Petition on Change.Org - Allow Private Physicians to Prescribe Methadone for Addiction

L-Thanks for pointing this out.  I wrote the author and pointed out to him the numerous typos and encouraged him to revise it if he wanted to send it along to elected officials.-Cherbear

Good idea.  I also wrote the author and continue to write letters to local representatives about the need for allowing private docs to prescribe methadone, not just buprenorphine, for addiction. 

I didn't read the petition yet (will do it soon) but I want to add a point about letting private physicians prescribe methadone for addiction. I know many of you may really disagree with me but I believe that if physicians should be allowed to prescribe methadone for addiction in their offices there has to be a requirement for additional training before they would be allowed to do so. Actually, I think that perhaps doctors should recieve extra training in order to be allowed to prescribe methadone at all.

There has obviously been an increase in methadone related deaths in the last few years that have coincided with an increase in methadone prescriptions written by "regular" doctors. Just giving physicians more freedom to prescribe methadone without proper safeguards would carry a big risk of an additional increase in methadone related deaths.
Don't get me wrong - I fully support bringing methadone treatment into the physicians office, especially for stable patients and those who live in rural areas, but it has to be done right. As it is now many physicians don't seem to understand how methadone works and that it's not like other opiates or opiods. I read about someone who had been prescribed 30mg of methadone to take three times a day, adding up to 90mg a day. Needless to say this opiate naive patient was dead within a couple of days. Even methadone prescribed at lower doses can become deadly for an opiate naive person once the drug builds up in the person's system. Not to mention the dangers of mixing methadone with certain other medications.
Methadone is a different drug. It has properties that other opiates do not and that's why it works so well for us. But if not used correctly those differences can be deadly. It's not methadone in itself that is dangerous. It's the combination with ignorant doctors that make it so. The answer, in my opinion, is to require mandatory training for doctors on how methadone works before they are allowed to prescribe it. The same should be required for other medications that can be tricky to use. The problem with methadone in particular though is that doctors just assume it's like all other opiates and therefore prescribe methadone like they would prescribe Vicodin.
 
What do you guys think? Am I wrong? Would a training requirement deter doctors from wanting to prescribe methadone? I'm open to arguments. 

There would be a differrence though if they were prescribing Methadone to addicts though because they aren't opiate naive. Maybe I'm confused but I don't understand exactly why you would say that if doctors were licenced to prescribe Methadone they would be prescribing it like they do Vicodens since Vicodens don't treat addiction. Not that I don't think doctors shouldn't be required to be educated, I think they should be. If docs treat the opiate addicts just like a clinic does, 30mgs with 10mg increases every day or so with evaluations in between, I don't see any more danger than clinics doleing it out. It's not like people are gonna go to be treated for addiction if they aren't addicts, right?

Marot

There would be a differrence though if they were prescribing Methadone to addicts though because they aren't opiate naive. Maybe I'm confused but I don't understand exactly why you would say that if doctors were licenced to prescribe Methadone they would be prescribing it like they do Vicodens since Vicodens don't treat addiction. Not that I don't think doctors shouldn't be required to be educated, I think they should be. If docs treat the opiate addicts just like a clinic does, 30mgs with 10mg increases every day or so with evaluations in between, I don't see any more danger than clinics doleing it out. It's not like people are gonna go to be treated for addiction if they aren't addicts, right?
Marot

-lapy

I didn't mean that doctors would prescribe methadone like they do vicodin if they were allowed to prescribe methadone for addiction. What I meant was that at this time ignorant doctors don't seem to understand the difference between methadone and vicodin and therefore they prescribe it just like it was vicodin, basically treating it like a short acting opiate like all the other opiates, like vicodin.

I gotcha momo. Did you know that doctors, even specialists, are not "required' to recieve any current certifications in anything, get CEUs ect?!! I'm a nurse and we're not only required to get CEUs but if we work in a specialty like labor and delivery/neonatal in my case not only are we required to get recertified in all aspects of the job every year or two but also have to take classes on current trends ect. When I first found that out about docs I was not only pissed about it but surprised and scared! So many docs are so concerned with making the big bucks and juggling tons of pts around that i'm sure they got no time for educating themselves. I find myself educating "them" quite often.

Marot

Momo, I do see your point, though I also believe that prescribing a stable dose of methadone to a long stable addict is not dangerous and that is what they would be doing.  If they were to be allowed to Rx methadone to anyone walking through the door (for addiction I mean) I would support additional training as well, just as the bupe doctors have. 

I personally think that methadone treatment should work like this:  addicts seek treatment at a clinic, where a trained person assesses the addict and the initial phases of treatment are handled at the clinic.  I do believe there is something to the daily interaction, just the physical act of entering the clinic, the connection with the staff, starts "us" on the road towards changing our daily activities from the chase/the cop towards a real life.  ONCE a patient reaches a stable dose and is participating in positive life activities, with the absence of drug using and seeking behavior, THEN the PCP steps in, if willing, or maybe even the clinic doctor continues to treat the patients, just in an "OBOT" type setting!

I signed the petition and added it to my facebook page, maybe some of my "friends" will join

I'm confused, I thought Doctors could already prescribe methadone for addicts? I keep hearing about Office based Opiate Treatment although I've never ever found one ANYWHERE.  So can doctors prescribe methadone for addiction or not?  Regardless I'm signing the petition Lol.

