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Competency Based Medical Education: Treating Addiction in LGBTQ Patients

 

Several experts provide an overview of sexual orientation, gender identity, gender expression, sex development and health, as relevant to addiction medicine clinicians and care providers.

 

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The Relevance of Twelve-Step Recovery in 21st Century Addiction Medicine


Is Twelve-Step Recovery an antiquated concept or intervention? Much of "what's new" in the professional treatment of addiction involves new pharmacological therapies.




Breaking News

Education & Training

Forum Held to Discuss Expanding Access to Buprenorphine

by Matt Vandover | Jun 20, 2014
Dr. Corey Waller and Sen. Levin

About the forum: On Wednesday, June 18, 2014, Senators Carl Levin (D-MI) and Orrin Hatch (R-UT) hosted a forum on opioid addiction and obstacles that have made it difficult for patients to have access to buprenorphine. ASAM member Dr. Corey Waller, ABAM Diplomate, spoke on behalf of ASAM about raising the 100-patient limit. According to DATA 2000 physicians who meet certain requirements can prescribe buprenorphine to a limited number of patients (30 total patients in the 1st year and 100 thereafter upon being approved for an expanded waiver). There was discussion at the Forum about raising the 100-patient limit, allowing nurse practitioners and physician assistants prescribe and understanding the reasons why waivered physicians are not prescribing.

ASAM’s take: ASAM is concerned that prescribing limits restrict patient access to treatment. ASAM recommends that the patient limits be lifted in a graduated, thoughtful approach that focuses on higher levels of training for non-addiction certified physicians who are interested in prescribing beyond the 100-patient limit.

What you can do:

9 Comments

  1. 9 Carey M Vigor MD 25 Apr

    As the former director of Addiction Psychiatrry for a VA, I can attest to the tremendous roadblocks for DATA2000 physicians who follow the rules. The biggest problem is obtaining the "Prior Authorization" from the insurance company. No doctor has four hours to sit on hold, or the time to fax and refax up to ten times the forms for the PA. The Medicaid payers in particular tell the patient the doctor has faxed the wrong form, which is not true. Or they change the form at the last minute and don't put it on their website. Most recently, Anthem has changed its rules on whether they pay for the brand name film or the generic tab forcing the doctor to cancel, resubmit the PA, and rewrite all the Rx's, an impossible task. Local police tell the news media that buprenorphine is synthetic heroin and the list goes on. No doctor can provide what Medicaid payers demand and meet his her overhead expenses.

  2. 8 Bradley 10 Apr
    If it's such a specialty then why do 99% of the addiction treatment doctors treat only patients that pay cash. They are a bunch of crooks. As a former Oxycontin addict I found that I never once had a problem getting a doctor to charge my insurance and write me a prescription for a drug that was literally killing me. However when I finally made up my mind to get treatment for my addiction through the use of suboxone I couldn't. Every doctor I called within a 500 mile radius who could prescribe buprenorphine only accepted cash and had a 6 month waiting list! I found it easier to get Suboxone off the street!!! Which over the course of 6 months I did, tapering the dose and successfully avoiding withdrawals and cravings...With no thanks to a single so called addiction specialist. I've been clean for 3 years now!!!! No Pain killers, No Suboxone, No Nothing! Its because of buprenorphine that I'm clean today. So why don't you doctors stop ripping off the poor and helpless. Help your fellow man like you said you would when you took your Hippocratic Oath. Grow a pair and help support and pass this Bill Now, Before another Life is Lost!!!
  3. 7 Christene Amabile 01 Feb

    I work in the field of addiction medicine and it is appalling to me that I can prescribe a Butrans patch to a client for pain but I can't script someone buprenorphine for their opiate addiction. When I tell someone that they will have to get on a waiting list for an MD to give them buprenorphine, I often wonder if they'll live long enough to get to that app't. I feel as though this is an urgent matter that is receiving a sluggish (at best) response. Let's do all we can to change this outdated legislation preventing NPs and PAs from prescribing buprenorphine!

