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  #1  
Old 26-10-2010, 16:08
dyingtomorrow dyingtomorrow is offline
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Is it now a requirement that suboxone doctors drug test patients? U.S.

Back in the old days, SWIM would pay $50, walk into the doctors office the same day, get however much suboxone he wanted, and leave - all of which took like 30 minutes.

SWIM went to get a suboxone prescription a couple months ago, and the doctor said that she had to periodically drug test SWIM because of a federal regulation. $200 for the visit, $45 for the drug test on the random months she did it which SWIM thought was bullshit. The last SWIM checked this was not a legal requirement.

SWIM girlfriend just went to get some suboxone yesterday, and the doctor made her take a drug test right away, and said he has to drug test her every month.

Now my question is, is this actually a federal regulation which went into effect at some point, or are the doctors bullshitting just to overcharge for a drug test?

Anyone know?
  #2  
Old 26-10-2010, 16:15
davestate Gold member davestate is offline
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Re: Is it now a requirement that suboxone doctors drug test patients?

I guess an appropriate question to ask would be: How does the doctor actually know the patient is actually an opiate addict? There is a real liability that, with the arrangement you described, potentially anyone could walk in off the street and get suboxone and OD. Testing for opiates would at least allow some sort of liability cover if this happened. IIRC in the UK, before any substitution opiate is prescribed there must be 3 "dirty" piss tests, though I'm sure someone will totally clarify that. What sort of tests are they? Simple dipstick or GS/MC, which quantify the level of opiates in the urine?

Another angle may be that the random tests may provide another reson to stay clean, that the suboxone prescription could become more strict (less pills at once, weekly prescriptions rather than monthly) if there were a failed urine test, since it's kinda difficult to be taking subs and heroin at the same time without awful WDs, leading to the assumption that the patient ain't taking them, is selling them or isn't committed to the treatment

This is all pure speculation of course
  #3  
Old 26-10-2010, 16:22
dyingtomorrow dyingtomorrow is offline
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Re: Is it now a requirement that suboxone doctors drug test patients?

Quote:
Originally Posted by davestate View Post
I guess an appropriate question to ask would be: How does the doctor actually know the patient is actually an opiate addict? There is a real liability that, with the arrangement you described, potentially anyone could walk in off the street and get suboxone and OD. Testing for opiates would at least allow some sort of liability cover if this happened. IIRC in the UK, before any substitution opiate is prescribed there must be 3 "dirty" piss tests, though I'm sure someone will totally clarify that. What sort of tests are they? Simple dipstick or GS/MC, which quantify the level of opiates in the urine?

Another angle may be that the random tests may provide another reson to stay clean, that the suboxone prescription could become more strict (less pills at once, weekly prescriptions rather than monthly) if there were a failed urine test, since it's kinda difficult to be taking subs and heroin at the same time without awful WDs, leading to the assumption that the patient ain't taking them, is selling them or isn't committed to the treatment

This is all pure speculation of course
None of the doctors SWIM saw drug tested SWIM off the bat (even the most recent who said she would require tests in the future), they just took his word, and prescribed their dose based on the amount SWIM said he was using. Back in the day none had even mentioned the necessity of drug testing, ever. The only place SWIM was drug tested was at methadone clinics.

Yesterday SWIM's gf went in, got drug tested, and then the doctor made her wait another 24 hours and wouldn't give her the suboxone until the next day. He also charged her for the second visit which I think is a total fucking scam.

