Stimulants in Suboxone patients

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

eaglepsych

Full Member
10+ Year Member
Joined
Apr 29, 2010
Messages
40
Reaction score
11
I have posted about this before. I currently work for a Community practice (FQHC) with high substance abuse rates, I see many patients on suboxone (I am not a suboxone prescriber). I inherit/asked to consult on many patients who are on Suboxone and also have hx of "ADHD". i know the true answer includes really digging deep and seeing to what degree they really have adhd, but i have a different question for the group:

Might it be best both for individual patients, and for the community at large (there is currently a large prescription drug abuse epidemic in the region), for our practice to essentially have a policy stating that we do not treat ADHD with stimulants in persons on opioid replacement therapy (or obviously actively abusing substances). Any thoughts would be greatly appreciated.

Members don't see this ad.
 
I have been in a similar situation at a clinic (inner city FQHC) but the issue was methadone + benzodiazepines in patients with reported "panic attacks" who had been maintained on very high doses of xanax and or klonopin....and there were a subset who actually on top of that reported ADHD and the previous doctor had kept them on methadone + benzo + stimulant for YEARS. :(

Needless to say my life was hell there while i adjusted their treatment.

Im not sure what would have been best ethically or evidence based, but I told the patients that my preference/practice is that I do not prescribe benzodiazepines nor stimulants to anyone on long term opioid agonist therapy (I made exceptions on a case by case basis).

Just curious, is the clinic/center willing to allow the policy to be created, ie that the its the clinic's decision as opposed to yours? That was a challenge in my experience.
 
  • Like
Reactions: 1 user
Any substance of abuse in a Suboxone user should be of extreme concern.


That said, a lot of Suboxone users do have ADHD. To simply ignore they have it could make the situation worse. Of course try the non-stimulants first, but if they truly have it, IMHO don't completely close off the possibility of a stimulant. The data goes either way. There's some showing that treating ADHD with a stimulant could reduce further drug abuse, but despite that there's other day going the other way, and I've seen several ADHD people abuse stimulants by either selling it, or only needing X-amount to stabilize but wanting more because at that higher dosage it gets them high.

As for benzos, avoid. Again don't be completely black and white but unlike with ADHD, the best treatments are usually not something's potentially abusable. SSRIs, B-blockers, gabapentin, pretty much anything before using a benzo. There's even less reason to give it, and mixing it with Suboxone raises the risk of respiratory depression.

A big frustration for me when I joined U of Cincinnati was I took over another doctor's Suboxone case load and she liberally gave out benzos and used the Suboxone inappropriately. E.g. patient couldn't sleep because he had sleep apnea-she upped his Suboxone to help him sleep better. Another patient would scream at her for more Suboxone and that doctor caved into the screaming, apparently not knowing what boundary setting was. I had to spend about 2-3 months putting the ship that was in mutiny back on course.

It's far harder to take away something someone already had vs not giving it in the first place. I had dozens of patients, thanks to the above doctor, that already had high amounts of benzos, Seroquel, already with the Suboxone. Several of those patients were not happy and I had to show them data from actual sources such as ASAM and the DEA to show them that I wasn't making up the stuff. .."Why would Dr. X, a licensed doctor, give me Xanax if I'm not supposed to take it with Suboxone?"

In fact, one of the reasons she left U of C was she even told me she couldn't handle her Suboxone patients. I don't know WTF was going on with her. She was an FP doctor that did an addiction fellowship, so that's why she was in a psych dept.

On top of that, the office she used was just dirty gritty dirty with me putting the keyboard upside down (when I took over her office) with pretty much a cupful of boogers, nails and what you falling out of it, and staff members told me she dumped the urine from the drug tests in the coffee room sink.
 
Last edited:
  • Like
Reactions: 2 users
Members don't see this ad :)
thank you Mojetter and Whopper. Both of your points are well taken. I am the medical director of a team of psychiatric providers, and we are all pretty much overwhelmed by this scenario. This scenario clearly gobbles up a lot of our resources that could otherwise be used to treat other psychiatric disorders - where frankly i feel our ability to make meaningful positive improvements in persons' lives is better ,and the risk/benefit ratio of the treatment would be much better as well. as for "policy," medico-legally it may be better for me (and my team could make their own decision), to simply practice consistently, that we do not feel the potential benefits outweigh the risks most of the time.
 