  4. 6 Lucinda Grande, MD 29 Jul
    Navigating the insurance prior authorization maze is a huge headache and a burden on our limited resources. But that is not the reason primary care physicians avoid this lifesaving treatment. I think a big problem is the misguided belief that buprenorphine is more dangerous than the pure opioid agonists, when in fact the opposite is true. This belief is due to the extra training required by DATA 2000. For a PR boost, we need a national education campaign on 1) the dramatically greater safety of buprenorphine compared to pure opioid agonists, and 2) awareness of addiction in patients on chronic opioid therapy.  We need to allow mid-level providers to treat addiction with buprenorphine, especially in rural areas - this is just common sense! And better reimbursement might nudge a few more physicians into looking into it.
  5. 5 JeanAnne Johnson Talbert 26 Jun
    It is dumbfounding that Nurse Practitioners (NPs) can prescribe oxycontin and methadone, yet cannot prescribe buprenorphine.  The same standard should be set for NPs- take the course, and certify to become a buprenorphine prescriber.  This is one more reason that buprenorphine access is limited.
  6. 4 Robert Stafford, MD 24 Jun
    We in South Carolina are also frustrated with the extra hours of work needed to get Pre-Authorization to treat these patients. If the patient is to be started on Suboxone, the are required to be in withdrawal when they come in to start the medication, and then told they cannot start until it is PA by their insurance company. We believe in having a Suboxone Program and not just a dispensary to hand out the drug. (They do that downtown on street corners) We require attendance to groups in our treatment center, individual counseling and have family groups. This is the only way the patient will be prepared for recovery when they are eventually slowly detoxed off of the drug. Of course, the time frame is different for each patient. We emphasize the term PATIENT, as opposed to CLIENT! 
  7. 3 Michael W Shore, M.D. 24 Jun
    ASAM and Dr. Waller present an excellent summary and salient points with regard to Buprenorphine and barriers to necessary treatment.  One point that was not addressed are the barriers placed on these treatments by the Insurance companies.  It is becoming increasingly the norm to have to spend significant amounts of time to get Buprenorphine treatment "Prior Authorization" approval to have the patient gain access to the treatment.  I personally spend hours every month on the phone, sending faxes, etc. for what often is only a 6 month approval, necessitating doing it all over again.  I have a proposal that balances the patient's need for acute treatment and immediate access to medication with the Insurance company having input as well.  I suspect that there are indeed waivered physicians who have "opted out" of these treatments due to the difficulties that the Insurance companies cause.  This is unconscionable.  Michael W Shore, M.D.  Cherry Hill, NJ
  8. 2 illiam Santoro 24 Jun
    Raising the 100 limit is a double-edged sword.  On the one hand, responsible physicians interested in treating patients would be able to continue to do so with less restrictions.  On the other hand, there are physicians who take advantage of this population.  Many patients would prefer to see a physician who is not as concerned about successfully treating patients as they are in simply seeing an increased number of patients.  We all know physicians whose was only criteria to write a prescription is that the patient pay their bill.  I believe the physicians in the this 2nd category need to be addressed as the physicians in the 1st category need to be allowed to care for patients.
  9. 1 ASAM 20 Jun

Comment

  1. RadEditor - HTML WYSIWYG Editor. MS Word-like content editing experience thanks to a rich set of formatting tools, dropdowns, dialogs, system modules and built-in spell-check.
    RadEditor's components - toolbar, content area, modes and modules
       
    Toolbar's wrapper 
     
    Content area wrapper
    RadEditor's bottom area: Design, Html and Preview modes, Statistics module and resize handle.
    It contains RadEditor's Modes/views (HTML, Design and Preview), Statistics and Resizer
    Editor Mode buttonsStatistics moduleEditor resizer
      
    RadEditor's Modules - special tools used to provide extra information such as Tag Inspector, Real Time HTML Viewer, Tag Properties and other.
       

Government Affairs

Forum Held to Discuss Expanding Access to Buprenorphine

by Matt Vandover | Jun 20, 2014
Dr. Corey Waller and Sen. Levin

About the forum: On Wednesday, June 18, 2014, Senators Carl Levin (D-MI) and Orrin Hatch (R-UT) hosted a forum on opioid addiction and obstacles that have made it difficult for patients to have access to buprenorphine. ASAM member Dr. Corey Waller, ABAM Diplomate, spoke on behalf of ASAM about raising the 100-patient limit. According to DATA 2000 physicians who meet certain requirements can prescribe buprenorphine to a limited number of patients (30 total patients in the 1st year and 100 thereafter upon being approved for an expanded waiver). There was discussion at the Forum about raising the 100-patient limit, allowing nurse practitioners and physician assistants prescribe and understanding the reasons why waivered physicians are not prescribing.