I see what you mean about the liability, and about the issue of people just using the doctor to score and sell the suboxone. SWIM always sold the vast majority of his suboxone, he rarely took that unfulfilling bullshit. I think the drug testing is still stupid. Correct me if I'm wrong, but with the inverse effectiveness/mg curve of suboxone dosing, I don't think it is possible for any daily user, even with a tiny tolerance, to overdose on 16 mgs, which I think is about what they usually prescribe for low to medium tolerances. Regarding the commitment factor/selling factor, that is a stupid reason too. First of all they should know better than anyone that addicts are constantly relapsing, especially on such a crappy drug as suboxone. Second, it's not like it's hard to just not use heroin for a couple days before the test, and otherwise use the rest of the month. Third, what are they going to do for a positive test, cut the user off? make them come every week? The former will just result in the addict going back out on the street, getting readdicted, committing crimes to feed their habit , and living a generally fucked up life - exactly what suboxone maintenance is supposed to prevent. Making them come every week is probably as good as cutting them off for most addicts - if an addict had an extra hundred something bucks a week, they probably wouldn't be on suboxone in the first place. Even if they want to be on suboxone, how many addicts have that much extra money for constant doctors visits? It's just an all around dumb policy, and if it's not a federal law, it is at least to some degree a scam by doctors to make extra money.

Really though, I was curious if it is something that particular doctors just do to cover their ass, or if it actually became a law that they have to drug test.

Last edited by dyingtomorrow; 26-10-2010 at 16:33.
  #4  
Old 29-11-2010, 09:41
Eden Eden is offline
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Re: Is it now a requirement that suboxone doctors drug test patients?

There is no such law. It is completely at the discretion of the physician whether or not to test patients.


[LEFT]

[[Page 114 STAT. 1101]]
Public Law 106-310-106th Congress-An Act
TITLE NOTE: Drug Addiction Treatment Act of 2000. XXXV--Waiver Authority for Physicians who dispense or prescribe certain narcotic drugs for maintenance treatment or detoxification treatment

SEC. 3501. NOTE: 21 USC 801 note. SHORT TITLE.
This title may be cited as the "Drug Addiction Treatment Act of 2000''.

SEC. 3502. AMENDMENT TO CONTROLLED SUBSTANCES ACT.
(a) In General.--Section 303(g) of the Controlled Substances Act (21 U.S.C. 823(g)) is amended--
[[Page 114 STAT. 1223]]
(1) in paragraph (2), by striking "(A) security'' and inserting "(i) security'', and by striking "(B) the maintenance'' and inserting "(ii) the maintenance'';(2) by redesignating paragraphs (1) through (3) as subparagraphs (A) through (C), respectively;(3) by inserting "(1)'' after "(g)'';(4) by striking "Practitioners who dispense'' and inserting "Except as provided in paragraph (2), practitioners who dispense''; and (5) by adding at the end the following paragraph:</SPAN> "(2)(A) Subject to subparagraphs (D) and (J), the requirements of paragraph (1) are waived in the case of the dispensing (including the prescribing), by a practitioner, of narcotic drugs in schedule III, IV, or V or combinations of such drugs if the practitioner meets the conditions specified in subparagraph (B) and the narcotic drugs or combinations of such drugs meet the conditions specified in subparagraph (C)."(B) For purposes of subparagraph (A), the conditions specified in this subparagraph with respect to a practitioner are that, before the initial dispensing of narcotic drugs in schedule III, IV, or V or combinations of such drugs to patients for maintenance or detoxification treatment, the practitioner submit to the Secretary a notification of the intent of the practitioner to begin dispensing the drugs or combinations for such purpose, and that the notification contain the following certifications by the practitioner:"(i) The practitioner is a qualifying physician (as defined in subparagraph (G)."(ii) With respect to patients to whom the practitioner will provide such drugs or combinations of drugs, the practitioner has the capacity to refer the patients for appropriate counseling and other appropriate ancillary services. "(iii)In any case in which the practitioner is not in a group practice, the total number*The total* of such patients of the practitioner at any one time will not exceed the applicable number. For purposes of this clause, the applicable number is 30,except that the unless, not sooner than 1 year after the date on which the practitioner submitted the initial notification, the practitioner submits a second notification to the Secretary of the need and intent of the practitioner to treat up to 100 patients. A second notification under this clause shall contain the certifications required by clauses (i) and (ii) of this subparagraph. The Secretary may by regulation change such total number."(iv) In any case in which the practitioner is in a group practice, the total number of such patients of the group practice at any one time will not exceed the applicable number. For purposes of this clause, the applicable number is 30, except that the Secretary may by regulation change such total number, and the Secretary for such purposes may by regulation establish different categories on the basis of the number of practitioners in a group practice and establish for the various categories different numerical limitations on the number of such patients that the group practice may have*
[ *Changed by public law 109-56 on 8-2-2005 ]

