A webinar series offered by the American Psychiatric Association as part of the CSAT-Funded Physicians Clinical Support System-Buprenorphine (PCSS-B). This webinar on September 13, 2011 will be presented by Dr. George Kolodner. As the use of buprenorphine has increased, a variety of new problems have confronted prescribing physicians. In this webinar, Dr. George Kolodner will describe approaches to address some of the more common problems.
Click here for more information. Register at https://www2.gotomeeting.com/register/979392002
Monthly Archives: August 2011
Combined liquid chromatography-coulometric detection and microextraction by packed sorbent for the plasma analysis of long acting opioids in heroin addicted patients.
Authors: Somaini L, Saracino MA, Marcheselli C, Zanchini S, Gerra G, Raggi MA
Abstract
The sublingual combination of buprenorphine and naloxone (Suboxone(®)) and Methadone Maintenance Therapy have been found effective in treating heroin addiction. A new analytical method suitable for the simultaneous determination of buprenorphine, norbuprenorphine, methadone and naloxone in human plasma by means of liquid chromatography with coulometric detection has been developed. The chromatographic separation was achieved with a phosphate buffer-acetonitrile mixture as the mobile phase on a cyano column. The monitoring cell of the coulometric detector was set at an oxidation potential of +0.600V. A rapid clean-up procedure of the biological samples using a microextraction by packed sorbent te…
MedWorm Sponsor Message: Directory of the best January Sales in the UK. Find the best Christmas presents too.
Combined liquid chromatography-coulometric detection and microextraction by packed sorbent for the plasma analysis of long acting opioids in heroin addicted patients.
Authors: Somaini L, Saracino MA, Marcheselli C, Zanchini S, Gerra G, Raggi MA
Abstract
The sublingual combination of buprenorphine and naloxone (Suboxone(®)) and Methadone Maintenance Therapy have been found effective in treating heroin addiction. A new analytical method suitable for the simultaneous determination of buprenorphine, norbuprenorphine, methadone and naloxone in human plasma by means of liquid chromatography with coulometric detection has been developed. The chromatographic separation was achieved with a phosphate buffer-acetonitrile mixture as the mobile phase on a cyano column. The monitoring cell of the coulometric detector was set at an oxidation potential of +0.600V. A rapid clean-up procedure of the biological samples using a microextraction by packed sorbent te…
Combined liquid chromatography-coulometric detection and microextraction by packed sorbent for the plasma analysis of long acting opioids in heroin addicted patients.
Authors: Somaini L, Saracino MA, Marcheselli C, Zanchini S, Gerra G, Raggi MA
Abstract
The sublingual combination of buprenorphine and naloxone (Suboxone(®)) and Methadone Maintenance Therapy have been found effective in treating heroin addiction. A new analytical method suitable for the simultaneous determination of buprenorphine, norbuprenorphine, methadone and naloxone in human plasma by means of liquid chromatography with coulometric detection has been developed. The chromatographic separation was achieved with a phosphate buffer-acetonitrile mixture as the mobile phase on a cyano column. The monitoring cell of the coulometric detector was set at an oxidation potential of +0.600V. A rapid clean-up procedure of the biological samples using a microextraction by packed sorbent te…
Short-term safety of buprenorphine/naloxone in HIV-seronegative opioid-dependent Chinese and Thai drug injectors enrolled in HIV Prevention Trials Network 058
Conclusions: In Chinese and Thai opioid-dependent injectors, we found BUP/NX to be effective in reducing opioid withdrawal symptoms and safe during short-term use. ALT increases were observed over 4-week-follow-up, which are consistent with reports from Western populations. Long-term safety and efficacy evaluations are indicated. (Source: International Journal of Drug Policy)
Short-term safety of buprenorphine/naloxone in HIV-seronegative opioid-dependent Chinese and Thai drug injectors enrolled in HIV Prevention Trials Network 058
Conclusions: In Chinese and Thai opioid-dependent injectors, we found BUP/NX to be effective in reducing opioid withdrawal symptoms and safe during short-term use. ALT increases were observed over 4-week-follow-up, which are consistent with reports from Western populations. Long-term safety and efficacy evaluations are indicated. (Source: International Journal of Drug Policy)
Psychiatric Assessment For Methadone Addiction : Why Come Prepared? Part 1
Psychiatric Assessment : Addiction, Methadone, and Suboxone Treatment
If you are thinking about finding out about addiction, methadone treatment, or suboxone treatment, this is what you need to know for the psychiatric assessment . When you visit your doctor, your psychiatric assessment will take between one and two hours. The better you prepare before a visit with your doctor, the better the results.
Be honest during the interview. I understand people lying to their doctor and I actually expect it to happen. The psychiatric assessment for addiction covers sensitive topics. You should know the law has more strict rules for patient confidentiality and medical record release. There are financial consequences for breaking confidentiality and mental health staff are aware. I ask my patients to tell me if they do not want to discuss a topic rather than lying to me. Dishonesty can lead to an incorrect diagnosis and treatment, wasted sessions, and higher cost.
If only physicians could ask all the questions during a psychiatric assessment… We all know that physicians are limited in time seeing patients. For many patients, this means only the most pressing parts of the psychiatric assessment are covered and many questions are simply skipped. A complete psychatric assessment could take three hours. I’ve found that 1 ½ hours with a prepared patient is enough time. Anything under 60 minutes, and questions will be skipped. There is just too much information. This is where you can help with some preparation. By reviewing a psychiatric assessment before seeing your MD, you can help address important topics and avoid them from being overlooked.