ASAM’s take: ASAM is concerned that prescribing limits restrict patient access to treatment. ASAM recommends that the patient limits be lifted in a graduated, thoughtful approach that focuses on higher levels of training for non-addiction certified physicians who are interested in prescribing beyond the 100-patient limit.

What you can do:

9 Comments

  1. 9 Carey M Vigor MD 25 Apr

    As the former director of Addiction Psychiatrry for a VA, I can attest to the tremendous roadblocks for DATA2000 physicians who follow the rules. The biggest problem is obtaining the "Prior Authorization" from the insurance company. No doctor has four hours to sit on hold, or the time to fax and refax up to ten times the forms for the PA. The Medicaid payers in particular tell the patient the doctor has faxed the wrong form, which is not true. Or they change the form at the last minute and don't put it on their website. Most recently, Anthem has changed its rules on whether they pay for the brand name film or the generic tab forcing the doctor to cancel, resubmit the PA, and rewrite all the Rx's, an impossible task. Local police tell the news media that buprenorphine is synthetic heroin and the list goes on. No doctor can provide what Medicaid payers demand and meet his her overhead expenses.

  2. 8 Bradley 10 Apr
    If it's such a specialty then why do 99% of the addiction treatment doctors treat only patients that pay cash. They are a bunch of crooks. As a former Oxycontin addict I found that I never once had a problem getting a doctor to charge my insurance and write me a prescription for a drug that was literally killing me. However when I finally made up my mind to get treatment for my addiction through the use of suboxone I couldn't. Every doctor I called within a 500 mile radius who could prescribe buprenorphine only accepted cash and had a 6 month waiting list! I found it easier to get Suboxone off the street!!! Which over the course of 6 months I did, tapering the dose and successfully avoiding withdrawals and cravings...With no thanks to a single so called addiction specialist. I've been clean for 3 years now!!!! No Pain killers, No Suboxone, No Nothing! Its because of buprenorphine that I'm clean today. So why don't you doctors stop ripping off the poor and helpless. Help your fellow man like you said you would when you took your Hippocratic Oath. Grow a pair and help support and pass this Bill Now, Before another Life is Lost!!!
  3. 7 Christene Amabile 01 Feb

    I work in the field of addiction medicine and it is appalling to me that I can prescribe a Butrans patch to a client for pain but I can't script someone buprenorphine for their opiate addiction. When I tell someone that they will have to get on a waiting list for an MD to give them buprenorphine, I often wonder if they'll live long enough to get to that app't. I feel as though this is an urgent matter that is receiving a sluggish (at best) response. Let's do all we can to change this outdated legislation preventing NPs and PAs from prescribing buprenorphine!

