RE: Two-Timed

[Guest guest]

One word...Suboxone.

To: Sent: Saturday, July 4, 2009 7:06:26 AMSubject: Two-Timed

This is a first for me. I had a long standing patient in the hospital recently. He is 63 yo alcoholic, retired mason with atrial fibrillation and alcoholic cardiomyopathy. He has bilateral extensive shoulder disease in that both shoulders barely move anymore and gout. He is on chronic pain meds and has been very stable with his use for years. He has been my patient since 1993. Moved with me to my new office and everything. He kept taking the same amount of pain meds after he retired, which disappointed me a little as the meds were to help him quit working and when not working I expected him to use less but that’s all. Recently, he didn’t call for his refills and was late by a month so we called him. He missed his appointment and ended up in hospital with uncontrolled a fib as he had stopped his cardiac meds too and was just drinking heavily.

Well, another doctor recognized him by another name. (we have 7 active primary care docs on staff) This doctor has been treating him for pain since 1996 but hasn’t seen him since Sept 2008. Paid him cash, claimed unemployed and uninsured. I called some pharmacies and most had him by either the name I new him as, or the other name, same birth date, same address. One pharmacy had him as a customer under both names and this is a small, family owned pharmacy but it was also many years ago. The other name hasn’t been active anywhere since Sept 2008. I have been lied to and duped before but never anything like this. Anyway, he had a roommate his last day in the hospital after I learned all this and I did not want to try to have this conversation with non-medical people being able to overhear so I will confront him at my office.

But I learned something interesting. The pharmacies require no ID if someone pays cash for a script. Even a controlled drug. I got, “It’s not required by law.†So anyone can come in with anyone’s script and fill it without a second thought. The controlled drug registries won’t pick up this kind of patient as you need to know the name, you can’t check for aliases.

I don’t know what I am going to do. He wants to get sober. I told him that he will get only the oxycontin at the dose he was getting in the hospital, no extras and no Vicodin (which was the drug he was abusing). I have him on Remeron for insomnia and depression and will confront him about his alias. It’s been 7 months since he has used it so the problem might have burned itself out or he doesn’t have the money anymore to do that. I believe he was taking it all if you saw his desperation in the hospital when he thought I was stopping his narcotics, not selling them or he’d still be doing it for the money.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypr actice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

[Guest guest]

I would not waste one of my " slots " for buprenorphine treatment on a patient like this. Burprenorphine therapy is meant to help narcotic addicts to control the withdrawal symptoms and in some(most?) cases also provide a maintenance option.

This patient has not been honest, what did the urine toxicology show?

Pedro Ballester, M.D.Warren, OH

One word...Suboxone.

[Guest guest]

So say some day Pedro you mess up and get into big big  trouble  BIG trouble. Really big.Want some one to say they would not waste time on someone like you?All addicts lie  Why are we  so surpised when  we catch them at it?

It is the  disease.HOw exactly tell me  does KAthy  gain  if she discharges the patient? tell me what  she gets?Keeping him  not giving narcs  offering help however frsutrating is uh her job and I bet  she  can  can do it well.

Jean

I would not waste one of my " slots " for buprenorphine treatment on a patient like this. Burprenorphine therapy is meant to help narcotic addicts to control the withdrawal symptoms and in some(most?) cases also provide a maintenance option.

This patient has not been honest, what did the urine toxicology show?

Pedro Ballester, M.D.Warren, OH

One word...Suboxone.

-- If you are a patient please allow up to 24 hours for a reply by  email/please note the new email address.Remember  that e-mail may not be entirely secure/     MD

        ph   fax impcenter.org

[Guest guest]

Does the patient really need narcotics?Is he selling them?Some patients have to be cut off if the toxicology shows no narcotics in the system, or the presence of cocaine.There is a " market " for buprenorphine, patients that want to " cool " the withdrawal storm, until they can get their hands on the more potent pure mu agonists.

Kathy is in NJ, according to the Census Bureau, the whole state is an urban area, he needs a referral to an addiction treatment center, possibly in-patient, maybe methadone for addiction.We need to have a nationwide narcotic registry so we are not " surprised " and can treat patients in a safe manner without being abused or taken advantage of.

In my hospital there was a case of an overdose that involved buprenorphine and benzodiazepines, in my area (OH and PA) at least three Physicians have lost their license because of indiscriminate narcotic prescription and frank patient abuse,  $150 every two weeks to get the narcotic Rx, for example.

