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…

More Methadone, If WE Can Profit From It.

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…

Tapering Suboxone

How to Stop Buprenorphine or Suboxone, Pt 2

In the last post we discussed some of the misconceptions about tapering off opioids.  Today we will discuss a couple basic principles, and then describe the approach I recommend for my patients tapering off buprenorphine. Presenting how to stop buprenorphine or Suboxone, Pt 2 Opioids act at receptors that normally Read more…

pain pill overdose deaths

Can I Get High From Suboxone?

Can a person get high from Suboxone or buprenorphine, the active part of that medication? I suspect most pharmacists, police officers, and legislators would answer ‘yes!’, but the answer is more complicated. The people who serve patients who take Suboxone should learn how the medication works, when it is dangerous, Read more…

Pharmacists, Do Better

This is a ‘bone to pick’ post. Yesterday a patient who has done well on buprenorphine for the past 6 years shared his pharmacy experience. His experience is typical of whatI hear far too often. I understand that pharmacists are overworked and understaffed, but the complaints I hear so often Read more…

Get Help. Get Buprenorphine, Not Methadone.

In the first part of this series I described my experiences working in methadone-assisted treatment, including aspects of that industry that, in my opinion, warrant serious consideration. In the second part I described steps that potential patients can take that might help them avoid spending their entire lives attached to Read more…

Methadone Treatment Can Become a Lifetime Curse

I know. Nothing brings out the boo-birds like a negative story about methadone. For the record I agree that methadone treatment, properly provided, is a vital and life-sustaining weapon against opioid overdose deaths. But too often, methadone treatment can become a lifetime curse. This is long because the story is Read more…

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. Read more…

The Real Reason Fentanyl is So Dangerous

Fentanyl plays a role in more and more opioid overdose deaths. Most fentanyl used ‘on the streets’ starts in China, with precursors shipped to California or Mexico before distribution throughout the US. Fentanyl acts very potently at the same receptors as heroin, morphine, and oxycodone. Reports of overdose deaths caused Read more…

Stopping Buprenorphine in Three Steps

Readers will sometimes ask for my thoughts about buprenorphine. I’m always happy to respond, time permitting. I’ve described how my patients taper off buprenorphine in prior posts, but the interest out there warrants revisiting the topic. Most people who become dependent on opioids become very fearful of withdrawal. That fear Read more…