Suboxone clinic?

[Iamnew2]

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Hey all, do any of you do suboxone prescribing/suboxone clinic? I did a pain fellowship, work in input though, but there is a lot of need for opioid management/suboxone management in my community. Just wanting to hear others thoughts in terms of anyone who might do Suboxone as part of their practice - positives/negatives?

Thanks

 

[willabeast]

Hey all, do any of you do suboxone prescribing/suboxone clinic? I did a pain fellowship, work in input though, but there is a lot of need for opioid management/suboxone management in my community. Just wanting to hear others thoughts in terms of anyone who might do Suboxone as part of their practice - positives/negatives?

Thanks

Wife worked in a Suboxone clinic for a short time(her job description got changed involuntarily). She hated it. She left that job. I just asked her your question. She said it can be useful by switching an opioid addict to Suboxone then tapering them off Suboxone. But she thought in order to effectively use it you would need to be an Addictionologist AND have done extensive reading on Suboxone.

 

[Agast]

PainApplicant loves his clinic

 

[kstarm]

If you are interested in doing suboxone and feel comfortable with it, then it can be rewarding and you will likely save some lives. Often times this can be much more straightforward then chronic pain. If you get into a space of being "the opioid doctor" and you are just getting everything sent to you that is opioid related instead of straightforward addiction then that can be miserable. You also should be sure to know your limits: are you going to do sublocade, refer to methadone clinics, teach naloxone, provide fentanyl test strips, work with behavioral health etc.

 

[Iamnew2]

Wife worked in a Suboxone clinic for a short time(her job description got changed involuntarily). She hated it. She left that job. I just asked her your question. She said it can be useful by switching an opioid addict to Suboxone then tapering them off Suboxone. But she thought in order to effectively use it you would need to be an Addictionologist AND have done extensive reading on Suboxone.

That's probably a fair assessment. Thank you

 

[Pain Applicant1]

PainApplicant loves his clinic

Indeed. I love it and I highly recommend it. I started doing suboxone when a friend of mine died from an overdose as did the brother of a previous employee (also still a friend of mine). It's a very ugly way to die. My only regret is that I didn't start prescribing it earlier.

I was a bit apprehensive in the very early stages but I now look forward to seeing these patients on the schedule. Most are Medicaids and despite having a history of incarceration, end up doing remarkably well and seem to be really appreciative. The ones that don't, don't typically come back. I enjoy talking to these pts and hearing about their lives and they seem to get a lot out of having an ear to vent to. They don't seem to be as negative as the chronic pain population.

As far as I know, I lost 2 suboxone pts to overdose deaths. I know this because the detectives requested my notes. Both were after the first visit. One, Medicaid wouldn't pay for suboxone until the prior auth was done so the pt used heroin/fentanyl instead. Medicaid has since changed this policy. The other I only saw for one visit. Too bad because this pt really wanted to get better. I could've helped both of these pts had they just avoided relapsing for just a few more days. I guess it comes with the territory but I don't think I'll ever forget these two.

I'm trying to change my practice to maybe ~10-20% pain and the rest suboxone. In place of retiring, I think I'd just work a few hours per week doing suboxone.

Mr. and Mrs. DEA, please lift the suboxone caps!!!!

 

[mid|ine]

PA1, do you accept insurance for your suboxone clinic? I know a lot around here used to be cash only.
Also, NPs have a separate cap for suboxone patients

 

[Pain Applicant1]

PA1, do you accept insurance for your suboxone clinic? I know a lot around here used to be cash only.
Also, NPs have a separate cap for suboxone patients

I don't accept cash at all. I found that cash pays would have expectations for opioids and I was sick of fighting with them.

In fact, I mostly only accept medicaids for my suboxones.

 

[geauxg8rs]

That is hero level work

 

[geauxg8rs]

Medicaid patients are so poorly managed by their pcps. I hate to say it. You have so much that you can do to help these people when nobody else will

 

[Pain Applicant1]

That is hero level work

I think you're referring to me so thanks if you are.

I hate to admit this but it's not very altruistic of me and I'm definitely no hero. Accepting that would be like stolen valor. I like the Medicaid suboxone population. Most are young and otherwise healthy. They're mostly appreciative, straightforward, pretty easy to deal with and don't really complain much. I'd take them any day before an entitled pt with better insurance.

I don't accept Medicaid outside of Suboxone because it's not worth the complications. If I was selfless enough, I would, but unfortunately for me, I'm not 🙁 Boo to me, lol.