Concierge Telemedicine in Fort Lauderdale, FL

What does concierge telemedicine with Dr. Leeds mean?

Concierge telemedicine means that one physician takes care of one patient, from the first consultation to the last visit. Dr. Leeds sees every patient himself, by secure video for patients located anywhere in Florida and in person at his office in Fort Lauderdale.

There is no substitute doctor and no hand-off to non-physician staff at any point in care. Who takes your history at the first visit? Who answers a text three weeks later? Who decides when the dose changes? In this practice, the answer to all three is Dr. Leeds.

The practice is deliberately small. Dr. Leeds limits the number of patients he takes on, because the whole point of the model is time. It takes time to understand what a medication has done to a person, and time to notice a small change from one week to the next.

So, why would a person choose a private physician at home over a facility with a full staff and a program? That question is the reason this page exists.

What does a visit with Dr. Leeds look like?

Patients tapering off of a benzodiazepine, a z-drug, or a psychiatric medication see Dr. Leeds by video weekly or monthly, depending on the plan and the patient, and a visit often runs up to an hour. A 15-minute medication check cannot hold a taper conversation, so the visits are not built that way.

Between visits, patients have direct text access to Dr. Leeds for urgent questions. So, a symptom that shows up on a Tuesday night does not have to wait for Thursday, and the person answering already knows the case.

Patients treated with buprenorphine for opioid dependence are seen monthly, and weekly when needed. While that is a lighter schedule, it is the same doctor at every visit, and the cadence follows the condition rather than a calendar that applies to everyone.

Visits happen from home, with no waiting room, no travel, and no group. A family member or advocate is welcome at a visit when the patient invites them, and never required. And, privacy is part of the treatment. There is no group circle here, so there is no other patient who knows your name.

What does Dr. Leeds treat?

Benzodiazepine and z-drug tapering is the primary focus of the practice. Dr. Leeds tapers patients who have become physically dependent on prescribed benzodiazepines such as Xanax (alprazolam), Klonopin (clonazepam), Ativan (lorazepam), and Valium (diazepam), and on z-drugs such as Ambien (zolpidem), using the Ashton Manual crossover taper, hyperbolic tapering, the Maudsley Deprescribing Guidelines, and compounded formulations when a dose needs to be smaller than any tablet. The telehealth benzodiazepine tapering program describes how that care is arranged.

Psychiatric medication deprescribing is the second focus. SSRIs, SNRIs, gabapentinoids such as gabapentin and pregabalin (Lyrica), and antipsychotics are tapered on the same principles, slowly and at a pace the patient sets. Dr. Leeds’ work with these medications is getting patients off of them, not putting patients on them.

Opioid dependence is treated with buprenorphine, the medication in Suboxone and ZubSolv, as films or tablets, by telemedicine for new patients in Florida. The first doses are taken at home with phone support, and when fentanyl is involved Dr. Leeds begins with a low-dose induction when needed. The Suboxone treatment page covers the details.

Alcohol use disorder is treated with the Sinclair Method, or TSM, in which naltrexone is taken about an hour before drinking. Over time the drinking loses its reward, a process known as pharmacological extinction, and cravings and consumption fall. It is done at home, and no one has to check in anywhere.

Why a private physician rather than a facility program?

Because treatment should match the condition, not the facility’s program. A person who has taken Xanax, Klonopin, Ativan, or Valium every day for years, exactly as prescribed, is physically dependent on it. Physical dependence is not addiction. It is a medical condition caused by the medication, and the treatment for it is a gradual, patient-directed taper.

A facility built for addiction treats that person with an addiction program. The length of the taper is usually set by what insurance will cover, the goal is to be off the drug by discharge, and the days are filled with group meetings and a recovery curriculum written for a different problem. The discharge date is on the calendar before anyone at the facility has met the patient.

What a benzodiazepine-dependent patient needs is taper coaching, help with withdrawal symptoms, and steady encouragement through the hard stretches, over months rather than days. While addiction counseling is the wrong tool for someone who was never addicted, therapy itself is not off the table. A person can be dependent and not addicted and still have things worth working on with a therapist, and Dr. Leeds refers out when that is wanted.

Unfortunately, a fast taper does not simply fail. It can leave a person with protracted withdrawal that lasts long after the facility has closed the chart, and the 2020 FDA benzodiazepine label update warns that abrupt discontinuation or rapid dose reduction can bring on withdrawal reactions that can be life-threatening.

One warning stands above everything else: never stop a benzodiazepine suddenly, and never let a taper turn into an abrupt stop. Sudden discontinuation can trigger seizures and can be life-threatening. Fortunately, a taper does not have to be fast to work. However it is shaped, it should be gradual and medically supervised.

What about opioid dependence and alcohol?

The same mismatch shows up with opioids. A facility program often tapers a person off of opioids with buprenorphine over one to two weeks, with abstinence from everything as the goal at discharge. Unfortunately, the brain has not had time to recover in two weeks, and in Dr. Leeds’ experience many people relapse within a few months of going home.

Long-term buprenorphine treatment gives the brain that time. Cravings are quiet, the person goes to work and comes home, and the pathways that drove the addiction fade over months and often years. How long any one person stays on it is its own question, answered by that person and their doctor rather than by a program calendar.

