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PostPosted: Tue Feb 14, 2017 11:59 pm 
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With all the information we have here on our forum it seems most of it goes to waste concerning the DEA, or any government entity when deciding how best to handle the opiate crisis.

So many doctors will only accept cash, which I do understand to some extent depending on services rendered like our own Dr. Junig. But a lot of others only want the money and it makes me wonder if they are really interested in helping addicts find recovery or if it's purely about the bottom line.

I have been fortunate to have found two separate doctors in different states that both accepted insurance. The first one has now changed that to cash only from what I've heard. My Suboxone doctor now had a slot for me and he is now my GP who handles most of my basic health needs. He keeps his cap at about 70-80% to allow for failures to return. If I move back to my old state I don't know if I'll be able to find another one who will take my insurance. Being retired, it means a lot, but not a deal breaker.

Okay, bottom line. Is there any organization, club, or group to join to help educate the DEA or whoever in the government about the benefits of Suboxone therapy? Call, write letters, emails, etc. Obama tried but still didn't understand what needed to be done to help get the addicts who need help onto Suboxone. Why is it so friggin' hard to get them to listen? I want to do something to help but have no clue on which way to go.

I'm just throwing this out there to see if anyone has heard of any organization who pursues this. The 100 patient cap is absurd and the 250 new cap is asking doctors to jump through hoops with no financial gain by doing so. What needs to be done is to allow every doctor to prescribe Buprenorphine without that special DEA number that they need now. It isn't that complicated but it seems that no one understands the dynamics of medication assisted therapy. (MAT)

Thanks everyone, I'm just venting with the hopes that maybe we can do something in the future. You know, save some lives maybe? Too many are dying now with this combo of Heroin, Fentanyl, and Carfentanil. Plus the shortage of Narcan, so they say. What can we do as a group? Any ideas will be appreciated.

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PostPosted: Wed Feb 15, 2017 8:43 am 
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Hey rule,

Very thoughtful post. I think you hit on the most effective strategy when you talk about writing letters
and making calls. I'd say the best way to go about this would be for members of the forum to
get in touch with their congresspeople. Also to those in congress who are taking leadership positions
in this area.


I found this online...here's most of it. It's written b congressman Kevin McCarthy of California. He mentions by name several congresspeople who are active in this area: I don't know anything about the politicians he names, or anything about McCarthy. But seems well intended.

"Unfortunately, the numbers of those affected by this opioid epidemic are on the rise, stretching far past Kern county across America and ruining countless lives.

According to the Centers for Disease Control and Prevention (CDC), 78 Americans die every day from an opioid overdose. That’s not counting the thousands who are estranged from their families, unable to work, and living shadows of their former lives because of their addiction.

And this problem has only gotten worse over time. The CDC has found that now more than six out of ten drug overdoses involve opioids. Opioid addiction is tied strongly to prescription abuse, and in 2012 health care providers wrote 259 million prescriptions to people for opioids, enough that every single adult in America could have had their own bottle of pills. Since 1999, opioid prescriptions have quadrupled. As of 2013, a full 55 percent of all drug deaths are linked to prescription opioid painkillers or heroin.

This epidemic is now increasingly affecting women. Men continue to die of painkiller overdoses at a higher rate than women, but that gap is getting smaller. The CDC reports that more than five times as many women died from such overdoses in 2010 as they did in 1999, increasing to about 18 deaths per day.

These numbers have a real human cost, and opioid addiction affects every race, gender, and socioeconomic level in America.

While families and communities are and should remain on the front lines to fight the tide of addiction, Congress has a role as well. The federal government should support community efforts to battle addiction and improve regulations governing opioid prescriptions.

The Senate—led by Kelly Ayotte of New Hampshire and Rob Portman of Ohio—should be commended for their work to combat opioid addiction.

Members of the House have been working hard to respond to this crisis as well, and as Majority Leader, I plan to schedule multiple bills on the floor to address the nationwide opioid epidemic.

