Enrollment is initiated through a phone interview that takes 5 to 10 minutes.

Criteria for enrollment in this program:

Criteria
Resident of Dallas Fort Worth, or nearby area
Serious medical problems, like seizures, liver or kidney disease, etc.
Allergic to Naloxone
Intravenous drug user
Pregnant
Medicare, Medicaid, Tricare
No insurance / Self pay
Commercial insurance as self pay
Not willing to attend counseling

Phone Interview

There is no walk-in. A phone interview is required before an appointment can be offered.

The purpose of the phone interview is to confirm that the patient can be treated in my clinic, and inform patients about certain aspects of my practice that differs from other practices, so that they can decide for themselves whether my clinic will be appropriate for them.

I have a small, part time practice, and do not have the resources and facilities that a larger full time practice can offer.

Interview questions
1. Where do you live?

I need to know the city that you live in. If you live too far from my clinic, then I will not be able to accept you in my practice. Patients are better served by going to a clinic that is closer to them.

The clinic is located at Grapevine, North of DFW airport. It is convenient for patients in the mid-cities area of DFW.

It is still preferable that you start treatment while you are waiting to find a doctor close to where you live.

A medical doctor’s role is very limited in your treatment … the role is to provide a prescription. Your treatment may take a long time … six months to several years, … that means you will be going to the doctor at least once a month for a long time, … that is why it is important to chose a doctor that is convenient to you.

2. Do you have insurance?

Patients who have insurance need to discuss this with their insurance first before they start calling doctors. If you have insurance you will be better served by a doctor that has been provided by your insurance.

You will require assistance with claims, prescriptions, pre-authorizations, etc. I do not have the resources to provide that kind of service.

Patients with Medicare, Medicaid, or Tricare, are never accepted in my practice. Medicaid does cover this treatment so call your insurance and go to your insurance approved program.

Patients who have commercial insurance through their employer can be accepted in my practice as self-pay patients with the understanding that I will not file any insurance claim, and will not assist in filing any claims, or obtaining pre-authorizations.

I do see some patients who have commercial or self employed insurance: These are patients

  • whose insurance does not cover this treatment,
  • or they have used up the coverage,
  • or they have high deductible that will not be reimbursed till they reach the deductible limit,
  • or they have decided that they will not be filing for reimbursement or prescription coverage.

3. Are you an IV drug user?

IV drug users require more intensive therapy, need to be seen more frequently, require additional tests and treatments for co-occurring medical problems. My clinic can not provide these services, and therefore IV drug users are not accepted.

Patients who have been through an intensive program, have had all these tests done, and whose medical problems are being addressed by a PCP, and have not used any IV drugs for more than 30 days can be accepted. I will need a faxed record from their PCP.

4. For women … are you pregnant?

Pregnant patients require more intensive therapy, monitoring, and coordination with other healthcare providers. I do not have the resources to provide such care.

Additionally pregnant patients can not have Buprenorphine induction in the clinic. Buprenorphine induction requires patients to be in withdrawal … pregnant patients can not be asked to go in withdrawal due to possible adverse effects on pregnancy. These patients require inpatient induction process, or a slow stepped induction. I do not have the resources to provide such services.

5. Have you been in treatment before?

If you have been in treatment multiple times and it was unsuccessful … then there is no point in coming to my clinic. You should look for something more intensive. Though I do not reject patients simply because they have failed treatment elsewhere … I do review it, and if I feel that the patient will be better served in an intensive program … then I may not accept the patient.

Patients who have been through an intensive program and are ready to transition to an outpatient program are accepted.

I also consider what dose of Suboxone you have been on. Some one who has been on three 8mg Suboxone tablets a day for three years will not be accepted.

My protocol is to start patients at a maximum of 16 mg/day, and taper them down to 8mg/day within six months. Beyond that I leave it to the patients as to how long they want to take to taper off completely.

Patients who were in my program and dropped out, or were discharged for not keeping current with counseling, or for any other violation of clinic policy, are not accepted back.

6. Do you have other severe medical problems?

For example liver failure, kidney failure, seizures, psychosis, AIDS, etc. Such patients are better served by a medical specialist who also prescribes Suboxone. Ask your insurance for a list of such doctors. I will accept such patients only after a discussion with their treating specialist, and only temporarily, … till they are able to enroll into a program provided by their insurance.