Lately, I have been cutting back on the amount of narcotics I pescribe to individual patients, an ER visit was the first red flag in many cases.I received my buprenorphine DEA number in December, I am limited to 30 patients the first year, and up to 100 thereafter. I help my patients by accepting insurance payments or just charge them $300 for the first 2 weeks of assessment and titration and $50 a visit for follow-up if they don't have insurance. Some of these poor souls are spending several hundred dollars a week to support their habit!

I would like to believe that I am providing a caring service that will help my community, I don't want to be taken advantage of nor be involved in a narcotic related death.Pedro Ballester, M.D.

Warren, OH

[Guest guest]

This is an interesting debate.

1st off, I thought suboxone was for heroin addiction

2nd) I am not a suboxone subscriber so moot point.

3) What about his pain. He is not a candidate for

NSAIDs. Ultram may not be enough. His pain is still real even if

his behavior is that of an addict. Can we say “pseudo addiction”

which is a well describe physician created problem.

4) The problem seems to have burnt itself out with age and

illness. It has been 6 months since he has seen the other doctor and gotten

drugs in the other name.

5) I need to talk to the guy first and see what he has to say.

6) ER did not do a urine drug screen. Just the alcohol

level. They were very excited with his complaints of shoulder pain that

radiates down his arm WITH MOVEMENT but decided he was probably experiencing

ischemia from his rapid, uncontrolled afib (rate 130) and put him in the unit

with cardizem drip and Cardiac injury profile as rule out. They did not

call me with him but the physician on-call and I don’t know why or I

could have told them he was chronic a fib, he has shoulder pain not chest pain

radiating to the shoulder and he didn’t need cardizem drip but to be put

back on his oral meds. I probably need to find out why they bypassed

me. The on-call doc found out I was his doctor after managing the

admission and signed him over to me the next morning. He also had been

off his narcotics for a month as drinking to heavily to go out and get his

meds, all of them, so urine drug screen should have been negative which wouldn’t

have told us much of anything.

I am not going to “dump” him until I have talked to

him about the problem At least I know what he is all about. I could

set him loose on the other doctors in the area but that would free him to do

the same behavior wouldn’t’ it.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

From:

[mailto: ] On Behalf Of Jean

Antonucci

Sent: Monday, July 06, 2009 8:06 AM

To:

Subject: Re: Two-Timed

So say some day Pedro you mess up and get into big big trouble

BIG trouble. Really big.Want some one to say they would not waste time on

someone like you?

All addicts lie

Why are we so surpised when we catch them at it?

It is the disease.

HOw exactly tell me does KAthy gain if she discharges the

patient? tell me what she gets?

Keeping him not giving narcs offering help however frsutrating is

uh her job and I bet she can can do it well.

Jean

I would not waste one of my

" slots " for buprenorphine treatment on a patient like this.

Burprenorphine therapy is meant to help narcotic addicts to control the withdrawal

symptoms and in some(most?) cases also provide a maintenance option.

This patient has not been honest, what did the urine toxicology show?

Pedro Ballester, M.D.

Warren, OH

On Mon, Jul 6, 2009 at 6:58 AM,

nancy blake

wrote:

One word...Suboxone.

--

If you are a patient please allow up to 24 hours for a reply by email/

please note the new email address.

Remember that e-mail may not be entirely secure/

MD

ph fax

impcenter.org

[Guest guest]

This is an interesting debate.

 

1st off, I thought suboxone was for heroin addiction

2nd) I am not a suboxone subscriber so moot point.

3)  What about his pain.  He is not a candidate for

NSAIDs.  Ultram may not be enough.  His pain is still real even if

his behavior is that of an addict.  Can we say “pseudo addiction”

which is a well describe physician created problem.Not always  doc -created but real and  under recongnized

4) The problem seems to have burnt itself out with age and

illness.  It has been 6 months since he has seen the other doctor and gotten

drugs in the other name.

5) I need to talk to the guy first and see what he has to say. YES

6) ER did not do a urine drug screen.  Just the alcohol

level.  They were very excited with his complaints of shoulder pain that

radiates down his arm WITH MOVEMENT but decided he was probably experiencing

ischemia from his rapid, uncontrolled afib (rate 130) and put him in the unit

with cardizem drip and Cardiac injury profile as rule out.  They did not

call me with him but the physician on-call and I don’t know why or I

could have told them he was chronic a fib, he has shoulder pain not chest pain

radiating to the shoulder and he didn’t need cardizem drip but to be put

back on his oral meds.  I probably need to find out why they bypassed

me.  The on-call doc found out I was his doctor after managing the

admission and signed him over to me the next morning.  He also had been

off his narcotics for a month as drinking to heavily to go out and get his

meds, all of them, so urine drug screen should have been negative which wouldn’t

have told us much of anything.