"(C) For purposes of subparagraph (A), the conditions specified in this subparagraph with respect to narcotic drugs in schedule III, IV, or V or combinations of such drugs are as follows: "(i) The drugs or combinations of drugs have, under the Federal Food, Drug, and Cosmetic Act or section 351 of the Public Health Service Act, been approved for use in maintenance or detoxification treatment."(ii) The drugs or combinations of drugs have not been the subject of an adverse determination. NOTE: Federal Register, publication. For purposes of this clause, an adverse determination is a determination published
[[Page 114 STAT. 1224]]
in the Federal Register and made by the Secretary, after consultation with the Attorney General, that the use of the drugs or combinations of drugs for maintenance or detoxification treatment requires additional standards respecting the qualifications of practitioners to provide such treatment, or requires standards respecting the quantities of the drugs that may be provided for unsupervised use.

"(D)(i) A waiver under subparagraph (A) with respect to a practitioner is not in effect unless (in addition to conditions under subparagraphs (B) and (C) the following conditions are met: "(I) The notification under subparagraph (B) is in writing and states the name of the practitioner."(II) The notification identifies the registration issued for the practitioner pursuant to subsection (f )."(III) If the practitioner is a member of a group practice, the notification states the names of the other practitioners in the practice and identifies the registrations issued for the other practitioners pursuant to subsection (f ).

"(ii) Upon receiving a notification under subparagraph (B), the Attorney General shall assign the practitioner involved an identification number under this paragraph for inclusion with the registration issued for the practitioner pursuant to subsection (f ). The identification number so assigned shall be appropriate to preserve the confidentiality of patients for whom the practitioner has dispensed narcotic drugs under a waiver under subparagraph (A)."(iii) NOTE: Deadline. Not later than 45 days after the date on which the Secretary receives a notification under subparagraph (B), the Secretary shall make a determination of whether the practitioner involved meets all requirements for a waiver under subparagraph (B). If the Secretary fails to make such determination by the end of the such 45-day period, the Attorney General shall assign the physician an identification number described in clause (ii) at the end of such period.

"(E)(i) If a practitioner is not registered under paragraph (1) and, in violation of the conditions specified in subparagraphs (B) through (D), dispenses narcotic drugs in schedule III, IV, or V or combinations of such drugs for maintenance treatment or detoxification treatment, the Attorney General may, for purposes of section 304(a)(4), consider the practitioner to have committed an act that renders the registration of the practitioner pursuant to subsection (f ) to be inconsistent with the public interest. "(ii)(I) NOTE: Expiration date. Upon the expiration of 45 days from the date on which the Secretary receives a notification under subparagraph (B), a practitioner who in good faith submits a notification under subparagraph (B) and reasonably believes that the conditions specified in subparagraphs (B) through (D) have been met shall, in dispensing narcotic drugs in schedule III, IV, or V or combinations of such drugs for maintenance treatment or detoxification treatment, be considered to have a waiver under subparagraph (A) until notified otherwise by the Secretary, except that such a practitioner may commence to prescribe or dispense such narcotic drugs for such purposes prior to the expiration of such 45-day period if it facilitates the treatment of an individual patient and both the Secretary and the Attorney General are notified by the practitioner of the intent to commence prescribing or dispensing such narcotic drugs.

"(II) NOTE: Federal Register, publication. For purposes of subclause (I), the publication in the Federal Register of an adverse determination by the Secretary pursuant
[[Page 114 STAT. 1225]]
to subparagraph (C)(ii) shall (with respect to the narcotic drug or combination involved) be considered to be a notification provided by the Secretary to practitioners, effective upon the expiration of the 30-day period beginning on the date on which the adverse determination is so published.