That policy will definitely offer some nice lawsuit protection and peace of mind at the clinic. I am not as worried about stimulants combined with opioids since there is no real lethal interaction. In the case of benzos it's hard to justify a benzo for anxiety in your mortality review.
 
  • Like
Reactions: 1 users
Also your patients will talk in the lobby and disclose their medications. Now you have to address with the "how come they get Adderall and I don't?" question. Before you know it 1/3 of your clinic has ADHD.
 
  • Like
Reactions: 1 users
It's a tricky line to negotiate, but people with ADHD are at higher risk of substance abuse if the ADHD is poorly-controlled...
 
Fonzie's quote: "Also your patients will talk in the lobby and disclose their medications. Now you have to address with the "how come they get Adderall and I don't?" question. Before you know it 1/3 of your clinic has ADHD."

I feel like this is the crux of the issue we are dealing with here. stimulants are a sought out currency, and i reckon produce a really nice buzz especially when added to suboxone....
 
  • Like
Reactions: 1 user
When I worked in a FQHC, there was already a policy that we didn't prescribe stimulants for patients over 18 unless they were in school, working, or in job training. That eliminated a depressing proportion of the adult population, but it does seem like the risks outweigh benefits when patients are spending the whole day at home.
I was extremely grateful that there wasn't a suboxone program in the clinic and we weren't being asked to treat pain, but the proportion of patients who were on chronic opioids from other prescribers was scary, as was the proportion of patients I inherited on benzos. The state didn't have a great tracking system for controlled substance prescriptions and with the absence of time to coordinate care, it seemed like tragedy waiting to happen.
 
  • Like
Reactions: 2 users
There is a new FDA-approved EEG based method to assist in dx of ADHD. I don't know anyone yet who does it but I'm thinking of getting my own department to get it since we're combined neuro and psych a SLU.
 
There is a new FDA-approved EEG based method to assist in dx of ADHD. I don't know anyone yet who does it but I'm thinking of getting my own department to get it since we're combined neuro and psych a SLU.
complete pseudoscience if you ask me
 
  • Like
Reactions: 1 users
I don't see how you can legitimately have a policy like this. It's discriminatory and potentially could have legal ramifications. Either you prescribe stimulants for patients or you don't. whether they are on suboxone or not is irrelevant. What is more important is whether they are actively using or there is concern of prescription diversion. I think it is reasonable to have a blanket ban on benzos in patients on opiate substitution as there is clearly an interaction and increased risk of mortality. Likewise the pharmacological antagonism between stimulants and benzos means it is good practice not to prescribe the two together. However if you believe in treating ADHD then I don't see how you can get away from prescribing stimulants to patients on OST. you might want to give them methylphenidate rather than Adderall mind you.

Also, the first line treatment for ADHD is stimulants +/- CBT. It's not bupropion/venlafaxine/guanfacine/insert other ineffective drug and as being on suboxone is not a contraindication to stimulants, you cannot justify not using stimulants as a first-line treatment if you really think the patient has ADHD and should be treated. Now if you don't believe it, that's a different story altogether.

I don't want to minimize the risk of psychostimulants but they are amongst the safest psychotropic drugs.

BTW I am someone who does not and will not see patients for ADHD as a primary diagnosis.
 
  • Like
Reactions: 1 users
I don't see how you can legitimately have a policy like this. It's discriminatory and potentially could have legal ramifications. Either you prescribe stimulants for patients or you don't. whether they are on suboxone or not is irrelevant. What is more important is whether they are actively using or there is concern of prescription diversion. I think it is reasonable to have a blanket ban on benzos in patients on opiate substitution as there is clearly an interaction and increased risk of mortality. Likewise the pharmacological antagonism between stimulants and benzos means it is good practice not to prescribe the two together. However if you believe in treating ADHD then I don't see how you can get away from prescribing stimulants to patients on OST. you might want to give them methylphenidate rather than Adderall mind you.

Also, the first line treatment for ADHD is stimulants +/- CBT. It's not bupropion/venlafaxine/guanfacine/insert other ineffective drug and as being on suboxone is not a contraindication to stimulants, you cannot justify not using stimulants as a first-line treatment if you really think the patient has ADHD and should be treated. Now if you don't believe it, that's a different story altogether.

I don't want to minimize the risk of psychostimulants but they are amongst the safest psychotropic drugs.

BTW I am someone who does not and will not see patients for ADHD as a primary diagnosis.

