Methadone-Not Your Average Controlled Substance
~ t f l 1L. fl;J;

[.A ,et gdone-,. Jot
Your Average
Controlled Sub-
stance

* Hogar CREA
International of
Florida, Inc.

* November ba-
bies

Hospitalist Hu.
mor

Inside this issue:

Board Certified 2

Healthease Net- 2
k

Methadone is a long-acting opiate agonist used for the
treatment of chronic pain and withdrawal symptoms
related to opioid-addiction. Methadone is a Schedule II
controlled substance strictly regulated under federal law.
When used as a treatment for withdrawal, patients must
be enrolled in a Narcotic Treatment Program (NTP) to
receive methadone.
No physician, even those registered as a NTP, can
write a methadone prescription for treatment of addic-
tion. Only when methadone is being used for analgesic
purposes can a physician prescribe methadone.
Although they cannot write a prescription, physicians
who are registered with the Drug Enforcement Agency
(DEA) as a NTP can administer or directly dispense
methadone for treatment of addiction. When arrange-
ments are being made to enter the patient into a treat-
ment program, physicians who are NOT registered as a
NTP may administer or directly dispense methadone for
the purpose of alleviating withdrawal symptoms ONLY
under the following conditions:
* No more than a one-day supply of medication may
be administered or directly dispensed to a patient at

one time,
* Treatment may not be carried out for more than
three days
* This three-day period cannot be renewed or ex-
tended
If a patient is enrolled in a NTP and is admitted to the
hospital for a reason other than addiction, an unregis-
tered physician may order methadone for the patient.
At Shands Jacksonville, the pharmacist will verify the
maintenance dose with the methadone facility before
methadone is dispensed for this purpose.

References

Section 1306 07 Administering or dispensing of narcotics drugs 21
CFR 1306 07 (b) ONLINE Available http/
www deadversion usdol gov/21cfr/cfr/1306/1306 07 htm {October 9,
2008)
Pharmacists Manual An Information Outline of the Controlled Sub-
stances Act of 1970 April 1994 ONLINE Available http/
www deadiversion usdol gov/pubs/manuals/pharm2 manual pdf
(October 15, 2008)

Methadone and Buprenorphine +/- Naloxone (Subutex and Suboxone)

Hoar CREA nternationl of Florida Inc.

Ir Hogar CREA International of Florida is a non-profit organization that has over 40 years dedicated to the prevention
This Month's 2 and treatment of alcohol and substance abused persons. Juan Jose Garcia Rios founded Hogar CREA in May 1968
events in Trujillo Alto, Puerto Rico. To date, CREA International has 104 facilities operating throughout Puerto Rico,

Personal Message 3 United States, Caribbean, Central and South America. According to CREA International's brochure, the residents
from Dr House of Hogar CREA, participate in programs that are exposed to a real home environment with the physical, emotional,

Journal Club 3 spiritual and moral components that contribute to the formation of a sound character; in which, the resident learns
to assume responsibility for their own life and conduct. CREA's prevention programs include, drug addiction, alco-
Getting to know 3 holism, AIDS and crime. Gary Enos, case manager that works closely with the Division of Hospital Medicine, has
you
begun to use this program in this hospital. If you would like further information in regards to Hogar CREA, please

call 904.346.1772. Please note This article is for informational purposes only The Division of Hospital Medicine promote nor necessarily
support the views or actions of CREA International

Is M N st

November

birthdays:

November 19

Dr. AlAshhab

ARIM Exams

Every year, thousands of residents take the American Board of Internal Medicine exam. Our division is now
100% board certified for all 21 physicians. Please extend a congratulations to the
physicians listed below who recently passed the exam:
Dr. Al Ashhab
Dr. Ruchi Gupta
Dr. Roger Maalouf
Dr. Michael Hernandez
Dr. Win Aung

Please note: Dr. Wilfredo Sanchez recently completed his Infectious Disease exam in late October. We wish him
the best of luck while he waits for his results.