7. What drugs are you using and in what quantity?

Patients using multiple drugs for example opioids + cocaine, or methamphetamine, or alcohol … need more intensive therapy, which is not available in my clinic. Also, there is no magic drug like Suboxone for cocaine or methamphetamine addiction treatment.

The above mentioned issues are limitations of my clinic … do not let this discourage you. Other practices may not have these limitations, … and may be able to accept you.


Same day enrollment is generally not available.

Exceptions are:
if I am at the clinic, and the patient is transferring from another program
or
it is a new enrollment, the patient is in withdrawal, and it has been at least 24 hours since last use.


Examples of patients not accepted:

  • Patients who have obtained Suboxone from two doctors or more within the last one year.
  • Patients who have been on Suboxone for more than two years at a dose exceeding 16mg/day.
  • Patients who have been on Suboxone/Subutex and went back on prescription opioids.
  • Veterans. VA Medical Center offers a Suboxone program for Veterans.

Essentially I do not have anything to offer that you did not already receive from your last program, so it does not make any sense to join a similar program. You will benefit from a more intensive program and should look for such a program.

Enrollment Process

Enrollment is a two step process, and may be completed in one day, … or over two days. It also depends on whether you need an in-office induction, or are transferring from another practice. In most cases the entire process is completed the same day, rarely it may be completed over two days.

Step 1:

Completion of one page application form, followed by a brief interview to answer your questions, and to confirm that this program is suitable for you. If you decide to enroll then a copy of your ID is made, and a package of consents and medical history forms is printed and given to you. This takes about 20 to 30 minutes to complete.

Step 2:

After completion of enrollment forms, and payment of fees, I will go over the consents, review your medical history, and answer any questions that you may have, … then you will have a physical exam.

It is a routine physical exam, … the emphasis is on drug use and neurological exam. I do not do any genital or pelvic exam. After the exam I will discuss the findings, suggest actions to be taken, discuss the treatment plan, give you a prescription for 30 days and provide you with your next appointment.

If induction is needed, then you are provided with a prescription for induction dose, and are asked to come back to the clinic with medications.

In office induction is the standard policy. In-office induction is waived under certain conditions at my discretion. Patients who have been in a similar program within the last one year, are treated as transfer patients, and typically do not need induction. They still have to be in withdrawal to receive a Suboxone prescription.

Requirement to be in withdrawal:

Induction requires that the patient abstain from any narcotic/opioid use for 24 to 48 hours. This is necessary to reduce the amount of opioids in your system, and decrease the possibility of precipitated withdrawal. Induction is done with Buprenorphine mono preparation. If you prefer, … it can be done with Buprenorphine+Naloxone preparation.

If you are using short acting opioids like Lortab, Percocet, or substances like Heroin; then it will take 24 hrs from the last dose to be in at least moderate withdrawal.
If you are taking long acting opioids like Oxycontin, MS contin, Methadone, or fentanyl dermal patches then it will take 48 to 72 hrs from the last dose to be in at least moderate withdrawal.

If you plan to change over from Methadone to Suboxone, or are coming off from high doses of opiods then discuss with your physician first. You may require additional medications like Benzodiazepines, Clonidine, etc., to smooth-en this transition.

You may experience withdrawal earlier than 48/72 hrs, however this drug free time period is required to reliably reduce the amount of opioids in your system.

An in-office induction is inconvenient but is far less expensive and much more convenient than an in-patient detox. An in-office induction and initiation of treatment costs $300 to $600 compared to in-patient detox which costs several thousand dollars.

Even if you have had in-patient detox you will still need to enroll with a Suboxone provider for follow up prescriptions of Suboxone to prevent ongoing withdrawal, until you can completely taper your dose. It is best to enroll with a provider before you are discharged … so that you do not have a gap in treatment, … do not go in withdrawal, … and do not risk a relapse.


Discharges

Patients who do not show any progress in tapering the dose, or are found to ignore clinic policies, counseling, appointments, and record keeping requirements are discharged without notice.

Once discharged, patients are not re-enrolled.

You are enrolling in one of the least expensive … and convenient programs available in this area. Follow the rules … and complete your recovery. Dropping out or getting discharged will set you back. You will have to find another program … and will have to go through this whole process again.