  4. 6 Lucinda Grande, MD 29 Jul
    Navigating the insurance prior authorization maze is a huge headache and a burden on our limited resources. But that is not the reason primary care physicians avoid this lifesaving treatment. I think a big problem is the misguided belief that buprenorphine is more dangerous than the pure opioid agonists, when in fact the opposite is true. This belief is due to the extra training required by DATA 2000. For a PR boost, we need a national education campaign on 1) the dramatically greater safety of buprenorphine compared to pure opioid agonists, and 2) awareness of addiction in patients on chronic opioid therapy.  We need to allow mid-level providers to treat addiction with buprenorphine, especially in rural areas - this is just common sense! And better reimbursement might nudge a few more physicians into looking into it.
  5. 5 JeanAnne Johnson Talbert 26 Jun
    It is dumbfounding that Nurse Practitioners (NPs) can prescribe oxycontin and methadone, yet cannot prescribe buprenorphine.  The same standard should be set for NPs- take the course, and certify to become a buprenorphine prescriber.  This is one more reason that buprenorphine access is limited.
  6. 4 Robert Stafford, MD 24 Jun
    We in South Carolina are also frustrated with the extra hours of work needed to get Pre-Authorization to treat these patients. If the patient is to be started on Suboxone, the are required to be in withdrawal when they come in to start the medication, and then told they cannot start until it is PA by their insurance company. We believe in having a Suboxone Program and not just a dispensary to hand out the drug. (They do that downtown on street corners) We require attendance to groups in our treatment center, individual counseling and have family groups. This is the only way the patient will be prepared for recovery when they are eventually slowly detoxed off of the drug. Of course, the time frame is different for each patient. We emphasize the term PATIENT, as opposed to CLIENT! 
  7. 3 Michael W Shore, M.D. 24 Jun
    ASAM and Dr. Waller present an excellent summary and salient points with regard to Buprenorphine and barriers to necessary treatment.  One point that was not addressed are the barriers placed on these treatments by the Insurance companies.  It is becoming increasingly the norm to have to spend significant amounts of time to get Buprenorphine treatment "Prior Authorization" approval to have the patient gain access to the treatment.  I personally spend hours every month on the phone, sending faxes, etc. for what often is only a 6 month approval, necessitating doing it all over again.  I have a proposal that balances the patient's need for acute treatment and immediate access to medication with the Insurance company having input as well.  I suspect that there are indeed waivered physicians who have "opted out" of these treatments due to the difficulties that the Insurance companies cause.  This is unconscionable.  Michael W Shore, M.D.  Cherry Hill, NJ
  8. 2 illiam Santoro 24 Jun
    Raising the 100 limit is a double-edged sword.  On the one hand, responsible physicians interested in treating patients would be able to continue to do so with less restrictions.  On the other hand, there are physicians who take advantage of this population.  Many patients would prefer to see a physician who is not as concerned about successfully treating patients as they are in simply seeing an increased number of patients.  We all know physicians whose was only criteria to write a prescription is that the patient pay their bill.  I believe the physicians in the this 2nd category need to be addressed as the physicians in the 1st category need to be allowed to care for patients.
  9. 1 ASAM 20 Jun

Comment

  1. RadEditor - HTML WYSIWYG Editor. MS Word-like content editing experience thanks to a rich set of formatting tools, dropdowns, dialogs, system modules and built-in spell-check.
    RadEditor's components - toolbar, content area, modes and modules
       
    Toolbar's wrapper 
     
    Content area wrapper
    RadEditor's bottom area: Design, Html and Preview modes, Statistics module and resize handle.
    It contains RadEditor's Modes/views (HTML, Design and Preview), Statistics and Resizer
    Editor Mode buttonsStatistics moduleEditor resizer
      
    RadEditor's Modules - special tools used to provide extra information such as Tag Inspector, Real Time HTML Viewer, Tag Properties and other.
       

Your ASAM

Forum Held to Discuss Expanding Access to Buprenorphine

by Matt Vandover | Jun 20, 2014
Dr. Corey Waller and Sen. Levin

About the forum: On Wednesday, June 18, 2014, Senators Carl Levin (D-MI) and Orrin Hatch (R-UT) hosted a forum on opioid addiction and obstacles that have made it difficult for patients to have access to buprenorphine. ASAM member Dr. Corey Waller, ABAM Diplomate, spoke on behalf of ASAM about raising the 100-patient limit. According to DATA 2000 physicians who meet certain requirements can prescribe buprenorphine to a limited number of patients (30 total patients in the 1st year and 100 thereafter upon being approved for an expanded waiver). There was discussion at the Forum about raising the 100-patient limit, allowing nurse practitioners and physician assistants prescribe and understanding the reasons why waivered physicians are not prescribing.

ASAM’s take: ASAM is concerned that prescribing limits restrict patient access to treatment. ASAM recommends that the patient limits be lifted in a graduated, thoughtful approach that focuses on higher levels of training for non-addiction certified physicians who are interested in prescribing beyond the 100-patient limit.

What you can do:

9 Comments

  1. 9 Carey M Vigor MD 25 Apr

    As the former director of Addiction Psychiatrry for a VA, I can attest to the tremendous roadblocks for DATA2000 physicians who follow the rules. The biggest problem is obtaining the "Prior Authorization" from the insurance company. No doctor has four hours to sit on hold, or the time to fax and refax up to ten times the forms for the PA. The Medicaid payers in particular tell the patient the doctor has faxed the wrong form, which is not true. Or they change the form at the last minute and don't put it on their website. Most recently, Anthem has changed its rules on whether they pay for the brand name film or the generic tab forcing the doctor to cancel, resubmit the PA, and rewrite all the Rx's, an impossible task. Local police tell the news media that buprenorphine is synthetic heroin and the list goes on. No doctor can provide what Medicaid payers demand and meet his her overhead expenses.

