Methadone for ERAS Spine Cases
Do any of your institutions have methadone infusions as part of ERAS or general protocols for spine cases? Would be interested in hearing others' experiences with this. (Source: Student Doctor Network)
Source: Student Doctor Network - February 5, 2024 Category: Universities & Medical Training Authors: gasman19 Tags: Anesthesiology Source Type: forums
Subutex Initiation
Hi All, is there a user friendly guide on starting someone on Subutex that I can read and learn from? Didn't get much training in residency and now that I am out in the real world have been needing to start and manage people on Subutex/Suboxone/Methadone and looking for a guide to help me learn. Thanks. (Source: Student Doctor Network)
Source: Student Doctor Network - July 9, 2023 Category: Universities & Medical Training Authors: moto_za Tags: Psychiatry Source Type: forums
Belbucca TID?
Didn't get a ton of exposure to belbucca in fellowship, but want to use it more in my practice.
Have a patient who had previously been on methadone at roughly 120 MME who was rotated off of it to morphine and titrated down to about 60 MME by an NP at a different pain clinic locally. Patient didn't endorse great benefit from the morphine at any time she was on it, so I offered a rotation to belbucca. Currently on 150mcg BID dosing. She's getting good relief, but notes it isn't lasting got...
Read more (Source: Student Doctor Network)
Source: Student Doctor Network - December 4, 2022 Category: Universities & Medical Training Authors: agolden1 Tags: Pain Medicine Source Type: forums
Can I say NO to contacting my current employer?
I’m a year out of training working at a community hospital. A position has opened up at the VA, actually at my old training programme. Seems like a good fit since they desperately need someone to take over suboxone and methadone prescribing as their current guy is retiring, and I’m fellowship trained in addictions and want to do addictions almost full time.
So as I’m going through the credentialing process, the ROI says to allow them to contact anyone, including current employer. I...
Read more (Source: Student Doctor Network)
Source: Student Doctor Network - August 24, 2022 Category: Universities & Medical Training Authors: vanfanal Tags: Psychiatry Source Type: forums
Methadone clinic question
Hello! I am currently a PIC at a methadone clinic in Virginia, I really like my job but I think I could do more here. My proposal that I've told my boss about is that I could enter a collaborative practice agreement with the doctor and I could manage the patients doses (increases, decreases, phase changes, etc.) and meet with patients to do med recs and full assessments or just to talk about a dose increase. She loves the idea but is unsure about what the laws have to say about this since...
Read more (Source: Student Doctor Network)
Source: Student Doctor Network - May 17, 2022 Category: Universities & Medical Training Authors: isaacsrd Tags: Job Market Source Type: forums
Metahdone for cancer patients
Hey all,
Do any of you routinely prescribe methadone for cancer patients? In my area, it seems a number of the docs prescribe Methadone for their cancer patients. Where I did residency pretty much no one prescribed Methadone for just about anything.
Thoughts on this? (Source: Student Doctor Network)
Source: Student Doctor Network - November 19, 2021 Category: Universities & Medical Training Authors: Iamnew2 Tags: Pain Medicine Source Type: forums
How are you guys handling inherited methadone patients?
I have some Mehthadone patients I've inherited on like 10 TID for years no ekg and in general don't need to be on high opioids if at all.
I'm trying to clean it up. What is the dose limit you guys are using for Metha done? I've read and calculated one day 10mg BID to be the absolute max in terms of adhering to CDC guidelines.
Methadone has a disproportionately high amount of complications related to it.
Also how are you guys weaning these patients? (Source: Student Doctor Network)
Source: Student Doctor Network - November 13, 2021 Category: Universities & Medical Training Authors: Nonphysiologic Tags: Pain Medicine Source Type: forums
Learning more complex detox regimens
Hi, so I have an interest in doing addiction work after residency. I've been told by more than one attending to skip the fellowship and just learn what I can during residency and then in practice. Problem is our chemical dependency rotation is quite weak. Aside from the basics of Suboxone, methadone, etoh detox there isn't much more learning opportunities. Any recommendations of where to learn more about more complex detox management? (Source: Student Doctor Network)
Source: Student Doctor Network - September 8, 2021 Category: Universities & Medical Training Authors: Psychresy Tags: Psychiatry Source Type: forums
local PCP retires. dumped all their patients on me - opioids benzos etc etc
Methadone, short acting, long acting, opioids, benzos, soma
WTF?
