Uncoupling of analgesia, tolerance, and euphoria from mu-agonists using buprenorphine

I presented this topic at the Atlanta meeting of ASAM a couple weeks ago.  There are too many slides, but the historical stuff was just too fascinating to leave out.  I wanted to demonstrate,  by lining it up on the side, how time has compressed the most critical discoveries to […]

Ten Gripes of Buprenorphine Doctors

I recently gave a lecture to medical students about opioid dependence and medication assisted treatment using buprenorphine, methadone, or naltrexone. I was happy to see their interest in the topic, in contrast to the utter lack of interest in learning about buprenorphine shown by practicing physicians. In case someone from […]

Opioid Analgesia Without Addiction

I don’t have pull with the addiction-related organizations out there.  I’m never been a joiner, and I tend to notice the problems caused by medical societies over the good things that they supposedly accomplish.    For example PROP, or ‘Physicians for Responsible Opioid Prescribing’, have a specific mission.  Once a […]

Taking Buprenorphine, Having Surgery

Originally Posted 8/12/2013 I will get to ‘Part II’, but today I talked with a patient about something that happens too often, that deserves to be pointed out.  The person was in the ER with an injury that resulted in tib/fib francture.  The ER doc provided no analgesia, in the […]

Humana's End Run to Deny Buprenorphine Coverage

Humana Health Insurance recently revised their guidelines to ultimately reduce the number of scripts for Suboxone that they will cover.  I am in the process of writing the Humana Grievance Department a letter to regain coverage for a patient who was doing very well on the medication.  To provide context, […]

Endorphin Deficiency Syndrome and Buprenorphine

Every now and then I receive an e-mail  or comment that is sufficiently long to warrant a post of it’s own.  Below is the comment without interruption;  a bit lower I repeat parts of the comment, interspersed with my own responses.  I hope you find it interesting. The comment: I […]

Clean Enough, Chapt. 3: A Primer on Suboxone

What is Suboxone? Suboxone is the trade name for a medication that contains buprenorphine and naloxone. A similar medication, Subutex, contains buprenorphine without naloxone.  Both are manufactured and sold by Reckitt-Benckiser, a company based in the UK with operations world-wide. Suboxone is FDA indicated for the treatment of opioid dependence.  […]

Buprenorphine for pain- recent studies

From an astute reader: I copied and pasted this article. It’s been my impression that bupenorphine isn’t superior for chronic pain. I also read an article that three amputees with phantom pain got adequete relief from using buprenorphine suppositories. Is there a difference between using the under the tongue med […]

Pain treatment becomes more rational

Pain Treatment Becomes More Rational

I’ve spent 15 years treating addiction, mostly to opioids. I’ve worked in residential treatments, methadone programs. I have testified in cases related to overdose deaths. I know the harm that is possible from excess opioid precribing or use. But I also hope that some day, pain treatment becomes more rational. […]

Post-op Pain on Suboxone

Many patients on Suboxone or buprenorphine eventually require pain treatment, just like people who aren’t on buprenorphine products.  I’ve written about post-op pain control several times, but I continue to get emails from patients who haven’t seen my comments and who view an upcoming surgery with the same fear experienced […]

A New Way to Stop Suboxone?

Originally Posted 10/27/2013 I usually have my wife/business partner review my posts and provide her opinion whether my arguments are sound.  For the record, she tells me that this post is technical and boring.  I disagree, but we aren’t planning to separate over the issue.  A valid criticism, I think, […]

DA Asks Why Still On Suboxone?

First Posted 10/13/2013 A person in my practice was stable on Suboxone/buprenorphine for several years, until he developed a painful injury.   During the time the injury was treated, the person experienced significant pain.  I worked with his surgeon to provide adequate pain relief, which for patients on buprenorphine or Suboxone  […]