Semistructured interviews were recorded and transcribed. NVivo10 program QSR International was used to analyse the data using qualitative description methodology.
Results: Participants largely reported similar BNX film preparation techniques, although the texture of BNX film during preparation to inject was reported to be unusual gluggy , and there were many varied accounts associated with the amount of water used. Physical harms reported as associated with injecting BNX film were described including local and systemic issues ; participants reported injecting the film to enhance its immediate effects, yet generally reported that sublingual administration provided longer-lasting effects.
Discussion and conclusions: Understanding knowledge acquisition about injecting new formulations of opioid substitution therapy is crucial in developing more effective harm-reduction strategies. Dissemination by peer networks to those who are currently or planning to inject BNX film regarding the 'gelatine like' texture when mixing, using only cold water and double filtering is important to ensure safer injecting practices.
Findings from this study highlight the importance of peer networks for the dissemination of harm-reduction information. Nicholas Merola, of southeastern Ohio, said he also first got Suboxone from a cash-only doctor. He recalled being prescribed a month's worth of tablets, taking half a tablet a day and selling the rest.
Over the next four years, he said, he did the same with prescriptions from 10 other doctors. Taking half a day, it made me feel not sick," Merola said. Evan Blessett of Jeffersonville, Ind. That's why he tried it at 17, buying it from a friend with a prescription. Like Stearns and Merola, Blessett got hooked.
None is a fan of Suboxone. To effectively treat addicts with Suboxone, physicians need more than the minimum eight hours of required training, Murphy said; they must also be caring professionals who closely monitor patients and ensure they receive counseling or similar support. But you have to have the behavioral aspect as well," said Murphy, who prescribes the drug to a small number of addicts.
Murphy is among the majority of Suboxone prescribers who have never been disciplined by the medical board; in fact, he has consulted with the board as a pain expert. But Diakov said Suboxone prescribing, which can be lucrative, has attracted some doctors with troubled pasts and questionable practices. She said the board investigates issues brought to its attention, relying on an opinion spelling out "acceptable and prevailing medical practices" required by law.
In February, the board revoked the license of Berea physician Jon Strauss over issues that included problematic Suboxone prescribing — four years after placing his license on probation after a complaint alleging sexual misconduct. The recent order cites a review of medical records for five Suboxone patients that found Strauss "did not order lab tests, did not prescribe the recommended dosage of medication, did not perform appropriate drug monitoring and did not record in his patient charts an adequate treatment plan.
His attorney, J. Fox DeMoisey of Louisville, said they are appealing the revocation and believe the current case is affected by the older one, which was tainted by "woefully insufficient evidence. While acknowledging Strauss could have documented his prescribing better, DeMoisey said "we had patients come in and say what a tremendous job he was doing" treating them with Suboxone.
State law "puts a high requirement on record-keeping," DeMoisey said. Another Suboxone prescriber with a troubled past is Dr. David Suetholz, a Kenton County primary care physician whose license was restricted in — banning him from prescribing controlled substances for three months — after a board consultant found prescribing irregularities.
Although the order didn't mention Suboxone, it said several patients received early refills of the painkillers Oxycodone and Hydrocodone, were not properly monitored or subject to pill counts, and received higher and higher doses without adequate documentation about why. Suetholz said in an interview that he doesn't agree with all of the findings but accepted the restrictions anyway.
He said he monitors them with drug screenings every month and recommends but does not require that they get support or therapy. Regulators, law enforcement officials and treatment professionals agreed that Suboxone can help some addicts kick drugs — which is why they don't want to cut off access for legitimate patients.
We want as many people as possible to get help, but we don't want the abuse," Ingram said. The goal is to gradually reduce the dosage over time until a patient tapers off the medication, and some take it for years. But much of the research into its effectiveness looks at short-term use. A study in the Journal of the American Medical Association showed that addicted youths who took Suboxone for 12 weeks were less likely to use opioids, cocaine or marijuana, or to drop out of treatment, than those who received only short-term detox and counseling.
But Ingram said there's a fierce debate between experts favoring medication-assisted treatment and favoring residential treatments that don't use medicine. A report showed only 8 percent of people treated at Kentucky recovery centers, which offer a long-term residential program without medication therapy, were using illegal drugs at a six-month follow-up. Plus, he and others argued, there is simply not enough residential treatment for the growing number of addicts.
Conway said Kentucky has just a tenth of the treatment beds it needs, and a Courier-Journal analysis found that less than 15 percent of treatment and recovery sites offer hour residential care; most are for outpatients only. Although Hascal works in a recovery center that doesn't use Suboxone, she said the medicine may work for some people and should be part of the arsenal for treating the persistent scourge of addiction.
It's touted as the solution for addiction, but it's not. Facebook Twitter Email. Addiction medicine Suboxone now being abused. Show Caption.
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