Re: Suboxone - any problems? -- treatment of opioid dependence in an office-based setting

[Guest guest]

It's a good medication. But it can be abused like everything else. I am doing only a couple patients since moving to private practice. I've always had the addiction specialists start it and get it to a stable level then I'll write it. But others on the list do seem to be doing the adjustments too. Some state it's a good money maker as it's cash. I've always had disabled patients and so have never had cash paying patients on it. I've been duped with this as much as others when at the community health center. But boy when it works! It works! The couple who have followed me from the health center are turning their lives around because of it! When I recently tried ot get a patient off Duragesic Patch and onto Suboxone the detox team at the hospital admitted and

monitored and did the intial adjustments. I do find these folks often are more needy than others but I'm coming from a impoverished patient population. IMHO

To: ; Clinical Procedures Sent: Thu, April 1, 2010 4:12:53 PMSubject: Suboxone - any problems? -- treatment of opioid dependence in an office-based setting

Anyone prescribing Suboxone for their patients – or are you referring to addiction/pain specialists for this Rx?

Seems like it should be reasonable to prescribe in the office, but wasn’t sure what everyone’s experiences have been – pro’s, con’s.

Here is a link to find a prescriber in your area…

http://heretohelppr ogram.com/ treatment/ doctor_results. aspx?zipcode= 81621 & radius=100

And info below about what it does

Locke

============ ========= ========= ========= ========

http://www.suboxone.com/

SUBOXONE is the first opioid medication approved under DATA 2000 for the treatment of opioid dependence in an office-based setting. SUBOXONE also can be dispensed for take-home use, just as any other medicine for other medical conditions.

The primary active ingredient in SUBOXONE is buprenorphine.

Because buprenorphine is a partial opioid agonist, its opioid effects are limited compared with those produced by full opioid agonists, such as oxycodone or heroin. SUBOXONE also contains naloxone, an opioid antagonist.

The naloxone in SUBOXONE is there to discourage people from dissolving the tablet and injecting it. When SUBOXONE is placed under the tongue, as directed, very little naloxone reaches the bloodstream, so what the patient feels are the effects of the buprenorphine. However, if naloxone is injected, it can cause a person dependent on a full opioid agonist to quickly go into withdrawal.

SUBOXONE at the appropriate dose may be used to:

Reduce illicit opioid use

Help patients stay in treatment

by

Suppressing symptoms of opioid withdrawal

Decreasing cravings for opioids

============ ========= ========= ========= =========

Locke, MD

[Guest guest]

The hardest part is the carriers (any suprise there???) not wanting to panel primaries in doing the therapy. And then we have some who want to pay us only regular office visit E & M's for those first 3 special induction visits that are supposed to be part of the incentive to do this stuff because at least those visits pay twice as much as normal est 99214's and the like. Also I have heard that the ability to bill for the separate drug screens per class on let's say a 10 class test is now going to be reduced to just one code for the entire panel of tests, another sort of way of getting paid better bucks for the secondary part of the treatment by piss testing them at every visit to try and make sure they are staying clean. And those multi substance, class urine tests are not cheap either, and then to

start getting jipped on those as well starts to get to be a bit too much....

But in a cash only practice that can charge and code, and get paid as they see fit, it certainly could be a good income suppliment which is part of our possible strategy for escaping the tightening clutches of the insurance racket... That's the basics... Make sure the carriers will properly pay an FP to do this as we have run into a number who won't or they will only pay an FP the standard codes and not the special codes. Heck UHC would not even get of the phone or communicate with us in ANY way about this, it was as though we almost were not there.... we had half a dozen patients of their ready and willing to get well and we could not get a single phone call or any other communication going with them. I guess that is another way to ration care and payment for care by never having provider relations even have an intelligent discussion with your doctor's office so they can't even start such a great, and life changing, perhaps even life saving

therapy. What BS.....

To: ; Clinical Procedures Sent: Thu, April 1, 2010 4:12:53 PMSubject: Suboxone - any problems? -- treatment of opioid dependence in an office-based setting

Anyone prescribing Suboxone for their patients – or are you referring to addiction/pain specialists for this Rx?

Seems like it should be reasonable to prescribe in the office, but wasn’t sure what everyone’s experiences have been – pro’s, con’s.