Alcohol follows the same logic in a different form. Cravings for alcohol can persist for months after a person leaves a facility, and returning to the same kitchen with the same cravings is where many relapses start. With the Sinclair Method, the patient stays home, takes naltrexone before drinking, and lets extinction do the work gradually.

In each case the medicine fits the condition, and the person keeps their life while it works. That is not a perk. It is the treatment.

Why do facility programs fail these patients?

Many facility programs, including well-regarded ones, still run on an abstinence-only culture that formed before there was effective medication treatment for opioid or alcohol dependence. Some have added medication to their programs, yet abstinence remains the corporate culture and medication sits on the second tier.

In Dr. Leeds’ practice, medication treatment is offered on its own terms, not as a second-tier option to abstinence-only programs. If the evidence supports buprenorphine or naltrexone over a meeting, the recommendation is the medicine.

Twelve-step meetings are not recommended as part of medical care here, and no patient is required to attend a group. Still, some people find real support in a 12-step group for their own reasons, and that is their choice to make.

Of course, a meeting is not a medical treatment, and taking a prescribed medication is not a failure of recovery. The program a person needs is the one that fits the condition they actually have.

Can two people really do better than a facility full of staff?

Often, yes. Walk into a residential program and you will see nurses, counselors, technicians, directors, and administrators, an army of staff. This practice is a doctor and a practice manager. As they say, sometimes too many chefs spoil the soup.

While that is not a perfect analogy, the point holds. Yet, a large staff cannot give one patient a full hour with the same physician, and that hour is where the work happens.

And, the tone matters. Addiction is not a moral failing. It is a mental health condition, and people carrying it are looking for kindness and support, not “tough love.” Tough love does not work.

Kindness is not softness. A patient who is treated with respect tells the doctor the truth about how the taper is going, and a taper cannot be adjusted without it.

Why does this model work?

Patients dealing with benzodiazepine dependence, psychiatric medication withdrawal, or an addiction to opioids or alcohol need more than a prescription and a follow-up in three months. They need a physician who knows the case well enough to notice a subtle change in how they are responding, and who is reachable when the question comes up between visits. Realistically, only a small practice can promise that.

The model also lets a person research their doctor before committing. Dr. Leeds is a named physician whose writing is on this site and whose podcast is on every major platform. In fact, a person can read and listen for weeks before ever filling out a form, which is a different proposition from a facility whose staff you meet on admission day.

Treatment fits around work, family, and a phone instead of replacing them. The facility ladder of residential care, then partial hospitalization, then an intensive outpatient program, is a program calendar. It is not a clinical necessity, and how long care lasts here is set by the person and their condition. A taper often extends over several months, with the timeline depending on the medication, the dose, and the years of use, and nobody is discharged on a date chosen in advance.

Patients direct the pace of their own care.

Dr. Leeds treats each patient as a partner in their treatment plan. Patients keep control over the pace and direction of their care, and no one is pushed to taper faster than they can tolerate or to follow a plan they are uncomfortable with.

Of course, the taper process is patient directed within limits that keep it safe. If a taper is going too fast, Dr. Leeds must help the patient slow it down. While no one is hurried, a taper that is going slowly and well may speed up a bit, as tolerated, when patient and doctor agree.

Coaching and counseling happen inside the medical visits rather than as a separate service. Dr. Leeds spends part of many visits helping intelligent, creative people reconnect with the activities that give their life meaning, because that reconnection supports the healing. When a patient wants a dedicated therapist as well, Dr. Leeds refers out, and therapy is never a condition of care.

Patient intelligence and autonomy are respected. The goal is collaboration, not directives handed down from above, and a patient who disagrees with the plan is expected to say so.

What can this practice do, and what can it not do?

Dr. Leeds provides prescribing and ongoing care by telemedicine to patients located in Florida, with in-office visits available at 3290 NE 33rd St in Fort Lauderdale. The practice tapers benzodiazepines, z-drugs, and psychiatric medications, treats opioid dependence with buprenorphine films and tablets, and offers the Sinclair Method for alcohol use disorder, with coaching and counseling provided within medical care. It is a concierge practice that accepts no insurance or discount plans. It does not treat patients outside Florida, it is not a psychiatry practice, it has no residential beds and no group program, and it offers no separate counseling or therapy service. Long-acting injectable medications such as Sublocade, Brixadi, and Vivitrol are not a service of the practice, although Dr. Leeds can advise on them in a consultation. An initial consultation comes before any medical treatment, and it is a conversation rather than a medical visit, so it does not by itself establish a physician-patient relationship. The services page lists every tapering service by medication.

Who is Dr. Leeds?

Dr. Leeds is an osteopathic physician and deprescribing specialist providing concierge telemedicine in Florida. He graduated from Des Moines University College of Osteopathic Medicine in 1996 and completed his residency in family medicine at Westchester General Hospital in 1999, and he has over 26 years of experience in family medicine and over two decades of experience in treating medication and drug dependence and addiction.

Dr. Leeds serves on the medical advisory board of the Benzodiazepine Information Coalition, or BIC. He hosts The Rehab Podcast on the Mental Health News Radio Network, available on all major podcast platforms, where his guests include physicians, best-selling authors, and filmmakers working in addiction, recovery, and deprescribing.

Care is available to patients located in Florida by telemedicine, with in-office visits in Fort Lauderdale. To ask whether this practice fits your situation, contact Dr. Leeds through the contact form to request an initial consultation.

This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.