Category: Addiction Treatment

Where Can I Find A Sublocade Doctor In Michigan?

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7 August 2020

Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog; Where can I find a Sublocade Doctor in Michigan. In Beyond Primary Care blogs I highlight healthy and fun recipes, healthcare news, advice for medical conditions, as well as how membership for care works! Dr. Jeff O’Boyle is the owner of Beyond Primary Care, which is an insurance free, membership based family medicine and addiction medicine clinic. Beyond Primary Care is the only Direct Care clinic serving patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County giving families and employers peace of mind with healthcare costs by providing affordable, accessible, and authentic primary care services.

The primary purpose of the blog is to introduce healthy lifestyle concepts and answer common questions I receive from patients that I believe are important. I want to start discussions that will help educate, benefit, and improve your well-being. 

In this blog post, I wanted to answer a common question…

Where can I find a Sublocade doctor in Michigan?

First, Sublocade Explained

Sublocade is a brand name medication available by prescription only from physicians or other professionals with a special Drug Enforcement Agency (DEA) license. Sublocade is actually injectable Buprenorphine, one of the active medications in brand name medications such as Suboxone and Zubsolv. This medication is delivered directly to the physician’s office, and is typically given every 28 days- roughly once a month.

Sublocade is injected by a physician as a liquid right under the skin in a patient’s abdominal area. Once inside someone’s body, it turns into a solid gel that gradually releases buprenorphine at a controlled rate all month.

What is Sublocade used for?

Sublocade is used to treat opioid addiction, a type of substance use disorder that is classified as a neurobiological disease. Addiction has genetic, psychosocial, and environmental factors influencing its development and manifestations. 

A great way to think of how opioids and the medication works is to imagine your brain has a bunch of empty ice cream cones on it- we’ll call these ‘receptors.’ When the ice cream- we’ll call these ‘opioids,’ enters the space by the brain, they normally fit right into the empty cone. Unless you have a dairy allergy or are lactose intolerant, this will feel really good for most people. 

This same mechanism is what happens for opioids (pills, drugs) in the brain, when they result in a release of Dopamine creating a sense of pleasure and reward.

Sublocade and the medication in it, buprenorphine, attaches to those ice cream cones making other scoops of ice cream less likely to park. 

Why Sublocade Is Important

The simple answer is this medication is a method of harm reduction against opioid use disorder, and it saves lives. I previously talked about what ‘harm reduction’ is in a post about The Sinclair Method here.

According to the Centers for Disease Control:

  • 40% of overdose deaths are due to natural opioids such as morphine and codeine or semisynthetic opioids such as oxycodone or hydrocodone
  • 15% of overdose deaths are attributed to synthetic opioids such as fentanyl
  • 10% of overdose deaths are attributed to methadone
  • 35% of overdose deaths are attributed to heroin

While on Sublocade, individuals will receive a continual delivery of the medication buprenorphine all month, and it only requires a once-monthly injection by a trained physician. 

This is important. 

Why? The injection takes out any compliance issues for many folks battling opioid addiction such as:

  • Forgetting doses
  • Missing doses
  • Losing medication

The injection also results in a safer community through less diversion of the Buprenorphine films or tablets. 

Where to find Sublocade Doctors in Michigan

You can always click through the Sublocade website and look for providers that way. In addition to being a board certified family medicine doctor, I am also a board certified addiction doctor. I utilize buprenorphine products such as Sublocade, Suboxone, and Zubsolv at my clinic, Beyond Primary Care in Ann Arbor, Michigan. I use an eclectic and personalized approach towards assessing and resolving your life changes and stressors. Not a ‘cookie cutter’ one size fits all plan. In addition to a thorough health history, I am going to ask about your family, where your quality of life is being most affected, and—most importantly—what you want to do.

Reach Out For Help

If you think some health concerns of what you may be experiencing may be due to excessive opioid consumption, or if you notice any coworkers, friends, or family members silently struggling, send them a link to this post so that they can join the conversation!

You can also contact Dr. O’Boyle directly. I look forward to hearing from you!

