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PostPosted: Wed Oct 25, 2017 12:13 am 
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Hey everyone,
Its been a while since I have posted. I have decided since I began my induction that I was going to try and stay on suboxone long term. The longer time went on, the more assured I have become that I want to stay on maintenance indefinitely.

My doctor seems to not believe in maintenance. I found this out the last visit. I am 8 months in. I have talked about wanting to be on maintenance using suboxone because I feel it is far superior for me and what I want, and over having to deal with everything that comes with the methadone clinic situation in my state. He seemed to not bat an eye. He always asked me if I wanted to begin a taper, but it always seemed not mandatory and just a question. Well last time I saw him, he was pissed at me for not wanting to taper and get off suboxone, chewed me out. He seems to think being on buprenorphine is the worst thing in the world... as apposed to what I think? Being a danger to my own miserable existence constantly and never knowing a stable moment? I don't know if he really appreciates or gets the gravity of my situation and how life changing suboxone is for me. He has never even heard of SMART recovery and has more than once professed suboxone to be dangerous and "not good for me". Again, as apposed to what blares in my mind. I havent been stable in 20 years. I always sing praises for what its done for me when I post here.

Anyway... I asked the front desk people if he believed in maintenance at all. They said no, he puts every patient on it and brings them off. It royally pissed me off to hear it. I said I might have to go elsewhere then. I went outside, and began balling my eyes out. I havent cried in forever. But it just kills me. To think such important medication can be treated this way with people. It made me feel like I was just part of a money making scheme, put on and taken off so that he can keep billing new patients under his patient limit instead of cheaper ones on maintenance who often times may owe their life to the man writing the script. I dont know how valid that is, but...

Yeah so I cried and went inside, asked to speak with the doctor again. He met me in the waiting room. I professed how talking about taking me off this medication is like talking about wanting to rip my insides out, how it has saved and given back my life, how I owe everything to the chance the medication has given me and I have no intentions of coming off suboxone.

He gave me an updated "terms" agreement and asked for me to read everything carefully, really carefully, and sign it. He then left while I did and came back with a 3 month script, not a month script like usual. I was so thankful because I do not have much money and the save on visits meant a ton to me. I do not know what my 3 month script means though, in regards to how my doctor is going to treat me moving forward. I worry it was a goodbye gesture and I will get a phone call soon that he cannot treat me anymore or some nonsense.

Right now I am purposely not working a high paying job and working very few hours to stay on state insurance because I was in a bad way and out of work when I began suboxone, and do not want to jeopardize my treatment. I am currently on 8mg 3x a day so it is pricy, alongside gabapentin and wellbutrin. I cannot pay $1,200 a month on medication... Right now I am just living a simple life and appreciating every moment.

So I am in a bind. I see challenges ahead. When I am ready to move on with my life and get a real job and move out from my familys house... hell I have some places Id rather be, out of state places even. I cant stay on my situation forever. And my doctor isnt making it any easier, making me feel very uneasy like he may drop me for a BS reason one day because I do not taper. Thing is, my dose just works. I dont want to change anything. Again, stability. God it means everything. I havent ever had it, I dont want to change it.

So idk. I know ultimately if something happened, I could fall back on methadone but god I really do not want to. I want my life and I want to KEEP IT THIS WAY.

Its a god damned SHAME this medication is not more talked about, more readily available, easier to pay for. And its a shame there are doctors that flat out will not do or do not believe in maintenance. Why oh why.

Anyways. Does anyone have a commiserating thing to post, or maybe tips moving forward? I know that I want to stay on suboxone. I dont have a doubt. But I worry about the doc and I worry about insurance changes and my future sustaining my treatment. Anything or nothing would be helpful to reply with. Its been burdening my mind a bit lately and I cant talk about it at meetings... I figured I would come here and get it off my chest and see what people say.

Peace


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PostPosted: Wed Oct 25, 2017 10:17 am 
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This issue has been the fuel behind my blog and the impetus for this forum. Things have changed in a positive way over the past 10 years, but there still is a long way to go.

I live in the Midwest, where ignorance about buprenorphine is the rule. It has been a bizarre experience over the past couple months as I study for Boards in Addiction Medicine; the textbooks say that opioid use disorder should be treated using a 'chronic disease' model, in the same way we treat other illnesses. Medications should be used for at least a year, and in some cases indefinitely. That's the way that I approach treatment with buprenorphine, and over the years I've accumulated patients who want to stay on the medication long-term. I'm fine with that, and the literature supports that approach, but those patients are constantly asked 'why are you still taking that?' by pharmacists, county agency workers, and primary care docs. So frustrating to see the level of ignorance, and worse-- that those people are not even aware of the standard of care.