Psychiatric Assessment : The Most Important Part
An accurate time history of your drug use and addiction along with other symptoms is the most important item of a psychiatric assessment . Doctors call it a good history. A clear history is worth it’s weight in gold. The diagnosis becomes clear. I’ve found most patients do not give a good history without enough time and questioning. When the time runs short, the doctor will have to ask more questions and cut off the patient from talking. After a while the patient becomes upset and feels the physician doesn’t care. If the physician lets the patient continue talking without limits, they will not get all the information.
You can help by thinking about the history of the problem prior to going to the psychiatric assessment. I always ask these questions to the patients I see. You would be surprised that patients really need to concentrate to answer the many questions. Asking these questions to help prepare you:
- When did the problem start?
- When was the last time you were doing well?
- What problems and symptoms came first?
- What sequence did they come next?
- What made the symptoms better or worse?
Psychiatric Assessment : Setting Goals
When patients go to the doctor, many just “want to feel better.” One needs to be more specific with what they mean by “getting better.” It could mean not feeling depressed. It could mean being able to hold down a job. How about not yelling at their children? It is important to define goals important to you before seeing the doctor.
Once you decide what YOU want to see improved, you will be more likely to benefit from treatment. Some say what their physician wants is not what they want. Be very specific about your goals of treatment. Tell your physician what you want and look at the goals in few weeks. You can always make more goals or change them.
After the initial psychiatric assessment you don’t want to end up in the position with your doctor saying you are doing better and that you disagreeing with this. Set goals and measure them. Here are a some examples of specific assessment goals.
- I will rested in the morning at least 5 days per week by the end of the month.
- I will not have suicidal thoughts for two days.
- I will not cut on myself for the next for 5 days
- I will not use any alcohol in the next 30 days.
- I will keep my current job for 6 more months
- When I feel the urge to fight with someone, I will walk away from the argument and call my sponsor.
These goals can be measured. They will be clear to all when achieved. Setting goals is not complicated. However, not setting good goals will lead to treatment not working well. You may end up moving from doctor to doctor.
In part 2 of Psychiatric Assessment : Addiction, Methadone, and Suboxone Treatment I will go over more specific questions your physician will ask. You will become more familiar with them before your visit. Being ready for your visit helps you spend more time going over what you feel is most important with your doctor.
Suboxone Treatment Directory For Help With The Long Term Effects of Opioids
Dr. Rich is a Board Certified Psychiatrist with licenses in Texas and Hawaii. He specializes in the treatment of opioid addiction with buprenorphine and runs a FREE locator service to find Addiction Treament including Suboxone treatment, methadone treatment, and oxycontin addiction treatment. Find a Suboxone Doctor in your area.
Dr. Rich has written more articles on the cost of oxycontin, buprenorphine (Suboxone) including frequently asked questions and a recent post : How Do I Find A Suboxone Doctor? If you are looking for a suboxone doctor in hawaii, Dr. Rich can be found in hawaii.
Here are more resources for psychiatric assessment for addiction and suboxone treatment :
- Psychiatric assessment – Wikipedia, the free encyclopedia – A psychiatric assessment,
- Practice parameter for the psychiatric assessment and management of – Psychiatry 2009 Feb;48(2):213-33. This is the current release of the guideline.
- The Psychiatric view of ME/CFS. What is it? – The psychiatric assessment should be systematic..
How Is Suboxone Treatment Different than Drug Abuse?
Physicians who treat opioid addiction also have the option of utilizing ‘medication-assisted treatment,’ and the most common medications used in the treatment of opioid dependence today are methadone, naltrexone, and buprenorphine (Suboxone).
Most people cannot just walk away from opioid addiction. They need help to change their thinking, behavior, and environment. Unfortunately, “quitting cold turkey” has a poor success rate – fewer than 25 percent of patients are able to remain abstinent for a full year. This is where medication-assisted treatment options like methadone, naltrexone, and Suboxone benefit patients in staying sober while reducing the side effects of withdrawal and curbing cravings which can lead to relapse.
Methadone
Methadone is an opioid and …
How Is Suboxone Treatment Different than Drug Abuse?
Physicians who treat opioid addiction also have the option of utilizing ‘medication-assisted treatment,’ and the most common medications used in the treatment of opioid dependence today are methadone, naltrexone, and buprenorphine (Suboxone).
Most people cannot just walk away from opioid addiction. They need help to change their thinking, behavior, and environment. Unfortunately, “quitting cold turkey” has a poor success rate – fewer than 25 percent of patients are able to remain abstinent for a full year. This is where medication-assisted treatment options like methadone, naltrexone, and Suboxone benefit patients in staying sober while reducing the side effects of withdrawal and curbing cravings which can lead to relapse.
Methadone
Methadone is an opioid and …
How Is Suboxone Treatment Different than Drug Abuse?
Physicians who treat opioid addiction also have the option of utilizing ‘medication-assisted treatment,’ and the most common medications used in the treatment of opioid dependence today are methadone, naltrexone, and buprenorphine (Suboxone).
Most people cannot just walk away from opioid addiction. They need help to change their thinking, behavior, and environment. Unfortunately, “quitting cold turkey” has a poor success rate – fewer than 25 percent of patients are able to remain abstinent for a full year. This is where medication-assisted treatment options like methadone, naltrexone, and Suboxone benefit patients in staying sober while reducing the side effects of withdrawal and curbing cravings which can lead to relapse.
Methadone
Methadone is an opioid and …
MedWorm Sponsor Message: Find out how you can get your message posted here and on over 100,000 other medical web pages in just a couple of days, plus support MedWorm at the same time.