  2. 8 Bradley 10 Apr
    If it's such a specialty then why do 99% of the addiction treatment doctors treat only patients that pay cash. They are a bunch of crooks. As a former Oxycontin addict I found that I never once had a problem getting a doctor to charge my insurance and write me a prescription for a drug that was literally killing me. However when I finally made up my mind to get treatment for my addiction through the use of suboxone I couldn't. Every doctor I called within a 500 mile radius who could prescribe buprenorphine only accepted cash and had a 6 month waiting list! I found it easier to get Suboxone off the street!!! Which over the course of 6 months I did, tapering the dose and successfully avoiding withdrawals and cravings...With no thanks to a single so called addiction specialist. I've been clean for 3 years now!!!! No Pain killers, No Suboxone, No Nothing! Its because of buprenorphine that I'm clean today. So why don't you doctors stop ripping off the poor and helpless. Help your fellow man like you said you would when you took your Hippocratic Oath. Grow a pair and help support and pass this Bill Now, Before another Life is Lost!!!
  3. 7 Christene Amabile 01 Feb

    I work in the field of addiction medicine and it is appalling to me that I can prescribe a Butrans patch to a client for pain but I can't script someone buprenorphine for their opiate addiction. When I tell someone that they will have to get on a waiting list for an MD to give them buprenorphine, I often wonder if they'll live long enough to get to that app't. I feel as though this is an urgent matter that is receiving a sluggish (at best) response. Let's do all we can to change this outdated legislation preventing NPs and PAs from prescribing buprenorphine!

  4. 6 Lucinda Grande, MD 29 Jul
    Navigating the insurance prior authorization maze is a huge headache and a burden on our limited resources. But that is not the reason primary care physicians avoid this lifesaving treatment. I think a big problem is the misguided belief that buprenorphine is more dangerous than the pure opioid agonists, when in fact the opposite is true. This belief is due to the extra training required by DATA 2000. For a PR boost, we need a national education campaign on 1) the dramatically greater safety of buprenorphine compared to pure opioid agonists, and 2) awareness of addiction in patients on chronic opioid therapy.  We need to allow mid-level providers to treat addiction with buprenorphine, especially in rural areas - this is just common sense! And better reimbursement might nudge a few more physicians into looking into it.
  5. 5 JeanAnne Johnson Talbert 26 Jun
    It is dumbfounding that Nurse Practitioners (NPs) can prescribe oxycontin and methadone, yet cannot prescribe buprenorphine.  The same standard should be set for NPs- take the course, and certify to become a buprenorphine prescriber.  This is one more reason that buprenorphine access is limited.
  6. 4 Robert Stafford, MD 24 Jun
    We in South Carolina are also frustrated with the extra hours of work needed to get Pre-Authorization to treat these patients. If the patient is to be started on Suboxone, the are required to be in withdrawal when they come in to start the medication, and then told they cannot start until it is PA by their insurance company. We believe in having a Suboxone Program and not just a dispensary to hand out the drug. (They do that downtown on street corners) We require attendance to groups in our treatment center, individual counseling and have family groups. This is the only way the patient will be prepared for recovery when they are eventually slowly detoxed off of the drug. Of course, the time frame is different for each patient. We emphasize the term PATIENT, as opposed to CLIENT! 
  7. 3 Michael W Shore, M.D. 24 Jun
    ASAM and Dr. Waller present an excellent summary and salient points with regard to Buprenorphine and barriers to necessary treatment.  One point that was not addressed are the barriers placed on these treatments by the Insurance companies.  It is becoming increasingly the norm to have to spend significant amounts of time to get Buprenorphine treatment "Prior Authorization" approval to have the patient gain access to the treatment.  I personally spend hours every month on the phone, sending faxes, etc. for what often is only a 6 month approval, necessitating doing it all over again.  I have a proposal that balances the patient's need for acute treatment and immediate access to medication with the Insurance company having input as well.  I suspect that there are indeed waivered physicians who have "opted out" of these treatments due to the difficulties that the Insurance companies cause.  This is unconscionable.  Michael W Shore, M.D.  Cherry Hill, NJ
  8. 2 illiam Santoro 24 Jun
    Raising the 100 limit is a double-edged sword.  On the one hand, responsible physicians interested in treating patients would be able to continue to do so with less restrictions.  On the other hand, there are physicians who take advantage of this population.  Many patients would prefer to see a physician who is not as concerned about successfully treating patients as they are in simply seeing an increased number of patients.  We all know physicians whose was only criteria to write a prescription is that the patient pay their bill.  I believe the physicians in the this 2nd category need to be addressed as the physicians in the 1st category need to be allowed to care for patients.
  9. 1 ASAM 20 Jun

