1. tic

    Ten days of methadone taper seems to be the standard around here, even for babies born to mothers on relatively low maintenance doses of 2 mg buprenorphine a day. All my patients have also gotten an automatic referral to a high risk pregnancy specialist. They come back to me concerned about why they need a maternal-fetal medicine referral if the buprenorphine I am prescribing is really not going to hurt their baby.

  2. mirimar

    Well, I guess when they cannot make tens of thousands of dollars, any other form of Continued, Practical, Private Remission from active addiction just doesn’t work. I am here to tell them, Horsepuckey ! ! I live and have been living a Normal, Productive, Asset to My Family and the Community Lifestyle for several years now thanks to Suboxone and a Dr. I like and respect. Mr. Clearbrook can keep all the BS they feed you in treatment facility’s and then Boom…..You have to get back in the game of life, and believe me it’s hard after years of addiction. More power to all that strictly adheres to 12 Steps and it’s principals, just don’t tell me there aren’t safe, reliable, private alternatives.

  3. tic

    We do use a reference lab routinely for patients with insurance. We also have point of care (POC)12 substance cups that cost us about $6 each. While the lab does bill some crazy amount for the drug panel that we do, insurance usually only reimburses $100 or less, and the lab has usually taken that as payment in full, although rarely patients will owe a small copay, usually under $20. Uninsured patients and patients with high deductibles are never charged more than about $85. Every billing problem was resolved with a patient call to the lab. We routinely use a reference lab when we trust the patient (because results take about 5 days), if there is a discrepancy between the POC test and what the patient is telling us, and if the patient has insurance. We do not bill insurance for doing POC tests because it is a huge administrative pain in the neck, so if a POC test is done we charge the patient $15. Patients can use their HSA for POC testing. Patients sometimes prefer to use the reference lab and have no copay as opposed to an additional cash charge of $15 at the office. A fair number of our patients have medicaid, and pay cash for their visit, since we do not take any medicaid plans. Medicaid for example pays 100% of the patients lab, and I do not have to charge the patient $15 a visit for a POC test.
    I agree completely that drug screens are not to catch people doing wrong, but to allow them to “prove themselves” and to find out who might be struggling and afraid to admit it, or keeps thinking they can handle it on their own. Some patients like regular urine tests since they say it helps keep them honest, and especially if they have struggled on buprenorphine in the past, they feel helps it proves to me and sometimes their families that they are going well, like an A+ or gold star on a report card.
    This crazy billing strategy is not just something that happens with urine drug screens, but with other labs, procedures, medications, and testing as well.

  4. mirimar

    Perhaps the reason they are so hyped up on counseling is because that is where the better money is. I’m not knocking treatment centers, but they are pricey and if the persons insurance doesn’t pay for it. The taxpayers do. I doubt seriously the Treatment Center cares who pays them, as long as they get paid. Having been through both traditional treatment and one on one Dr treatment/maintenance, I personally prefer the one on one Dr. route. It’s all in the numbers if you ask me. If you own an operate a conventional treatment facility, I would wager that the objective is to Keep it Full as best as possible. Doctors such as yourself, take away from the available pool of addicts/abusers, thus lowering the head count ie MONEY. It quite possibly may be no more of an argument that.

  5. tic

    A patient recently asked me if giving suboxone to a person who was overdosing would save them. I think the question was precipitated by Prince’s death. I answered possibly not because the the time of onset for suboxone SL is about 20 – 40 min, and someone who is already unconscious may stop breathing before the suboxone has started working. IV, IM, or nasal Narcan is a better choice because of it’s more rapid rapid onset of action.

    • Absolutely– plus there are risks from injecting anything that is not specifically intended for injection. I have known of reversals with buprenorphine given by injection– but that would only work if the heart is still beating, as otherwise the drug will stay in the arm. But yes– naloxone is a better option!

  6. mirimar

    Why can’t Dr’s standardize the rates we pay monthly for treatment ? According to Dr Burson, 80 to 100 dollars per 20 min visit is sufficient. Especially when one is paying in cash every month, why do some Dr’s charge 250 an 350 per month ? This is where you start to piss people off. Do not charge me more than you charge everyone else, so you can make up some money you are losing on John Doe. You may justify this by saying, oh so n so has a good job and can afford it, Bullshit already..One wonders why some people have such low opinions of Dr.’s in general. This is dam sure one of them…Please write an article yourself on this matter and be honest about it. Thank you

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