Armed man with AR-15 enters substance abuse clinic and gets taken down by security guard

[Agast]

An unarmed guard prevented a gunman from entering a Buffalo treatment clinic


Surveillance video of the guard being a badass:

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[hyperalgesia]

That guy gets a raise!

To be fair, an AR-15 in a room the size of a closet - probably not a great choice lol.

 

[mid|ine]

Strong pill mill vibes: security guard, security door, security camera...

Is the line outside the waiting room?

 

[Agast]

Strong pill mill vibes: security guard, security door, security camera...

Is the line outside the waiting room?

It’s a methadone clinic

 

[drusso]

When the Sh i T hits the fan many of our colleagues, I'm thinking recently of those in Oklahoma and Texas, wish they had the option of having access to personal protection with a firearm. Some places explicitly deny employees that option.

Austin Pediatrician Dr. Dodson & Under-Desk Holsters Revisited

https://www.buzzfeednews.com/article/tasneemnashrulla/pediatrician-murder-suicide-austin-dodson This story has been blowing up my social media. Dr. Dodson worked with one of my friends from med school at that clinic. I took a lot of flack on here a while back for suggesting that pain docs...

forums.studentdoctor.net

 

[Pain Applicant1]

It’s a methadone clinic

It sounds counterintuitive but methadone and suboxone clinics can definitely also be pill mills.

I think, but am not sure, that's the reason why the DEA is limiting suboxone patients for providers.

 

[Ferrismonk]

Suboxone also has a high street value fwiw

 

[Pain Applicant1]

I think $20 for an 8mg strip, at least around here. That's one reason I say to flood the market with it. Whoever needs it should have the right to have it. No one should have to go to the street to use it to prevent withdrawal, which is usually what it's used for when it's purchased illicitly.

 

[kstarm]

I think $20 for an 8mg strip, at least around here. That's one reason I say to flood the market with it. Whoever needs it should have the right to have it. No one should have to go to the street to use it to prevent withdrawal, which is usually what it's used for when it's purchased illicitly.

I agree, we need to make WAYYYYY easier for people to get suboxone/bupe for substance use disorder. It needs to be easier to get bupe then fentanyl.

 

[kstarm]

An unarmed guard prevented a gunman from entering a Buffalo treatment clinic


Surveillance video of the guard being a badass:

Looked like the guard couldn't go anywhere...I'm not sure what I would have done. Lucky he didn't get killed and just makes me further question why I prescribe any opioids at all.

 

[Doctodd]

I felt like I needed a firearm more often for the patients that I deny opioids to. If you don’t have a pill mill type practice, you don’t have to worry about the opioids you do prescribe. Maybe worry about the ones you don’t. I think a surgeon was killed a few months/a year ago by his LFBSS patient.

 

[Pain Applicant1]

I agree, we need to make WAYYYYY easier for people to get suboxone/bupe for substance use disorder. It needs to be easier to get bupe then fentanyl.

How about a relatively happy medium with the dea? Limit Suboxone patients for cash practices. Raise the limit for those who accept insurance and even more for those who accept Medicaid and then again even more for those who are seeing recently released prisoners or who work in an underserved area.

Maybe patients can be classified into groups based on who will be at the highest risk of relapsing, overdosing, recidivating, etc. or who has the least access to suboxone providers.

 

[Ducttape]

heres some radical ideas.

suboxone 8 mg covered by insurance. expand the max number of people that can be prescribed to say 200. allow PCPs to prescribe 2 mg pills to those who have completed a treatment program.

buprenorphine 0.5 or 1 mg available OTC primarily to prevent withdrawal.

naloxone nasal spray available OTC.

 

[Pain Applicant1]

heres some radical ideas.

suboxone 8 mg covered by insurance. expand the max number of people that can be prescribed to say 200. allow PCPs to prescribe 2 mg pills to those who have completed a treatment program.

buprenorphine 0.5 or 1 mg available OTC primarily to prevent withdrawal.

naloxone nasal spray available OTC.

From my experience I haven't had much of an issue with getting suboxone covered. This hasn't always been the case.

