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…
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…
The FDA stated last week that transmucosal buprenorphine has been associated with dental problems, including tooth loss. The statement was based on 305 reports to the FDA Adverse Event Reporting System (FAERS) database since buprenorphine was approved 20- years ago. Many of my patients on buprenorphine medications have had dental Read more…
In my last post I teased that I would write about fake science. I’ll try to make it interesting. The internet allows everyone to do research about symptoms and treatments for any condition. If not for need for prescriptions, people could act as their own doctors. But a huge dose Read more…
I’ll share an interesting story about the data used for the prescription drug database in Wisconsin and other states. I’ve been holding back on writing about this issue in hopes that the reason for the story would be corrected, and I would have no story to tell. But that hasn’t Read more…
I’ve been frustrated by the people behind the Wisconsin PDMP, or Prescription Drug Monitoring Program, for their mistakes related to buprenorphine. Whoever came up with the numbers made a rookie error when calculating the equivalent morphine dose of patients taking buprenorphine products. The error is easy to notice by anyone Read more…
Naltrexone induces mu-receptor hypersensitivity. Buprenorphine’s protective ‘ceiling effect’ may not prevent overdose in patients with this ‘reverse tolerance’. A new patient described his recent history of respiratory failure several days into buprenorphine treatment. He was told by his doctors that he experienced an allergic reaction to Suboxone. The rarity of Read more…
The safety of buprenorphine when not combined with a benzodiazepine has been twisted to suggest buprenorphine is uniquely dangerous when combined with benzodiazepines, which is not true. I’ve heard more and more from insurers, regulators, and well-meaning agencies about the dangers of combining buprenorphine and benzodiazepines. Some insurers protest paying 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…
I’ve been busier than I like, and haven’t had as much time for posting. But I spend a lot of time answering emails from my patients, and some of my responses may be useful for others. Below I’ll share my answer to a patient who has been unable to get Read more…
Today on SuboxForum people were writing about their experiences with different buprenorphine formulations. Doctors occasionally have patients who prefer brand medications over generics, but buprenorphine patients push brand-loyalty to a different level. The current thread includes references to povidone and crospovidone, compounds included in most medications to improve bioavailability. Some Read more…
For years, people familiar with the benefits of buprenorphine have wondered– who is the idiot standing in the way of increasing access to this life-saving treatment? One of the idiots was recently identified, when an open-records request by the Huffington Post uncovered a letter to HHS Secretary Sylvia Burwell from Read more…