I don't think it would be a legal risk to tell patients that you don't perscribed schedule 2 drugs to patients who are addicts (I am not saying anything about ethics here). Society considers stimulants to be highly dangerous drugs. If a psychiatrist doesn't want to put his DEA license on the line by prescribing stimulants to addicts, that is his legal right.
 
  • Like
Reactions: 1 user
Members don't see this ad :)
Fonzie's quote: "Also your patients will talk in the lobby and disclose their medications. Now you have to address with the "how come they get Adderall and I don't?" question. Before you know it 1/3 of your clinic has ADHD."

I feel like this is the crux of the issue we are dealing with here. stimulants are a sought out currency, and i reckon produce a really nice buzz especially when added to suboxone....

Yeah, and they are currency as well....
 
This thread is amusing to me- suboxone practices(meaning physicians who see patients only for suboxone and don't prescribe or treat other things) often turn a blind eye to benzos and stimulants because that's the best way to fill up your 100 patients at cash pay rates and get them in and out very quickly.

As for what individual prescribers do....they can do whatever they want. Is it right(on either end) for the primary psychiatrist(or internist or whatever) to give benzos and/or stimulants and the suboxone dr to give three strips a day for eternity? No....I think everyone recognizes that....it's not brain surgery to figure out that maybe this addict being prescribed 24mg daily suboxone(most of it they won't take), 4 mg Xanax daily and 60mg adderall daily is not good practice from anyone....but we all know it happens and since there isn't anything I can do about it I don't let it bother me.

Individual prescribers(myself included) shouldn't worry about what everyone else is doing with their patients. They are their patients for a reason. And that's true for transfer patients I get as well. Patient comes in and says so and so was giving them a bunch of adderall, suboxone, and klonopin. So? What does that have to do with me and you?
 
  • Like
Reactions: 1 users
I don't see how you can legitimately have a policy like this. It's discriminatory and potentially could have legal ramifications. Either you prescribe stimulants for patients or you don't. whether they are on suboxone or not is irrelevant. What is more important is whether they are actively using or there is concern of prescription diversion. I think it is reasonable to have a blanket ban on benzos in patients on opiate substitution as there is clearly an interaction and increased risk of mortality. Likewise the pharmacological antagonism between stimulants and benzos means it is good practice not to prescribe the two together. However if you believe in treating ADHD then I don't see how you can get away from prescribing stimulants to patients on OST. you might want to give them methylphenidate rather than Adderall mind you.

Also, the first line treatment for ADHD is stimulants +/- CBT. It's not bupropion/venlafaxine/guanfacine/insert other ineffective drug and as being on suboxone is not a contraindication to stimulants, you cannot justify not using stimulants as a first-line treatment if you really think the patient has ADHD and should be treated. Now if you don't believe it, that's a different story altogether.

I don't want to minimize the risk of psychostimulants but they are amongst the safest psychotropic drugs.

BTW I am someone who does not and will not see patients for ADHD as a primary diagnosis.

Of course it is discriminatory.....and?

We discriminate against various patients everyday....and that's a good thing. Providing care without discrimination would be chaos.

It is entirely reasonable for a psychiatrist to believe that the risk/benefit ratio in general of treating ADHD in the case of opiate addicts tilts over the line towards the unfavorable side.....and thus has a blanket policy. That's not a position I hold, but it's certainly ok for those that choose to.
 
It's far harder to take away something someone already had vs not giving it in the first place. ....
On top of that, the office she used was just dirty gritty dirty with me putting the keyboard upside down (when I took over her office) with pretty much a cupful of boogers, nails and what you falling out of it, and staff members told me she dumped the urine from the drug tests in the coffee room sink.

:barf:
 
Individual prescribers(myself included) shouldn't worry about what everyone else is doing with their patients. They are their patients for a reason. And that's true for transfer patients I get as well. Patient comes in and says so and so was giving them a bunch of adderall, suboxone, and klonopin. So? What does that have to do with me and you?

Solid boundaries. It is a skill that some people never learn.
 
It's a tricky line to negotiate, but people with ADHD are at higher risk of substance abuse if the ADHD is poorly-controlled...
Is there a research study that demonstrates this or is this just "common knowledge". The research I have seen has been correlational and mixed. There are also two very different questions to ask. 1. Does use of stimulants in kids reduce risk of later substance abuse? 2. Does prescribing stimulants in recovering addicts improve outcomes? Obviously, the latter question would have more applicability to the OPs question.
 