Two of my colleagues, Rep. Jim Sensenbrenner (WI-5) and Dr. Larry Bucshon (IN-8) are working on bills to improve treatment, prevention, and education efforts for those with opioid addiction.

Meanwhile, Rep. Susan Brooks (IN-5) has a bill that would create better guidance to the medical community about the best practices for pain management and medication prescribing so that fewer people fall into the trap of addiction through perfectly legal prescriptions.

Likewise, Rep. Evan Jenkins (WV-3) has focused on babies suffering from withdrawal after being born of opioid-addicted mothers with a bill to improve newborn care.

However, we cannot forget that so many of these problems stem not only from abuse, but from the illicit drug trade as well. Unfortunately, today we are consistently a step behind in stopping trafficking of opioids and other illegal drugs, but Reps. John Katko (NY-24) and Charlie Dent (PA-15) are working on bills to improve operation of our drug laws.

The House’s goal is simple. We want to build on efforts to prevent addiction and treat those suffering, crafting legislation that will gather bipartisan support and get signed into law. The President’s own proposals to combat opioid addiction demonstrate that there is ample opportunity to reach a bipartisan consensus, and the Senate’s recent work to combat opioid addiction shows bicameral legislative interest. We will review all of these ideas as we move forward in scheduling legislative action.

House Committees should complete work on legislation in April, and I plan to bring these bills for a vote on the House floor in May.

There is no quick cure to the problem of opioid addiction, but we can and should do more to stop the tide of this epidemic so the American people can live freer and happier lives."

Here a link to the article: https://kevinmccarthy.house.gov/media-c ... d-epidemic


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PostPosted: Wed Feb 15, 2017 10:18 am 
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In my area, just my immediate area, it's almost harder for ppl paying cash that doesn't have insurance like myself. When I first started this treatment 5 yrs ago, ppl in my area with insurance couldn't get help because no doctor around here would take insurance. So bk then (I'm just speaking about my surroundings towns) if u couldn't pay cash then u were screwed basically. My clinic didn't accept insurance either but is the cheapest place I've found..., which is still $350 a month plus medication costs.

Now my clinic accepts Medicaid and other insurance plus cash paying patients. Another clinic down the next street over, that used to accept just cash, now is accepting insurance, and now raised their price to $500 a month for cash paying patients which used to be $400. Their reason for upping their price to 500.... is because they are now accepting Medicaid. I don't understand that. So because they now take Medicaid, the ppl who pay cash has to pay an extra hundred dollars?? Glad I didn't start out at that clinic! Talk about a price increase.

So in my area, if ya don't have insurance, it's getting harder too. And I understand we're all supposed to have insurance, but I don't. I applied for our states BlueCare and they told me that I qualify but aren't accepting any new enrollment right now. All the other plans are expensive so I just pay cash. I'd love to change that and maybe I can soon.

So imo I think it's made hard for everyone in some areas. I don't know why more doctors can't prescribe buprenorphine. I know they have their reasons but dang that'd be great and hope it can change.

The main thing in my area is clinic settings. I'd love to be able to see my doctor in a private practice setting. I just wish this treatment wasn't so expensive and there were more options without waiting lists, basically what u said Rule. This treatment works so well, ppl need to understand that. I'd call, write, email or whatever I could do to make a difference. Any ideas I'm ready to do to help :)

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PostPosted: Thu Feb 16, 2017 12:13 am 
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I got posters remorse this morning and thought to delete my thread but of course my ISP wouldn't let me in until this evening so forget that one.

Good info you two. With me, or any of us, we are a small group of addicts who will probably never have a voice about the opiate crisis so my thread was most likely posted in vain. But there was something I wanted to touch on about all the scripts for pain killers written over the last few years. When the DEA changed Hydrocodone and others to a schedule II narcotic it made it harder for people to get their medication, both real pain patients and addicts alike. Really not fair for those who depend on opiates to ease their pain of whatever disorder they are suffering from. They now have to go monthly, get drug tested, and half the time the pharmacy doesn't have it in stock due to a change in ordering large quantities. So who does it hurt? Those on a fixed income who are not addicts and now go through w/d's almost every month unless they found a good pharmacy.