"(F)(i) With respect to the dispensing of narcotic drugs in schedule III, IV, or V or combinations of such drugs to patients for maintenance or detoxification treatment, a practitioner may, in his or her discretion, dispense such drugs or combinations for such treatment under a registration under paragraph (1) or a waiver under subparagraph (A) (subject to meeting the applicable conditions)."(ii) This paragraph may not be construed as having any legal effect on the conditions for obtaining a registration under paragraph (1), including with respect to the number of patients who may be served under such a registration."(G) For purposes of this paragraph:"(i) The term `group practice' has the meaning given such term in section 1877(h)(4) of the Social Security Act. "(ii) The term `qualifying physician' means a physician who is licensed under State law and who meets one or more of the following conditions:"(I) The physician holds a subspecialty board certification in addiction psychiatry from the American Board of Medical Specialties."(II) The physician holds an addiction certification from the American Society of Addiction Medicine."(III) The physician holds a subspecialty board certification in addiction medicine from the American Osteopathic Association."(IV) The physician has, with respect to the treatment and management of opiate-dependent patients, completed not less than eight hours of training (through classroom situations, seminars at professional society meetings, electronic communications, or otherwise) that is provided by the American Society of Addiction Medicine, the American Academy of Addiction Psychiatry, the American Medical Association, the American Osteopathic Association, the American Psychiatric Association, or any other organization that the Secretary determines is appropriate for purposes of this subclause."(V) The physician has participated as an investigator in one or more clinical trials leading to the approval of a narcotic drug in schedule III, IV, or V for maintenance or detoxification treatment, as demonstrated by a statement submitted to the Secretary by the sponsor of such approved drug."(VI) The physician has such other training or experience as the State medical licensing board (of the State in which the physician will provide maintenance or detoxification treatment) considers to demonstrate the ability of the physician to treat and manage opiate-dependent patients."(VII) The physician has such other training or experience as the Secretary considers to demonstrate the ability of the physician to treat and manage opiate-dependent patients. Any criteria of the Secretary under this subclause
[[Page 114 STAT. 1226]]
shall be established by regulation. Any such criteria are effective only for 3 years after the date on which the criteria are promulgated, but may be extended for such additional discrete 3-year periods as the Secretary considers appropriate for purposes of this subclause. NOTE: Federal Register, publication. Such an extension of criteria may only be effectuated through a statement published in the Federal Register by the Secretary during the 30-day period preceding the end of the 3-year period involved.

"(H)(i) In consultation with the Administrator of the Drug Enforcement Administration, the Administrator of the Substance Abuse and Mental Health Services Administration, the Director of the National Institute on Drug Abuse, and the Commissioner of Food and Drugs, the Secretary shall issue regulations (through notice and comment rulemaking) or issue practice guidelines to address the following:"(I) Approval of additional credentialing bodies and the responsibilities of additional credentialing bodies. "(II) Additional exemptions from the requirements of this paragraph and any regulations under this paragraph.

Nothing in such regulations or practice guidelines may authorize any Federal official or employee to exercise supervision or control over the practice of medicine or the manner in which medical services are provided."(ii) NOTE: Deadline. Not later than 120 days after the date of the enactment of the Drug Addiction Treatment Act of 2000, the Secretary shall issue a treatment improvement protocol containing best practice guidelines for the treatment and maintenance of opiate-dependent patients. The Secretary shall develop the protocol in consultation with the Director of the National Institute on Drug Abuse, the Administrator of the Drug Enforcement Administration, the Commissioner of Food and Drugs, the Administrator of the Substance Abuse and Mental Health Services Administration and other substance abuse disorder professionals. The protocol shall be guided by science.