Is there a research study that demonstrates this or is this just "common knowledge". The research I have seen has been correlational and mixed. There are also two very different questions to ask. 1. Does use of stimulants in kids reduce risk of later substance abuse? 2. Does prescribing stimulants in recovering addicts improve outcomes? Obviously, the latter question would have more applicability to the OPs question.

From a medicolegal standpoint, diversion is a risk that also needs to be taken into account.
 
  • Like
Reactions: 1 user
Given the risk for abuse and diversion I think it would be best to just prescribe the Suboxone and refer out for ADHD evaluation and treatment.
 
Any substance of abuse in a Suboxone user should be of extreme concern.


That said, a lot of Suboxone users do have ADHD. To simply ignore they have it could make the situation worse. Of course try the non-stimulants first, but if they truly have it, IMHO don't completely close off the possibility of a stimulant. The data goes either way. There's some showing that treating ADHD with a stimulant could reduce further drug abuse, but despite that there's other day going the other way, and I've seen several ADHD people abuse stimulants by either selling it, or only needing X-amount to stabilize but wanting more because at that higher dosage it gets them high.

As for benzos, avoid. Again don't be completely black and white but unlike with ADHD, the best treatments are usually not something's potentially abusable. SSRIs, B-blockers, gabapentin, pretty much anything before using a benzo. There's even less reason to give it, and mixing it with Suboxone raises the risk of respiratory depression.

A big frustration for me when I joined U of Cincinnati was I took over another doctor's Suboxone case load and she liberally gave out benzos and used the Suboxone inappropriately. E.g. patient couldn't sleep because he had sleep apnea-she upped his Suboxone to help him sleep better. Another patient would scream at her for more Suboxone and that doctor caved into the screaming, apparently not knowing what boundary setting was. I had to spend about 2-3 months putting the ship that was in mutiny back on course.

It's far harder to take away something someone already had vs not giving it in the first place. I had dozens of patients, thanks to the above doctor, that already had high amounts of benzos, Seroquel, already with the Suboxone. Several of those patients were not happy and I had to show them data from actual sources such as ASAM and the DEA to show them that I wasn't making up the stuff. .."Why would Dr. X, a licensed doctor, give me Xanax if I'm not supposed to take it with Suboxone?"

In fact, one of the reasons she left U of C was she even told me she couldn't handle her Suboxone patients. I don't know WTF was going on with her. She was an FP doctor that did an addiction fellowship, so that's why she was in a psych dept.

On top of that, the office she used was just dirty gritty dirty with me putting the keyboard upside down (when I took over her office) with pretty much a cupful of boogers, nails and what you falling out of it, and staff members told me she dumped the urine from the drug tests in the coffee room sink.


I had a similar experience when I took over another physicians practice when he retired.
 
Curious to know why not?
It brings me no joy. It's not why I went into psychiatry. I don't have the time or the inclination to get collateral from family or hunt down school reports or verifiable diagnoses from childhood. I don't have the time to do a detailed assessment (e.g. using Connor's etc). I don't have a good way of measuring improvement. There is no good way of telling who is genuine and who is just seeing for some stimulants. I would rather spend my time seeing patients with more severe and complex problems that would benefit from my input.I don't think I got particularly good training in diagnosis and mx of ADHD.

I have started stimulants for ADHD only a few times - 2 of the patients were wrongly diagnosed with bipolar disorder but developmental history was suggestive of ADHD and they thought they were bipolar and had been told so. And all the patients had another psychiatric disorder. I only have one pt I am treating for ADHD who also has HIV dementia (and narcissistic personality disorder).
 
  • Like
Reactions: 1 users
It brings me no joy. It's not why I went into psychiatry. I don't have the time or the inclination to get collateral from family or hunt down school reports or verifiable diagnoses from childhood. I don't have the time to do a detailed assessment (e.g. using Connor's etc). I don't have a good way of measuring improvement. There is no good way of telling who is genuine and who is just seeing for some stimulants. I would rather spend my time seeing patients with more severe and complex problems that would benefit from my input.I don't think I got particularly good training in diagnosis and mx of ADHD.

I have started stimulants for ADHD only a few times - 2 of the patients were wrongly diagnosed with bipolar disorder but developmental history was suggestive of ADHD and they thought they were bipolar and had been told so. And all the patients had another psychiatric disorder. I only have one pt I am treating for ADHD who also has HIV dementia (and narcissistic personality disorder).

