Discussions that mention suboxone

Pain Management board


Hey Sunshine, Methadone clinics have made significant changes in the last few years. Mainly treatnig the patient as a whole person including psych counseling, addressing HIV and HEP health problems. It will more than likely take more than simply going through withdrawal to be excepted into a program unless he's willing to admit things that may or may not be true.

There are new options that can be used by docs in private practice outpatient rather than a meth clinic, like Buprenorphine (Suboxone) to ease withdrawal, you might want to look for an addictionologist that uses suboxone for outpatient treatment. Some PM docs are even using it to treat pain. But I doubt an ER is going to do more than point him in the direction of a clinic or a doc and treat symptoms like high BP and dehydration.

This is what he should expect at a meth clinic intake interview

Principles of Medical Management of Methadone Patients
--------------------------------------------------------------------------------

Select appropriate patients and complete physical examination and psychiatric evaluation
Minimum age of 18 years (generally)
At least one year of physiologic dependence on a narcotic
Meets criteria for opioid dependence (see Table 2)

TABLE 2
Criteria for Opioid Dependence
--------------------------------------------------------------------------------

At least three of the following symptoms must occur during a 12*month period:
Tolerance
Withdrawal
Opioid use in greater quantities or for longer periods of time than planned
Failed attempts to quit or cut back (at minimum, a wish to cut back)
Considerable time devoted to obtaining drug, using drug or recovering from use of drug
Interference with social, occupational or recreational activities
Ongoing use despite awareness of drug problem
--------------------------------------------------------------------------------

I'm really not a mean person or implying he's getting what he deserves, Meth really isn't the scarry drug you may think it is and if there are no psych factors involved people generally aren't permanatly harmed by withdrawal, other than remembering it's something never worth doing again. Even that doesn't stop an addict though.

Subutex is probably the better option as far as detox because of an even longer half life and if he needs PM he may have to start over and find a doc willing to prescribe his previous dose or be willing to try a med the doc is comfortable with , rather than the med and dose the patient requests.

Just because Doctor X in LA beleves 120 mgs is perfectly safe, It doesn't mean all docs in your new area will believe the same thing. Each doc has his own comfort level and veiws on the use of opiates. Many docs are antiquated and flat out wrong, but you have to look at it simply as their opinion, and move on and find a doc willing to work with him if he truly neeeds that dose of meds.

Exceeding the dose, knowing this will happen doesn't make alot of sense. It puts the doc in a difficult situation, they can't allow a patient to self medicate and not folllow their directions and simply refill a class 11 med 2 weeks early. Class 11 meds are seen by the DEA and govt as the group of drugs with the highest abuse and diversion potential.

I wish you both luck and hope ehe never has to experience something like this again, but he has to understand the doc is in charge of his dose and he's the one that pays the price.
Take care, Dave