I don't have the bandwidth to see these patients to wean them down. I'd rather not even pick up that hot potato since we already refuse if they are already on benzo and opioids in combination
what to do? (Source: Student Doctor Network)
Source: Student Doctor Network - December 19, 2019 Category: Universities & Medical Training Authors: oreosandsake Tags: Pain Medicine Source Type: forums
My parents want to take my heroin addict brother on an Ayahausca trip...
So my brother has been a heroin addict for years now. He has been to in patient and out patient treatment programs for the last few years and has just finished methadone. He as far as we know is not currently using opiates. He is smoking weed and doing hallucinogens occasionally.
He has somehow convinced my parents that they should take him on a luxury vacation to Costa Rica to undergo an Ayahuasca experience as he feels like this will heal his addiction once and for all.
My major problem...
My parents want to take my heroin addict brother on an Ayahausca trip... (Source: Student Doctor Network)
Source: Student Doctor Network - May 12, 2018 Category: Universities & Medical Training Authors: BiochemGrad14 Source Type: forums
Opioid Shortages
Opioid shortages leave US hospitals scrambling - CNN
Does anyone else's hospital have this problem? We've been out of dilaudid for over a month now and are critically low on fentanyl, morphine, and ketamine. Many of us are moving onto IV methadone, demerol, alfentanil... (Source: Student Doctor Network)
Source: Student Doctor Network - April 1, 2018 Category: Universities & Medical Training Authors: banister Source Type: forums
Prescription monitoring and methadone
Today a new patient came in. I ran his date of birth and name through the prescription monitoring for my state. I ran it for adjoining states as well. It came up empty.
He tells me he is on methadone, liquid from a clinic. He showed me the bottles. He gets the medication from the clinic.
Do these clinics bypass having to report to the prescription monitoring sites? This kind of defeats the purpose for a doctor like me.
Luckily, he told me he is on it and showed me the bottles. I...
Prescription monitoring and methadone (Source: Student Doctor Network)
Source: Student Doctor Network - March 10, 2018 Category: Universities & Medical Training Authors: GroverPsychMD Source Type: forums
Exam Room 4: Burn victim, FNT/Actiq, non-consented taper...
58 year old female with history of alcoholism, status post DUI/MVC sustaining burns over 60% of body, poly-trauma, head injury, and facial deformity. Protracted hospital stay, rehabilitation, and post-acute care. DC'd from SNF on 240mg of Methadone. Referred to outside pain specialist and rotated to 200 mcg TD FNT Q48 with ACTIQ 400 mcg Q6 PRN BTP. Pain specialist no longer RX'ing due to pending municipal class action litigation. At last PCP appointment patient told by clinic medical...
Exam Room 4: Burn victim, FNT/Actiq, non-consented taper... (Source: Student Doctor Network)
Source: Student Doctor Network - February 20, 2018 Category: Universities & Medical Training Authors: drusso Source Type: forums
HIV medication drug interactions
I am studying for my consult psych recert boards. Various sources indicate that ritonavir and other HIV antivirals tend to lower methadone levels. According to the UCSF site, ritonavir may induce 3A4, thus lowering methadone levels: Interactions with Methadone.
However, other sources, including wikipedia, states the ritonavir inhibits 3A4 - thus increasing the levels of drugs such as statins.
the package insert...
HIV medication drug interactions (Source: Student Doctor Network)
Source: Student Doctor Network - February 4, 2018 Category: Universities & Medical Training Authors: michaelrack Source Type: forums
Prescription heroin
Was listening to NPR on the way home today, interview of a journalist for vox who claims prescribing heroin TID on taxpayer dollars to curb the opioid epidemic has worked well on a small scale in one Vancouver clinic and advocated attempting this in the US. Sounded ridiculous hearing this but the online articles are there. Also had made multiple unsubstantiated statements such as placing patients on methadone or suboxone reduced the risk of death by more than 50% compared to other opiates....
Prescription heroin (Source: Student Doctor Network)
Source: Student Doctor Network - January 9, 2018 Category: Universities & Medical Training Authors: TheLoneWolf Source Type: forums
