PMHNP & Suboxone

PG2018 · Sep 13, 2016

I got some information once we could take the certification course, which I wanted to do, but we can't prescribe as of yet. I'm not sure why the hang up.

Having said that, I'm sick of absorbing clozapine patients and so I'm not doing any special meds anymore, e.g. clozapine. Frankly, I'm content with whatever is on the Medicaid preferred list that's old and cheap.

But let me know if you hear something. Interesting proposition to say the least.

Spaciousness · Sep 13, 2016

Thanks for your response. I always appreciate your posts PsychGuy. I suspect that the information that NPs can offer Suboxone TX is not accurate. As a PMHNP student I am curious about your comment. Where are you absorbing the clozapine patients from (do you work in an agency or government system that sees a lot of people with severe and persistent mental illness?)? When you refer to special meds are you talking about meds that need close lab monitoring? What do you find aversive about working with folks on these kinds of meds? If you care to share that would be great. Thanks.

verene, MSN · Sep 13, 2016

Assuming I am reading and interpreting the law correctly it looks like NPs can prescribe and administer suboxone treatment for opioid addiction management as of July 2016. (Providing NP prescription of 3N drugs is allowed by their state, they adhere to any collaboration/supervision agreements as needed by state law, and they undertake a prescribed number of hours of specialized training).

See Comprehensive Addiction and Recovery Act of 2016. Section 303: Medication Assisted Treatment for Recovery.

Jules A, MSN · Sep 14, 2016

Disclaimer I'm not fan of long term MAT in general but I shudder to imagine the train wreck when non addictions savvy NPs start prescribing for this population.

allnurses Guide · Sep 14, 2016

Disclaimer I'm not fan of long term MAT in general but I shudder to imagine the train wreck when non addictions savvy NPs start prescribing for this population.

True but we need to do something. I had two patients under the age of 22 die in the past three months while awaiting treatment. There is a 6 month wait here to get into one of the two treatment centers. We have no suboxone prescribers in a 20 mile radius with a major heroin problem. These were kids that had a problem knew they did, sought help, and died waiting. That's not acceptable. Less than 1 in 5 people with moderate to severe addiction get treatment.

To make matters worse, both of these patients at one point were told by the ED when they presented for help because they were scared that they couldn't be helped because they were sober and were told/suggested to go home and get high/drunk then come back. That's just what and addict scared for their life needs to hear.

Dying From Opioid Overdose While Waiting For Treatment: Politics In Real Life : NPR

PG2018 · Sep 14, 2016

I got some information once we could take the certification course, which I wanted to do, but we can't prescribe as of yet. I'm not sure why the hang up.
Having said that, I'm sick of absorbing clozapine patients and so I'm not doing any special meds anymore, e.g. clozapine. Frankly, I'm content with whatever is on the Medicaid preferred list that's old and cheap.
But let me know if you hear something. Interesting proposition to say the least.

I work for an organization providing comprehensive treatment to SMI patients. The clozapine patients have come from hospitals, community MH, private practice, inheritance, etc.

Labwork is hard to enforce. It's largely the reason I refrain from prescribing lithium with any frequency. I don't use Tegretol much either. I use Depakote a lot but find myself less concerned with quants. I used to order labs daily but now weeks upon weeks pass before an order because I can't get patients to go. Heck, they don't come to the refill appointment. Why would they go to labs?

Spaciousness · Sep 15, 2016

Thanks Verne for finding that information! Your efforts and skill with tracking down the information are greatly appreciated!!! I am going to try and contact my State Board to see what they say.

Spaciousness · Sep 15, 2016

As with any specialty area, I agree that the provider (be it a PA; MD; NP; DO; etc.) needs to have experience and training in the area. I believe that there is a great need for this service given the dismal results (based on what my preceptor told me) of recovery without the help of Suboxone. AND it is important that the provider not only be knowledgable, but have a passion for the work and compassion for these patients along with having excellent boundaries and some streetwise discernment--anything less will not help anyone.

Spaciousness · Sep 15, 2016

I have heard in class that lab monitoring can be a major pain. I don't know what the solution is, other than some kind of visiting nurse (RN; LPN) doing home visits or something. It looks like the specialty of mental health clearly can has its own unique set of challenges. On the other hand, I know people that work in primary care and in other specialties beside psych that are unhappy with poor patient initiative and follow-through. Thanks for the feedback.

Jules A, MSN · Sep 16, 2016

I believe that there is a great need for this service given the dismal results (based on what my preceptor told me) of recovery without the help of Suboxone. .

I'd urge everyone to do their own research before forming an opinion on this topic. It is my mine that there are minimal long term studies showing superior outcomes with sobriety or survival and 42 mos isn't what I consider long term.

Aromatic · Sep 16, 2016

Suboxone is good for making pharm and clinics money. And drug testing companies

otherwise they would probably use like some sort of depo shot or implant