With all due respect, I could not disagree with Ms. Amabile more [“Full practice authority and opiate use,” January]. I am in my 31st year as a physician assistant and had several years of practice in emergency medicine and addiction medicine during that time.
I worked in a facility in my addiction medicine years where the supervising physicians would prescribe Suboxone (which is what Ms. Amabile wishes for all mid-levels to be able to prescribe). If/when mid-levels are able to do this, she might regret her words.
I, for one, was grateful that we mid-levels at the facility could NOT prescribe it. There are many tough conversations that surround the prescription of this medicine. It, too, can be abused (sold on the street, etc.). It is not, by any stretch of the imagination, a “benign” medication.
Sad to say, I learned of physicians (through our addicts) who viewed this medication as a means to increase the census in their offices. It simply became “Pay $ ___ (fill in the blank) for a visit, and we will continue your Suboxone.” I would want NO part of that. That is not practicing good medicine.
In my opinion, agents such as Suboxone and Narcan have their place. But among addicts, these are just tools to help feed an addiction and/or keep them alive for the next time they use.
A better usage of our time and money would be to help addicts get off of opiates (and not use any substitutes). That may sound harsh to some. However, I have seen folks stay on Methadone or Suboxone for much longer than was intended and never wish to wean themselves off of either.
So, my message, again is to BE THANKFUL that you cannot prescribe it as a mid-level. I have seen numerous problems associated with patients and providers who are in this loop of Suboxone maintnenance. It’s not pretty, and I never wish for any mid-level to be a part of it.
This also can be painful for those providers whose work sites are caught up in Press Ganey surveys. If you do not keep the patient(s) happy, your survey scores suffer. We have a local ER that is known for dispensing pain medications. And its mid-levels are, unfortunately, caught up in this primarily because their supervisor values survey results. What a shame. And being able to prescribe Suboxone would just make that whole picture worse.—PATTY PULVER, MPH, PA-C, Albany, N.Y. (209-1)
These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical pearl, submit it here.