I often receive emails from patients on buprenorphine (or Suboxone) who are preparing for surgery or other painful medical procedures. Ideally in such cases, the surgeon would have a discussion with the person prescribing buprenorphine, in order to coordinate the plan for treating postoperative pain. In practice such discussions don’t Read more…
I recently accepted a young man as a patient who was addicted to hydrocodone (the opioid in Vicodin), prompting a discussion about treatment options for someone who hasn’t been using very long, and who hasn’t pushed his tolerance all that high. Perhaps it will be informative to share my thought 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…
I just wrote a note to a friend who works in the molecular sciences– she has been studying opioid receptors since the early 1980’s, when things were just getting started on a molecular level. I’m keeping her name to myself, but I’ll share a few thoughts about what is needed to Read more…
A reader wrote with a question that I don’t think I’ve addressed on the blog. Do you have a threshold for how much narcotic a patient must be using before you will put them on buprenorphine? I am concerned about narcotic addicts that are using 6-10 Vicodin (hydrocodone) a day Read more…
Thanks, all of you who wrote comments to my last post. I remind everyone once again to consider taking your comments here and after writing them, also taking them to SuboxForum.com. I am going to put up a new category to discuss topics that were initiated here; it would be 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…
The questions:I am having surgery and my doc was unaware of some things and I thought that you could confirm them for him? Could you advise him to take me off the Suboxone 10-14 days prior to surgery? I have been researching this religously and I have come to the Read more…
Be sure to take a look at ‘buprenorphine news’ halfway down in the right column– there are new things popping up lately about buprenorphine. The top two studies are particularly interesting; the first looked at patients wearing low-dose buprenorphine patches (yes, they are coming folks!) in pain patients to see Read more…
thank you anyway for replying.. So when i do get into seeing a doctor, i must be in withdrawal? I am so confused on this issue. I am taking suboxone, but most likely have to take the lortab when it is out of my system because of the pain i do Read more…
The strength of opiates varies from person to person depending on individual genetics as describe below. Doctors assume that they are ‘tipped off’ to narcotic abuse when a patient says ‘codeine doesn’t work for me– I need vicodin’. The more we learn about opiate metabolism, the more it appears that Read more…
I received a letter today– a person discussing the use of opiates by a family member with chronic pain. I was not sure if the letter was asking questions about my opinions, or was instead arguing that my ideas were off-base. In either case it is worth publishing, as several Read more…