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 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 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…
Another question from a reader: The current blog brings up the notion of long term use of Bupe or short term detox. You say you are a fan of long term use, and that is clearly a good thing when the patient is one headed back to a drug culture Read more…
I presented this topic at the Atlanta meeting of ASAM a couple weeks ago. There are too many slides, but the historical stuff was just too fascinating to leave out. I wanted to demonstrate, by lining it up on the side, how time has compressed the most critical discoveries to Read more…
Next month I will be presenting a paper at the annual meeting of ASAM, the American Society of Addiction Medicine. The paper discusses a new method for treating chronic pain, using a combination of buprenorphine and opioid agonists. In my experience, the combination works very well, providing excellent analgesia and Read more…
An Article by Mike Berens and Ken Armstrong, Seattle Times, discusses some of the problems with using methadone as a first-line treatment for pain: When it comes to battling pain, Washington health officials have encouraged doctors to reach for methadone, a powerful and inexpensive prescription drug. For the past decade, Read more…
Wow. I just read an email about a story that I was vaguely aware of– about a doctor in Kansas and his wife, who were together linked to scores of overdose deaths. But that is just the beginning. The doctor was supported, during his trial, by Siobhan Reynolds, founder of Read more…
On May 27th, 2011, actor Jeff Conaway died from complications of opioid dependence. His death has been attributed to several causes—sepsis, pneumonia, and aspiration among them— but there is little debate over the ultimate cause of his death at the age of 60 years, that being addiction to opioid pain Read more…
Today I received a call from a patient who has been taking Suboxone for about six months, asking for help with a pain issue. Before getting into the specific details I’ll mention something that I have mentioned many times before; some people do very well on Suboxone maintenance for opiate Read more…
I answered a post today that is similar to many prior posts– a patient with significant pain is no longer getting good pain relief from the pain pills he has taken for the past three years, and he asked whether it was a good idea to change from one narcotic– Read more…