Comment

  1. RadEditor - HTML WYSIWYG Editor. MS Word-like content editing experience thanks to a rich set of formatting tools, dropdowns, dialogs, system modules and built-in spell-check.
    RadEditor's components - toolbar, content area, modes and modules
       
    Toolbar's wrapper 
     
    Content area wrapper
    RadEditor's bottom area: Design, Html and Preview modes, Statistics module and resize handle.
    It contains RadEditor's Modes/views (HTML, Design and Preview), Statistics and Resizer
    Editor Mode buttonsStatistics moduleEditor resizer
      
    RadEditor's Modules - special tools used to provide extra information such as Tag Inspector, Real Time HTML Viewer, Tag Properties and other.
       

OP-ED

Forum Held to Discuss Expanding Access to Buprenorphine

by Matt Vandover | Jun 20, 2014
Dr. Corey Waller and Sen. Levin

About the forum: On Wednesday, June 18, 2014, Senators Carl Levin (D-MI) and Orrin Hatch (R-UT) hosted a forum on opioid addiction and obstacles that have made it difficult for patients to have access to buprenorphine. ASAM member Dr. Corey Waller, ABAM Diplomate, spoke on behalf of ASAM about raising the 100-patient limit. According to DATA 2000 physicians who meet certain requirements can prescribe buprenorphine to a limited number of patients (30 total patients in the 1st year and 100 thereafter upon being approved for an expanded waiver). There was discussion at the Forum about raising the 100-patient limit, allowing nurse practitioners and physician assistants prescribe and understanding the reasons why waivered physicians are not prescribing.

ASAM’s take: ASAM is concerned that prescribing limits restrict patient access to treatment. ASAM recommends that the patient limits be lifted in a graduated, thoughtful approach that focuses on higher levels of training for non-addiction certified physicians who are interested in prescribing beyond the 100-patient limit.

What you can do:

9 Comments

  1. 9 Carey M Vigor MD 25 Apr

    As the former director of Addiction Psychiatrry for a VA, I can attest to the tremendous roadblocks for DATA2000 physicians who follow the rules. The biggest problem is obtaining the "Prior Authorization" from the insurance company. No doctor has four hours to sit on hold, or the time to fax and refax up to ten times the forms for the PA. The Medicaid payers in particular tell the patient the doctor has faxed the wrong form, which is not true. Or they change the form at the last minute and don't put it on their website. Most recently, Anthem has changed its rules on whether they pay for the brand name film or the generic tab forcing the doctor to cancel, resubmit the PA, and rewrite all the Rx's, an impossible task. Local police tell the news media that buprenorphine is synthetic heroin and the list goes on. No doctor can provide what Medicaid payers demand and meet his her overhead expenses.

  2. 8 Bradley 10 Apr
    If it's such a specialty then why do 99% of the addiction treatment doctors treat only patients that pay cash. They are a bunch of crooks. As a former Oxycontin addict I found that I never once had a problem getting a doctor to charge my insurance and write me a prescription for a drug that was literally killing me. However when I finally made up my mind to get treatment for my addiction through the use of suboxone I couldn't. Every doctor I called within a 500 mile radius who could prescribe buprenorphine only accepted cash and had a 6 month waiting list! I found it easier to get Suboxone off the street!!! Which over the course of 6 months I did, tapering the dose and successfully avoiding withdrawals and cravings...With no thanks to a single so called addiction specialist. I've been clean for 3 years now!!!! No Pain killers, No Suboxone, No Nothing! Its because of buprenorphine that I'm clean today. So why don't you doctors stop ripping off the poor and helpless. Help your fellow man like you said you would when you took your Hippocratic Oath. Grow a pair and help support and pass this Bill Now, Before another Life is Lost!!!
  3. 7 Christene Amabile 01 Feb

    I work in the field of addiction medicine and it is appalling to me that I can prescribe a Butrans patch to a client for pain but I can't script someone buprenorphine for their opiate addiction. When I tell someone that they will have to get on a waiting list for an MD to give them buprenorphine, I often wonder if they'll live long enough to get to that app't. I feel as though this is an urgent matter that is receiving a sluggish (at best) response. Let's do all we can to change this outdated legislation preventing NPs and PAs from prescribing buprenorphine!

