Tolerance is an Important Consideration

It is nice to see the growing number of buprenorphine prescribers on the ASAM forums. There are many APNP’s getting involved, and many of them will probably be better at the job than physicians. One concern I have, though, is whether those prescribers fully understand that tolerance is an important Read more…

Pregnant, in jail

Methadone, a Dead Baby, and a Rushed Judge

Now and then, an attorney will ask me to provide an expert opinion on addiction. I can usually quickly review records to find issues that attorneys might miss.   Moreover, with access to electronic libraries, it usually does not take long to find articles supporting my opinion. I come from a Read more…

Suboxone Treatment over Fifteen Years

I have teased this…. a description of Suboxone treatment over fifteen years, described in 183 pages as I grew to treating 279 and eventually 300 patients on buprenorphine medications. In those early days I battled many different forces. Insurance companies demanded reasons to cover a person beyond one year. Most Read more…

Fentanyl Also Complicates Buprenorphine Induction

Most buprenorphine docs know that long-acting agonists like methadone complicate induction. In fact, doctors who induce 24 hours after a patient stops methadone learn never to do it again – or to ensure the patient does it at home! I write ad nauseam about precipitated withdrawal on this blog, so Read more…

Cardiac Status Not Quite Ready

I spent the weekend in NYC, realizing how much I like the place. Most of us in the Midwest read a lot of negatives about NYC, primarily related to crime and urban decay. But there is still much to love. On Friday I walked to the High Line with my Read more…

Buprenorphine and Dynamic Character Defects

This is an important discussion, and I hope people will take a moment to follow the link I’ll get to in a moment. When I started this blog in 2008 I received a great deal of pushback from the sober recovery crowd. This article in particular stirred some animal spirits. Read more…

VA Gets it Right and Wrong on Buprenorphine

The Veterans Administration recently released guidelines for chronic pain that recommend using buprenorphine if opioids are indicated. That idea has some validity, but the VA, and commenters, get much of the issue wrong. Buprenorphine is a very potent opioid, a partial agonist, with a ‘ceiling effect.’ That means that buprenorphine Read more…

Data from open-source VAERS for COVID vaccines

If A Tree Falls and Nobody Tells VAERS, Did It Really Happen?

My last post teased my summer illness story that I’ll continue writing on my ‘personal’ blog. Springtime is coming, which will create some writing challenges. But for now, understand that I had lifesaving open-heart surgery at UC San Diego, called pulmonary endarterectomy, that included hours of deep hypothermic cardiac arrest. Read more…

The Summer of Walking Through Ashes

I walked two miles with my wife each night after work in three of our four Wisconsin seasons. The loop through our neighborhood passed from an open area lined with Ash trees through wooded areas. The road gradually dropped and rose about 200 feet in one wooded area and then Read more…

DEA, Let Them Have Adderall!

I specialize in treating addiction and other psychiatric conditions. A clear connection has been established in the literature between addictive disorders and attention deficit disorders. The exact reason for the association can’t be proven, but I see a process where students who do poorly in school become labeled a certain Read more…

A Wisconsin Tesla Story

A friend brought his new Tesla to our Wisconsin home over Christmas. We didn’t worry too much about charging because he lived only an hour away. That was a mistake. Read on for a Wisconsin Tesla Story. He left home with 100% charge after charging in his garage overnight. He Read more…

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Taking New Suboxone Patients in Wisconsin

I mentioned that the DEA removed limits on the number of patients a prescriber may have on buprenorphine medications. I can treat more patients, so I am taking new Suboxone patients in Wisconsin. Search engines like to see relevant words over and over, so I’ll add that I’m taking new Read more…