This Page is About Choosing a Medication for Your Substance Program.
Choices:
Methadone Liquid 5mg / ml, doses to max 130mg
Subutex tablets
0.4mg, 2.0mg, 8.0mg
Suboxone Films 2.0mg and 8.0mg
Injectable Buprenorhine : Buvidal and Sublocade
Doctors deal with other minor medications and frequently use benzodiazepines in staged restricted format to control symptoms in patients with anxiety disorder and panic attacks.
The use of each medictaion is individualised to the person's circumstances and degree of problems.
Discussion
Not every person who has a drug problem/substance use problem needs to be on an opioid replacement therapy (ORT) program. (These medications are methadone, Suboxone and Subutex).
There are new medications now available : the LAIs ,
aka Long Acting Injectables. The names are Sublocade and Buvidal. These may be especially useful for people who just think that they don't want to have to trust themselves to do the right thing. Having medication in your system all the time can help to control cravings better than pills or films.
See Buvidal Patient Booklet.pdf
There are many reasons people take drugs including legitimate reasons such as control of pain, discomfort and feeling unwell.
Opioids such as methadone, Suboxone and Subutex are not indicated as a treatment for depression. However they do help with this problem.
Opioids such as methadone, Suboxone and Subutex are not indicated for the treatment of amphetamine use – crystal meth, ice. However, they can help with this problem.
People who have opioid abuse problems/substance use problems can at times take a number of illegal opiates. For example many people in prison use Suboxone while they are in prison. When they leave prison they are more likely to use Subutex, Methadone, Heroin or OxyContin /Oxycodone/ Targin.
The message here is that to help people to stop using drugs/substances, an appropriate therapy is required. This requires an assessment of a patient’s circumstances, needs and direction in life. Not everyone with medication issues needs to be put on an opioid replacement therapy (ORT) program.
The different ORTs available suit different people for different reasons: Methadone Liquid, Subutex Tabs, Suboxone Films, LAI Buvidal or LAI Sublocade. (LAI = Long Acting Injectable).
Our clinic policy is “ONE PROBLEM --- ONE CONSULTATION”.
Our doctors bulk bill with a few exceptions.
Side Effects
All opioids cause constipation. I would recommend that patients take a good dose of Psyllium husk at least twice a day. {Psyllium husk – the little flakes (not the powder) are cheap and natural and can be used long term as a healthy fibre add- in to the diet.}
My usual instructions for Managing Constipation are:
Put two or three big heaped teaspoons of Psyllium husk in a glass.
Add Water or Juice. (Water is tasteless, as is the Psyllium husk essentially).
Mix
Eat or drink. If the mix is taken quickly, it can be drunk. This seems to be the most preferred method of taking Psyllium husk. If left for a little while, the mix turns to jelly and will need to be eaten.
Take the mix TWICE a day- with or after a meal.
Adding Sedative medications
eg Benzodiazepines > Diazepam/Valium/Antenex, Oxazepam/Murelax/Alepam.
There is a growing opposition and the medical community to the prescription of diazepam and oxazepam (and other benzos). These medications need to have good justification for the use. There needs to be a good safety profile with the use of these medications as well.
To continue to use these medications, I have decided to undertake to develop a 'plan of care' for everyone taking these medications. Stability of clinical psychiatric symptoms is very important. Safety is important too.
You must sign a “contract of care”. (Sample at bottom of page).
In addition to the “contract of care”, you must fill in a form to tell me how much you need this medication, what this medication does for you and tell me what problems you may face if this medication is not prescribed for you.
You will need to see a psychiatrist to review your case. This will be available here at the clinic and will be bulk billed.
You will need to undertake some psychological counselling with a psychologist. This will be available here at the clinic and will be bulk billed.
A DDU application form will be done by me to legitimise your use of this medication, as necessary, in the long term.
Some general issues:
Do not seek these medications from multiple doctors.