Here is a link to find a prescriber in your area…

http://heretohelppr ogram.com/ treatment/ doctor_results. aspx?zipcode= 81621 & radius=100

And info below about what it does

Locke

============ ========= ========= ========= ========

http://www.suboxone.com/

SUBOXONE is the first opioid medication approved under DATA 2000 for the treatment of opioid dependence in an office-based setting. SUBOXONE also can be dispensed for take-home use, just as any other medicine for other medical conditions.

The primary active ingredient in SUBOXONE is buprenorphine.

Because buprenorphine is a partial opioid agonist, its opioid effects are limited compared with those produced by full opioid agonists, such as oxycodone or heroin. SUBOXONE also contains naloxone, an opioid antagonist.

The naloxone in SUBOXONE is there to discourage people from dissolving the tablet and injecting it. When SUBOXONE is placed under the tongue, as directed, very little naloxone reaches the bloodstream, so what the patient feels are the effects of the buprenorphine. However, if naloxone is injected, it can cause a person dependent on a full opioid agonist to quickly go into withdrawal.

SUBOXONE at the appropriate dose may be used to:

Reduce illicit opioid use

Help patients stay in treatment

by

Suppressing symptoms of opioid withdrawal

Decreasing cravings for opioids

============ ========= ========= ========= =========

Locke, MD

[Guest guest]

You need to complete a 8 hour CME course, free if you don't get the CME credits.Then you apply for the special DEA " X " number, in the next 12 months you can enroll up to 30 patients, after exactly 12 months, they will allow up to 100 patients.

Browse:http://www.asam.org/http://buprenorphine.samhsa.gov/http://www.suboxone.com/

your local rep will gladly provide you with a CD-ROM, contacts with a mentorhttp://heretohelpprogram.com/Any Family Physician can learn the process, you don't need to refer to anybody else unless, you don't have you DEA " X " number, or you have filled your quota.

I would advise against prescribing buprenorphine for pain management without the DEA waiver, there will be DEA office inspections of all buprenorphine prescribers, many Physicians have lost their license when they abused the system (100 opioid dependent patients and several more " pain management " )

I have posted my office forms in the past, let me know if you need another copy Pedro Ballester, M.D.Warren, OH

[Guest guest]

You have received

a secure message from MaineGeneral Health

Read your secure

message by opening the attachment, securedoc.html. You will be prompted to open (view) the

file or save (download) it to your computer. For best results, save the

file first, then open it in a Web browser. To access from a mobile device,

forward this message to mobile@... to receive a mobile login URL.

If you have concerns about the validity of this message, contact the sender

directly.

First time users - will need to register

after opening the attachment.

Help -

https://res.cisco.com/websafe/help?topic=RegEnvelope

About Cisco

Registered Email Service - https://res.cisco.com/websafe/about

1 of 1 File(s)

securedoc._html

[Guest guest]

,

You are aware that you have to complete the DEA & FDA

mandated suboxone training before you can prescribe it right?  We have had 4

practices near hear recently raided after the pharmacy reported the doctors for

writing the scripts without verification of the training.  The SAMHSA  web site

has the information about the requirements for legally being able to prescribe

suboxone.  2 of the practices have been hit with 6 digit fines for the illegal

management of a class 2 controlled substance.  1 practice has already closed

and the other one is in limbo.  These doctors were not writing excessive

scripts and had adequate documentation but since the doctors didn’t complete

the mandated training on the drug, they are being persecuted.  On top of the

feds coming down on them, a wonderful lawyer is trying to sue all 4 doctors for

malpractice and is seeking 5x the fees paid by the suboxone patients plus a

ridiculous amount for pain & suffering.  Just a word to the wise.

Information on the Federal requirements to prescribe suboxone

can be found at the following website: http://www.suboxone.com/hcp/certification/

http://www.suboxone.com/hcp/certification/qualifications.aspx 

lists all of the qualifications and limitations imposed on doctors wanting to

prescribe suboxone for opioid addiction.

http://www2.aaap.org/buprenorphine 

or   http://www.buppractice.com/ 

detail the information about the available online based training that will

satisfy the   SAMHSA Data 2000 training requirements.

I just thought I would provide the information in case you or

anyone else on the list might be interested in providing this type treatment in

your offices.  One other thing you should know is that the feds are also

looking at putting price controls on treatment services to prevent price

gouging behaviors by doctors offering suboxone management.

