Writing
The core continuity argument, followed by two foundational essays on staying in treatment and understanding buprenorphine.
Continuity · 8-10 min read
When a patient relapses during buprenorphine treatment, the first explanation offered is often a character explanation. The patient was not ready. The patient did not want it badly enough. The patient failed treatment.
Read the continuity essay →8 min read
If you are starting Suboxone, or thinking about starting, there is a number worth knowing before you begin.
Read article →6 min read
If you're considering Suboxone for yourself or a loved one, you have probably already heard some version of this question. It comes from family members. It comes from coworkers. It sometimes comes from people in twelve-step rooms, and -- most painfully -- it sometimes comes from the patient's own internal voice. If I take this medication, am I really sober? Or am I just on a different drug?
Read article →Practical transfer preparation stays separate from the essays, but it should be easy to find.
Resource
A physician-reviewed guide for patients who need to continue buprenorphine or Suboxone care after a prescriber retires, a practice closes, or treatment is at risk of interruption.
Read the transfer resource →Essays on the handoff, pharmacy counter, and telehealth system around the medication.
Transfer of care · 6-8 min read
A buprenorphine prescriber can disappear in ordinary ways. A doctor retires. A practice closes. A clinic changes policy. A telehealth company stops serving a state. A prescriber leaves and the replacement does not prescribe buprenorphine. A patient calls for a refill and learns, for the first time, that the old system is gone.
Read article →Pharmacy/refill issues · 6-8 min read
The moment a physician sends a buprenorphine prescription, the treatment is not yet protected.
Read article →Continuity · 7-9 min read
Telehealth is often sold as convenience. No commute. Faster scheduling. Appointment from home. Less friction.
Read article →Procedure planning matters because unmanaged pain and unplanned medication changes can become continuity risks.
Continuity · 6-8 min read
Dental work has a strange way of being treated as minor until it is not.
Read article →Clinical context for comparing medications and formulations without turning the decision into a slogan.
8 min read
There are three FDA-approved medications for opioid use disorder: buprenorphine, sold as Suboxone, Zubsolv, and others, and as the long-acting injection Sublocade; methadone; and naltrexone, sold as the monthly injection Vivitrol. All three work. None of them is universally the right answer. The right one for any given patient depends on their pharmacological situation, their life circumstances, and what kind of treatment structure actually fits into their week.
Read article →Comparison
A practical comparison of office-based buprenorphine care and methadone treatment structure.
Read the resource →Formulation
Questions to discuss with a treating clinician when formulation, cost, or pharmacy availability changes.
Read the resource →What patients often want to know before the first appointment or before choosing an online provider.
8 min read
If you are reading this, you have probably already done the hardest thing, which is making the decision to seek treatment. What follows is logistics. Logistics are scary mostly because they are unfamiliar, so this article walks through exactly what the first day actually looks like -- minute by minute, more or less -- so the unfamiliarity gets used up before you arrive.
Read article →Guide
Use continuity questions before choosing a telehealth practice.
Read the resource →Longer essays on addiction medicine, physician training, and the assumptions patients inherit.
11 min read
A consultation. The patient is a young man in his late twenties, the son of a family that has been managing his opioid use disorder, with increasing distress and increasing expense, for nearly two years. He has been through detoxification, two residential placements, and a period of intensive outpatient treatment. He is again at risk. His mother, on the introductory call, asks a question that requires the longer answer.
Read article →4 min read
Most people carry a definition of addiction they have never actually examined. It arrives early and is assembled from images rather than evidence: the person asleep on a sidewalk, the friend who cannot stop after the first drink, the relative everyone has quietly given up on. In that picture, addiction is a failure of character — weakness, selfishness, an absence of will. It is one of the most durable misunderstandings in medicine, and it is wrong.
Read article →Care Access
Start with secure intake so the practice can review your situation and coordinate the next appointment-based step.