I don't disagree with some of this reasoning- where I differ is that the problem is many/most patients with 'severe and complex problems'(that are perhaps more diagnostically interesting) also won't benefit nearly as much from treatment than many ADHD patients will.

I don't find ADHD to be an interesting diagnosis either...and obviously first line treatments(ie the treatments that actually work) aren't brain surgery.

But if one views the key aspect of our jobs as improving patients lives, I'm not sure there is much in psychiatry that comes close to the functional improvement seen in many run of the mill ADHD patients when they are put on adderall.
 
But if one views the key aspect of our jobs as improving patients lives, I'm not sure there is much in psychiatry that comes close to the functional improvement seen in many run of the mill ADHD patients when they are put on adderall.
Wholeheartedly agree. It is staggering how much impact a stimulant rx can have in a patient with pure strain ADHD. It truly can be life-changing for the patient, and it is very gratifying to be involved in their care.
 
  • Like
Reactions: 1 user
One things I've seen many doctors do, even some docs here advocated it, and I'm against it, is the view that if you provide Suboxone that's all you do.

So patient shows up, you just give them their Suboxone after a test, and do nothing else. Forget it if the patient is depressed, manic what have you. You are a psychiatrist and you're going to ignore everything else except for the Suboxone.

I believe such practice is BS. Several here have defended it saying so long as you have a patient sign a contract ahead of time stating you will ignore everything about their case minus the Suboxone you're fine.

I didn't know the doctor-patient relationship could be redefined by an individual doctor (and not the law or professional ethics) to only treat the patient on a very specific medication based approach with nothing else.

I didn't know one had to go to medical school, graduate from a residency, get a state license and then ignore about 99.9% of their education when treating a patient.

Maybe surgeons should just cut open without taking vital signs, other meds, and possible infections into regard.
 
One things I've seen many doctors do, even some docs here advocated it, and I'm against it, is the view that if you provide Suboxone that's all you do.

So patient shows up, you just give them their Suboxone after a test, and do nothing else. Forget it if the patient is depressed, manic what have you. You are a psychiatrist and you're going to ignore everything else except for the Suboxone.

I believe such practice is BS. Several here have defended it saying so long as you have a patient sign a contract ahead of time stating you will ignore everything about their case minus the Suboxone you're fine.

I didn't know the doctor-patient relationship could be redefined by an individual doctor (and not the law or professional ethics) to only treat the patient on a very specific medication based approach with nothing else.

I didn't know one had to go to medical school, graduate from a residency, get a state license and then ignore about 99.9% of their education when treating a patient.

Maybe surgeons should just cut open without taking vital signs, other meds, and possible infections into regard.

A related way of looking at this situation is that the doctor who is prescribing suboxone is treating addiction, and is responsible for directing the treatment of all parts of the patient addiction. Part of the treatment of addiction is managing the other addictive meds the patient takes- this may include consulting with other specialists (for example, if you have another doc eval the pt for adhd) and coordinating the prescription of other addictive meds. If adderall is felt to be necessary, the 2 docs should discuss who will be prescribing it (maybe the consultant would start it and the suboxone doc would continue it)
 
I gotta agree with MichaelRack. There's no neglect issues or obligation to treat [from my understanding], as this is an elective issue rather than life threatening/acute/urgent. Can always refer elsewhere.

For the last year+ I have been developing a thorough non-medication protocol for treating ADHD (always in revision) which include screening and treating attention mimics (anxiety, dissociation, depression), lifestyle/environment changes (sleep, diet, caffeine use, a desk), teaching cognitive strategies (CBT for ADHD), leveraging technology (iPhone reminder systems, automating tasks), thorough to do systems, and use of hypnosis and self-hypnosis. It's all a work in progress, but trying to be more comprehensive than just stimulants or even CBT alone (which is helpful but still leaves a lot of gaps).

It's OK IMO to diverge from community practice if you can legitimize that your standard is higher, more beneficial, and less harmful/risky. The community standard is pretty low for prescribing stimulants, so anything that is more conscientious IMO is good. Including weighing risk profiles for polysubstance and poor impulse control before potentially increasing iatrogenic problems. After examining the literature of decreased risk in treating ADHD, I think the evidence base is quite soft, and not strong enough to legitimize treating ADHD to therefore decrease risk of diversion/antisocial bx's/addiction as a mandate.
 