 

I am not going to “dump” him until I have talked to

him about the problem  At least I know what he is all about.  I could

set him loose on the other doctors in the area but that would free him to do

the same behavior wouldn’t’ it.TRUE.  HI s pain may indeed be tough to control however he may need antidepressants referral to someone who can do addicitons work or suboxone and you provide the long term relationship.

Let us know   -Jean

 

..

-- If you are a patient please allow up to 24 hours for a reply by  email/please note the new email address.Remember  that e-mail may not be entirely secure/     MD

        ph   fax impcenter.org

[Guest guest]

Perhaps the other doc, the one of us, and the patient could all get together to help this person. Few people want to remain in a situation like that. They have options.

To: Sent: Saturday, July 4, 2009 2:51:10 PMSubject: Re: Two-Timed

Kathy,

I agree with the others who would discharge this patient. I think keeping him as a patient is just asking for more trouble. Good luck.

Seto

South Pasadena, CA

I don’t know what I am going to do. He wants to get sober. I told him that he will get only the oxycontin at the dose he was getting in the hospital, no extras and no Vicodin (which was the drug he was abusing). I have him on Remeron for insomnia and depression and will confront him about his alias. It’s been 7 months since he has used it so the problem might have burned itself out or he doesn’t have the money anymore to do that. I believe he was taking it all if you saw his desperation in the hospital when he thought I was stopping his narcotics, not selling them or he’d still be doing it for the money.

Kathy Saradarian, MD

[Guest guest]

agree with Jean

To: Sent: Monday, July 6, 2009 8:06:07 AMSubject: Re: Two-Timed

So say some day Pedro you mess up and get into big big trouble BIG trouble. Really big.Want some one to say they would not waste time on someone like you?All addicts lie Why are we so surpised when we catch them at it?It is the disease.HOw exactly tell me does KAthy gain if she discharges the patient? tell me what she gets?Keeping him not giving narcs offering help however frsutrating is uh her job and I bet she can can do it well.Jean

On Mon, Jul 6, 2009 at 7:42 AM, Pedro Ballester <DrBallester@ gmail.com> wrote:

I would not waste one of my "slots" for buprenorphine treatment on a patient like this. Burprenorphine therapy is meant to help narcotic addicts to control the withdrawal symptoms and in some(most?) cases also provide a maintenance option.This patient has not been honest, what did the urine toxicology show?Pedro Ballester, M.D.Warren, OH

On Mon, Jul 6, 2009 at 6:58 AM, nancy blake <nancycblake@ yahoo.com> wrote:

One word...Suboxone.

-- If you are a patient please allow up to 24 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax impcenter.org

[Guest guest]

So Pedro I am sure you are a good guy  But   you leave your umbrella at Gordon's this year and  we may just  not return it:)

Does the patient really need narcotics?Is he selling them?Some patients have to be cut off if the toxicology shows no narcotics in the system, or the presence of cocaine.There is a " market " for buprenorphine, patients that want to " cool " the withdrawal storm, until they can get their hands on the more potent pure mu agonists.

Kathy is in NJ, according to the Census Bureau, the whole state is an urban area, he needs a referral to an addiction treatment center, possibly in-patient, maybe methadone for addiction.We need to have a nationwide narcotic registry so we are not " surprised " and can treat patients in a safe manner without being abused or taken advantage of.

In my hospital there was a case of an overdose that involved buprenorphine and benzodiazepines, in my area (OH and PA) at least three Physicians have lost their license because of indiscriminate narcotic prescription and frank patient abuse,  $150 every two weeks to get the narcotic Rx, for example.

Lately, I have been cutting back on the amount of narcotics I pescribe to individual patients, an ER visit was the first red flag in many cases.I received my buprenorphine DEA number in December, I am limited to 30 patients the first year, and up to 100 thereafter. I help my patients by accepting insurance payments or just charge them $300 for the first 2 weeks of assessment and titration and $50 a visit for follow-up if they don't have insurance. Some of these poor souls are spending several hundred dollars a week to support their habit!

I would like to believe that I am providing a caring service that will help my community, I don't want to be taken advantage of nor be involved in a narcotic related death.

Pedro Ballester, M.D.

Warren, OH

-- If you are a patient please allow up to 24 hours for a reply by  email/please note the new email address.Remember  that e-mail may not be entirely secure/     MD

        ph   fax impcenter.org

[Guest guest]

I would encourage anybody interested to get the certification, if you don't get CME it is free!First step is to contact the Beckitt Benckiser rep to get the CD...These are the documents I use in my practice:

Initial Assessment

Name ___________________________________ Date _________

You

have come to my office to address a narcotic misuse or abuse problem.