Where can I find The Sinclair Method Doctors?

admin

24 April 2020

Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog; where can I find The Sinclair Method Doctors. In my blogs I highlight healthy and fun recipes, healthcare news, advice for medical conditions, as well as how membership for care works! Dr. Jeff O’Boyle is the owner of Beyond Primary Care, which is an insurance free, membership based family medicine and addiction medicine clinic. Beyond Primary Care is the only Direct Primary Care clinic serving patients in Ann Arbor, Ypsilanti, Saline, Dexter and the rest of Washtenaw county that offers virtually unlimited office visits, wholesale medications dispensed from the clinic, and wholesale blood work completed at the time of visit.

The primary purpose of the blog is to introduce healthy lifestyle concepts and answer common questions I receive from patients that I believe are important. I want to start discussions that will help educate, benefit, and improve your well-being. 

In this blog post, I wanted to answer a common question, where can I find The Sinclair Method Doctors?

What is The Sinclair Method?

According to the C3 foundation, the Sinclair Method (TSM) is a treatment for alcohol addiction that use a technique called pharmacological extinction- the use of an opiate blocker to ‘turn habit-forming behaviors into habit-erasing behaviors.’ The effect returns a person’s cravings for alcohol to its pre-addiction state. The Sinclair Method is named for the researcher, John Sinclair, Ph.D, who first developed it and helped it gain momentum, most notably in Europe. The Sinclair Method utilizes taking a medication,  Naltrexone, prior to drinking alcohol- which for some people may be everyday.

In America, many physicians have a very narrow ‘one size fits all’ approach to substance abuse, in that a person needs to totally quit the drug in order to be considered successful. While good natured and in some cases necessary, this maxim is dangerous when applied to every person. Instead, the American term for what The Sinclair Method accomplishes is better known as ‘harm reduction.’ As comparison, the idea being 5 cigarettes is better than 20 cigarettes if you refuse to quit smoking. Still not a great habit, but long term there is less harm from a quarter pack than a full pack. 

How does Naltrexone Work?

Naltrexone competes with other drugs for opioid receptors in the brain. 

Wait right there! 

This is a blog about alcohol treatment, why would we consider a medication that is meant for pain pills? 

Multiple bodies of evidence such as this, this, here too, suggest alcohol reinforcement mechanisms – what we call cravings- involve activation of our endogenous opioid system. Alcohol binds to and alters functioning of opioid signaling receptors. Originally use to treat opioid dependence, Naltrexone is also FDA approved for the treatment of alcohol dependence. 

Will Naltrexone Work For You?

As a board certified addiction doctor, I see hear the different stories all the time. As example:

  • The young executive who drinks too much at the end of the day
  • The liquor distribution salesman where drinks are a part of the job
  • The 67 year old grandmother drinking a case of beer a day and her family has no idea

You may of scoured every internet article for information that looked informed and accessible. In fringe support groups there are people enthusing about elixirs and ‘ten-day’ fixes. In ‘recovery’ websites you may feel like a marketing person’s dream- marginally desperate: open to attempt anything.

When you feel vulnerable trying to make sense of the treatments, take some confidence that Naltrexone is a very real possibility for changing your life for the better. 

Naltrexone is a great medication for a lot of reasons. It’s a generic medication- so it is affordable. It is not habit forming nor a drug of abuse. It’s side effect profile is comparable to many other medications, and are typically mild and short in duration. As long a you start it under the guidance of a trained physician, you will likely not discontinue for tolerance reasons. It has little impact on other medications. 

It is also important to know that taking Naltrexone alone does not guarantee success nor any successes will be long term. What improves the chances of success and duration of success? Follow-up with an addiction-trained physician and counseling with a certified therapist who has a substance abuse background are huge starts. From there, we can guide you on sleep health, journaling, support group meetings, exercise, diet, dealing with set-backs, and importantly- recognizing successes. 

