1. lofiDoc

    From one Doc to another (I’m in Australia). You may be interested (or possibly know) how we do things here. Basically, addicts can register at any Dr who’s completed a programme and is then authorised to prescribe what we call Schedule 100 drugs: mainly buprenorphine and methadone. Almost all these Dr’s ‘bulk bill’ ie. are free for the patient. Once prescribed, the patient turns up at a chemist (who’s set up to dispense S100 drugs) daily and receives their dose. After 2-3 months of stability ‘takeaways’ may be authorised by the Dr: up to 3-4 a week. In general terms there is almost NO prescribing of 30 day bottles here – Px need too see the pharmacist daily and their Dr at least once a month. This is free for the patient, however most pharmacies will charge a couple of dollars a day to dispense, and keep patient’s skin in the game. The provision of the drugs themselves is free. ie. done by the Dept. of Health. So..all in all our systems is quite different in that it’s a) pretty much cost-free to the patient and b) requires regular attendance at a pharmacy ie. daily or almost daily.
    In terms of prescribing: Dr’s over here are far less ‘go my own way’ than the US (I have found anyway). There is established practice, and you leave yourself wide open to criticism from your peers if you vary from that. In the case of suboxone, the established standard is to keep patients on suboxone for as long as possible, if not permanently. We are under no pressure to ween addicts off suboxone/methadone, and in general I actively discourage it, except for a very few motivated individuals with stable lives eg. other healthcare workers. A Dr that promoted leaving a programme would face a barrage of criticism, and possibly be reported by his/her peers. This is great in one way, but bad in others: the individual’s healthcare can’t be overly tailored.
    So…that’s buprenorphine et al in Australia…hope you and your readers find it interesting, and keep up the outstanding work of this blog!

  2. tulsaride

    I’ve been on 8 mg of subutex for over 2 years. Over a short period of time, I started feeling bad, wher before I was enrgetic, happy etc. anyone experience this? Thhe affect of the drug was great, the dissapated, and it just not working.
    It’s been tia way for months…I can’t figure it out.
    Any comments would be appreciated

    • I have close to 100 patients in my practice who have been on buprenorphine for a long time– a couple years or more. I do not see this effect– but they are all susceptible to ‘the usual suspects’ in psychiatry, i.e. major depression, dysthymia, bipolar disorder, anxiety disorders, etc. Since active opioid dependence occupies SO much of a person’s life and time, going on buprenorphine and ending the obsession to use opioids has a major effect on the person’s life. Suddenly there is a great deal of extra free time; suddenly the mind is less distracted and more aware of the problems that may have been put off for months or even years; suddenly the problems in a marriage, such as loss of intimacy, become apparent instead of being repressed.
      Buprenorphine does ONE thing– and that is to remove the chemical obsession to use opioids (a ‘conditioned’ obsession may remain for some period of time). Buprenorphine is not a panacaea; life continues to throw challenges each day, and we must all struggle to keep our chins up and trudge forward… and every once in awhile we have a little fun, too. Please check out http://www.suboxforum.com if you haven’t already.

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