I'm confused, I thought Doctors could already prescribe methadone for addicts? I keep hearing about Office based Opiate Treatment although I've never ever found one ANYWHERE.  So can doctors prescribe methadone for addiction or not?  Regardless I'm signing the petition Lol.

-yorki

They can with special permits and stuff like that. Not any doctor anywhere can prescribe methadone to addicts. As it is right now, as I understand it, very few doctors are willing to  jump through all the hoops to become OBOT providers so at the current time there are only a handful in the whole country. I may be wrong but I think there are just 4-5 of them - a couple in New York and a couple in Baltimore if I'm not mistaken.

THERE ARE NO "SPECIAL PERMITS" required for OBOT,  ANy doctor can do it, the problem is a source for the medication.

A doctor cannot write a "prescription" for methadone to treat addiction that a person takes to any old pharmacy, a doctor can only write a "medication order" or dispense the meds themselves from their office.  i.e. Dr. Salsitz in NYC dispenses himself, he picks up the methadone for his days patients from the pharmacy in the hospital where his is affilaited, i.e. Beth Israel, then he hands out the meds to the patient as they come in for their appointments.

Dr. Hayes in Baltimore runs a full service addiction medicine center, he offers MMT, bup and OBOT from the same office, so if you are an OBOT patient, his PA dispenses your meds to you when you come into the office for your monthly appointment.

There are several OBOTs in NYC where the patients take their medication orders to a pharmacy that has an agreement with the doctor to dispense the meds.

Thats all you need, a pharmacy to agree to dispense the meds.  We had a longterm poster here who got their meds that way, they were in Wisconsin, I believe.

Anyhow, its not that hard to do, but WE have to do  the footwork.  If you have a doctor who will work with you, its worth talking about.

I KNOW i could do it here in DC with my private doc, I have already talked to him about it, but as I have FREE treatment.....just havent pursued it.  I went to pick up my monthly meds monday and I was in the klinik for FIFTEEN MINUTES including leaving a u/a.  And its FREE....cant beat that.

Oh, I was under the impression that the doctor needed the same licensing that a methadone clinic does and it's just too many hoops to jump through. I didn't know that all they have to go it to get the medication and dispense it. It makes sense though. If you are in a hospital the doctor there can prescribe and dispense methadone to you.

So if all the doctor needs is a pharmacy to work with them why isn't that being done in rural areas and small towns where there are no clinics? Where can I find information about this to show to doctors? What about ua's and counseling? Is counseling still required in OBOT?

My understanding is that Doctors can only write scripts for methadone to treat pain.   They cannot prescribe it for addiction, outside of the umbrella of a clinic.  I believe that in Canada they can, with special permits, but I think you have to go to the pharmacy for every dose, which would defeat the purpose I think.    There are Doctors out there I am sure, who are willing to do it, but they are taking a big risk.    I think Doctors should be able to prescribe at least for people with a long history of compliance.  Even prisoners get paroled sometime!!!!   I think the best you can hope for now, is being in a state that allows the  federal limit on take outs which is a month.  Not in Maine!   One week is it!  and I have been a client for almost 17 years. (in Mass)

There are DRAFT guidelines for OBOT, I think they are on the NAMA site, and I have a paper copy, but I charge $20 to copy and mail it, its about 60 pages long.

There are no counseling requirments with OBOT, and I am almost positve there are no u/a requirements either, but it may also be the eight per year, I have forgotten that, but all the OBOT docs I know of do monthly u/a's or tox testing (oral swabs).

Any patient can ask their private doc to do it for them.  If you have a good longterm relationship with your doctor, its worth asking about.

For example, my doctor has a relationship with a local family owned pharmacy, he treats ALOT of AIDS patients, and that pharmacy would dispense my meds if I decided to pursue OBOT.  All it takes is an agreement between the doctor and the pharmacy.

Or if your doc works in a hospital with a pharmacy, the hospital pharmacy can dispense the meds.

Its not that difficult, but WE need to do the footwork. The kliniks do not want OBOT cause thats money out of their pockets, and "they lose all their best patients", i.e. long term compliant ones.

But I would love to see more of US advocate for our own OBOT treatment.  As we get older, I am sure it will expand, plus healthcare reform will push it, since more people will have insurance after 2014.

How much does OBOT cost? How much do you pay the doc and how much do you pay the pharmacy for the actual drug? What I'm wondering is if there is any financial incentive for doctors to do this. Even if it doesn't cost much to set it up - working with a pharmacy would take care of a lot of the logistical issues - I would think that there is some work involved in it. If nothing else it would take some time to do one's homework on the legalities and praciticalities and doctors want to get paid.

I don't have a good relationship with my doc - I got a new one since my old one went to prison for child molestation (nice huh?) - but it's good to know how it works in case it would be needed in the future. I have a strong feeling that most physicians are not aware of this posibility and it would take a lot to convince them that it's even legal. But if there are no clinics nearby it may be worth it. I can imagine that it would be much easier to get insurance to pay for it since it's done in a regular doctor's office.

it costs whatever the doc charges for the office visit, then the meds cost about 25cents per 40mg diskette, something like that, most scripts are less than $40/month at the pharmacy.
Most docs charge around $100 for an office visit here in DC, some 120.

It depends on where you live as to what it would cost, I bet.

Its much cheaper than OTP however you look at it, less services, less cost.  Oh yea, you pay for the tox test, i think thats about $6.00 or 10.