So what did the addicts do? The cheaper and easier route. Buy Heroin laced with all those supper strong synthetic opiates manufactured in China and Russia. The DEA made it worse IMO. They hurt those who are legit and hurt and or may kill the addicts who were forced to buy off the street. That is what really burns my butt.

Okay, I'll end it here. My post is really just a rant and I didn't expect much in the answer department because we know most everything there is about Bupe. And we're lucky enough to have Dr. Junig and docm2 to give their expert opinions on what to do.

Say the word and I'll just delete this thread and we'll get back to business as usual.

r

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PostPosted: Thu Feb 16, 2017 12:40 am 
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The cash issue is complicated. I charge $200 per month at first. If a person is stable for several months I will see them every 2 months, and at a year every 3 months. So the total charge for stable patients at that point is $800 per year-- about $65 per month.

Methadone treatment is covered by medicaid, but as soon as people get jobs the lose medicaid, and then the cost is about $600 per month.

Residential treatment is rarely covered entirely by insurance. My own treatment cost $60,000 for three months, and then I paid for urine tests and counseling for the next 6 years. I spent well over $100,000 out of pocket. I used to own a small lake cottage in Wisconsin; that was sold for my treatment.

With those things in mind, my charges seem pretty fair. I often hear people say that they can't afford treatment, but I have never met a person with an opioid habit that cost less than $65 per month! In fact, the cost of methadone, at $600 per month, is cheaper than most heroin habits. And the straight price comparison doesn't take into account that treatment is worth something, and leads to a better life-- so maybe it SHOULD cost a bit more than a heroin habit!

Ive written about this on my web site (the one at psychtimes.com), but I've worked in many different settings over the years. I've worked in a clinic where I accepted all insurances. They made me see 6 people per hour, because the numbers didn't work otherwise. It is HARD to see 6 people per hour! That means that I have 10 minutes for people to settle in and take their coats off, tell me their problems, and then tell the their options, write scripts, and then dictate the encounter. In 10 minutes! Sometimes I had a cancellation or two , and I had a whole 15 minutes-- but by the time the person gets to the room and sits down, there is no time to talk. If a person wants me to collaborate with another doctor, that would take up the entire appointment!

I noticed that doctors working in those settings tend to prescribe a LOT of meds. It takes much, much more time to refuse benzos than to just write the script! The same goes for a diagnosis of bipolar. A patient says 'mood swings', and doctors start writing a script for a medication that they have no time to discuss. Patients end up on zyprexa or depakote, gain 80 pounds in three months, and never know why.

Accepting cash only means that every patient pays the same thing. With insurance, I get, literally, $36 from some patients, and $160 from other patients. I would hope I treat people the same-- but can people see how that might not be the case with all doctors? Would you worry about that, knowing that the the doc you are seeing got $150 from the patient before you and after you, and was getting $30 from you? If he spent a few extra minutes with those patients, would you be sure it had nothing to do with insurance? Or what if the patient before and after you paid nothing for their care, and joked about that in the waiting area-- and you were paying $400 because of your high deductible? Would that bother you?

I like knowing that every patient pays the exact same thing. More than that, I like that I can provide 30 full minutes for every single patient, and I can save an hour at the end of the day in order to answer every patient's emails-- personally and completely. Beyond the $200 every 1, 2, or 3 months, everything else is free. If a person needs a med adjustment, I do it by phone or email at no charge. If they need a note to an employer, I do it for free. Their regular payment means having my services available at all times, for no extra charge.

I don't charge anything for drug tests. Every patient is offered a free cup of coffee, soda, or bottled water upon arrival. I always start on time; there is never a wait to see me. That means you can leave work for a 2 PM appointment and know you'll be back by 2:40.

