Patients with multiple controlled substances.
I'm seeing this constantly now, patients on 2-3 controlled substances at once by the same prescriber.
e.g. Xanax 2 mg TID, Adderall 20 mg BID, Suboxone 8-2 mg BID
I've been tempted to just tell patients I will only prescribe only 1 controlled substance at once.
How do you handle transfers or new patients with these regimens? (Source: Student Doctor Network)
Source: Student Doctor Network - January 16, 2024 Category: Universities & Medical Training Authors: littlefred Tags: Psychiatry Source Type: forums
Too late to get addiction pathway boarded?
So I've been out of residency for two years, mostly private practice (a little bit of psych ED moonlighting in the beginning). I'd say about 20% of my patients have some substance issues, mostly alcohol and marijuana. I did get th e x-waiver but don't really prescribe much suboxone currently.
How hard would it be to get the hours to get addiction boarded? I imagine I'd need to also switch up my practice setting to get more addiction demographics too. (Source: Student Doctor Network)
Source: Student Doctor Network - October 25, 2023 Category: Universities & Medical Training Authors: Dopamemes Tags: Psychiatry 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
There are wins sometimes
December 2020: Patient presents for intake on following combination of medications (among others) from elderly out of state psychiatrist who is not good about responding to communication but patient kind of idolizes:
Diazepam 15 mg qAM, 10 mg qnoon, 10 mg q4PM, 15 mg qHS
Adderall IR 20 mg TID
temazepam 30 mg qHS
Ambien 15 mg qHS
gabapentin 600 mg qAM + 300 mg qHS
Patient had struggled to get off suboxone they were put on for chronic pain in the past but had been sober for a few years...
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Source: Student Doctor Network - May 26, 2023 Category: Universities & Medical Training Authors: clausewitz2 Tags: Psychiatry Source Type: forums
Suboxone induction protocol
Gearing up for my first job outside residency at an addiction recovery center (outpatient clinic)
Sad to say, residency training has not given me the volume of outpatient Suboxone patients to feel comfortable with all the details of Suboxone induction.
Looking online, there are a variety of Suboxone initiation protocols available, with variable dosing schedules.
Since I'm just getting started, I would like a concrete protocol to operate on for the first month, and then be more flexible and...
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Source: Student Doctor Network - December 15, 2022 Category: Universities & Medical Training Authors: yoloswagpoop42069 Tags: Psychiatry Source Type: forums
Outpatient PA supervisor question
I wasn’t sure how to title this..
There is a PA I work with who has an outpatient suboxone and testosterone clinic basically, he started doing ozempic for weight loss recently as well. He has a retired ER doc that started the practice and now just has his name on it for legal purposes. His current doc is retiring from everything and I was approached to take his place.
I’m interested because I’m getting burned out and would like to do some outpatient medicine. I’ve been considering ketamine...
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Source: Student Doctor Network - December 3, 2022 Category: Universities & Medical Training Authors: jikenyson Tags: Emergency 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...
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Source: Student Doctor Network - August 24, 2022 Category: Universities & Medical Training Authors: vanfanal Tags: Psychiatry Source Type: forums
Suboxone dosing.
I have lately seen a provider who does BID and even TID suboxone dosing for some patients. Is there any evidence to this? I am not an expert at suboxone, but my understanding is that with the half life its just dosed once a day. Also any strong evidence for going over doses >16mg? It looks like most from what I read, recommended that as the max, in regards to efficacy. (Source: Student Doctor Network)
Source: Student Doctor Network - May 3, 2022 Category: Universities & Medical Training Authors: DrAmazingishere Tags: Psychiatry Source Type: forums
Adventures of a 50K Walgreens Sign-On Bonus job
I shall talk about my job adventures of a 50k sign on bonus location for Walgreens.
Day 1: Showed up and nobody was in the pharmacy but me. 267 printed, 35 in entry, 265 to review. Two people at the register, 2 suboxone patients in the drive thru with several cars behind them. I wonder.. I thought there was supposed to be a second pharmacist, and 2 technicans????? The RxOM is on vacation too. I **** my pants. 9:07 rolls around and a tech shows up. 1 minute later, second pharmacist shows up...
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Source: Student Doctor Network - September 27, 2021 Category: Universities & Medical Training Authors: Heroic Combo Tags: Job Market 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
More buprenorphine stories
There seems to be a prevalence of people using or wanting to use buprenorphine more for chronic pain.
Reasons PRO (some debatable):
Less addictive
Less prone to abuse
Less euphoric
Less tolerance
Reverse tolerance
Less respiratory depression (but
same if on other respiratory depressants)
Schedule 3
Doesn’t show up in popular music as far as I know.
No buprenorphine pill mills (suboxone/ chain addiction centers are another story).
Cons:
Transition to buprenorphine from a schedule 2...
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Source: Student Doctor Network - September 4, 2021 Category: Universities & Medical Training Authors: ateria radicularis magna Tags: Pain Medicine Source Type: forums
Suboxone clinic w just intern year
Totally hypothetical. I’m actually somewhat enjoying residency right now. But if I were to quit after intern year with a medical license, is there any reason I wouldn’t be able to start a suboxone clinic? Seems pretty straightforward medically speaking and wouldn’t need to be hired by a hospital. Would being covered by insurance be the issue? (Source: Student Doctor Network)
Source: Student Doctor Network - July 31, 2021 Category: Universities & Medical Training Authors: flapjack3d Tags: General Residency Issues Source Type: forums
FM Addiction Medicine Fellowship
There's very little on SDN about addiction medicine fellowships--let alone from the FM side of things. And most of the relevant threads are about those who were grandfathered in rather than doing the actual fellowship since it's such a young specialty.
Any idea what fellowships are looking for other than just high volumes of suboxone/substance use disorders patients? The faculty at my residency is uncertain as well what the expectations or goals should be for a resident interested in...
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Source: Student Doctor Network - May 4, 2021 Category: Universities & Medical Training Authors: Sardonix Tags: Family Medicine Source Type: forums
Salary Question
Hello,
I am wondering if it is reasonable to make $300k+ in psych working around 40 hours/week. People I've talked to say you can make "a lot" in psych but have been hesitant to discuss actual numbers. I don't mind working hard and want to provide good care for my patients but I also want to be able to pay off my loans and live a good life after putting in all this work. Additionally, I would be interested in having more than one job potentially, something like work in a suboxone clinic for...
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Source: Student Doctor Network - March 1, 2021 Category: Universities & Medical Training Authors: RevDO Tags: Psychiatry Source Type: forums
Belbucca initiation in opioid tolerant
I have no experience with Belbucca. Used Butrans a few times and Suboxone quite a few times when it first became available. Reading the product literature they suggest tapering opioid naive patient down to 30 MED and then dosing based upon PRE-TAPER dose of opioid. Is that really how people are doing this. I'm thinking about it in a refugee left stranded on 100mg Oxycodone/day. (Source: Student Doctor Network)
Source: Student Doctor Network - December 18, 2020 Category: Universities & Medical Training Authors: NJPAIN Tags: Pain Medicine Source Type: forums