I

need to know the extent of your problem in complete detail:

When

did you start using narcotics?

Why

did you start?

What

do you use?

How

do you use it?

When

was the last time that you used any chemical of abuse?

What

happens when you don't use narcotics?

How

long does it take to start feeling “sick” (withdrawal)?

What

do you do to get some relief if you cannot get narcotics?

Do

you drink alcohol? What do you drink? How much do you drink? 'How

often do you drink?

Do

you use marihuana? How do you use it? How much do you use? How often

do you use marihuana?

Do

you use any other chemicals or drugs to get “high”, help you

“relax” or get you through the day? How do you use it? How much

do you use? How often do you use it?

Where

do you get the narcotics?

How

much do spend a week?

Are

you in financial distress because of your narcotic use?

Is

anyone helping you financially?

How

do you plan to pay for the medication and office visits?

Have

you tried to quit before?

What

did you try to help you quit?

How

many times have you tried?

Why

did you fail?

Why

do you want to quit?

Do

you need to quit?

Is

someone forcing you to come here?

Do

you have any legal problems? Have you ever been on probation?My " contract " , I ask the patients to initial each line:

Narcotic (Pain

Medication) and Anxiety (Nerves) Medication Contract

I am using narcotic pain

medications to relieve pain, so I can work or have some quality of

life.

I understand that there

are side effects, adverse reactions and dependence on narcotics and

sedatives,

I will let Dr. Ballester

know if I am having any side effects or adverse reactions.

I am not

using narcotic medications to get “High”.

I am not

sharing or selling my pain medications.

I am not

getting any prescriptions for narcotics or sedatives from any other

doctors. If I need or use narcotics from other doctors, I will not

get any more prescriptions from Dr. Ballester, and the Doctor-Patient

relationship is terminated immediately.

I am not

using illegal or “street” drugs, I am

not abusing

over the counter medications.

If I have an “addiction”

problem, I will let Dr. Ballester know to be referred to get

treatment.

I am not

drinking more than 1 glass of wine or 1

beer or 1 “shot” of liquor a day.

If I lose my medications,

I will not ask

for a refill.

I will keep my medications

in a secure, locked location, if my medications are stolen, I will

file a report with the Police and will

press charges.

I agree to random urine or

blood tests that check for prescription and non-prescription

medications or “street” drugs in my body, I will pay for these

tests if they are not covered by my insurance. If the test shows that

the narcotic is not present (negative test), Dr. Ballester will not

prescribe anymore the narcotic. If the test shows the presence of

drugs without medical applications, the Doctor-Patient relationship

will end immediately.

I waive any privacy right

with regard to communications with Pharmacists, Doctors, Hospitals,

Police, Detectives, Drug Enforcement Agency, State of Ohio Board of

Pharmacy.

I understand that Dr.

Ballester can check my prescription history in Ohio, if the report

from Ohio or any other State shows that I have filled prescriptions

for narcotics from other doctors while this contract is in effect,

the Doctor-Patient relationship will end immediately.

I will schedule follow-up

appointments before I run out of medications, I will not call after

hours or during week-ends or Holidays to get refills. If I plan to

travel, I will make an appointment to get refills before my trip.

Dr. Pedro A. Ballester has

explained the risks and answered all my questions regarding narcotic

therapy.

I give this to all the patients in the first visit:(Narcotics Anonymous meeting list for

Trumbull County, OH)