My office is very comfortable, private, and discreet. There is a separate hallway to exit that avoids the wait area, and since I see one person every 30 minutes there is no risk of running into someone who your don't want to know about your care.

I've never taken the time here to describe my practice, but honest, this is what it looks like ( I think I may have pictures at my site at fdlpsych.com-- may have taken them down?). But my point is that many people just talk about 'insurance practices' vs. 'cash practices'. There are usually other differences that go along with the insurance difference-- although I can't vouch for other practices. Knowing what I know, I'd take the practice where I have the time I need, and where I don't have to wait for half an hour to be seen. The nice thing, of course, is when people have a choice-- which is the case in my town. I've had patients leave my practice because the 'other doc' takes insurance.... and I always feel like I'm on the right track when they return, saying they never had time to say anything with that place and so they want to come back. It happens so often that I usually hold the spot for at least a few months after they leave.

Just another perspective on the issue....


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PostPosted: Thu Feb 16, 2017 8:31 am 
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Quote:
I spent well over $100,000 out of pocket. I used to own a small lake cottage in Wisconsin; that was sold for my treatment.


I found this especially poignant. Such things sting. I wake up from dreams sometimes in which I've lost some great sum of money, or done something extremely stupid with money, and quickly realize that it's about guilt..

Most times when you have a bad dream you feel great relief on waking. Ah, it was only a dream. Whew!
Not so in such druggie guilt dreams. I expect such bad dreams will be with me for the rest of my life.


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PostPosted: Thu Feb 16, 2017 2:40 pm 
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Dr J, my fiance travels to Wisconsin sometimes. I often joke with him that I'd just go with him once a month if I could be a patient of Dr. Junig :)

Ur practice sounds amazing! And everything u just said, makes me understand my doctor a little bit more. There's a lot more going on than as patients we know.

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PostPosted: Thu Feb 16, 2017 9:29 pm 
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Thanks Doc, for not taking my post too personal. It was really just a rant about not enough people being able to get treated. Your price for what a patient gets in return is worth much more than you charge IMHO, and I'd be so happy to live close enough to be one of your patients. My fear is moving back to our home state and not being 1) able to find a Suboxone doctor to treat me, or 2) they charge hundreds more than what you do. It's a double edge sword that I'll have to face eventually. That, or keep my residence here in Nevada and just rent a place close to my family. Maybe we'll put out an ad in the newspaper wanting a rich uncle to adopt us. Wouldn't that be nice!

Thanks Godfrey for that great link and also the boost of knowing we are not alone in trying to help.

I'll let this thread rest in peace now.....

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PostPosted: Sun Feb 26, 2017 9:51 am 
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suboxdoc wrote:
The cash issue is complicated. I charge $200 per month at first. If a person is stable for several months I will see them every 2 months, and at a year every 3 months. So the total charge for stable patients at that point is $800 per year-- about $65 per month.

Methadone treatment is covered by medicaid, but as soon as people get jobs the lose medicaid, and then the cost is about $600 per month.

Residential treatment is rarely covered entirely by insurance. My own treatment cost $60,000 for three months, and then I paid for urine tests and counseling for the next 6 years. I spent well over $100,000 out of pocket. I used to own a small lake cottage in Wisconsin; that was sold for my treatment.

With those things in mind, my charges seem pretty fair. I often hear people say that they can't afford treatment, but I have never met a person with an opioid habit that cost less than $65 per month! In fact, the cost of methadone, at $600 per month, is cheaper than most heroin habits. And the straight price comparison doesn't take into account that treatment is worth something, and leads to a better life-- so maybe it SHOULD cost a bit more than a heroin habit!