"(I) During the 3-year period beginning on the date of the enactment of the Drug Addiction Treatment Act of 2000, a State may not preclude a practitioner from dispensing or prescribing drugs in schedule III, IV, or V, or combinations of such drugs, to patients for maintenance or detoxification treatment in accordance with this paragraph unless, before the expiration of that 3-year period, the State enacts a law prohibiting a practitioner from dispensing such drugs or combinations of drug."(J)(i) NOTE: Effective date. This paragraph takes effect on the date of the enactment of the Drug Addiction Treatment Act of 2000, and remains in effect thereafter. except as provided in clause (iii) (relating to a decision by the Secretary or the Attorney General that this paragraph should not remain in effect).

"(ii) For purposes relating to clause (iii), the Secretary and the Attorney General may, during the 3-year period beginning on the date of the enactment of the Drug Addiction Treatment Act of 2000 Office of National Drug Control Policy Reauthorization Act of 2006, make determinations in accordance with the following: "(I) The Secretary may make a determination of whether treatments provided under waivers under subparagraph (A)
[[Page 114 STAT. 1227]]
have been effective forms of maintenance treatment and detoxification treatment in clinical settings; may make a determination of whether such waivers have significantly increased (relative to the beginning of such period) the availability of maintenance treatment and detoxification treatment; and may make a determination of whether such waivers have adverse consequences for the public health."(II) The Attorney General may make a determination of the extent to which there have been violations of the numerical limitations established under subparagraph (B) for the number of individuals to whom a practitioner may provide treatment; may make a determination of whether waivers under subparagraph (A) have increased (relative to the beginning of such period) the extent to which narcotic drugs in schedule III, IV, or V or combinations of such drugs are being dispensed or possessed in violation of this Act; and may make a determination of whether such waivers have adverse consequences for the public health.

"(iii) NOTE: Federal Register, publication. Effective date. If, before the expiration of the period specified in clause (ii), the Secretary or the Attorney General publishes in the Federal Register a decision, made on the basis of determinations under such clause, that this paragraph should not remain in effect, this paragraph ceases to be in effect subparagraph (B)(iii) should be applied by limiting the total number of patients a practitioner may treat to 30, then the provisions in such subparagraph (B)(iii) permitting more than 30 patients shall not apply, effective. 60 days after the date on which the decision is so published. The Secretary shall in making any such decision consult with the Attorney General, and shall in publishing the decision in the Federal Register include any comments received from the Attorney General for inclusion in the publication. The Attorney General shall in making any such decision consult with the Secretary, and shall in publishing the decision in the Federal Register include any comments received from the Secretary for inclusion in the publication.''.

(b) Conforming Amendments.--Section 304 of the Controlled Substances Act (21 U.S.C. 824) is amended--(1) in subsection (a), in the matter after and below paragraph (5), by striking "section 303(g)'' each place such term appears and inserting "section 303(g)(1)''; and(2) in subsection (d), by striking "section 303(g)'' and inserting "section 303(g)(1)''.

(c) Additional Authorization of Appropriations.--For the purpose of assisting the Secretary of Health and Human Services with the additional duties established for the Secretary pursuant to the amendments made by this section, there are authorized to be appropriated, in addition to other authorizations of appropriations that are available for such purpose, such sums as may be necessary for each of fiscal years 2001 through 2003.


Post Quality Evaluations:
informative answer with references to back it up - well done!

Last edited by Alfa; 02-07-2011 at 01:47.
  #5  
Old 29-11-2010, 12:03
squeezix squeezix is offline
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Re: Is it now a requirement that suboxone doctors drug test patients?

In Florida and most southern states this has become standard operating procedure. I believe it is part of Florida legislature. Also most pain clinics now test as well to make sure you are only using the prescribed drugs, they will discontinue scripts if one is suspected of taking combos or selling.

If you have been to South Florida, a drive down any city street will reveal several pain clinics with custom cars in the parking lots, out of state plates and dealers on cell phones telling their marks to hold out until they cash in their script.

It's gotten out of hand down here

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