  • Like
Reactions: 1 user
Maybe surgeons should just cut open without taking vital signs, other meds, and possible infections into regard.

As an intern, I remember many cases where I was consulted to manage ongoing medical problems and they were responsible for the post-op process only. The difference between 2 lines and continuing work compared to 1.5 pages due to the multiple comorbidities.
 
Whopper, in every other specialty, there are specialists. I don't do suboxone-only treatment, as some do, but I could see a valid argument as a "specialist." Just as you might go to an EP sub specialist to work on your pacemaker, you don't have the expectation that they manage all your cards issues. A suboxone provider could run a clinic that focuses on that. Now doing only that when someone has no other providers and can't find one might be more questionable.
 
Oh cripes--Suboxone isn't pacemaker electrophysiology.
It's ridiculous that any yahoo with a DEA number can create an infinite number of new addicts with a few strokes of a pen, while an evidence-based treatment for that addiction is kept so tightly regulated and shrouded in mystique. It only serves to perpetuate the stigma.
 
Oh cripes--Suboxone isn't pacemaker electrophysiology.
It's ridiculous that any yahoo with a DEA number can create an infinite number of new addicts with a few strokes of a pen, while an evidence-based treatment for that addiction is kept so tightly regulated and shrouded in mystique. It only serves to perpetuate the stigma.

I think if we're opening up the pill mill can of worms, we're gonna need a bigger boat.

[Mixed metaphors intended]
 
2 pill mills arrive in your neighborhood. The Oxy clinic and the Bup clinic. You do not know which one to go to! You can fake being in pain and get full agonism or admit you are an addict and get partial agonism. Where is everyone else going? The Oxy clinic wins by a landslide! However despite popular demand you wisely choose the Bup clinic for that partial agonism and ceiling effect. Hurrah!
 
The specialist argument works only if you're a specialist that can only treat the specific facet you're treating.

In my example, I'm talking about a psychiatrist that is treating a Suboxone patient with other psychiatric disorders, and ignores those other disorders.

So the counter-argument works if you're a psychiatrist prescribing Suboxone, but the patient also has a Staph aureus infection that is being co-managed an ID specialist. Leave the infection to the ID specialist. Fine. Works. Logical.

But the counter-argument doesn't work in the case I presented with the opioid addict with other psychiatric disorders. As we also full-well know, mood disorders (and other psych disorders) can make the addiction more problematic. Further, many can't get separate psych services very easily.

From my own experience, adding another psychiatrist to the mix can make the situation worse. E.g. I prescribe Suboxone and the other psychiatrist starts prescribing Xanax, and when I call them up and ask them why, they won't answer the phone.

Further, several of the Suboxone-only plces I see treat the patient using very questionable methods. E.g. one doctor I know gets all of his Suboxone patients to show up on a Saturday, form a line of about 100 patients, and they just go into his office, and he signs a script and they walk out with virtually no discussion and about 3 minutes a patient. He also charges them quite a bit of money too.

If a psychiatrist is simply running a "Suboxone mill" that goes against the recommendations of making sure the patient is getting counseling, IMHO that's not appropriate care. Further, if you are actually making sure the person is getting psychotherapy, it just naturally follows that you treat the other psych disorders going on.

The line in the sand, "Suboxone-only" practice I can only see an argument for if you're only for the money and want to dump your responsibilities as a physician. Such practice is not appropriate in other areas of psychiatry. It's not parity. Depressed? Here's an antidepressant, I don't want to know anything else about your case. Can't sleep? Here's a sleep-med I don't want to know anything else about your case.

Even the quick med-check type practices that many here abhor at least try to deal with the psychiatric patient on a dimension more sophisticated than 1 disorder-1 treatment only.
 
Last edited:
Their cocktail where I lived was suboxone, one of the higher doses, 3-4 2 mg Xanax all day, 40 mg of Adderall XR and they always had Ambien in bed. I still see them at the pharmacy sometimes and they are so not worried about HIPAA that they brag about the cocktail they are on... after being let out on bail for burglarizing 4-5 houses for a "victimless crime".
 
