7 Comments

  1. Kyle

    Doc how can I get into contact with you? I cannot find an email, but I am trying to get more people to stand behind my petition. It doesn’t matter what state the the people live in, but I have contacted the AATOD, NAMA, SAMHSA. Some of them have promoted the petition, but we need more help as the deadline inches foward. I will include a link to the petition, and it would be great to have another doctor help with the situation at hand. These patients need as much help as they can get, and so far the petition has had overwhelming support.
    https://www.change.org/p/terry-mcauliffe-virginia-opioid-treatment?recruiter=19915210&utm_source=share_for_starters&utm_medium=copyLink

  2. William Taylor, MD

    Next to last paragraph: did you mean to say “PW occurs when bound agonist is suddenly displaced by buprenorphine? Always enjoy your enlightened commentary.

  3. This is very insightful especially the sharing of the case of the patient.
    Would agree with you that Buprenorphine induction is always more dangerous in patients with low opioid tolerance and that patient selection should be done more carefully.

  4. Rob

    My partner was on Norco for 4 years and he built a tolerance to it that stopped it from helping his lower back pain. They sent him to a pain clinic who put him on Suboxone. We can’t seem to get any answers from our medical professionals…..He is not an addict, doesn’t and never has abused his medication. The pain clinic doctor put him on Suboxone to detox his body, even though he isn’t addicted to it, she said his body was. Now we have the issue of him having a low pulse ox level, he was supposed to have the cortizone shot in his back yesterday, and was taken to the ER instead because that doctor said his blood ox was too low and he couldn’t do the shot due to possible complications. FINALLY, the ER nurse did tell us that Suboxone can do that. With him not being an addict, and no chance of “relapsing”, how do we address this with the pain clinic doctors in a way where they will get it without acting like “He’s an addict”? I just think there’s a chance this course of treatment may have been misunderstood. We want off narcotics, not because of addiction, but because of built up tolerance and less results in the pain along with the other complications they cause. Any advice would be wonderful.

    • Rob, the pulse-ox should be addressed first. All opioids, including buprenorphine, can cause respiratory depression. If someone with a very low opioid tolerance takes buprenorphine (or Suboxone), the opioid effect of buprenorphine could cause slower breathing, along with other signs of overdose– small pupils, nausea and vomiting, and sedation. People who have higher tolerances, or who build up their tolerance to buprenorphine for a week or more, do NOT have respiratory depression from buprenorphine meds, and will NOT have a low pulse oximetry reading.
      How low was the pulse-ox? Normal is 98-100. If it is significantly lower than that, something serious could be going on. I’ve seen ERs miss all sorts of things by blaming buprenorphine/Suboxone. I had a patient who had a low pulse-ox and a temp of 103; the ER told him ‘it must be the Suboxone.’ He almost died from the pneumonia that they missed.
      Things that cause a low pulse ox include pneumonia, pulmonary embolus/infarction, congestive heart failure, drug overdose (including benzos), lung tumor, COPD, asthma, etc. Make sure your partner is OK.
      Buprenorphine/Suboxone is NOT a good med for what you describe. It likely pushed his tolerance higher than it was on Norco (which is hydrocodone, a weaker opioid). It is difficult to taper off buprenorphine because there are not many choices in doses. The lowest dose is 2 mg, which is lower than 8 mg, but still is a very high dose of buprenorphine. Buprenorphine is a ‘microgram drug’– i.e. the taper needs to go down by micrograms if withdrawal is to be avoided.
      As for getting them to differentiate between ‘addict’ and ‘pain patient’, that is a difficult point to get across. Addiction is such a loaded diagnosis these days, and once that label is even whispered, it is extremely hard, and rare, for it to be erased.
      Check out my forum, http://www.suboxforum.com — you will find help for your other questions.

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