1. angelo212

    “I will probably make a couple small changes in my practice in light of things that I heard”.
    Doc, can you share the small changes that you may make in your practice in light of the things you heard? Since I been following you I take everything you say as the final word so if there is things you may hae said in you videos or blog that are different now can you share with us. Thanks Doc.

  2. Thanks Angelo– that is a fair question. Because of my own addiction experiences and the long time I have been attending meetings, meeting addicts, working as a shrink in the prison system, etc, I feel like I have a pretty good sense of who is being honest with me and who is not. So while I do have the capability to do urine testing in my office, I don’t do them regularly, but rather only when something doesn’t fit right– I have a ‘funny feeling’, or the person reports losing his medication, or comes in looking a bit ‘buzzed’. I believed that testing constantly gets in the way of trust, and that it was better in the long run if the patient believed that I trusted him.
    After some comments by other docs at the meeting I remembered when I was being monitored by the state of Wisconsin– for six years!– and I LIKED being tested, because then I had proof that I had been clean. I saw testing as a positive, as it allowed me to BUILD trust. So I might re-assess the frequency that I do testing.
    I also have been allowing greater intervals between appointments, mainly because most people do pretty well. But young people DON’T do as well as older people, and after hearing that most of the docs see people more frequently, particularly early in the process, I think I will see people a bit more often early on as well. Some docs insist on seeing the person on days 1, 2, 5, 10, 20… I do not see people that often, and I don’t think it is necessary to see them THAT often– but I might move a bit more frequent than I currently am doing.
    The final issue is ADD; I have been extremely happy with the lack of trouble I have seen from Vyvanse in addicts, so I tend to treat ADD in addicts using that medication. Many doctors believe that addicts shouldn’t have stimulants– period. I don’t agree with that stance, but I recognize that if I ever had to defend my practice in court, I might have trouble finding other psychiatrists to say that treating ADD with stimulants is fine. I recognize the need to be careful that patients are on a good, solid foundation before adding something that is potentially addictive. On the other hand, I have seen studies that show fewer relapses in opiate addicts who had their ADD treated with stimulants.
    Thanks for your question and support!

  3. texastechstudent

    Too groovy man. I wish you woulda asked them my question about why partial agonists, like bupe tend to antagonize at larger doses. I wonder what they have cooked up for us…
    And the line about ‘cheaper drugs mean cheaper street drugs’ I find to be kind of BS. They was suboxone is over rxed and people tend to get by on as little as 2mg or 4mg, means there is PLENTY of suboxone out there among the opiate addict groups. Coupled with the partial agonist/antagonist properties, it is ONLY good for kicking/ORT. I beilive the french began using bupe to treat addiction in the 70s. and the caucus states began using subutext specifically to treat addiction and saw bad IV use, which led to suboxone. I saw what you said about DATA allowing schedule 3-5 drugs used to treat addiciton (maintance type treatment) and that is true, as long as there are studies done with that certain medication regarding maitnance. I read that and got my hopes up about some hydrocodone maitance therapy. Heh. Shit, codeine and tramadol have show great mu agonism potential. Let me get the thread.
    Also, I TOTALLY AGREE even mentioning the word ‘high’ when speaking of suboxone just complicates the sitation. I had a discussion with my parents when first deciding what to do about my opiate addiction and I mentioned suboxone maintance. They asked if ‘it gets you high’. I have this thing with my parents if as long as I tell the 100% truth everything will be okay, so I began. ‘Well, i mean, I wouldn’t get high, but I guess some non-opioid addicts could get a good buzz. I mean, they had addiction problems in Georgia (caucuses)’. They said they wouldn’t be involved with me if I got on suboxone. When I relaped after rehab about 5-6 months later, then again 6 months later, they were a bit more receptive to other options. Suboxone depot… sounds cool man. I have seen people litterally CUT OUT their naltrexone implants and end up in the ER. Of course, they COULD have used suboxone to take the edge off, but don’t tell them that. There was a judge up in baltimore that was FORCING people to get the implant by saying ‘You get the implant and 6 months rehab, or 10 years in jail’.
    I wonder how that judge would feel if his kid ended up in the er with his implant cut out. Or commited suicide, as we know suicide rates are 3x time higher when treating an alcoholic with vivitrol and the likes, I think the reason they don’t shoot for FDA approval with opioid illness, is because the suicide rates would be even higher. I have already read more than 5 threads on bluelight of someone getting the vivitrol shot and getting kidney stones or appendicidis and coming in BEGGING for pain relief. After they told their doctors about vivitrol it was 800mg ibuprofin and THATS IT. I auctually called vivitrol about it and asked if they recommended any opioid with a higher affinity (suboxone being one I know of offhand, with many other pure agonists avaible. I don’t know any that are FDA approved though) THey said they recommend short acting opioids. Like some ER doctor is going to administer 5mg of fent to bust through the great wall only to sit there and watch you breath for 3 hours to make sure you don’t die. No, the junky scum NEEDS to suffer.
    Anyway man, I love your blog and always follow it. If you were in my area, you would be my doctor. Also, make a post advertisting your podcast, I can’t find a link

  4. texastechstudent

    Oh and I heard something about RB reformulating suboxone to make them dissolve quicker to decrease diversion (other countries have dosing setup like methadone). You think they will or think generics will take care of that? I hear generics come in october.

  5. Thanks for the comments, everyone. Mike, I think they are working on something like a listerine strip that comes in an individual packet. I’m not sure if that will help with diversion, but the goal of it is to reduce the chance of exposure to children.

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