Where to find The Sinclair Method Doctors

You can always click through TSM website and look for providers that way. In addition to being a board certified family medicine doctor, I am also a board certified addiction doctor and have been utilizing The Sinclair Method for years. At my clinic Beyond Primary Care in Ann Arbor, Michigan, I use an eclectic and personalized approach- not a ‘cookie cutter’ conversation- towards accessing and resolving your life changes and stressors. In addition to a thorough health history, I am  going to ask about your family, where your quality of life is being most affected, and—most importantly—what you want to do.

Outreach

If you think some of what you may be experiencing may be due to excessive alcohol consumption, or if you notice any coworkers, friends, or family members silently struggling, send them a link to this post so that they can join the conversation!

You can also contact Dr. O’Boyle directly. I look forward to hearing from you!

Keeping Laboratory Costs Low

admin

10 May 2019

Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog; where I highlight healthy and fun recipes, healthcare news, advice for medical conditions, as well as how membership for care works! Dr. Jeff O’Boyle is the owner of Beyond Primary Care, which is a new approach to family medicine and addiction medicine that creates the time and space your healthcare deserves. Beyond Primary Care is a Direct Care clinic serving patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County.

The primary purpose of the blog is to introduce healthy lifestyle concepts and answer common questions I receive from patients that I believe are important. I want to start discussions that will help educate, benefit, and improve your well-being. 

In this post I am answering a common question that I receive, and that is how does Beyond Primary Care (DPC) keep laboratory costs low for it’s members? Offering low bill rates for labs is a key feature of virtually all Direct Primary Care (DPC) practices, and is something that is done to increase the value of a membership. Just how low? Many DPC practices do in-clinic phlebotomy and can provide numerous laboratory studies to their patients at a tenth of the costs that many hospitals and fee-for-service providers can provide.

How DPC Practices Keep Laboratory Costs Low

To start DPC practices typically do their own phlebotomy (that is the collection of blood from your veins) and rarely bill for these services. This starts the savings before a single drop of blood is collected. DPC practices then contract with laboratory diagnostic companies, many times the same companies that service smaller hospitals or fee-for-service clinics. My clinic, Beyond Primary Care, uses a few laboratory diagnostic companies, Quest Diagnostics, True Health, and Aurora Diagnostics

Prior to drawing any labs for our patients, DPC practices negotiate what we call ‘client bill rates’ with these diagnostic companies. A client bill rates is basically saying, what is the lowest cash price for a particular laboratory study you can offer to my clinic’s patients? Compare this to smaller hospitals or fee-for-service providers. They bill for phlebotomy (U of M states they charge $9 for this service alone) and then these providers bill the labs through your insurance. Often times the laboratory costs often never negotiated down on behalf of the patient because there is no incentive from the practice to do this. 

DPC gets these low laboratory fees for their members in this innovative manner because our primary business is taking care of you and NOT being just a blood-draw center. Your membership for care to a DPC practice allows for this innovation.

Savings from Laboratory Costs

I have a colleague who recently had a pap smear completed, which is a diagnostic test used in females to detect cervical cancer.  She claimed she had ‘Cadillac Health Insurance’ through her employer, meaning basically she thought she had really great insurance that would cover the costs of her healthcare. Look at her bill below and what she was left to pay out of pocket. At my clinic, Beyond Primary Care, the procedure of completing the pap smear if part of the membership. No extra charges. The fee for the pathologist (that I have negotiated) is $44. The difference in costs in this ONE laboratory study alone would pay for months of healthcare at any DPC clinic.

DPC Members can obtain Labs other Doctors Order

DPC providers understand you may need to see another specialist from time to time, and these providers may want their own labs completed. A common question I receive is if the other specialist request labs, can I get them done through your clinic? 

Yes, absolutely this is another great way to minimize your financial impact. No doctor or hospital can force any patient to have routine laboratory studies done only at their location or where they tell a patient to complete them at. That is against the law. They may use convincing language saying ‘the results integrate into our electronic system faster,’ or ‘those other providers may not know exactly what I want.’ Stay firm and request a written and signed order for your labs. Your DPC clinic will complete the exact same labs, bill you at the much lower rates (compared had you used your insurance), and will promptly fax the results over to the requesting specialists that meet their needs. As noted by this Wall Street Journal article analysis of medical services, prices tend to be higher when services are performed in hospital outpatient facilitates instead of at doctors’ offices.

