Daily suboxone dispensing clinic

[Village]

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Hi everyone
I just recently took a position as medical director of a non profit organisation that runs a methadone and suboxone clinic. They are trying to change suboxone part to be like methadone part where patients come in for daily dosing. I will imagine this will deter patients from establishing services. They will have to come every day for their doses meanwhile PCP and psychiatrists are willing to provide weekly to monthly scripts. Will also imagine increase in cost (drug screens, BAL), paperwork hazzles etc. I will appreciate any feedback or advise. This is new to me . Thanks guys

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[michaelrack]

I left a job like that in late May, regulations ( I am not sure if state or federal) required suboxone to be dispensed daily
I don't think it's a scam... I believe it was due to fed regs
Well I don't like the whole methadone clinic concept, at least the way it's done in practice, but I don't think the clinic is trying to scam anyone by offering daily suboxone

 

[Village]

I left a job like that in late May, regulations ( I am not sure if state or federal) required suboxone to be dispensed daily
I don't think it's a scam... I believe it was due to fed regs
Well I don't like the whole methadone clinic concept, at least the way it's done in practice, but I don't think the clinic is trying to scam anyone by offering daily suboxone

The clinic wants to build suboxone clinic caseload and am.not sure this is a good way to achieve that. It will deter patients to other outpatient programs that do not require daily dosing. These are Medicaid clients with financial and transportation issues. It might bring in uninsured (state has a grant towards that ) and those that cant get a dr appnt.

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[whopper]

It's not the usual way to do it but it can be done and a good friend of mine made one. He wanted me in but at the time I was a professor and the university wouldn't allow me in due to a no-compete clause.

Make sure you're following all the regulations state and federal.

 

[michaelrack]

Village, I think I know exactly which company you are talking about. No use fighting it, either comply or leave

 

[Village]

It's not the usual way to do it but it can be done and a good friend of mine made one. He wanted me in but at the time I was a professor and the university wouldn't allow me in due to a no-compete clause.

Make sure you're following all the regulations state and federal.

Thanks whopper. I will really appreciate some info on some of procedures ,regulations and protocols. You mind putting me in contact with your friend please ?

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[Village]

Village, I think I know exactly which company you are talking about. No use fighting it, either comply or leave

My contract is not up till Feb 2019. So I will have to work with them on getting it going for the least. I have been researching info on procedures,protocols, DEA and SAMHSA requirements etc. I

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[whopper]

My friend, a Ph.D. candidate and substance abuse counselor, doesn't like to take phone calls or e-mails. Nice guy but not into the teaching thing.

The law is important. You don't want to do something that'll cost you plenty as an investment. I know of a doctor that made a methadone clinic, bought the property, had it modified on the inside, and after putting in 6 figures into this clinic, found out that he wasn't allowed to operate it cause it was within a few blocks of a school. Turned out you couldn't have a methadone clinic within a specific distance and his clinic was within it.

If this clinic is operated by an existing company, if it's big enough it likely has a lawyer. You could ask for assurances by the lawyer or someone official in the company that everything you're doing is kosher.

 

[FlowRate]

Some of our affiliated SUD clinics offer this as an option for greater support or for patients with a history of diversion. IMO doing this right involves having additional services tied in (social workers/therapists/groups). More structure to the day is helpful for a lot of these patients.

 

[Village]

My friend, a Ph.D. candidate and substance abuse counselor, doesn't like to take phone calls or e-mails. Nice guy but not into the teaching thing.

The law is important. You don't want to do something that'll cost you plenty as an investment. I know of a doctor that made a methadone clinic, bought the property, had it modified on the inside, and after putting in 6 figures into this clinic, found out that he wasn't allowed to operate it cause it was within a few blocks of a school. Turned out you couldn't have a methadone clinic within a specific distance and his clinic was within it.

If this clinic is operated by an existing company, if it's big enough it likely has a lawyer. You could ask for assurances by the lawyer or someone official in the company that everything you're doing is kosher.

This is an existing non for profit organisation, average size. They used to have a lot of clients but lost some due to internal changes. Not sure if the client case load for methadone is over 200. The company has a small caseload of 46 at this time but want to start dispensing suboxone at window like methadone. Am still calling diff agencies to find out what laws are in this case so we stay in compliance

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[Village]

Some of our affiliated SUD clinics offer this as an option for greater support or for patients with a history of diversion. IMO doing this right involves having additional services tied in (social workers/therapists/groups). More structure to the day is helpful for a lot of these patients.

You are right. I think its more for diversion reasons if anything. Working on getting more staff hired to run groups and individual counseling

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[Dan12345]

Can’t imagine having to drive all the way to a suboxone clinic here in Miami just for 1 dose and then repeating that every day. Especially considering it’s a long drive for people in many cities with little options to choose from.

 

[Sushirolls]

1) Patients who are appropriate for burprenorphine will leave. With PA/ARNP also able to prescribe, access is greater. Part of the history of buprenorphine and the DATA 2000 waiver was to not be a daily dispensing treatment like methadone.
2) Diversion issues? Switch to sublocade. Once Buvidal gets the green light, it'll likely be the new standard, diversion issues virtually gone.