http://portaltools.na.org/portaltools/MeetingLoc/Counseling Resources

www.HereToHelpProgram.com

www.addictionsurvivors.org

(local counselors)Meeting List

DATE:___________________TYPE

OF MEETING:_____________________________

MEETING

NAME:____________________________LOCATION:_________________

SIGNATURE OF

CHAIR:__________________________________________________

………………………………………………………………………………………………

DATE:___________________TYPE

OF MEETING:_____________________________

MEETING

NAME:____________________________LOCATION:_________________

SIGNATURE OF

CHAIR:__________________________________________________

………………………………………………………………………………………………

DATE:___________________TYPE

OF MEETING:_____________________________

MEETING

NAME:____________________________LOCATION:_________________

SIGNATURE OF

CHAIR:__________________________________________________

………………………………………………………………………………………………

DATE:___________________TYPE

OF MEETING:_____________________________

MEETING

NAME:____________________________LOCATION:_________________

SIGNATURE OF

CHAIR:__________________________________________________

………………………………………………………………………………………………

DATE:___________________TYPE

OF MEETING:_____________________________

MEETING

NAME:____________________________LOCATION:_________________

SIGNATURE OF

CHAIR:__________________________________________________

………………………………………………………………………………………………

Meeting List

DATE:___________________TYPE

OF MEETING:_____________________________

MEETING

NAME:____________________________LOCATION:_________________

SIGNATURE OF

CHAIR:__________________________________________________

………………………………………………………………………………………………

DATE:___________________TYPE

OF MEETING:_____________________________

MEETING

NAME:____________________________LOCATION:_________________

SIGNATURE OF

CHAIR:__________________________________________________

………………………………………………………………………………………………

DATE:___________________TYPE

OF MEETING:_____________________________

MEETING

NAME:____________________________LOCATION:_________________

SIGNATURE OF

CHAIR:__________________________________________________

………………………………………………………………………………………………

DATE:___________________TYPE

OF MEETING:_____________________________

MEETING

NAME:____________________________LOCATION:_________________

SIGNATURE OF

CHAIR:__________________________________________________

………………………………………………………………………………………………

DATE:___________________TYPE

OF MEETING:_____________________________

MEETING

NAME:____________________________LOCATION:_________________

SIGNATURE OF

CHAIR:__________________________________________________

………………………………………………………………………………………………

Meeting List

DATE:___________________TYPE

OF MEETING:_____________________________

MEETING

NAME:____________________________LOCATION:_________________

SIGNATURE OF

CHAIR:__________________________________________________

………………………………………………………………………………………………

DATE:___________________TYPE

OF MEETING:_____________________________

MEETING

NAME:____________________________LOCATION:_________________

SIGNATURE OF

CHAIR:__________________________________________________

………………………………………………………………………………………………

Help me help you!

Log on to the Internet,

and fill out this

personalized health inventory.

The information will

remain confidential,

unless you want me to

have access by printing the reports.

http://www.howsyourhealth.org/

Office code: IP0131

You may visit this site

to get health information:

http://trumbullfamilypractice.blogspot.com/

My e-mail

is DrBallester@...,

it is not secure for

confidential, sensitive communication

Answering Service/after

hours phone: ***-***-****

Search YouTube for HBO

“Addiction” and “supplementary series” videos

Feel free to copy, modify or suggest changes for your own practicePedro Ballester, M.D.Warren, OH

[Guest guest]

I just use all the standar Suboxone forms. SO far I do not have need for anything else

To: Sent: Monday, July 6, 2009 1:36:42 PMSubject: Re: Two-Timed

I would encourage anybody interested to get the certification, if you don't get CME it is free!First step is to contact the Beckitt Benckiser rep to get the CD...These are the documents I use in my practice:

Initial Assessment

Name ____________ _________ _________ _____ Date _________

You have come to my office to address a narcotic misuse or abuse problem.

I need to know the extent of your problem in complete detail:

When did you start using narcotics?

Why did you start?

What do you use?

How do you use it?

When was the last time that you used any chemical of abuse?

What happens when you don't use narcotics?

How long does it take to start feeling “sick†(withdrawal) ?

What do you do to get some relief if you cannot get narcotics?

Do you drink alcohol? What do you drink? How much do you drink? 'How often do you drink?

Do you use marihuana? How do you use it? How much do you use? How often do you use marihuana?

Do you use any other chemicals or drugs to get “highâ€, help you “relax†or get you through the day? How do you use it? How much do you use? How often do you use it?

Where do you get the narcotics?

How much do spend a week?

Are you in financial distress because of your narcotic use?

Is anyone helping you financially?

How do you plan to pay for the medication and office visits?

Have you tried to quit before?

What did you try to help you quit?

How many times have you tried?

Why did you fail?

Why do you want to quit?

Do you need to quit?

Is someone forcing you to come here?

Do you have any legal problems? Have you ever been on probation?

My "contract", I ask the patients to initial each line:

Narcotic (Pain Medication) and Anxiety (Nerves) Medication Contract

I am using narcotic pain medications to relieve pain, so I can work or have some quality of life.

I understand that there are side effects, adverse reactions and dependence on narcotics and sedatives,

I will let Dr. Ballester know if I am having any side effects or adverse reactions.

I am not using narcotic medications to get “Highâ€.

I am not sharing or selling my pain medications.

I am not getting any prescriptions for narcotics or sedatives from any other doctors. If I need or use narcotics from other doctors, I will not get any more prescriptions from Dr. Ballester, and the Doctor-Patient relationship is terminated immediately.

I am not using illegal or “street†drugs, I am not abusing over the counter medications.

If I have an “addiction†problem, I will let Dr. Ballester know to be referred to get treatment.

I am not drinking more than 1 glass of wine or 1 beer or 1 “shot†of liquor a day.

If I lose my medications, I will not ask for a refill.

I will keep my medications in a secure, locked location, if my medications are stolen, I will file a report with the Police and will press charges.

