program beyond two years are on 4mg/day or less. I have one patient who has been on it for five years, his current dose is 2mg once in 2 to 4 days.

I look at social, professional, and, personal achievements as markers of recovery, and determine whether I will retain patients in my practice ... or suggest to them that they find a better doctor.

8mg/day effectively stops withdrawal symptoms in the majority of patients, prescribing more than that ... over long periods, does not appear to me as sound medical practice. You can look at the data from Government run programs in other countries and compare that to how much Buprenorphine US doctors prescribe, and more important how much Buprenorphine US patients demand.

Addiction is a behavior problem ... it can not be cured by a pill. The role of Buprenorphine is to prevent withdrawal symptoms and the lowest dose that prevents withdrawal should be used.

Yes, I understand that addiction is a brain disease characterized by relapse, but if Buprenorphine could prevent relapse then no one would ever have relapse.

The medical fact is Buprenorphine does not prevent relapse ... it prevents withdrawal. As yet we do not have any medication that prevents relapse.

And it is beyond my power to improve the life of patients ... I can only assist them if they want to improve their lives ... it is a struggle, but it is they who are willing to put in the effort that will recover ... addiction is not cured by a prescription.

And No ... I do not kick out people just because they had one relapse ... I look at the overall clinical scenario ... most people are given a chance ... but some are not.

It is poor service to the patient, and, inappropriate to go on prescribing the same high dose without a demand for tapering ... or prescribe the medication to patients who disregard instructions and continue to relapse. It is my job to push them to taper ... if I am not pushing them I am not doing my job.

My philosophy is if I can not make a difference to you ... then go to some one who can.

Everyone is entitled to their own opinion ... and I am entitled to mine. And I base my opinion on current literature, physiology, pharmacology, and clinical experience ... of five years now ... and I used to do pain management before that, so I have a fair idea why some one refuses to taper.

There are very few patients who can make a complete recovery on the very first attempt. It takes multiple attempts ... but I am not willing to prescribe this medication to someone who is obviously not serious about making this attempt.

There are programs that run on the principle of "harm reduction" ... partial success is still success ... and is better than no success. But, I have found it very difficult to offer such a program as a solo practitioner. Those programs are better run by state agencies, or by organizations which have more resources.

It does not matter which doctor you go to ... the doctor's role is very limited ... it is to prescribe Buprenorphine ... and any doctor can do that. But just as a good coach can push you to achieve more ... a doctor who pushes you to take the lowest dose ... and demands a change in behavior, ... will be good for your health, and your recovery.

And yes I do charge a fee for what I do and it brings me additional funds ... I do not get any funds from the government or charitable institutions ... and No, I do not do it just to get money ... if that was the reason, I would have followed your advice and prescribed high doses for ever and ever. You need to look into your own conscience and examine why you are promoting high doses that have no pharmacological basis.

At this point I am satisfied in what I am doing, and the way I am doing it, ... and I will change it, ... if there is evidence that there is a better method.

It is gratifying to see those few patients who are willing to follow my advice ... and make a complete recovery, or at least achieve the lowest possible dose, ... and I am here to serve them.


I have actually never advocated for high doses for anyone, except at the beginning of treatment when the receptors need to be totally filled up to reach the ceiling limit, eliminate cravings, and stop withdrawals. I, myself tapered from 16 mg to 2 to 3 mg per day. I've been on this dose for 2.5 years. I think it is a bad idea for doctors to prescribe suboxone in large doses because that encourages patients to sell part of their prescription.

I was reacting to the idea that suboxone patients in your practice are to taper off completely, thereby "completing treatment". If your studies have included the research on the brain changes of addicts, and particularly opiate addicts, I don't understand your concept of completing treatment by tapering off suboxone. Addiction does not go away because you've been on suboxone for a specific amount of time. If you do have research that shows that opiate addicts will be recovered from addiction in a certain amount of time on suboxone I would very much like to see it. So far, the only research I've seen has shown that a year is usually not enough time to protect opiate addicts from relapsing.

Since addiction never goes away and opiate addicts are subject to cravings that come back at any time, that is why I question your desire to treat opiate addicts with suboxone for a certain amount of time and then wean them off. The terms of your practice sound fair, but I'm not understanding how you know when addicts should be weaned off. I certainly don't know everything there is to know about addiction treatment, but I am earning a masters in addiction studies at this time. I'm simply not aware of a cut off point that has proven effective for preventing relapse among opiate addicts.

I think it is a great idea to make sure that your patients are receiving counseling. I was very fortunate that my opiate addiction started in my 30s and that I was able to ask for help before I was in any legal, financial, or interpersonal trouble. My behavior changed immediately when I went on suboxone, but I sought therapy with an addiction counselor on my own because I wanted to examine the reasons behind my addiction and figure out what triggered me to use. I sometimes feel that I experienced addiction so that I could be helpful to other addicts and that is where my life is headed.

I have a wonderful doctor who has specialized in addiction medicine for a number of years now. He treats me like an equal because I have always treated him with respect and solicit his advice. I have clued him in on new research when I've found it and he always seems to appreciate when I'm able to bring him something new about buprenorphine or the field of addiction work. His office does random UAs and med counts (which I highly recommend to keep people from diverting their medication), and I have never been out of compliance with his protocols.

I certainly do not believe that patients should dictate what they want to their doctors. I don't have to research Michael Jackson or anything else because I don't think rich people should be able to bully their doctors. Doctors do have to protect themselves by establishing protocols that are in line with the expectations of the FDA or any other body who has authority in this area.

The reason I questioned your motives is because there are many doctors who aren't operating out of any sense of altruism, but have found a quick way to make extra money. These are doctors who run cash businesses and will stop treating addicts at the least provocation, so they can start a new addict on suboxone. The fees for new patients tend to be higher than the ones who are on a stable maintenance dose. I don't expect doctors to be like St. Teresa, but addicts are not well served by the doctors who don't give a damn either.

I understand why your solo practice has the limitations it does, especially after you've explained your reasons. I just wish you would consider letting your patients have longer on suboxone than a couple of years. Yes, help them wean down to an effective lower dose, but if they start to complain of increased cravings, recognize that they may need to be on the medication for a longer period of time.

Patients are probably not leaving your practice because they don't want recovery. Some might not be ready, but others are probably intimidated by the tapering schedule you set and think that you don't understand how much their addiction has them by the throat. Most suboxone patients want to feel that their doctor understands them and isn't going to abandon them down the road. We have addicts on sub come here all the time and say that their doctor has put them on an arbitrary taper schedule and they are terrified of prematurely going off their medication. They might say, "I have my life totally back on track and I'm doing so well! But now my doctor is telling me that I have to taper off suboxone all together!! Why is he/she taking away the only thing that has ever worked for me??" It's a legitimate question.

I hope I've cleared up any misunderstandings that you may have about my views. I think we probably have the same opinions on more subjects than those upon which we disagree. I am glad you are here to offer services to patients in the Dallas/Fort Worth a possible solution to their addiction problem.

Amy

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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

  • Board Certified Psychiatrist
  • Asst Clinical Professor, Medical College of Wisconsin

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