Beth Sullivan, DO

Ridgeway Family Practice

Commerce, GA  30529

From:

[mailto: ] On Behalf Of

Bleiweiss

Sent: Thursday, April 01, 2010 5:47 PM

To:

Subject: Re: Suboxone - any problems? --

treatment of opioid dependence in an office-based setting

The hardest

part is the carriers (any suprise there???) not wanting to panel primaries in

doing the therapy. And then we have some who want to pay us only regular office

visit E & M's for those first 3 special induction visits that are supposed to

be part of the incentive to do this stuff because at least those visits pay

twice as much as normal est 99214's and the like. Also I have heard that the

ability to bill for the separate drug screens per class on let's say a 10 class

test is now going to be reduced to just one code for the entire panel of tests,

another sort of way of getting paid better bucks for the secondary part of the

treatment by piss testing them at every visit to try and make sure they are

staying clean. And those multi substance, class urine tests are not cheap

either, and then to start getting jipped on those as well starts to get to be a

bit too much....

But in a cash

only practice that can charge and code, and get paid as they see fit, it

certainly could be a good income suppliment which is part of our possible

strategy for escaping the tightening clutches of the insurance racket... That's

the basics... Make sure the carriers will properly pay an FP to do this as we

have run into a number who won't or they will only pay an FP the standard codes

and not the special codes. Heck UHC would not even get of the phone or

communicate with us in ANY way about this, it was as though we almost were not

there.... we had half a dozen patients of their ready and willing to get well

and we could not get a single phone call or any other communication going with

them. I guess that is another way to ration care and payment for care by never

having provider relations even have an intelligent discussion with your

doctor's office so they can't even start such a great, and life changing,

perhaps even life saving therapy. What BS.....

From: " Locke,

MD "

To: ; Clinical Procedures

Sent: Thu, April 1, 2010 4:12:53 PM

Subject: Suboxone - any problems? -- treatment of

opioid dependence in an office-based setting

Anyone

prescribing Suboxone for their patients – or are you referring to

addiction/pain specialists for this Rx?

Seems

like it should be reasonable to prescribe in the office, but wasn’t sure what

everyone’s experiences have been – pro’s, con’s.

Here

is a link to find a prescriber in your area…

http://heretohelppr ogram.com/ treatment/ doctor_results.

aspx?zipcode= 81621 & radius=100

And

info below about what it does

Locke

============

========= ========= ========= ========

http://www.suboxone.com/

SUBOXONE is the first opioid medication approved under DATA 2000 for the

treatment of opioid dependence in an office-based setting. SUBOXONE also can be

dispensed for take-home use, just as any other medicine for other medical

conditions.

The primary active ingredient in SUBOXONE is buprenorphine.

Because buprenorphine is a partial opioid agonist, its opioid effects are limited

compared with those produced by full opioid agonists, such as oxycodone or heroin. SUBOXONE

also contains naloxone, an opioid antagonist.

The naloxone in SUBOXONE is there to discourage people from dissolving the

tablet and injecting it. When SUBOXONE is placed under the tongue, as directed,

very little naloxone reaches the bloodstream, so what the patient feels are the

effects of the buprenorphine. However, if naloxone is injected, it can cause a

person dependent on a full opioid agonist to quickly go into withdrawal.

SUBOXONE

at the appropriate dose may be used to:

Reduce illicit opioid use

Help patients stay in treatment

by

Suppressing symptoms of opioid withdrawal

Decreasing cravings for opioids

============

========= ========= ========= =========

Locke, MD

[Guest guest]

Myira,

 

Did you have to jump through hoops to be approved to Rx the Suboxone?

 

I got the impression you had to be on the Suboxone registry and send in paperwork and put an ID # on the Rx of Suboxone, etc.

 

Yes?

 

Thanks

 

Locke, MD

 

It's a good medication. But it can be abused like everything else. I am doing only a couple patients since moving to private practice.  I've always had the addiction specialists start it and get it to a stable level then I'll write it.  But others on the list do seem to be doing the adjustments too. Some state it's a good money maker as it's cash. I've always had disabled patients and so have never had cash paying patients on it.  I've been duped with this as much as others when at the community health center.  But boy when it works! It works! The couple who have followed me from the health center are turning their lives around because of it!  When I recently tried ot get a patient off Duragesic Patch and onto Suboxone the detox team at the hospital admitted and monitored and did the intial adjustments. I do find these folks often are more needy than others but I'm coming from a impoverished patient population. IMHO

To: ; Clinical Procedures

Sent: Thu, April 1, 2010 4:12:53 PMSubject: Suboxone - any problems? -- treatment of opioid dependence in an office-based setting

 

Anyone prescribing Suboxone for their patients – or are you referring to addiction/pain specialists for this Rx?