I agree to random urine or blood tests that check for prescription and non-prescription medications or “street†drugs in my body, I will pay for these tests if they are not covered by my insurance. If the test shows that the narcotic is not present (negative test), Dr. Ballester will not prescribe anymore the narcotic. If the test shows the presence of drugs without medical applications, the Doctor-Patient relationship will end immediately.

I waive any privacy right with regard to communications with Pharmacists, Doctors, Hospitals, Police, Detectives, Drug Enforcement Agency, State of Ohio Board of Pharmacy.

I understand that Dr. Ballester can check my prescription history in Ohio, if the report from Ohio or any other State shows that I have filled prescriptions for narcotics from other doctors while this contract is in effect, the Doctor-Patient relationship will end immediately.

I will schedule follow-up appointments before I run out of medications, I will not call after hours or during week-ends or Holidays to get refills. If I plan to travel, I will make an appointment to get refills before my trip.

Dr. Pedro A. Ballester has explained the risks and answered all my questions regarding narcotic therapy.

I give this to all the patients in the first visit:

(Narcotics Anonymous meeting list for Trumbull County, OH)

http://portaltools. na.org/portaltoo ls/MeetingLoc/Counseling Resources

www.HereToHelpProgr am.com

www.addictionsurviv ors.org

(local counselors)Meeting List

DATE:_______ _________ ___TYPE OF MEETING:____ _________ _________ _______

MEETING NAME:_______ _________ _________ ___LOCATION: _________ ________

SIGNATURE OF CHAIR:______ _________ _________ _________ _________ ________

………………………………………………………………………………………………

DATE:_______ _________ ___TYPE OF MEETING:____ _________ _________ _______

MEETING NAME:_______ _________ _________ ___LOCATION: _________ ________

SIGNATURE OF CHAIR:______ _________ _________ _________ _________ ________

………………………………………………………………………………………………

DATE:_______ _________ ___TYPE OF MEETING:____ _________ _________ _______

MEETING NAME:_______ _________ _________ ___LOCATION: _________ ________

SIGNATURE OF CHAIR:______ _________ _________ _________ _________ ________

………………………………………………………………………………………………

DATE:_______ _________ ___TYPE OF MEETING:____ _________ _________ _______

MEETING NAME:_______ _________ _________ ___LOCATION: _________ ________

SIGNATURE OF CHAIR:______ _________ _________ _________ _________ ________

………………………………………………………………………………………………

DATE:_______ _________ ___TYPE OF MEETING:____ _________ _________ _______

MEETING NAME:_______ _________ _________ ___LOCATION: _________ ________

SIGNATURE OF CHAIR:______ _________ _________ _________ _________ ________

………………………………………………………………………………………………

Meeting List

DATE:_______ _________ ___TYPE OF MEETING:____ _________ _________ _______

MEETING NAME:_______ _________ _________ ___LOCATION: _________ ________

SIGNATURE OF CHAIR:______ _________ _________ _________ _________ ________

………………………………………………………………………………………………

DATE:_______ _________ ___TYPE OF MEETING:____ _________ _________ _______

MEETING NAME:_______ _________ _________ ___LOCATION: _________ ________

SIGNATURE OF CHAIR:______ _________ _________ _________ _________ ________

………………………………………………………………………………………………

DATE:_______ _________ ___TYPE OF MEETING:____ _________ _________ _______

MEETING NAME:_______ _________ _________ ___LOCATION: _________ ________

SIGNATURE OF CHAIR:______ _________ _________ _________ _________ ________

………………………………………………………………………………………………

DATE:_______ _________ ___TYPE OF MEETING:____ _________ _________ _______

MEETING NAME:_______ _________ _________ ___LOCATION: _________ ________

SIGNATURE OF CHAIR:______ _________ _________ _________ _________ ________

………………………………………………………………………………………………

DATE:_______ _________ ___TYPE OF MEETING:____ _________ _________ _______

MEETING NAME:_______ _________ _________ ___LOCATION: _________ ________

SIGNATURE OF CHAIR:______ _________ _________ _________ _________ ________

………………………………………………………………………………………………

Meeting List

DATE:_______ _________ ___TYPE OF MEETING:____ _________ _________ _______

MEETING NAME:_______ _________ _________ ___LOCATION: _________ ________

SIGNATURE OF CHAIR:______ _________ _________ _________ _________ ________

………………………………………………………………………………………………

DATE:_______ _________ ___TYPE OF MEETING:____ _________ _________ _______

MEETING NAME:_______ _________ _________ ___LOCATION: _________ ________

SIGNATURE OF CHAIR:______ _________ _________ _________ _________ ________

………………………………………………………………………………………………

Help me help you!