Improve Your Financial Health

admin

20 April 2019

Dr. Jeff O’Boyle with Beyond Primary Care teams up with Dennis LaVoy CFP® CLU® with Telos Financial to discuss ways individuals, businesses, and families can free up cash flow.

Neurontin, Gabapentin, Controlled Substance

Gabapentin as a Controlled Substance

admin

10 January 2019

This past Monday, 1/7/18, the state of Michigan classified Gabapentin (brand name Neurontin) as a controlled substance (C V) as it has been increasingly been reported abused by some patients.

Gabapentin is approved by the Food and Drug Administration (FDA) to treat epilepsy and neuropathic pain caused by shingles. That is it! However, as many people already recognize it is prescribed ‘off label’ by health care providers for various reasons including including depression, anxiety, migraine, fibromyalgia, muscle and joint pain, and bipolar disorder. According to some estimates, over 90% of Neurontin sales are for off-label uses. A report by IMS health found that 57 million prescriptions for Gabapentin were written in the U.S. in 2015, a 42% increase since 2011.

Many providers, including myself, have never screened for Gabapentin abuse in the past as this medication is not tracked by the state’s controlled substance tracking system nor is it typically detectable in most office-based urine drug screens. When Gabapentin is taken alone there is little potential for abuse. Yet, when taken with other drugs, such as opioids, muscle relaxants, and other anxiety medications, there are reports that Gabapentin can have a euphoric effect.

While I see the concern for making Gabapentin a controlled substance in Michigan, it is going to be a tremendous headache for everyone. The community, hospitals, treatment facilities, and doctor offices.

Isn’t it ironic that Michigan is locking up Gabapentin (which IS affordable and has good application when used appropriately) but legalizing marijuana?

It will eventually be easier for people to smoke a joint then get Gabapentin.

Currently, a month supply at Beyond Primary Care for 300 mg (90 pills) is $4.59. The street value for Gabapentin just went up because of this classification and that makes me concerned. Hell, the CDC lists Gabapentin as a non-opioid alternative treatment for pain control. This move by the State of Michigan makes my job as a physician, patient advocate, and provider certified in chronic pain management increasingly harder to deliver affordable and effective treatment to my patients.

Avoiding Resignation with Addiction

admin

30 October 2018

As an addiction specialist offering addiction services, I have yet to meet a patient who enjoys being addicted to drugs. Addiction is a chronic illness around which is a great deal of confusion, few people know what to do. Faced with someone who appears to be driving heedlessly into the abyss, families often fight, freeze or flee, unable to figure out how to help.

 

Consider the opioid epidemic. This month, this news organization estimated that more than 300,000 Americans will die of drug overdoses in the next five years. Why are health professionals and the government not acting on this knowledge? Tradition? Prejudice? Utmost stupidity? The answer is sometimes all three.

 

Often times we scroll the sidebar reading about the passing of great actors and celebrities, such as Philip Seymour Hoffman, Heath Ledger, Michael Jackson, and Prince. But what about those who stray off course closer to home, who don’t get the huge publicity? The suburban middle-aged man, who is a credible business man and decorated community leader but passed from pancreatitis due to chronic alcohol use. Or the aspiring young woman who quietly finished her first marathon and worked unglamorously towards saving for her first house, but OD’d on heroin.

 

I can assure you that there is no as yet undiscovered riddle to these people, the disease of addiction recognizes none of these distinctions. It is indiscriminate, it is sad, it is irrational, and it is hard to understand. But what we should articulate, as I have outlined in this youtube video explaining my treatment of addiction, is that these deaths are unnecessary and something should be done. Fortunately, our brains are remarkably plastic. I know it is far easier said than done, but there is a way to find control and life without drugs. For those brave enough to share, recovery stories such as this are incredible and worth every effort.