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  2. Quest does perform confirmatory testing. Met w patient today. He continues to insist he is not using Fentanyl. He was called in a couple weeks ago for a "targeted" Suboxone strip count and oral drug screen. The strip count was perfect and the oral drug screen titers were consistent w what they have been all along. Will start getting urine, oral and blood testing done. We also discussed moving him to Sublocade. He is currently on 12 mg Suboxone daily. Also investigated the possibility of Genesight testing; however, the company is currently not testing for opioids as their reseacrh team s
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  5. Lead Mentor Dr. Andrew Saxon provided this response: Although fentanyl is stored in adipose tissue and released slowly, typically it would be a matter of days, not months, to clear fentanyl from the system sufficiently that it would not show up on toxicology testing. There probably are rare patients who may metabolize and excrete fentanyl in some kind of anomalous fashion which could be an explanation here. Is Quest doing confirmatory testing on all the specimens? If not, there are several commonly prescribed medications which cross react with fentanyl on the screening tests, which cou
  6. You also asked some questions regarding the recent waiver changes. No training is required anymore for physicians, NPs and PAs to prescribe buprenorphine to up to 30 patients. However applying for and receiving the waiver is still necessary. You can learn more information about all the changes here: https://www.samhsa.gov/medication-assisted-treatment/practitioner-resources/faqs
  7. Welcome to the Forum. If you are looking to apply for your waiver to prescribe buprenorphine, you can access it here: https://buprenorphine.samhsa.gov/forms/select-practitioner-type.php
  8. Hi everyone, I hope I’m in the right plans to get certified to write subs for a very poor pt pop. I’m most in a er own by yale and slow developing a small practice in ct Best to all john
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  10. I have a patient who swears he has not used Fentanyl for 3 months yet his oral drug screen from Quest persistently comes back + for low levels of the drug (0.25 - 0.4 w weekly testing). Have any of you seen persistently low levels of Fentanyl in someone who has not used for that length of time?
  11. Welcome to the PCSS Discussion Forums and good luck in your new role!
  12. SSLLC


    Hello, I am a PMHNP-BC and work in a rural community mental health clinic. I will be taking on a new role in the substance abuse side of out clinic and have been reviewing my MAT trainings to prepare. I am certain I will be visiting this forum to ask questions and learn. Thanks for providing this support, it is invaluable.
  13. Welcome! Be sure to check out the PCSS Mentoring page if you haven't done so: https://pcssnow.org/mentoring/
  14. Good Morning, My name is Michele Boutin, and I am from the “ Big Easy”(New Orleans). I am a member of ASAM, LA chapter, but I am new to Addiction Medicine. I am hoping to find a mentoring. I am a Family Nurse Practitioner. Thanks, Michele
  15. Hello from Austin! Just started at new specialty in substance abuse. Have an ER and PACU background. Looking for mentors and advice on clients treatments plans. Very Grateful to be here.., Teresa
  16. Welcome to the PCSS Forum. I hope you find lots of great information here!
  17. I'm a ambulatory care pharmacist working in primary care in rural WI and see patients with our providers to manage (mainly) chronic disease. Initially I found myself being used as a resource for a lot of pain patients with polypharmacy and slid into a role helping with suboxone initiation and maintenance with our only suboxone provider in the clinic. I see a handful of patients on Suboxone who almost exclusively had been found to be misusing their prescription opioids. We recently established with a young patient with multiple substance abuse (including heroin [primary] and meth). Their needs
  18. The answer here is surely not to take them off their Suboxone then you are risking relapse and Fentanyl heroin or prescription opiates that's not what we want here we want to keep addict clean off of what is going to kill them. My suggestion is tighten the rules do lab urinalysis and blood more often and have a relationship with the patient where you can be completely honest with each other if the patient is being completely honest with you that he used other drugs why punish him he or she has an addiction and we don't want to punish them because they used another drug we just want to help the
  19. Hello I am a newly certified PMHNP from CA. I am currently practicing as a FNP. I am very excited joining this forum and looking forward to learning more from everyone! Thank you :))
  20. I am really sorry about you losing him. It's really sad how many people we lose to SUD. To respond to the topics you mentioned: --prescription management: Overprescribing opioids is a common way that teens and young adults start using them (either their own Rx or trying out a family member's Rx that is sitting around). Safe storage of meds in a locked box would be ideal, as well as disposal services. Also when doctors, NPs, PAs rapidly taper people from Rx opioids, some people switch to heroin and OD that way (Including fentanyl contamination). So teaching clinicians about the risks
  21. The staff members at SAMHSA have helped me a lot via email, and often on the same day I ask a question. You could try that: infobuprenorphine@samhsa.hhs.gov
  22. Seth Acton


    Welcome to the PCSS Discussion Forums!
  23. Zubi


    I'm a DDS from Harlingen TX and I registered for the course on buprenorphine for CE credit and to gain personal knowledge about it's use.
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