Log on to the Internet,

and fill out this personalized health inventory.

The information will remain confidential,

unless you want me to have access by printing the reports.

http://www.howsyour health.org/

Office code: IP0131

You may visit this site to get health information:

http://trumbullfami lypractice. blogspot. com/

My e-mail is DrBallester@ gmail.com,

it is not secure for confidential, sensitive communication

Answering Service/after hours phone: ***-***-****

Search YouTube for HBO “Addiction†and “supplementary series†videos

Feel free to copy, modify or suggest changes for your own practice

Pedro Ballester, M.D.Warren, OH

[Guest guest]

Saw this thing being discussed on 60 mins

http://bjp.rcpsych.org/cgi/content/abstract/194/6/541

Seems very intriguing.

basically naltrexone embedded in a plastic polymer which is inserted

subcut and lasts about 6 months.

--

Graham Chiu

http://www.synapsedirect.com

Synapse - the use from anywhere EMR.

[Guest guest]

Pedro,

Thanks for sharing.

I’ll give you your umbrella back anytimeJ.

sharon

From:

[mailto: ] On Behalf Of Pedro

Ballester

Sent: Monday, July 06, 2009 10:37 AM

To:

Subject: Re: Two-Timed

I would encourage anybody interested to get the

certification, if you don't get CME it is free!

First step is to contact the Beckitt Benckiser rep to get the CD...

These are the documents I use in my practice:

Initial

Assessment

Name

___________________________________ Date _________

You have come to my office to

address a narcotic misuse or abuse problem.

I need to know the extent of

your problem in complete detail:

When did you start using

narcotics?

Why did you start?

What do you use?

How do you use it?

When was the last time that

you used any chemical of abuse?

What happens when you don't

use narcotics?

How long does it take to

start feeling “sick” (withdrawal)?

What do you do to get some

relief if you cannot get narcotics?

Do you drink alcohol? What do

you drink? How much do you drink? 'How often do you drink?

Do you use marihuana? How do

you use it? How much do you use? How often do you use marihuana?

Do you use any other

chemicals or drugs to get “high”, help you “relax” or get you through the day?

How do you use it? How much do you use? How often do you use it?

Where do you get the

narcotics?

How much do spend a week?

Are you in financial distress

because of your narcotic use?

Is anyone helping you

financially?

How do you plan to pay for

the medication and office visits?

Have you tried to quit

before?

What did you try to help you

quit?

How many times have you

tried?

Why did you fail?

Why do you want to quit?

Do you need to quit?

Is someone forcing you to

come here?

Do you have any legal

problems? Have you ever been on probation?

My " contract " , I

ask the patients to initial each line:

Narcotic (Pain Medication) and Anxiety (Nerves) Medication Contract

I am using narcotic pain medications to relieve pain, so I can work or have

some quality of life.

I understand that there are side effects, adverse reactions and dependence

on narcotics and sedatives,

I will let Dr. Ballester know if I am having any side effects or adverse

reactions.

I am not using narcotic medications to get “High”.

I am not sharing or selling my pain medications.

I am not getting any prescriptions for narcotics or sedatives

from any other doctors. If I need or use narcotics from other doctors, I will

not get any more prescriptions from Dr. Ballester, and the Doctor-Patient

relationship is terminated immediately.

I am not using illegal or “street” drugs, I am not

abusing over the counter medications.

If I have an “addiction” problem, I will let Dr. Ballester know to be

referred to get treatment.

I am not drinking more than 1 glass of wine or 1 beer or 1

“shot” of liquor a day.

If I lose my medications, I will not ask for a refill.

I will keep my medications in a secure, locked location, if my medications

are stolen, I will file a report with the Police and will

press charges.

I agree to random urine or blood tests that check for prescription and

non-prescription medications or “street” drugs in my body, I will pay for these

tests if they are not covered by my insurance. If the test shows that the

narcotic is not present (negative test), Dr. Ballester will not prescribe

anymore the narcotic. If the test shows the presence of drugs without medical

applications, the Doctor-Patient relationship will end immediately.

I waive any privacy right with regard to communications with Pharmacists,

Doctors, Hospitals, Police, Detectives, Drug Enforcement Agency, State of Ohio

Board of Pharmacy.

I understand that Dr. Ballester can check my prescription history in Ohio,

if the report from Ohio or any other State shows that I have filled

prescriptions for narcotics from other doctors while this contract is in

effect, the Doctor-Patient relationship will end immediately.

I will schedule follow-up appointments before I run out of medications, I

will not call after hours or during week-ends or Holidays to get refills. If I

plan to travel, I will make an appointment to get refills before my trip.

