Posted by pseudoname on November 5, 2005, at 20:06:45
In reply to Re: Buprenorphine Concerns, posted by bigcat on November 4, 2005, at 0:45:45
> I would'nt dare bring up the Buprenorphine idea if writing the script could even remotely put him at any legal or professional risk
It's perfectly legal for docs to write bupe scripts for depression, and I don't think we even have to worry about overzealous prosecution.
All of the problems I could find by Googling including what seemed like horrific injustices involved Schedule II drugs (like OxyContin), which are more "dangerous" and restricted than buprenorphines Suboxone (Sch III) or Buprenex (Sch V). They also involved HUGE amounts and many patients, even when seemingly justified.
I found these statements from the DEA (I assume you're in the U.S.). They're in "Prescription Pain Medications: Frequently Asked Questions and Answers for Health Care Professionals and Law Enforcement Personnel" (2004) which DEA has since withdrawn for errors in other sections:
Word FAQ: http://headaches.allinfoabout.com/articles/PRESCRIPTION%20PAIN%20MEDICATIONS.doc
PDF FAQ: http://headaches.allinfoabout.com/articles/pain_meds_faqs.pdfThe DEA says, "The DEA focuses its limited manpower and resources on the most flagrant violators." pg 42
DEA explicitly says that even *methadone* (let alone bupe) can be prescribed by ANY physician with a Schedule II registration. "An additional separate DEA registration is needed only when dispensing methadone for outpatient maintenance or detoxification, not when prescribing it for pain." pg 41
In 2003 the DEA sanctioned 584 doctors, dentists, veterinarians, and nurses. Of those, 434 WERE NO LONGER LICENSED to practice when they were writing the scripts. Most sanctions were just the loss of registration (and remember, most of the docs were already out of business). pg 42
The DEA gives these as examples of questions an investigator might ask a physician about an opioid prescription. (Substitute "depression" for "pain".)
How can you tell this patient has a chronic pain problem?
Is there justification for the drugs that have been prescribed?
Are the prescribed amounts appropriate?
If a patient is displaying drug-seeking behaviors, is this a sign of undertreated pain, addiction, or involvement in diversion? pg 46<quote>
Characteristics of a practitioner or pharmacy that warrant further inquiry that could lead to an investigation include:
A large proportion of prescriptions being paid for in cash.
Large distances between the doctor, patients, and pharmacy, particularly if a sizable proportion of a doctors prescriptions are being filled at a pharmacy not conveniently located to either the doctor or the patients.
Drugs and doses being prescribed are not individualized.
One physician writing multiple prescriptions for numerous patients that are filled consecutively in one pharmacy, indicating that either one person is presenting multiple prescriptions, or several people are filling similar prescriptions at the same time.
A high frequency of prescriptions to replace lost prescriptions or medications.
Frequent premature renewal or refilling of prescriptions.
Frequent prescribing of unusual combinations of drugs, such as stimulants and depressants.
<unquote> pg 46Matt, I hope this helps. It reassured me. I'm going to print out the FAQ for my pdoc. The biggest point is that it's completely LEGAL for your doc to give you a bupe script for depression. It won't even get on the DEA's radar.
poster:pseudoname
thread:81414
URL: http://www.dr-bob.org/babble/20051031/msgs/575759.html