PCPs can prescribe suboxone, anyone can. Just like in this forum, most people just don't want to. Around here they're so busy doing pcp stuff that they probably have no interest in treating this population. I'm not sh**ting you when i say there's a year's wait for new pts. If i was a pcp, i would just start a cash practice.

I don't personally think that 1mg would be enough to prevent withdrawal but i wouldn't necessarily be against making it otc to some degree. I can see the pros and cons to it and I wonder what the outcome would look like.

 

[Ducttape]

From my experience I haven't had much of an issue with getting suboxone covered. This hasn't always been the case.

PCPs can prescribe suboxone, anyone can. Just like in this forum, most people just don't want to. Around here they're so busy doing pcp stuff that they probably have no interest in treating this population. I'm not sh**ting you when i say there's a year's wait for new pts. If i was a pcp, i would just start a cash practice.

I don't personally think that 1mg would be enough to prevent withdrawal but i wouldn't necessarily be against making it otc to some degree. I can see the pros and cons to it and I wonder what the outcome would look like.

er...

PCPs have to submit an NOI to SAMSHA before they can prescribe for MAT, so it is not as easy as just writing a prescription. they can prescribe for pain, but this may raise percieved legal concerns.

Waiver Elimination (MAT Act)

www.samhsa.gov

i do agree that PCPs would rather not get involved, but if they are willing to write for percocets for patients, they can include buprenorphine.

 

[Pain Applicant1]

er...

PCPs have to submit an NOI to SAMSHA before they can prescribe for MAT, so it is not as easy as just writing a prescription. they can prescribe for pain, but this may raise percieved legal concerns.

Waiver Elimination (MAT Act)

www.samhsa.gov

i do agree that PCPs would rather not get involved, but if they are willing to write for percocets for patients, they can include buprenorphine.

er..

You seemed to have left out this part:

Recent Practice Guidelines have allowed for an alternative NOI for those seeking to treat up to 30 patients:

 

[Pain Applicant1]

er...

PCPs have to submit an NOI to SAMSHA before they can prescribe for MAT, so it is not as easy as just writing a prescription. they can prescribe for pain, but this may raise percieved legal concerns.

Waiver Elimination (MAT Act)

www.samhsa.gov

i do agree that PCPs would rather not get involved, but if they are willing to write for percocets for patients, they can include buprenorphine.

But nonetheless it's no different than what I or the what the majority of Suboxone providers had to do. It's the same across the board for almost anyone

 

[VA Hopeful Dr]

From my experience I haven't had much of an issue with getting suboxone covered. This hasn't always been the case.

PCPs can prescribe suboxone, anyone can. Just like in this forum, most people just don't want to. Around here they're so busy doing pcp stuff that they probably have no interest in treating this population. I'm not sh**ting you when i say there's a year's wait for new pts. If i was a pcp, i would just start a cash practice.

I don't personally think that 1mg would be enough to prevent withdrawal but i wouldn't necessarily be against making it otc to some degree. I can see the pros and cons to it and I wonder what the outcome would look like.

I did that. I don't have to tell most of y'all here that running a business can be a pain in the back side and it's definitely not for everyone.

 

[Ducttape]

er..

You seemed to have left out this part:

Recent Practice Guidelines have allowed for an alternative NOI for those seeking to treat up to 30 patients:

you still have to put in the NOI.

thats why i put in the link. the NOI states that an application has to be submitted, but you dont have to do the whole addiction course.

Specifically, the exemption allows these practitioners to treat up to 30 patients with OUD using buprenorphine without having to make certain training related certifications. This exemption also allows practitioners to treat patients with buprenorphine without certifying as to their capacity to provide counseling and ancillary services. This exemption specifically addresses reported barriers of the training requirement. Providers are still required to submit an application designated as a “Notice of Intent” in order to prescribe buprenorphine for the treatment of Opioid Use Disorder.

 

[Pain Applicant1]

I did that. I don't have to tell most of y'all here that running a business can be a pain in the back side and it's definitely not for everyone.

Were you a cash-pay PCP or did you have your own pain practice? If so, was it a cash-pay pain practice? I have my own private practice but I'd been interested in hearing more about your experience. Why'd you close up shop?