Dr. Pedro A. Ballester has explained the risks and answered all my questions

regarding narcotic therapy.

I give this to all the patients in the first visit:

(Narcotics Anonymous meeting list for Trumbull County, OH)

http://portaltools.na.org/portaltools/MeetingLoc/

Counseling Resources

www.HereToHelpProgram.com

www.addictionsurvivors.org

(local counselors)

Meeting List

DATE:___________________TYPE OF MEETING:_____________________________

MEETING NAME:____________________________LOCATION:_________________

SIGNATURE OF CHAIR:__________________________________________________

………………………………………………………………………………………………

DATE:___________________TYPE OF MEETING:_____________________________

MEETING NAME:____________________________LOCATION:_________________

SIGNATURE OF CHAIR:__________________________________________________

………………………………………………………………………………………………

DATE:___________________TYPE OF MEETING:_____________________________

MEETING NAME:____________________________LOCATION:_________________

SIGNATURE OF CHAIR:__________________________________________________

………………………………………………………………………………………………

DATE:___________________TYPE OF MEETING:_____________________________

MEETING NAME:____________________________LOCATION:_________________

SIGNATURE OF CHAIR:__________________________________________________

………………………………………………………………………………………………

DATE:___________________TYPE OF MEETING:_____________________________

MEETING NAME:____________________________LOCATION:_________________

SIGNATURE OF CHAIR:__________________________________________________

………………………………………………………………………………………………

Meeting List

DATE:___________________TYPE OF MEETING:_____________________________

MEETING NAME:____________________________LOCATION:_________________

SIGNATURE OF CHAIR:__________________________________________________

………………………………………………………………………………………………

DATE:___________________TYPE OF MEETING:_____________________________

MEETING NAME:____________________________LOCATION:_________________

SIGNATURE OF CHAIR:__________________________________________________

………………………………………………………………………………………………

DATE:___________________TYPE OF MEETING:_____________________________

MEETING NAME:____________________________LOCATION:_________________

SIGNATURE OF CHAIR:__________________________________________________

………………………………………………………………………………………………

DATE:___________________TYPE OF MEETING:_____________________________

MEETING NAME:____________________________LOCATION:_________________

SIGNATURE OF CHAIR:__________________________________________________

………………………………………………………………………………………………

DATE:___________________TYPE OF MEETING:_____________________________

MEETING NAME:____________________________LOCATION:_________________

SIGNATURE OF CHAIR:__________________________________________________

………………………………………………………………………………………………

Meeting List

DATE:___________________TYPE OF MEETING:_____________________________

MEETING NAME:____________________________LOCATION:_________________

SIGNATURE OF CHAIR:__________________________________________________

………………………………………………………………………………………………

DATE:___________________TYPE OF MEETING:_____________________________

MEETING NAME:____________________________LOCATION:_________________

SIGNATURE OF CHAIR:__________________________________________________

………………………………………………………………………………………………

Help me help you!

Log on to the Internet,

and fill out this personalized health

inventory.

The information will remain confidential,

unless you want me to have access by printing

the reports.

http://www.howsyourhealth.org/

Office code: IP0131

You may visit this site to get health

information:

http://trumbullfamilypractice.blogspot.com/

My e-mail is DrBallester@...,

it is not secure for confidential, sensitive

communication

Answering Service/after hours phone:

***-***-****

Search YouTube for HBO “Addiction” and

“supplementary series” videos

Feel free to copy, modify or suggest changes for your own

practice

Pedro Ballester, M.D.

Warren, OH

[Guest guest]

I forgot to add the 12 steps, I ask the patient how spiritual/religious they are and hand them one of the 3 versions, traditional AA, generic spiritual, or secular Humanist(atheist).Some of my little success cases owe everything to getting involved with their Church; one patient was a little put off with the traditional 12 steps, others participate in lame church programs that don't even follow the 12 steps.

The last patient patient I just dismissed could not make the appointment because he was in jail for stealing and his family decided not to bail him out... There were some warning signs, he had at least one relapse, oxycodone was detected in the second urine toxicology test. His case made me wonder about the effectiveness of the NA program, he was the chairman of at least 2 NA meeting groups!

I also find myself practicing regular medicine among my addiction patients, 2 of my Suboxone patients suffer from hepatitis C, one came from another doctor that lost his license and had ignored the test results for at least the previous year.

There is a lot of prejudice among Physicians, my sister is a Rheumatologist and asked me: Do you really want to have those patients in your practice? My experience thus far is that you can never tell who may have a substance abuse problem until they come asking for help...

Pedro Ballester, M.D.Warren, OH