H-ealtheasa Network

Healthease is a Medicaid replacement plan that is
sponsored by WellCare insurance plan. Shands Jack-
sonville is not participating in the Healthease Net-
work like other hospitals in the greater Jacksonville
area. The emergency rooms have seen a stable flow
of Healthease patients. Case Management has begun
to monitor these out of network cases on a daily
basis. Per an email sent by Pam Shiver, Director of
Case Management, case managers will be speaking
with the attending to identify if the patient is "stable"
enough to transfer to an in network hospital. If the
attending determines that the patient is "not stable"
for transfer, case management will not pursue an
accepting facility but will continue to monitor the
patient for changing conditions. The email also indi-

cates that an Attendings' responsibility with
Healthease patients as the following:

1. Determine if the patient is stable for transfer

2. Completion of transfer paperwork

3. Hand-off communication to receiving physician
at the receiving hospital

If you have any further questions in regards to this
topic, please contact Pam

Sor 904.244.4142.
or 904.244.4142. a!.

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SPage 2

ALk Dr House

Can unused vacation be car-
ried over to the following
year? Yes, your vacation that is ac-
crued does carry over to the following
year with the exception of TEAMS
days. TEAMS days are given by the
University after December 1st. Those
days must be used by June 30th or
else you'll lose them.

What is the hospital policy for
someone who wishes to
moonlight outside of UF?
Moonlighting that involves patient care is
prohibited by the University of Flor-
ida. Other forms of moonlighting such as
reviewing medical literature, pharmaceuti-
cal industry work (although this may
change in time), and reviewing medical
legal cases have not been prohibited.

fOcinhta r urnal Cliub

Presenter: Dr. Winn Aung

Article: Weight Loss with a Low
-Carbohydrate, Mediterranean or
Low-Fat Diet. NEMJ 2008; 359:
229-241.

Summary: A two year trial was
conducted in which 332 moder-
ately obese subjects were given 1
of the 3 diets: low-fat, restricted-
calorie; Mediterranean, restricted
-calorie or low-carbohydrate, non
-restricted-calorie. The results of
the study were as follows:

* All groups has a significant
decrease in waist circumfer-

ence and blood pressure.

* LIPID PROFILES: "HDL,
JTG, JTotal/HDL ratio
(more in Atkin's); no differ-
ence in LDL.

* T in high molecular weight
adipocetin, Ileptin in all
groups

* I fasting plasma glucose in
Mediterranean; I insulin in
all groups.

Main points from the article that
were discussed:

* Safety and Effectiveness

* Personal preference in regards to
a particular diet plan

* Weaknesses of the study

* Strengths of the study

In summary, low-carbohydrate, non-
restricted-calorie diet proved to be
more effective with weight loss reduc-
tion and maintaining the weight loss.
The slight catch to the study, it was
partially sponsored by Dr. Robert C.
and Veronica Atkins Research Foun-
dation.

Gittttinn....uknow Ravi

Full Name: Ravi Kumar Kancha

Place of Birth: India

Favorite Color: BLUE

Favorite Food: Chic(ken)

Something Unique about you: I am the proud father of 16+2 kids and I spend 10% of my income for charities.

Place you would like to visit: Hawaii

Ravi Kancha, MD PhD

SPage 3

Dr. Jeff House, Division
Chief Hospital Medicine

M ison o Hopita Medcin

Division of Hospital Medicine The Division of Hospital Medicine has an established team of highly
655 West 8th Street qualified, specially trained, experienced providers. Our team works in
cc262
Jacksonville FL 32209 partnership with various entities within the hospital including special-

Phone 904-244-7024 ists and case management.
Fax 904-244-4799
E-mail hospital medicine@jax ufl edu

"Hospital Medicine is a service that allows the physicians
to optimize and provide seamless patient coverage"
-Dr. House, Division Chief Hospital Medicine

SWe're on the web!
http://www.hsci.ufl.edu/im/hosp ]

Copyright 2002 by Randy Glasbergen.
www.glasbergen.com

"We can't find anything wrong with you, so we're
going to treat you for Symptom Deficit Disorder."

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