  4. 6 Lucinda Grande, MD 29 Jul
    Navigating the insurance prior authorization maze is a huge headache and a burden on our limited resources. But that is not the reason primary care physicians avoid this lifesaving treatment. I think a big problem is the misguided belief that buprenorphine is more dangerous than the pure opioid agonists, when in fact the opposite is true. This belief is due to the extra training required by DATA 2000. For a PR boost, we need a national education campaign on 1) the dramatically greater safety of buprenorphine compared to pure opioid agonists, and 2) awareness of addiction in patients on chronic opioid therapy.  We need to allow mid-level providers to treat addiction with buprenorphine, especially in rural areas - this is just common sense! And better reimbursement might nudge a few more physicians into looking into it.
  5. 5 JeanAnne Johnson Talbert 26 Jun
    It is dumbfounding that Nurse Practitioners (NPs) can prescribe oxycontin and methadone, yet cannot prescribe buprenorphine.  The same standard should be set for NPs- take the course, and certify to become a buprenorphine prescriber.  This is one more reason that buprenorphine access is limited.
  6. 4 Robert Stafford, MD 24 Jun
    We in South Carolina are also frustrated with the extra hours of work needed to get Pre-Authorization to treat these patients. If the patient is to be started on Suboxone, the are required to be in withdrawal when they come in to start the medication, and then told they cannot start until it is PA by their insurance company. We believe in having a Suboxone Program and not just a dispensary to hand out the drug. (They do that downtown on street corners) We require attendance to groups in our treatment center, individual counseling and have family groups. This is the only way the patient will be prepared for recovery when they are eventually slowly detoxed off of the drug. Of course, the time frame is different for each patient. We emphasize the term PATIENT, as opposed to CLIENT! 
  7. 3 Michael W Shore, M.D. 24 Jun
    ASAM and Dr. Waller present an excellent summary and salient points with regard to Buprenorphine and barriers to necessary treatment.  One point that was not addressed are the barriers placed on these treatments by the Insurance companies.  It is becoming increasingly the norm to have to spend significant amounts of time to get Buprenorphine treatment "Prior Authorization" approval to have the patient gain access to the treatment.  I personally spend hours every month on the phone, sending faxes, etc. for what often is only a 6 month approval, necessitating doing it all over again.  I have a proposal that balances the patient's need for acute treatment and immediate access to medication with the Insurance company having input as well.  I suspect that there are indeed waivered physicians who have "opted out" of these treatments due to the difficulties that the Insurance companies cause.  This is unconscionable.  Michael W Shore, M.D.  Cherry Hill, NJ
  8. 2 illiam Santoro 24 Jun
    Raising the 100 limit is a double-edged sword.  On the one hand, responsible physicians interested in treating patients would be able to continue to do so with less restrictions.  On the other hand, there are physicians who take advantage of this population.  Many patients would prefer to see a physician who is not as concerned about successfully treating patients as they are in simply seeing an increased number of patients.  We all know physicians whose was only criteria to write a prescription is that the patient pay their bill.  I believe the physicians in the this 2nd category need to be addressed as the physicians in the 1st category need to be allowed to care for patients.
  9. 1 ASAM 20 Jun

Comment

  1. RadEditor - HTML WYSIWYG Editor. MS Word-like content editing experience thanks to a rich set of formatting tools, dropdowns, dialogs, system modules and built-in spell-check.
    RadEditor's components - toolbar, content area, modes and modules
       
    Toolbar's wrapper 
     
    Content area wrapper
    RadEditor's bottom area: Design, Html and Preview modes, Statistics module and resize handle.
    It contains RadEditor's Modes/views (HTML, Design and Preview), Statistics and Resizer
    Editor Mode buttonsStatistics moduleEditor resizer
      
    RadEditor's Modules - special tools used to provide extra information such as Tag Inspector, Real Time HTML Viewer, Tag Properties and other.