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PostPosted: Tue Apr 10, 2018 3:58 pm 
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Hello!
A couple months ago my sub doc said that some "rules and regs" have changed and that in the very near future the option of not having to come in every month but instead once every 90 days was on the horizon..I didn't think much about it besides that would be so damn awesome haha..then last week my sponsor said his doc (different doc offoce) mentioned the same thing and that it won't be long. You would just have to come in for random urine screens but besides that only one visit with the doc every 90 days..has anyone else heard this or can speak to the truth of it?


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PostPosted: Tue Apr 10, 2018 4:19 pm 
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I don't know if that's a specific state law you are talking about. Because I know numerous people who only visit their suboxone doctor every 90 days or so. I believe that the law according to the DEA is that a patient receiving controlled substances needs to be seen at least every 6 months. That's what I remember reading on this subject.

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PostPosted: Tue Apr 10, 2018 4:40 pm 
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Any change your clinicians are reporting would be from the state. Nothing has changed from the Federal Guidelines. For several years if a person has been: compliant, in recovery and stable, I will see them every 3 months after one year of treatment.
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PostPosted: Tue Apr 10, 2018 5:27 pm 
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I agree with Amy and the doc, only I'd add in it might be an internal or facility "rule". While it's certainly possible, and I don't know regulations in all 50 states - and Lord knows they are changing all the time as elected legislators very often with zero medical training or experience think they know more than physicians with many years of training and experience and create laws as to how to practice medicine. That aside, I've not heard of any state law stating how often a bup patient with a private practice physician has to be seen. It's a function of the DEA schedule III controlled substances, While Bup needs a special license to prescribe it has no other regulations separate and apart from every other schedule III substance. That means refills are allowed for up to six total months of medication and it can be called in rather than having to be written.

I would have to wonder if this is a policy change with the provider you are seeing - especially if it's a large operation. If you tell us what state you are in, we might be able to help more. Otherwise I'd ask these people just what "law" they are talking about - or if this is a facility/organization decision.

Finally, I too have heard of multiple patients who see their docs every three months after they are stable. I've been on bup for over 8 years. I've been lucky to have only two docs and both have seen me every 3 months after I got established with them and was shown to be stable. My previous doc started UAs every month even though I saw him every 3 months. When those UAs started costing more than a thousands bucks a pop or should I say a piss, I left for my current doc. I've yet to hear of anyone allowing 4, 5 or 6 months between visits but it could be done by law. I actually wonder if some docs might be willing to do that with long term stable patients but are afraid of "how it would look" to some outsiders - as in being seen as outside the current standard of care due to a "controlled substance." The financial aspects may also come into play as well. I'm not sure I'd even think twice a year or every 6 months would be a good idea. Perhaps every 4 months, however, might be?

Hope that helps.


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PostPosted: Tue Apr 10, 2018 6:09 pm 
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Good to hear from you donh, always appreciate your perspective.
Tennessee has instituted a law that is more, not less restrictive. Mandating monthly visits, observed UA's, and some other draconian measures.


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PostPosted: Tue Apr 10, 2018 8:44 pm 
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I flat out refuse to have someone watch me pee. That is very degrading, dealt with it in jail and never again. That's mainly why I buy on street and not go to a clinic. For the amount that I do, it's prolly cheaper this way anyways.


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PostPosted: Wed Apr 11, 2018 11:14 am 
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My mindset is that I’ll do whatever I’m asked to do or get kicked out on my butt. I live in Tennessee but have never been to a clinic or doctor that prescribes buprenorphine, I go to one in KY. I can only assume by the rules being talked about goes for either KY too or it’s just up to the individual doctor themselves, heck I personally don’t know. Everyone I have ever talked to in person has had to do the same sort of ‘rules’ in my area (my area would be considered KY, TN and VA. That’s why I always assumed it was the clinic rules instead of a state or federal rule thing. I knew others on this forum have talked about getting refills or not having to go every month, so I knew it was ‘allowed’ but I’ve never heard anyone around my area ever having that luxury (trust me it is a luxury imo because I’d be so blessed to save a little money that way). In other words, I always assumed it’s individual on just how strict a doctor is on certain things. But I’m willing to do it, anything is better than what I was dealing with in active addiction.

I have someone watch me pee every single month, but it’s always the same person and turns out I was pretty good friends with her in school, so it’s kinda like catching up with a friend in the ladies room, I don’t consider that a deal breaker on not attending my clinic. Heck in my past, who didn’t watch me pee.... probation officers, rehabs, jails... I’m ok with that.

I see my doctor once a month and I’m required to attend a meeting (suboxone based held at my clinic) once a month or more, whatever I choose. I don’t care to do that because it’s good for me. Since I’ve been there a long time, I was just asked to be a peer support counselor with the IOP group, which makes me very happy. I’ve learned a lot and I’ve had to learn to be accountable. It use to upset me that my clinic was so strict but I was willing to do whatever I was asked to do.


Now the financial part that some ppl face trying to get this treatment is a whole other story. I think some ppl are being taken advantage of and some places are just so unrealistic in their prices. The medicine itself in some places are way overpriced and unfair. Heck it’s easier and cheaper to see a cardiologist than to get treatment for addiction in some areas.... I saw that first hand Monday. It’s a shame. It’s not like that everywhere but it is out there.