 

Seems like it should be reasonable to prescribe in the office, but wasn’t sure what everyone’s experiences have been – pro’s, con’s.

 

Here is a link to find a prescriber in your area…

 

     http://heretohelppr ogram.com/ treatment/ doctor_results. aspx?zipcode= 81621 & radius=100

 

And info below about what it does

 

 

Locke

============ ========= ========= ========= ========

 

http://www.suboxone.com/

 

SUBOXONE is the first opioid medication approved under DATA 2000 for the treatment of opioid dependence in an office-based setting. SUBOXONE also can be dispensed for take-home use, just as any other medicine for other medical conditions.

The primary active ingredient in SUBOXONE is buprenorphine.

Because buprenorphine is a partial opioid agonist, its opioid effects are limited compared with those produced by full opioid agonists, such as oxycodone or heroin. SUBOXONE also contains naloxone, an opioid antagonist.

The naloxone in SUBOXONE is there to discourage people from dissolving the tablet and injecting it. When SUBOXONE is placed under the tongue, as directed, very little naloxone reaches the bloodstream, so what the patient feels are the effects of the buprenorphine. However, if naloxone is injected, it can cause a person dependent on a full opioid agonist to quickly go into withdrawal.

SUBOXONE at the appropriate dose may be used to:

Reduce illicit opioid use

Help patients stay in treatment

by

Suppressing symptoms of opioid withdrawal

Decreasing cravings for opioids

============ ========= ========= ========= =========

 

Locke, MD

[Guest guest]

Thanks, Beth.

 

I was more interested in others experiences and not so much doing it myself.

 

My wife had a patient asking about it and she was searching around the area for options to refer to -- but not much available.

 

Patient says (uncorroborated) that the local pain specialist (an anesthesiologist) wanted $700 for the first visit. This isn't confirmed, but he is either jacking the price to only get patients that really, really want to do the program or as a profit center -- or both.

 

Thanks for the info.

 

Locke, MD

 

,

 

You are aware that you have to complete the DEA & FDA mandated suboxone training before you can prescribe it right?  We have had 4 practices near hear recently raided after the pharmacy reported the doctors for writing the scripts without verification of the training.  The SAMHSA  web site has the information about the requirements for legally being able to prescribe suboxone.  2 of the practices have been hit with 6 digit fines for the illegal management of a class 2 controlled substance.  1 practice has already closed and the other one is in limbo.  These doctors were not writing excessive scripts and had adequate documentation but since the doctors didn’t complete the mandated training on the drug, they are being persecuted.  On top of the feds coming down on them, a wonderful lawyer is trying to sue all 4 doctors for malpractice and is seeking 5x the fees paid by the suboxone patients plus a ridiculous amount for pain & suffering.  Just a word to the wise.

 

Information on the Federal requirements to prescribe suboxone can be found at the following website: http://www.suboxone.com/hcp/certification/

 

http://www.suboxone.com/hcp/certification/qualifications.aspx  lists all of the qualifications and limitations imposed on doctors wanting to prescribe suboxone for opioid addiction.

 

http://www2.aaap.org/buprenorphine  or   http://www.buppractice.com/  detail the information about the available online based training that will satisfy the   SAMHSA Data 2000 training requirements.

 

I just thought I would provide the information in case you or anyone else on the list might be interested in providing this type treatment in your offices.  One other thing you should know is that the feds are also looking at putting price controls on treatment services to prevent price gouging behaviors by doctors offering suboxone management.

 

Beth Sullivan, DO

Ridgeway Family Practice

Commerce, GA  30529

 

From: [mailto: ] On Behalf Of Bleiweiss

Sent: Thursday, April 01, 2010 5:47 PMTo: Subject: Re: Suboxone - any problems? -- treatment of opioid dependence in an office-based setting

 

 

The hardest part is the carriers (any suprise there???) not wanting to panel primaries in doing the therapy. And then we have some who want to pay us only regular office visit E & M's for those first 3 special induction visits that are supposed to be part of the incentive to do this stuff because at least those visits pay twice as much as normal est 99214's and the like. Also I have heard that the ability to bill for the separate drug screens per class on let's say a 10 class test is now going to be reduced to just one code for the entire panel of tests, another sort of way of getting paid better bucks for the secondary part of the treatment by piss testing them at every visit to try and make sure they are staying clean. And those multi substance, class urine tests are not cheap either, and then to start getting jipped on those as well starts to get to be a bit too much....

