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…
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. Read more…
I came across this public-accesss story, and wanted to share the perspective: Pauline Bartolone, Kaiser Health NewsEven as opioids flood American communities and fuel widespread addiction, hospitals are facing a dangerous shortage of the powerful painkillers needed by patients in acute pain, according to doctors, pharmacists and a coalition of Read more…
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 Read more…
I recently read a CBS news story about CHS, or Cannabinoid Hyperemesis Syndrome, describing a 100% increase in cases in Colorado since the legalization of marijuana there. A search for ‘THC’ and ‘CHS’ pulls stories from a range of sources including High Times, Wikipedia, Fusion.net, and Current Psychiatry. A broader Read more…
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 Read more…
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 Read more…
Originally Posted 1/11/2014I received the following email from a Suboxone patient (from another practice) after he experienced a painful injury. He shared what happened at the hospital when he was trying to get relief from pain, while taking Suboxone (the active component is buprenorphine). Hey there. Just to let you Read more…
I have received MANY messages over the years from patients on buprenorphine/naloxone (Suboxone) who required surgery, but whose doctors refused to provide post-op analgesia. Those of you not on Suboxone– can you imagine having surgery, and being told that ‘it is too much hassle to give you any medicine for Read more…
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 ER or at Read more…
Originally Posted 7/18/2013 Like most of you, I’m not thrilled with modern healthcare. I miss how things were twenty years ago, when I had a sense of ‘having a doctor’ who actually knew me, who had my best interests in mind. I remember my father, a defense attorney in a Read more…
Originally posted 12/19/2012 I’ve written about this topic a number of times, but I continue to receive emails from people on buprenorphine who describe inadequate pain control following surgery. I have prepared a document for my own patients to provide to surgeons, dentists, and ER staff to be used in the case of injury or Read more…