I won’t be going to my doctor every three months, I don’t ever see that happening. I would jump for joy if it did happen, but it won’t happen where I’m going. My advice to ppl out there who have that mindset that they’ll just buy off the streets because it’s to difficult or to strict.... please don’t look at it like that. Have the mindset that you’re going to do whatever u have to do. If I’d let that decide whether I went to a doctor or not, I guarantee u that I’d still be messing around a little bit because there’s going to be days that ur not going to find it on the street and then what will u do? Or buying from a dealer or ‘friend’ what will happen if they get cut off all of a sudden? If u need to test for a job or get stopped by the police....... There’s so many problems doing it that way. Regardless if the place is strict or not, just go the legal route.

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PostPosted: Wed Apr 11, 2018 12:14 pm 
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union carpenter, by continuing to buy it on the street only validates your addict behavior. We get it that no one likes to have someone watch you pee. I cannot do it either. Call around and find another doctor who only does random UA's or mouth swabs. My doctor has never asked me to pee. They swab my mouth or take blood to check my levels. Maybe mine is a rare breed. Hopefully you can find one who does the same.

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PostPosted: Wed Apr 11, 2018 12:51 pm 
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Another thing, I do understand why some doctors are so adamant with these urine screens and being somewhat strict. Here, it’s just raging and there’s ppl that only go to a clinic because their insurance covers it and they see it easier to get a medication that they can immediately go fill their script and sell every bit of their medicine to go buy their drug of choice like pills or meth. I see it in my clinic constantly. Without the urine screen, how would they weed these ppl out? If they aren’t ready to change, they’re taking up a spot for someone who really needs it. My nephew for instance, he only got this medication to sell it and go buy pills. He’d take his medicine here and there to keep it in his system and try to fool the doctor. He didn’t last long before they caught on. He never tried and his only goal was to sell the medicine unfortunately.

Where I live, to see many familiar faces at my doctor is becoming harder and harder because so many don’t last past a certain length of time. They aren’t there for the right reasons. I think clinics draw those that aren’t ready to achieve recovery, because they see it as an easy way. Without the screening and rules they have, it would be awful. It’s sad and a waste. I think to myself how lucky they are to get this treatment for free but they’re blowing it. I do think someday they’ll be ready but until then they shouldn’t take up a spot for someone who is. That’s just how I try to look at the strict type rules but I also know some places go way past the point of reasonable with their rules.


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PostPosted: Wed Apr 11, 2018 7:21 pm 
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Thanks for reminding me about Tenesee docm2. They are one of several states where these legislators want to legislate medical care. Although is it a required law there? I thought it was a "guideline" drafted at least in part by medical professionals? Of course they could use it to show a doc is not following the guidelines. So it may not be required by statute but could end up that way.

Here is what the 50 page document says:

"These Guidelines are intended for providers using buprenorphine-containing products in a nonresidential setting. These Guidelines are not meant to dictate medical decision making. They are Guidelines of generally accepted medical practice rather than absolutes. Providers still have flexibility to deal with exceptional cases. Occasional deviation from these Guidelines for appropriate medical reasons is to be expected and documented."

It's already been difficult getting patients into effective treatment. Increasing the costs and requirements will not help that. What sense having someone like me be required to see a provider every month, after 8 years without a failed UA or even a single slip, is beyond me.

Pretty much everything government puts their fingers in the make worse and screw up. As for UAs witnessed or not, I'm happy to provide a sample. Those with nothing to hide, hide nothing is how I feel. Test away, look if you'd like. :).


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PostPosted: Thu Apr 12, 2018 10:59 am 
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That’s exactly how I feel too :) doesn’t bother me, the only thing that does bother me about it is having to wait for my name to be called on a busy day when I’m about to pee on myself.

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PostPosted: Sun Apr 15, 2018 11:08 pm 
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I have almost peed myself a few times in the lab waiting room at the clinic. My doctor is comfortable with 3 month visits and 3 month ua. My last provider only had ua once every six months. I guess that every provider has different ideas.


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PostPosted: Mon Apr 16, 2018 11:43 am 
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The 2 methadone clinics in which I worked were in a very progressive New England state that covered addiction treatment for the poor at 100%. This meant that many (or most) patients got their medication free, drug tests (by mouth swab only) for free, individual counseling for free, and group counseling for free. And you can’t believe the number of people that did nothing but complain. One of my groups was a women’s group, where I had hoped that women could share about their particular issues and trauma. But quite honestly, I would say 75% of the group consisted of complaining about the clinic and all the things they were being “forced” to do (like attend the group).

It bugged me then, but now that I find myself back on Suboxone and paying out of pocket for all of the above, it’s almost incomprehensible to me.


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PostPosted: Mon Apr 16, 2018 2:49 pm 
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I understand all of that Luly, even though I am not a pro and vol my time, Many nights it is a complain fest from thoses who pay almost zero. I stop it by having each one of them think about where they d be without the cllinic or med. I too am a out of pocket patent and all the costs that go with it.


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