Ive written about this on my web site (the one at psychtimes.com), but I've worked in many different settings over the years. I've worked in a clinic where I accepted all insurances. They made me see 6 people per hour, because the numbers didn't work otherwise. It is HARD to see 6 people per hour! That means that I have 10 minutes for people to settle in and take their coats off, tell me their problems, and then tell the their options, write scripts, and then dictate the encounter. In 10 minutes! Sometimes I had a cancellation or two , and I had a whole 15 minutes-- but by the time the person gets to the room and sits down, there is no time to talk. If a person wants me to collaborate with another doctor, that would take up the entire appointment!

I noticed that doctors working in those settings tend to prescribe a LOT of meds. It takes much, much more time to refuse benzos than to just write the script! The same goes for a diagnosis of bipolar. A patient says 'mood swings', and doctors start writing a script for a medication that they have no time to discuss. Patients end up on zyprexa or depakote, gain 80 pounds in three months, and never know why.

Accepting cash only means that every patient pays the same thing. With insurance, I get, literally, $36 from some patients, and $160 from other patients. I would hope I treat people the same-- but can people see how that might not be the case with all doctors? Would you worry about that, knowing that the the doc you are seeing got $150 from the patient before you and after you, and was getting $30 from you? If he spent a few extra minutes with those patients, would you be sure it had nothing to do with insurance? Or what if the patient before and after you paid nothing for their care, and joked about that in the waiting area-- and you were paying $400 because of your high deductible? Would that bother you?

I like knowing that every patient pays the exact same thing. More than that, I like that I can provide 30 full minutes for every single patient, and I can save an hour at the end of the day in order to answer every patient's emails-- personally and completely. Beyond the $200 every 1, 2, or 3 months, everything else is free. If a person needs a med adjustment, I do it by phone or email at no charge. If they need a note to an employer, I do it for free. Their regular payment means having my services available at all times, for no extra charge.

I don't charge anything for drug tests. Every patient is offered a free cup of coffee, soda, or bottled water upon arrival. I always start on time; there is never a wait to see me. That means you can leave work for a 2 PM appointment and know you'll be back by 2:40.

My office is very comfortable, private, and discreet. There is a separate hallway to exit that avoids the wait area, and since I see one person every 30 minutes there is no risk of running into someone who your don't want to know about your care.

I've never taken the time here to describe my practice, but honest, this is what it looks like ( I think I may have pictures at my site at fdlpsych.com-- may have taken them down?). But my point is that many people just talk about 'insurance practices' vs. 'cash practices'. There are usually other differences that go along with the insurance difference-- although I can't vouch for other practices. Knowing what I know, I'd take the practice where I have the time I need, and where I don't have to wait for half an hour to be seen. The nice thing, of course, is when people have a choice-- which is the case in my town. I've had patients leave my practice because the 'other doc' takes insurance.... and I always feel like I'm on the right track when they return, saying they never had time to say anything with that place and so they want to come back. It happens so often that I usually hold the spot for at least a few months after they leave.

Just another perspective on the issue....

Do you think my major medical claim for my Suboxone visits is in vain? The clinic only takes cash. I am the one the PM'd you about my claim.

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PostPosted: Thu Mar 02, 2017 1:24 am 
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Buprenorphine is an amazing drug, it has helped many people come off much harder drugs. It is a much safer alternative than methadone. Some patients can take 4mg a day and can be great, and some patients have to have a higher dose. I am on 16 milligrams myself, and I am allergic to Narcan. I have it documented. It has saved my life, and I am currently in maintenance, but many Virginia patients need you alls help. They are trying to pass a bill HB 2163 that prohibits doctors from writing prescriptions to patients unless they are pregnant. Every other state that has passed a similar law has also included people with a hypersensitivity to Narcan. That isn't the only thing though, they are also going to prohibit federal licensed OTP's (Methadone clinics) from dispensing it in take homes. This would cut off thousands of patients overnight essentially. There is a petition that is getting overwhelming support but it needs all the help it can get, it doesn't matter what state you are from if you can sign it thats great if not I understand too. Us patients need to stand up for our rights because if they can do this they will do it to suboxone too. Here is a link to the petition

https://www.change.org/p/terry-mcauliff ... -treatment


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