{Buprenorphine Handout

You will be receiving this handout most likely as a result of calling Dr. Rotchford's office asking if we can help you by prescribing buprenorphine. In addition to specializing in pain management Dr. Rotchford has specialized in addiction medicine and he expects to be board certified by the end of 2004 . To possibly save you the money of an unnecessary intake evaluation, we decided to write down some office policies regarding prescribing buprenorphine. One difficulty with this is that medical care with buprenorphine needs to be individualized. As a result, the following are basic guidelines based on three broad categories of patients who seek help with buprenorphine.

The first category of patients is made up of patients who have had limited counseling or formal support in dealing with their chemical dependency to an opiate. (Whether it was prescribed or not)
These patients require an intense intervention to stabilize their chemical dependency. In addition to intensive counseling and often group therapy, they benefit from close medical supervision. Their care is often compromised by unrecognized or untreated medical and psychiatric problems. They warrant frequent physician visits for at least three months.
In Washington State there are basically three options for these patients.

a. Detoxification from opiates and inpatient care with the hope of becoming abstinent from all opiates. This is probably the cheapest alternative but is associated with the least favorable outcomes in terms of complications from chemical dependency and eventual return to the use of illicit opiates. It is often the only alternative for patients whose financial resources are limited to state aid. If you are interested in this option I highly recommend you contact Safe Harbor. Tel: 360-385-3866

b. Methadone/Buprenorphine Clinics
The closest clinic is in Lynnwood. (425)672-7293
They will require initial daily which may be extended to three times a week visits to pick up the buprenorphine. Care is comprehensive and costs approximately $800-1,000 per month. Consider three months of this care as a minimum.

c. Individual Providers
An individual provider can currently prescribe buprenorphine to only thirty patients. As a result most providers have waiting lists and are selective of patients who they will care for.
I will consider providing care to this subgroup of patients but costs for comprehensive care in a local setting needs to be coordinated and is more expensive with a cost of $1,500.00 per month and financing unaavailable. It is possible that some insurances will reimburse some of these costs. These fees also don't include the cost of the buprenorphine which can cost depending on dose approximately $200 to $600/month. Consider a minimum of three months of intensive care. Although more expensive this option provides the greatest possibility for individualized care and avoids long commutes.

The second category of patients are those patients who already have had fairly extensive chemical dependency rehabilitation and possibly are already attending a methadone clinic. These patients are looking to change from Methadone/or a stable opiate dose to buprenorphine in order to simplify their lives and avoid travel to distant centers and/or complications from using illicit opiates.
Medical fees alone for these patients are about ½ that of the above group or about $750.00 per month with the possibility of office visits eventually being reduced to once a month at a current cost of $115.00. There is no financing available in my office and a three month retainer fee would be required. Patient's who have completed successfully and complied with intensive treatment as outlined for the first category of patients fall into this second broad category.

The third category of patients are patients with longstanding chronic pain disorders who are on stable doses of Methadone or other opiates/ or are considering opiate therapy for chronic non-malignant pain. Because of a remote history of chemical dependency problems or because of the risks of diversion, social stigma, or side effects buprenorphine is an option to help meet their pain management needs.
These patients can schedule a consultation with Dr. Rotchford if they meet office requirements for a pain management consultation ie: specifically a referral from their primary care provider for a consultation.. At the time of the consultation Dr. Rotchford will review with them their pain management options and discuss the appropriateness of buprenorphine. The consultation will be a one time visit and no medicines will be prescribed. If a decision is made to go forward with a trial of buprenorphine patients would return for induction and costs of such induction and maintenance would be individualized and costs could be briefly discussed at the time of the consultation.
If you would like to know more about specifics we do suggest you make an appointment for an initial consultation.

References online:

Buprenorphine: http://behavenet.com/capsules/treatments/drugs/buprenorphine.htm
Suboxone: http://behavenet.com/capsules/treatments/drugs/Suboxone.htm
Opioids: http://behavenet.com/capsules/treatments/drugs/opioid.htm
Government Information: http://buprenorphine.samhsa.gov/

Book:
Cowan, Alan & Lewis, John W. (Editors) Buprenorphine - Combating Drug Abuse With a Unique Opioid Paperback 1995