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- Aug 28, 2019
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I'm hospital employed. Recently, a local pain management clinic was shut down. It was cash pay, non-Interventional. MED doses ranging from 30-300, probably 80% of patients on Benzos, vast majority uninsured or "self pay" with a smattering of Medicaid.
These patients have now fled into the community and most are seeing their PCP's, who give one month refills of their old regimen and then "refer to pain management." All the local PP's in town block them at the level of the receptionist, so they end up coming to one or two hospital systems.
I've been in this community for four years, when I first started out I did a lot of weaning, now I give recommendations for management to PCP's for reasonable patients.
These patients are not reasonable, will not abide by weaning recommendations, will threaten staff, file medical board complaints leave bad reviews. It was a poorly kept secret that most of these patients would sell a portion of their monthly Rx to fund continued refill visits for cash.
What do do?
My plan was to have my RN- who is addiction trained, counselor- call them and give them recommendations to wean off whatever they have left. Also offer medications for WD (Tizanidine, Clonidine) as well as self referral options to local Suboxone clinics which accept Medicaid or community service boards for MAT for self pay patients. Finally, offer clinic follow up once off opioids in 6-8 weeks if they want to pursue Buprenorphine for pain.
The PCP's will not cont. prescribing and will not even give weans, just advice to find "pain management."
Am I establishing a "treatment relationship" by prescribing meds for WD if I've never seen them in the office?
These patients have now fled into the community and most are seeing their PCP's, who give one month refills of their old regimen and then "refer to pain management." All the local PP's in town block them at the level of the receptionist, so they end up coming to one or two hospital systems.
I've been in this community for four years, when I first started out I did a lot of weaning, now I give recommendations for management to PCP's for reasonable patients.
These patients are not reasonable, will not abide by weaning recommendations, will threaten staff, file medical board complaints leave bad reviews. It was a poorly kept secret that most of these patients would sell a portion of their monthly Rx to fund continued refill visits for cash.
What do do?
My plan was to have my RN- who is addiction trained, counselor- call them and give them recommendations to wean off whatever they have left. Also offer medications for WD (Tizanidine, Clonidine) as well as self referral options to local Suboxone clinics which accept Medicaid or community service boards for MAT for self pay patients. Finally, offer clinic follow up once off opioids in 6-8 weeks if they want to pursue Buprenorphine for pain.
The PCP's will not cont. prescribing and will not even give weans, just advice to find "pain management."
Am I establishing a "treatment relationship" by prescribing meds for WD if I've never seen them in the office?