Hello I ran across this post that I fully realize is old but it made me want to respond anyways. I have a problem with using this cookie cutter mold concept lumping ALL suboxone patient's together as addicts. Using this generalized idea that if a patient is being prescribed Suboxone then they should not be even considered for treatment for their ADHD using stimulants such as Adderall. I personally have been on Suboxone for treatment of my chronic pain. I suffer from a spinal cord injury, a stomach rupture years after gastric bypass surgery and while 7mo. Pregnant, and last but not least I was recently diagnosed with a pituitary gland tumor. Suboxone works extremely well to manage my chronic pain. However, I have been labeled by our society as either a herion addict or opioid addict. Im neither one. So to say no one on suboxone should be considered for treatment of their ADHD with stimulants is unfair and should be reconsidered. Suboxone is starting to be used more often for chronic pain patients because it WORKS! So the medical field, pharmacists, and our society as a whole needs to consider each patient individually rather than smacking a label on ALL patients who are prescribed Suboxone.
Thank you,
Michelle Curtis
 
I had a patient yesterday not tell me about his suboxone because he was ashamed. However he was asking for adderall so it was highly relevant!
 
Dear everyone.

Let me start by saying I'm a highly functional professional from the big apple--I'm 33 and I have SUD, ADHD, and GAD/SAD. I'm also what some call a gifted adhd patient. I did well in school, but I was diagnosed in college by survey and didn't take it seriously. When I moved to the NYC environment, I started to notice my limitations more. Trouble maintaining multiple relationships, responsibilities, deadlines, and follow-through. So I had a full neuropsych work up (5 or 6 hours) that confirmed moderate to sever adhd. They estimated that I have a substantial double digit deficit when it comes to non creative thinking. That part of my brain is ~20% defective.

I've been looking for good HCPs who will work with me ever since in NYC. The good docs don't return my calls, so I'm left with questionable practices for healthcare.

Here's the rub, I grew up in philly, and surprise I abused oxy right when it got popular (13 to 14 years ago). Like over half of ADHD patients, I was undiagnosed and self medicating. I've been taking suboxone ever since. I haven't used opiates since. And my doctors trust me implicitly after all this time.

So bottom line, I'm prescribed a low .5 mg dose of k-pin daily + suboxone + adderall XR and regardless of the increased potency, it's all changed my life. Especially the klonopin. I haven't used an unprescribed substance since I started adderall. What's more, the little bit of kpin alleviates my social anxiety just enough to get me outside and about for a few hours. Helps my appetite, and alleviates my social anxiety as well.

But I happen to be a professional medical writer for a pharmaceutical company. So I at least understand the gravity of the risks. But I can't put into words how good it feels to not feel abnormal all the time.

I agree the law is important and so are licenses. But at some point, shouldn't we consider what helps the patient the most (if we know and trust that patient). Or at least consider it a little? I've nearly gotten fired before because of trouble accessing my Rx at the pharmacy. Every aspect of Tx is very stressful. Can anyone help ?
 
Saw a patient here in St. Louis who just moved from NYC. His doctor there had him on 10 mg of Xanax, 24 mg of Suboxone, 60 mg of Adderall!! I told the patient I'd only give him Adderall if there was good proof he had ADHD such as the other doctor's records, and if they weren't satisfactory some testing.
I also told him that I'd only provide him benzos if we made a strategy to wean him off.

Within 10 minutes he stormed out of my office extremely mad. I guess I'll never see him again.

I looked the other psychiatrist up and he also advertises he gives out Ketamine no surprise. I'm suspecting the guy is a quack. I'd love to put his name here but I'd be violating the SDN rules. (but hint hint his last name is a food group).
 
  • Like
Reactions: 2 users
Saw a patient here in St. Louis who just moved from NYC. His doctor there had him on 10 mg of Xanax, 24 mg of Suboxone, 60 mg of Adderall!! I told the patient I'd only give him Adderall if there was good proof he had ADHD such as the other doctor's records, and if they weren't satisfactory some testing.
I also told him that I'd only provide him benzos if we made a strategy to wean him off.

Within 10 minutes he stormed out of my office extremely mad. I guess I'll never see him again.

I looked the other psychiatrist up and he also advertises he gives out Ketamine no surprise. I'm suspecting the guy is a quack. I'd love to put his name here but I'd be violating the SDN rules. (but hint hint his last name is a food group).

And it's a wonder why state boards don't call these people to the carpet to demonstrate the evidence necessary for uppers and downers.
 
I looked the other psychiatrist up and he also advertises he gives out Ketamine no surprise. I'm suspecting the guy is a quack. I'd love to put his name here but I'd be violating the SDN rules. (but hint hint his last name is a food group).

Shame on Dr. Vegetable
 
  • Like
Reactions: 1 user
Top