As I've written many times on my blog, opioid use disorder should be treated in the same way we treat any chronic illness. If you look at what medicine does, we rarely cure things; we manage illness. Whether hypertension, high cholesterol, asthma, heart disease, cancer, diabetes... we manage those illnesses, and in most cases we start a medication that the patient will take for many years. Only with opioid use disorder do we have the expectation that med use should end. And the risk/benefit ratio is so much greater with buprenorphine than it is with many of the medications commonly prescribed.

And yes, doctors do have a motivation to discharge patients prematurely in order to make room for higher-paying patients. In your case there is that motivator, and also the possibility that your doctor is less-excited to treat someone on state assistance, which reimburses at much lower rates than private insurance.

The good news is that there are finally more practitioners getting involved. I try to avoid politics, and I know that bashing Trump is very popular and easy to do... but Trump's budget suggestions include much greater funding for opioid addiction. In the last year of his term, Obama finally mentioned 'opioids' and put $2 billion toward the problem; Trump proposed increasing that to $20 billion. His administration also recently gave NPs the ability to prescribe buprenorphine medications for addiction.

Hopefully the number of prescribers will continue to increase. I also encourage everyone here to do their own outreach and education whenever possible, by commenting on articles to correct misperceptions or by getting the word out to their own doctors (who know much less about buprenorphine than our readers!). And of course feel free to leave a link for the forum!

Thanks for sharing your experience; I hope your doc makes an effort to see the big picture, and do what is best for you-- rather than some cookbook approach.


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PostPosted: Wed Oct 25, 2017 12:07 pm 
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Iggy I relate to this so much. My last meeting had me feeling a bit down because that whole meeting was talking about coming off buprenorphine. A lot of patients at my clinic lately are state insurance patients. From what everyone has said (I know it's different in different states and different insurance) they're totally understanding that they'll start being tapered after a year and will be out the door within 2 years because of their insurance. I'm definitely a long term patient (I pay cash) but I haven't mentioned that to my doctor yet out of fear.

It's been almost 6 years and I'm scared that my time is coming too. My doctor has already tapered me once then I tapered myself again (with his knowledge of course) and I'm happy right where I'm at. But he still asks me pretty often if I'm ready to go down again. I always say no not yet. I really need to tell him that I'm thinking about life long treatment. I need to have that conversation eventually. I think as addicts we're afraid to 'rock the boat' or say something that's going to mess up this miracle of a treatment. It's sad to be afraid like that but I totally understand it.

I've always said that when it comes to the point of my doctor wanting to taper me completely off I'll have to look for another doctor. What I'd love to happen is my doctor be ok with being my doctor for life :) and who knows, maybe he will. If he doesn't then I will find a doctor who is in favor of it. That's about all we can do honestly.

Iggy I'd be sooooo happy to get a 3 month script. Omg that would save me so much $$. I do understand why you'd worry about why ur doctor did that, did u ask him why? Surly to goodness he'd have told u if that was a dismissal script, that's what I'd think anyway. Maybe he just finally understood how serious u are about this treatment. I sometimes feel that some doctors (mostly clinic type settings) see so many ppl that aren't serious about their recovery and see ppl just working the system to go out and still mess around, they really appreciate the patients that is really working their recovery and doing the right things. Maybe he gave u that 3 month script to help u out because he respected ur honesty.

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Jennifer


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PostPosted: Wed Oct 25, 2017 8:23 pm 
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Hi Iggy,
I don't know where you live but it seems I hear a lot about doctors and Suboxone and it sounds like a struggle for so many that I almost feel bad saying that I have been on Suboxone for 7 and a half years, my doctor sees me every 6 months and gives me 6 months refills. I started on 32mgs, and he has brought me down to 8mgs, which is great but he has never kind of forced me to get off of Suboxone. He asks me "Are you o.k. at 8 mgs?" I say "Yes" and that's it. Last year he asked me "Do you want to try for 4mgs. a day?" I said "I'm kind of scared. You know me and you know withdrawal terrifies me." He said, "o.k. then, stay on 8mgs." Now I know all doctors are not the same but why is it always with Suboxone that I hear so many different problems. Why can't all doctors follow the same procedure for the same medication? They do that for other medications.

I sincerly hope you can solve this. It's so unfair that he gives you a 3 month script and doesn't explain. Doctors like that make me feel like, "You're an addict and I don't care" So unfair. Please let us know what happened. We all need to know what happens in different situations. We never know when we may need to know this.

Don't give up, Hugs
Queenie


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