Those doctors that make their prescribing 'contingent' upon the patient complying with an 'actual' program of recovery tend to have the best results. Such successful programs include: random urines, a weekly suboxone support group, other outside support groups, one to one counseling, etc. Doctors however that prescribe the drug with an attitude of, "See you in two weeks," do a disservice to their patients. I know of several psychiatrists that come up here to the "Bay State" every couple of weeks from Connecticut to do precisely this. This is quality healthcare? I think not. What this is about is "money" and "money' only.
Those of us working in the addiction field are seeing a rise in the number of people that are 'chipping' (using their opioid of choice off an on). Use suboxone a few days, go off, use their opioid, then back on suboxone. Not to mention the fact that some are keeping half of their supply and selling the other half.
Ask your primary care physician how many hours he or she received in medical school on mental health and addiction. I am sure their answer will startle you. Yet, primary care doctors can receive "certification" to dispense suboxone without having any additional experience in psychiatry. Not a good idea.
Another problem that arose that Massachusetts has put a clamp-down on are the physicians that were double-dipping. They had patients in their regular practice that had MassHealth but they were not accepting this insurance for suboxone. Instead they were charging a cash "assessment" fee in addition to charges for the prescription. Ah, can't do that. Thank God the Attorney General stepped in. Ask anyone in the field, they can tell you who these doctors are/ were. As a matter of fact, ask the patients that were scammed by these immoral hacks.
The maufacturer of suboxone, Reckitt Benckiser, currently has a 1-800 number on their website (http://www.suboxone.com/), that one can access to find doctors in their area that provide suboxone and information on what types of insurance they accept.
2 comments:
It is so good to see such an honest account of what really goes on in the suboxone treatment arena. I have heard these accounts countless times. I know it has been detramental in treatment as well as successful. Of course it is up to the individual to apply the advantage of suboxone in recovery. Yet so many abuse it, and get away with it because they are not supervised. Thank you Willy for being so absolute in your clincal and academic skills.
I had a personal experience with suboxone, and I believe it saved my life as well as my career. Upon developing arthritis of the spine, I allowed my MD to put me on a pain management contract, after over 20 years clean from all substances. Being a hypermetabolizer, I needed oxycontin several times daily, and in increasing doses. There is a strong distinction between the physical dependence of pain management and the obsessiveness of addiction. There is even a condition called "pseudoaddiction" where the patient may exhibit drug-seeking behaviors and have a strong focus on the drug, but in this case it is due to ineffective pain management rather than true addiction.
Things were great for a while, but I began to realize that my focus on the drug was growing obsessive, regardless of the fact that I was not taking more than prescribed, nor was I having cravings, unless I accidentally missed a dose. I chose to stop the treatment before I fell all the way into addiction.
I found a reputable, confidential provider from outside my HMO (on purpose -- I was trying to get a job from them)He charged me just a few hundred dollars for all his time, and directed me to the least expensive pharmacy in town for my Rx. He provided Tx sessions that blended 12-step with guided visualization, something he was highly trained in. I have never been so sick in my life as that last 12 hours before I was far enough into physical withdrawal to allow safe induction with suboxone. Too soon, and it will backfire and make you sicker, plus block the original drug from relieving your withdrawal symptoms. I tapered gradually for almost 6 months, and he stuck with me all the way. I finally stopped at 1/2 mg every other day about a month ago. I was a little achy and had some chills, plus a bit of depression for about 3 days, with a killer sugar craving for about a week. All is well now, and the doctor still calls me every 3 months or so to see how I am doing. It saved my life, my marriage, and my career as a therapist.
I believe that addicts who try to self-administer suboxone are more likely to throw themselves into withdrawal than they are to get high. Yes, there is some extremely mild sedation with suboxone, but it sure ain't "high." It is an agonist/antagonist for opiates, and it acts a lot like Narcan in the system, if the patient isn't in full--blown withdrawal. Alternately, it is very effective at blocking the action of any subsequent opiates the patient may try to self-administer. All drugs have dangers associated with them -- this one is really minimal compared to the good it can do.
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