DEA has now allowed the use of Telemedicine for evaluating and initiating treatment for new patients for the duration of the current Health emergency.
… despite the CSA’s limitations on issuing prescriptions for controlled substances by means of the Internet, for the duration of the public health emergency, a practitioner may prescribe a controlled substance to a new patient via telemedicine—using a real-time, two-way, interactive audio-visual communication—without first conducting an in-person examination. See 21 U.S.C. 802(54)(D).
Requirements for enrolment through Telemedicine
- Reliable internet connection / wifi.
- Laptop / Computer / Cell Phone with camera.
- One and half to two hours of uninterrupted time.
- Credit / Debit Card and internet access to make payments.
- Ability to take a photograph or scan and send Driver License or approved ID.
- Ability to read and understand online consent forms and instructions.
Enrollment is initiated through a phone interview that takes 5 to 10 minutes. Please call or text 1-615-968-7727 once you have reviewed the information on this page.
Criteria for enrollment in this program:
|Resident of Murfreesboro, TN, or nearby area|
|Serious medical problems, like seizures, liver or kidney disease, etc.|
|Allergic or hypersensitive to Naloxone|
|Intravenous drug user|
|Medicare, Medicaid, Tricare, Tenncare|
|No insurance / Self pay|
|Commercial insurance as self pay|
: Not Enrolled
Counseling is not offered at my office. Counseling has to be arranged by the patient on their own.
It is my policy not to deny treatment to patients who do not attend counseling. Counseling is recommended but not mandatory. If patients do not have a relapse while on Suboxone then they have achieved the most important goal of addiction treatment.
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.
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.
I accept patients from Murfreesboro and surrounding areas, including, Smyrna, LaVergne, Mt. Juliet, Lebanon, Smithville, Woodbury, McMinnville, Shelbyville, Lewisburg, Manchester, Tullahoma, Winchester, Fayettville, Springhill, South Nashville, Antioch, and Brentwood.
Murfreesboro Clinic: I do not accept patients from North of Nashville, Cookeville, Sparta, Dickson, Decherd, Pulaski, and beyond.
2. Do you have insurance?
I am not a provider for any insurance network.
Patients who have insurance need to discuss this with their insurance first before they start calling doctors. If you have insurance then you will be better served by a doctor who is in your insurance plan network. Ask them for a list of Medical doctors in your insurance plan that are authorized to provide addiction treatment.
If you have insurance then 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, Tricare, or Tenncare are never accepted in my practice. Tenncare 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 so 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 can not 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. My clinic is not equipped to provide such a process.
Call one of the major medical centers like Vanderbilt and Meharry. They have high risk pregnancy units that cater to pregnant women who have substance use problems.
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. I do not prescribe more than 8mg/day.
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.
Examples of patients not accepted:
- Patients who have obtained Suboxone/Subutex from two doctors or more within the last one year.
- Patients who have been on Suboxone/Subutex for more than one year at a dose exceeding 16mg/day.
- Patients who have been on Suboxone/Subutex and went back on prescription opioids.
- Veterans are not accepted in my program. VA hospital at Murfreesboro 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 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. 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, 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. If needed you are provided with a prescription for induction dose and are asked to come back to the clinic with medications. 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.
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, provided their urine drug screen is negative for opioids.
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 12 to 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 transdermal 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., and need a longer abstinence from opioids 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.
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.
More affordable than a month at inpatient rehab … more dignified than daily attendance at a Methadone clinic.
This page was last modified on: April 21, 2020