 

But in a cash only practice that can charge and code, and get paid as they see fit, it certainly could be a good income suppliment which is part of our possible strategy for escaping the tightening clutches of the insurance racket... That's the basics... Make sure the carriers will properly pay an FP to do this as we have run into a number who won't or they will only pay an FP the standard codes and not the special codes. Heck UHC would not even get of the phone or communicate with us in ANY way about this, it was as though we almost were not there.... we had half a dozen patients of their ready and willing to get well and we could not get a single phone call or any other communication going with them. I guess that is another way to ration care and payment for care by never having provider relations even have an intelligent discussion with your doctor's office so they can't even start such a great, and life changing, perhaps even life saving therapy. What BS.....

 

 

To: ; Clinical Procedures

Sent: Thu, April 1, 2010 4:12:53 PMSubject: Suboxone - any problems? -- treatment of opioid dependence in an office-based setting 

Anyone prescribing Suboxone for their patients – or are you referring to addiction/pain specialists for this Rx?

 

Seems like it should be reasonable to prescribe in the office, but wasn’t sure what everyone’s experiences have been – pro’s, con’s.

 

Here is a link to find a prescriber in your area…

 

     http://heretohelppr ogram.com/ treatment/ doctor_results. aspx?zipcode= 81621 & radius=100

 

And info below about what it does

 

 

Locke

============ ========= ========= ========= ========

 

http://www.suboxone.com/

 

SUBOXONE is the first opioid medication approved under DATA 2000 for the treatment of opioid dependence in an office-based setting. SUBOXONE also can be dispensed for take-home use, just as any other medicine for other medical conditions.

The primary active ingredient in SUBOXONE is buprenorphine.

Because buprenorphine is a partial opioid agonist, its opioid effects are limited compared with those produced by full opioid agonists, such as oxycodone or heroin. SUBOXONE also contains naloxone, an opioid antagonist.

The naloxone in SUBOXONE is there to discourage people from dissolving the tablet and injecting it. When SUBOXONE is placed under the tongue, as directed, very little naloxone reaches the bloodstream, so what the patient feels are the effects of the buprenorphine. However, if naloxone is injected, it can cause a person dependent on a full opioid agonist to quickly go into withdrawal.

SUBOXONE at the appropriate dose may be used to:

Reduce illicit opioid use

Help patients stay in treatment

by

Suppressing symptoms of opioid withdrawal

Decreasing cravings for opioids

============ ========= ========= ========= =========

 

Locke, MD

 

[Guest guest]

Cancel the below -- I've answered it myself - plus the comments from everyone else.

 

Thanks

 

kelly

Myira,

 

Did you have to jump through hoops to be approved to Rx the Suboxone?

 

I got the impression you had to be on the Suboxone registry and send in paperwork and put an ID # on the Rx of Suboxone, etc.

 

Yes?

 

Thanks

 

Locke, MD

 

It's a good medication. But it can be abused like everything else. I am doing only a couple patients since moving to private practice.  I've always had the addiction specialists start it and get it to a stable level then I'll write it.  But others on the list do seem to be doing the adjustments too. Some state it's a good money maker as it's cash. I've always had disabled patients and so have never had cash paying patients on it.  I've been duped with this as much as others when at the community health center.  But boy when it works! It works! The couple who have followed me from the health center are turning their lives around because of it!  When I recently tried ot get a patient off Duragesic Patch and onto Suboxone the detox team at the hospital admitted and monitored and did the intial adjustments. I do find these folks often are more needy than others but I'm coming from a impoverished patient population. IMHO

To: ; Clinical Procedures

Sent: Thu, April 1, 2010 4:12:53 PMSubject: Suboxone - any problems? -- treatment of opioid dependence in an office-based setting

 

Anyone prescribing Suboxone for their patients – or are you referring to addiction/pain specialists for this Rx?

 

Seems like it should be reasonable to prescribe in the office, but wasn’t sure what everyone’s experiences have been – pro’s, con’s.

 

Here is a link to find a prescriber in your area…

 

     http://heretohelppr ogram.com/ treatment/ doctor_results. aspx?zipcode= 81621 & radius=100

 

And info below about what it does

 

 

Locke

============ ========= ========= ========= ========

 

http://www.suboxone.com/

 

SUBOXONE is the first opioid medication approved under DATA 2000 for the treatment of opioid dependence in an office-based setting. SUBOXONE also can be dispensed for take-home use, just as any other medicine for other medical conditions.

