FAQs: Residents/Physicians

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Hello, my name is Louis Fisher. I was with the Drug Enforcement Administration for 31 years. Now retired, I refuse to see my country go the way of opioid pills and heroin without a fight.

What is IntegraMedical of North Carolina?

IntegraMedical of North Carolina is a newly-formed company committed to addressing heroin and prescription opioid abuse and dependency in rural and underserved communities throughout North Carolina.

Why are you looking for medical professionals?

To date, there is a shortage of doctors authorized to prescribe buprenorphine. In order to expand availability to rural communities, our mobile medical units (MMUs) need residents, physicians, and physician’s assistants trained to provide medication-assisted treatment (MAT) to substance abuse patients. It is not a difficult process: it requires a resident or physician to participate in an eight-hour online course, application with SAMSHA for a Drug Addiction and Treatment Act of 2000 (DATA) waiver, and a special DEA number to prescribe buprenorphine. We will gladly assist with this process. Physician’s assistants currently may not prescribe buprenorphine; however, PAs are an integral part of our plan.

How many medical professionals do you need?

For the first year, a physician is limited to treating 30 patients with buprenorphine; after the first year, that number can be increased to 100. At full capacity, we anticipate needing at least two PAs and ten physicians per mobile unit during the first year to cover our projected patient population. Please encourage your colleagues to sign up!

How much will this cost me and how long will it take?

It will cost you nothing. For the first group of physicians to sign up we will cover the nominal cost of the training program and the DEA “X” number application fee; there is no fee associated with the SAMHSA waiver application. After you participate in the training, you may receive your waiver and DEA number in as few as 10 days, though it can take up to 45 days.

I have residency or work obligations during the day. Can I work in the evenings or on weekends?

The way our program is structured, other than your biannually-scheduled synchronous telemedicine clinic, you may work at your convenience to review asynchronous patient updates provided by MMU staff. For your biannual clinic schedule, you may opt for one eight-hour clinic, two four-hour clinics, or four two-hour clinics (particularly convenient for weekday evenings). All clinics may be conducted without ever leaving your home or office. You can literally save lives from your couch.

What is medication-assisted treatment (MAT)?

Medication-assisted treatment (MAT) is the treatment of heroin or opioid dependency or addiction with buprenorphine. Brand names of buprenorphine include SubutexButrans, BelbucaBuprenex; brand names of buprenorphine in combination with naloxone include SuboxoneZubsolv, and Bunavail.

What is buprenorphine and how does it work?

Buprenorphine is an opioid partial agonist. This means that, like opioids, it produces effects such as euphoria or respiratory depression. With buprenorphine, however, these effects are weaker than those of full agonist drugs such as heroin and methadone.

Buprenorphine’s opioid effects increase with each dose until, at moderate doses, they level off, even with further dose increases. This “ceiling effect” lowers the risk of misuse, dependency, and side effects. Also, because of buprenorphine’s long-acting agent, some patients may not have to take it every day.

What is naloxone?

Naloxone is added to buprenorphine to decrease the likelihood of diversion and misuse of the combination drug product. When these products are taken as sublingual tablets, buprenorphine’s opioid effects dominate and naloxone blocks opioid withdrawals. If the sublingual tablets are crushed and injected, however, the naloxone effect dominates and can bring on opioid withdrawals.

Isn’t treating addiction with buprenorphine just trading one addiction for another?

Absolutely not! Opioid addiction is a chronic disease, the same as diabetes and asthma are chronic diseases. Treating a disease with medication is a common practice, with the ultimate goal being to control the disease and to prevent a relapse.

Will a patient have to take buprenorphine forever?

In some cases, yes, the same as a diabetic has to take his or her medication forever. Some patients, though, do enter treatment with the ultimate goal of completely eliminating opioids from their life. With proper care, these patients can achieve that goal.

Who should be treated with buprenorphine?

The ideal candidate for opioid dependency treatment with buprenorphine:

  • Has been objectively diagnosed with an opioid dependency
  • Is willing to follow safety precautions for the treatment
  • Has been cleared of any health conflicts with using buprenorphine
  • Has reviewed other treatment options before agreeing to buprenorphine treatment

Isn’t there a lot of recordkeeping involved with treating substance abuse patients?

Yes, there is, but don’t worry. We’ll handle all of the administrative details so you can focus on taking care of patients.

I’ve heard the Drug Enforcement Administration (DEA) inspects doctors who prescribe buprenorphine. I’m concerned that I’ll be inspected if I get my DATA waiver.

It is possible the DEA will want to inspect patient records. I worked with my colleagues at the DEA for 31 years and know what the inspection requirements are. I am an integral part of this team and will work with you to ensure full compliance at all levels of our program.

Who provides the mental health services and counseling to my patients?

We have substance abuse counseling specialists that provide mental health and substance abuse counseling to each and every patient for whom it is indicated.

I am a third year resident. What if I want to keep treating my patients locally when my residency is completed?

We encourage that! If you decide to stay in your local area once you’ve completed your residency, we will assist you in every way possible to continue seeing the patients with whom you’ve established a relationship.

Some of the information included on this page was taken from the SAMHSA website.

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