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…
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…
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…
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…
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…
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…
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 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…
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…
Many people looked for a return to normalcy when they pulled the Biden lever in 2020. Since then we changed the English language, encouraged young children to explore their pre-pubertal sexuality through gender-changing hormones or surgery, and committed ourselves to energy sources that, after 20 years of development, currently provide Read more…
The older I get, the more I have a growing annoyance with experts. I have patients to see in a few minutes so this will be brief – and followed by a longer discussion at some point. Besides, my hosting service is down this morning so who knows when I’ll Read more…
A short holiday post today. Reading my newsfeed I came across an article by Jason Kletter, President of BayMark Health Services, complaining about Section 4 of the proposed Opioid Treatment Act that would allow pharmacies to dispense methadone for the treatment of opioid use disorders. At present, no opioid, including Read more…