The primary active ingredient in SUBOXONE is buprenorphine.

Because buprenorphine is a partial opioid agonist, its opioid effects are limited compared with those produced by full opioid agonists, such as oxycodone or heroin. SUBOXONE also contains naloxone, an opioid antagonist.

The naloxone in SUBOXONE is there to discourage people from dissolving the tablet and injecting it. When SUBOXONE is placed under the tongue, as directed, very little naloxone reaches the bloodstream, so what the patient feels are the effects of the buprenorphine. However, if naloxone is injected, it can cause a person dependent on a full opioid agonist to quickly go into withdrawal.

SUBOXONE at the appropriate dose may be used to:

Reduce illicit opioid use

Help patients stay in treatment

by

Suppressing symptoms of opioid withdrawal

Decreasing cravings for opioids

============ ========= ========= ========= =========

 

Locke, MD

[Guest guest]

I am a strong proponent of Suboxone (and I’m not even

paid by the manufacturer!)

I started prescribing in 2004 when a patient asked me to get

the education/license so he didn’t have to take a 12 hr train ride across

the state of MT to get the Rx. Since then, I have “accumulated” 37

Suboxone patients. 33 of them are doing well but the other 4 are sure PIA’s

(pain in A**).

Currently in MT there are only 3 physicians in the whole

state listed on the Suboxone web site that are taking new patients: myself

($200 initial appt), a doc in Bozeman ($350/initial

appt) and one in Missoula (may have reached his cap of 30 by

now). The prescriber just over the state line in ND as of yesterday is no

longer going to prescribe it because his nurses don’t like dealing with “that”

clientele. That means there are approx. 45 patients now looking for a new

Suboxone prescriber.

I haven’t decided how many of those I will likely take

on, since it is hard to tell initially who will be a PIA and who will be

compliant with counselling, UDS, pill counts, etc.

The medication works though; it keeps people out of jail and

on the job……if any one is interested in my Powerpoint presentation

I make for probation and parole locally, e-mail me off list. jmutt@...

Mutt

[Guest guest]

I thought the cap went up to 60?

To: Sent: Fri, April 2, 2010 4:43:36 PMSubject: RE: Suboxone - any problems? -- treatment of opioid dependence in an office-based setting

I am a strong proponent of Suboxone (and I’m not even paid by the manufacturer! )

I started prescribing in 2004 when a patient asked me to get the education/license so he didn’t have to take a 12 hr train ride across the state of MT to get the Rx. Since then, I have “accumulated†37 Suboxone patients. 33 of them are doing well but the other 4 are sure PIA’s (pain in A**).

Currently in MT there are only 3 physicians in the whole state listed on the Suboxone web site that are taking new patients: myself ($200 initial appt), a doc in Bozeman ($350/initial appt) and one in Missoula (may have reached his cap of 30 by now). The prescriber just over the state line in ND as of yesterday is no longer going to prescribe it because his nurses don’t like dealing with “that†clientele. That means there are approx. 45 patients now looking for a new Suboxone

prescriber.

I haven’t decided how many of those I will likely take on, since it is hard to tell initially who will be a PIA and who will be compliant with counselling, UDS, pill counts, etc.

The medication works though; it keeps people out of jail and on the job……if any one is interested in my Powerpoint presentation I make for probation and parole locally, e-mail me off list. jmuttmidrivers (DOT) com

Mutt

[Guest guest]

The current limit is 100Pedro Ballester, M.D.Warren, OH

[Guest guest]

You can only have 30 for the first year

and then have to apply to the DEA to increase the limit to 100. The increase

is nearly automatic once you apply.

[Guest guest]

The increase is not automatic, you have to call SAMHSA to increase the number:The Notification of Intent must contain information on the physician’s qualifying credentials (as defined below)

and additional certifications including that the physician has the capacity to refer such addiction therapy patients for appropriate counseling and other non-pharmacologic therapies, and that the physician

will not have more than 30 patients on such addiction therapy at any one time for the first year.

(Note: The 30-patient limit is not affected by the number of a physician’s practice locations. One year after the date on which the physician submitted the initial notification, the physician will be able

to submit a second notification stating the need and intent to treat up

to 100 patients.)http://buprenorphine.samhsa.gov/waiver_qualifications.html Pedro Ballester, M.D.

Warren, OH