Our team consists of:
1 board certified Family Practice/Accupuncture/Addiction Med MD with Data waiver
2 Psych PAs with Addiction Med Experience
5 Licensed Chemical Dependency Counselors
2 Licensed Mental Health Couselors
Together we staff and operate the Lummi Indian Nation Suboxone Clinic.
We have 98 patients that are all REQUIRED to:
1.) Attend a 1 hr group counseling session 5 days a week (group times are:0700, 0830, 1200, 1500, 1630)
2.) Attend 3 hrs of Mental Health counseling per week
3.) Submit a random U/A 1-6 times a week
4.) Attend a minimum of 2 12-step meetings per week.
The program pays for all meds (~18k every 2 weeks for Subutex, Suboxone, Campral, Multi-Vit, Omega III, Melatonin). We also have cultural therapy, Accupuncture/pressure, and a Massage Therapist available to the patients.
The average Patient is on 16mgs SL qd (some IV heroin users as high as 24mgs, some patients as low as 2mgs)
All meds are crushed and administered to patients on-site for a minimum of the first 90 days in our program to prevent diversion.
We dose every patient daily after group. Non-compliance= No Dose.
We DO NOT write prescriptions for take home meds, but we do give them their Sunday dose on Sat. (8:30-10:30).... the meds are delivered to us from the pharmacy and kept in a secure heavy duty safe in the office.
Subutex is reserved for pregnant patients and tapered to the lowest dose possible as she nears term.
We U/A them a minimum of once per week, but some weeks we will U/A them 3-5 times a week. Dirty U/A = Contract and crushed Meds. Break Contract with another dirty U/A= Inpatient Treatment. Refuse Inpatient Treatment=Rapid taper of Suboxone and out of the program.
After 8 months and stable without "dirty U/As"... we began a trial taper of 1/3rd the total dose. If patient tolerates this taper and remains clean for 30 days on this lower dose... then we graduate them to phase II.
Phase II is group counseling 3 times a week and non-crushed dosing 3 times a week with weekend dose given on Friday. Patient still must give a Random U/A atleast 1 time a week and attend 3 12-step meetings a week. After 8 months in phase II and stable without "dirty U/As"... we began a trial taper of 1/3rd the total dose. If patient tolerates this taper and remains clean for 30 days on this lower dose... then we graduate them to phase III.
At this point the patient has been in the program for 16 months...
Phase III is group counseling 2 times a week and dosing 2 times a week with 3 12-step meeting per week. After 8 months and stable without "dirty U/As"... we began a trial taper of the total dose. If patient tolerates this taper and remains clean for 30 days... then we graduate them from the program.
This program has been running since Jun of 2007.
We've learned quite a few things in this...
1.) Subutex is being injected, snorted, or smoked in the community
2.) Suboxone is being snorted and smoked in the community
3.) Patients DO get high off of Suboxone
4.) Some patients prefer Suboxone because the police will hesitant to arrest them as long as the prescription bottle is current. They also know that a U/A for buprenorphine must be SPECIFICALLY ordered, costs more, and therefore will not likely be detected by their jobs or probation/parole officers.
5.) 1 8mg tablet of Suboxone has a street value of $10 so you prescribers out there giving patients 14 day prescriptions of 24mgs per day (42 tabs = $420)are enriching the patients and basically subsidizing their oxy habit.
6.) Lots of Opioid addicts use Buprenorphine to "tide them over" until they can get their Opioid of choice.
7.) Some will self taper mid-week since they know the half-life (~72hrs) to get ready for the killer party over the coming weekend.
8.) Some will only take 2 tabs a week (and sell the rest) since they know the half-life (~72hrs)... to pass a buprenorphine U/A conducted by their Suboxone Provider to detect diversion.
9.) In many ways... PAWS from bupe is worst that most other Opioids.
10.) 3-10 mgs of Sublingual Melatonin helps with sleep
11.) Multi-Vit and Omega III supplimentation helps.
12.) Accupressure/puncture helps reduce cravings
13.) Some will feign PAWS and request an increase in dosage. Then continue to try and convince you that they need to be on >16mgs qd... but in reality they are only taking 2-4mgs per day and selling the rest.
Educate yourselves from the source (users/abusers/dealers)
here...
DocNusum
