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lyn1985

Prescribing Suboxone via Telephone

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Hello all.  I applied and interviewed for a telemedicine position, and was one of 3 PA's who received offers for this position, which includes acute medicine and jail medicine via telephone and video.  After I had spent months in the credentialing process, as well as licensure in another state, I was told part of our duties would be prescribing Suboxone and Ativan for jail medicine patients.  I have only held a license in a state that does not allow PA's to prescribe narcotics, so I have never even had a DEA number, and I am very uncomfortable with this requirement.  I have been researching online, and I'm not even sure if prescribing Suboxone this way is even within the scope of legal PA practice.  Does anyone have any experience or advice about a situation such as this?   I appreciate any input.  

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If you're uncomfortable with it, then don't take the job. If you want a job that allows you to work from home, since PA profession is basically a hands-on clinical profession, you will run into some limitations.

I Google-searched for literally 2 minutes and it appears that it is legal for PA's to write suboxone/buprenorphine prescriptions for addiction treatment (law passed in 2016 is in effect until 2021) for up to 30 patients. It seems like 24 hours of training/coursework are involved first - perhaps that would help you be more comfortable with the situation. Also, all presumably within the boundaries of local state law governing PA supervision (if these are not federal inmates, then state law would apply, I would think).

That said, I Am Not A Lawyer.

If you're uncomfortable with a job that asks you to (presumably, refill - or are these new prescriptions?) write for controlled substances, than don't take the job.

I hope that helps - good luck.

 

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We have to have the 24 hours of training to have the Suboxone waiver added to our DEA number to be allowed to prescribe.   I haven't been able to find info about prescribing via telemedicine or phone, for patients who would not be "regular" patients of a clinic I was working for.   It appears most of the PA's who are doing this would be working at an addiction clinic with patients that are established with them.   This would be jail medicine, so they would be in and out.

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Depending on the state a face-to-face visit may be required at certain intervals.  But, I can say with certainty that I would not be comfortable prescribing suboxone over the phone/telemedicine.  But, I'm hardly comfortable prescribing an antibiotic over the phone for a UTI (rarely do), so doesn't mean it's not ok.

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In my job I occasionally am asked to manage patients remotely (I can see them on a camera, I can talk to a nurse who is with the patient, I have access to their vitals, lab data and notes about them). I am not particularly comfortable doing so, I rely heavily on the nurse's assessment.

I agree with the general sentiment expressed by mgriffiths above; if that was the full-time situation, I wouldn't feel that was appropriate patient management, personally.

Everyone's tolerance is different however.

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Telemedicine in Jail is a face to face visit.  

A good Jail is the perfect place for this. 

 

Is likely legal and really good 

 

(btw I work in corrections and write suboxone for detox and this is all done off nursing assessments before I ever see patient. )

 

what state is this job in?  I want to apply!!!

 

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Minnesota.   But the jail med portion isn't telemedicine, it is done by telephone.

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Just because we can do something doesn’t mean we should.  That being said I am halfway through my training so I can prescribe the suboxone.  I have been a PA for over 16 years and mostly have done internal med and rural family practice. I did do some time in state corrections for 4 years and that definitely helped with the identifying mental illness issues and dealing with them with the help of the psychiatrist. 

Narcotics are a huge responsibility so if you don’t feel comfortable talk with the Physician you will be working with and get his/her take on things. 

Also find out about who the counselors are and how often these patients are seen and know who to call if you run into problems. Or if you don’t feel comfortable don’t take the job. Rely on your gut instinct upfront don’t ignore your feelings.

 

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Thank you, this is the best answer yet.   I have a "bad feeling" about it for several reasons, some of which would include some of the things they have requested from me during the credentialing process, AND the fact that they didn't disclose the requirement of prescribing Suboxone and Ativan until I was already neck deep in it.  I have two months until my commencement date, so I still have time.

On 6/11/2018 at 6:38 PM, Elpatodog said:

 

Just because we can do something doesn’t mean we should.  That being said I am halfway through my training so I can prescribe the suboxone.  I have been a PA for over 16 years and mostly have done internal med and rural family practice. I did do some time in state corrections for 4 years and that definitely helped with the identifying mental illness issues and dealing with them with the help of the psychiatrist. 

Narcotics are a huge responsibility so if you don’t feel comfortable talk with the Physician you will be working with and get his/her take on things. 

Also find out about who the counselors are and how often these patients are seen and know who to call if you run into problems. Or if you don’t feel comfortable don’t take the job. Rely on your gut instinct upfront don’t ignore your feelings.

 

 

Edited by lyn1985

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I can't think of a worse job in medicine than jail/corrections medicine or addiction treatment.  I would rather work in a Minute Clinic than deal with all the stress/craziness that comes with inmates and addicts.

God bless those who choose to work in such an environment.

 

 

Edited by Gordon, PA-C

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5 hours ago, Gordon, PA-C said:

I can't think of a worse job in medicine than jail/corrections medicine or addiction treatment.  I would rather work in a Minute Clinic than deal with all the stress/craziness that comes with inmates and addicts.

God bless those who choose to work in such an environment.

 

 

occupational health. people faking illness or injury for monetary gain or long term disability payments. I would also do correctional medicine before working at a quickie mart/minute clinic type setting. that isn't even medicine. it's pattern recognition using someone else's treatment protocols...

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2 hours ago, EMEDPA said:

occupational health. people faking illness or injury for monetary gain or long term disability payments. I would also do correctional medicine before working at a quickie mart/minute clinic type setting. that isn't even medicine. it's pattern recognition using someone else's treatment protocols...

Heh.  I love occ med.  No Dunning-Kr... err, Press Ganey to deal with.

But then, I have a background in security and investigations and have no particular problem with people lying to my face.  i mean, it's not fun, but I get way more bent out of shape about backstabbing administrators than lying patients.

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I have worked in both occ med and a retail clinic.   I enjoyed them both, and the pay was much better than my previous position in family practice.

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