If you have an electronic health record, your scripts are visible to a wide variety of people, often not very understanding of your problems. I would suggest you close down who can access your record, and limit to what extent they can access your record. QScript makes everyone able to access your medical prescription records.
Do not discuss your use of this medication with other doctors. Only discuss this medication with doctors who are comfortable with drug and substance use issues. If you are questioned about your drug use, you do not have to reply. Be very careful what comments you make. Many people / doctors are very 'polarised' in talking to people with addiction issues. If the wrong impression is created, this is likely to become enshrined in many medical letters and documents,
which cannot be fixed up - ever.
If you are in Emergency -doctors tend to leap to conclusions. These judgements may be impossible to remove from your medical record.
Contract Of Care.
I am aware of the following issues and requirements for approval.
1. I will not share information regarding possession/use of diazepam/ oxazepam/ other similar meds with others. These medications are potentially dangerous medications that can cause death when taken by anyone other than for whom they are prescribed.
2. Mixing other depressants or sedatives such as alcohol, Lyrica or other opioids with these medications can lead to drug overdose and death. I will discuss the usage of all sedative and psychiatric medications with my prescribing doctor.
(Mixing meds is dangerous- perhaps lethal).
3. I accept responsibility for safe storage and use of diazepam/ oxazepam/ other similar meds that I may receive. I will store all doses in a secure place out of the reach of children and am aware that a locked cabinet or safe is recommended. Storage in a refrigerator is not acceptable.
4. All doses will be consumed according to directions given by my prescriber. When multiple doses are prescribed, each dose will be taken on the day for which it is prescribed. Doses will not be accumulated and no more than the daily dose will be taken.
If medications are necessary but not being taken safely, restrictions on medication access may be instituted for your safety.
5. Medication must always be
carried in its own labelled box / container as dispensed from the pharmacy. Loose medications are illegal.
6. I will not sell, swap or give away my medication doses or any part thereof.
7. Doses that are lost or stolen will not be replaced and will be reported to my prescriber. Stolen doses should also be reported directly to the police.
8. Access to diazepam/ oxazepam/ other similar meds doses will be suspended if members of my treatment team consider them to be unsafe for me or the community at any time. (Prescribing will stop if meds are not used safely - diazepam/ oxazepam/ other similar meds)
9. Access to diazepam/ oxazepam/ other similar meds may be suspended if my urine drug tests detect other opioids, sedatives such as Lyrica or illicit drugs. Failure to provide a urine sample for drug testing when requested will be deemed a positive urine test.
10. Access to diazepam/ oxazepam/ other similar meds doses will also be suspended if I am assessed as being under the influence of any substances.
If my circumstances change and I am deemed unsuitable for full doses of medication; or for any other reason that the treatment team consider to indicate increased risk to myself or the community- safety restrictions will be instituted.
11. Diazepam/ oxazepam/ other similar meds doses can only be prescribed under the conditions and requirements set out within the policies and procedures of the Toombul Medical centre.
12. Any deviation from this agreement will result in a review of my treatment which will include access to full bottles/packets of medication and possible suspension / removal.
14. The rules of this medication program are to keep you safe and alive. The program is here to keep you safe and alive. The program allows you to get your finances together, to get your relationships together, to get your working life together, and to allow you to start to succeed in every aspect of your life.
15. We expect you to limit your usage of illegal drugs. Prescribing diazepam/ oxazepam/ other similar meds requires your commitment for safe medication use.
Using Illegal Drugs, keeps you broke and poor, and will take away many benefits of your medication regime for yourself and your significant others.
Signed by client.............................
Name:
Date:
ToombulDoc.com Go To Home Page ToombulDoc.com
Contact Details
Dr Andrew Pluta
UMC North Lakes Doctors
26 Torres Crescent, North Lakes
P: 3482 3123
umcnorthlakes@unitedmedical.net.au
The Science of Addiction Medicine www.DDDocs.com.au
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Victorian Opioid Doctors Crisis
Short Version ( Dr Pluta's Story) .
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