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. Opioids act at receptors that normally bind endorphins, which are released by neurons in response to a range of stimuli … [Read more…]
Many patients taking buprenorphine live in fear of a dark world around the corner where they will have to taper off the medication. They see horror stories on YouTube posted by people who, for some reason, abruptly stopped the medication and kept a video log of their experiences. My own patients sometimes ask, nervously, if … [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 forum members suggested that their … [Read more…]
This morning I responded to a woman at SuboxForum. Her baby was taken to the NICU for ‘withdrawal’, which is better identified as neonatal abstinence syndrome. She said that the baby is eating well, but there is concern that the baby sleep only 2 hours at a stretch. The baby is on morphine, and mom … [Read more…]
A post on the Forum asked about the best remedies for opioid withdrawal. I will review the medications and other treatments for opioid withdrawal that I have heard discussed by physicians or by people on the internet. Hopefully readers will leave comments about medications or approaches that they have found useful. Likewise, if you are … [Read more…]
First Posted 2/6/2014 A few weeks ago I wrote about the differing standards of care for women who deliver babies while treated with buprenorphine for opioid dependence. Some hospitals require newborns exposed to buprenorphine to stay in the neonatal ICU for arbitrary length of time. Intravenous infusions of opioid agonists are given to infants whose … [Read more…]
First Posted 2/1/2014 The topic of newborn abstinence syndrome from buprenorphine provokes strong emotions. Expectant mothers anticipate harsh attitudes from doctors and nurses. They worry that their use of buprenorphine will cause their babies to suffer from withdrawal. They hear about the experiences of women reported to CPS after delivery, or whose babies were kept … [Read more…]
First Posted 12/15/2013 People know my bias—that buprenorphine is best-considered a chronic, perhaps life-long treatment for a chronic, life-long disease. That said, I am aware of how many people out there are convinced that they need to be ‘off everything,’ no matter the misery opioids have caused in their lives. I don’t get it; my … [Read more…]