Zone! Sun, 23 Jan 2022 22:38:19 +0100 https://dev.medworm.com/896158211/the-real-reason-fentanyl-is-so-dangerous/ Fentanyl plays a role in more and more opioid overdose deaths. Most fentanyl used ‘on the streets’ starts in China, with precursors shipped to California or Mexico before distribution throughout the US. Fentanyl acts very potently at the same receptors as heroin, morphine, and oxycodone. Reports of overdose deaths caused by fentanyl usually blame potency, but the real reason for fentanyl’s outsized role in overdose is rarely mentioned – at least outside operating rooms. Fentanyl is as ubiquitous in the medical industry as it is on the street, in 50 microgram per cc, sterile vials rather than the small rocks ground up by drug dealers and added to heroin. Operating rooms are full of the stuff, as are dental offices, cardiac cath labs, and colonoscopy suites (why, b... Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 896158211 https://dev.medworm.com/831922978/ending-constipation-from-suboxone-and-buprenorphine/ Constipation is one of the few potential side effects caused by buprenorphine medications, including Suboxone Film and Zubsolv. Fortunately, ‘binding up’ can be managed by making minor changes to your lifestyle. Constipation from buprenorphine is caused by activation of mu opioid receptors in the small and large intestine, reducing the sequential squeezing and relaxation (called peristalsis) that pushes bowel contents forward. All opioids have similar effects, mimicking our natural endorphins throughout the body. Endorphins are released during trauma to naturally block pain and to divert blood flow to areas where it is needed most — and the bowel is relatively shut down during those periods to conserve energy. Constipation problems from buprenorphine (I’ll use... Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 831922978 https://dev.medworm.com/831753576/stopping-buprenorphine-in-three-steps/ Readers will sometimes ask for my thoughts about buprenorphine. I’m always happy to respond, time permitting. I’ve described how my patients taper off buprenorphine in prior posts, but the interest out there warrants revisiting the topic. Most people who become dependent on opioids become very fearful of withdrawal. That fear continues on buprenorphine medications like Suboxone, Zubsolv, and generic buprenorphine. Patients should strongly consider using buprenorphine to keep their addictions in remission for at least a year or two before starting a taper, and those prone to relapse to opioid use should consider life-long medication. Doctors regularly use medications with higher risk-profiles than buprenorphine to prevent illnesses with lower associated morbidity! But some... Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 831753576 https://dev.medworm.com/744708347/suboxone-forum-upgrade/ Regular readers know that I’m a psychiatrist and addiction doc – not a computer guy. When I started writing about Suboxone and buprenorphine twelve years ago, there were few other people writing about the medication. Of course heroin addiction was just taking off, and fentanyl was confined to operating rooms. I put together a couple sites that skyrocketed in readers. The most-used was SuboxForum, where we discussed controversial issues like ‘is Suboxone a drug for a drug’, and ‘do the films hurt your teeth?’ I did not work on SEO stuff, because (in case I didn’t say) I’m a psychiatrist. I watched my sites fall below sites that had almost no content, that only advertised spa-like treatment programs that have been proven not to work for ... Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 744708347 https://dev.medworm.com/744708348/tapering-off-buprenorphine-or-suboxone-pt-2/ 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 including trauma and rewarding behaviors such as eating a good meal or using addictive drugs.  Endorphin pathways elevate mood, reduce sensation of pain, and impact urine production, immune function, intestinal motility, and other bodily functions.  Endorphin pathways have a certain baseline activity or ‘opioid tone’ that is directly related to opioid tolerance.   When opioid stimulation is greater than one’s tolerance, opioid tone... Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 744708348 https://dev.medworm.com/744708349/tapering-off-buprenorphine-or-suboxone-pt-1/ 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 I plan to retire some day.  Some have asked what they should do if I ever, say, drop dead. It needn’t be all that bad.  Yes, sudden discontinuation of a typical dose of buprenorphine will result in withdrawal symptoms.  But if you taper correctly, your body will slowly reset your tolerance without putting you through the wringer.   In this post I’ll describe my typical approach to helping a person through that process.  But first we should correc... Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 744708349 https://dev.medworm.com/744708350/addiction-treatment-science-and-dead-rats/ 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 of caution is necessary before anyone takes that path. Realize first that doctors don’t treat themselves or even their family members.  The saying that ‘a person representing himself in court has a fool for a lawyer’ applies double in healthcare.  Treating someone close to one’s self introduces a bias that is hard to explain, but easy to notice.  As an example, I see a doctor annually to monitor a progressive condition that threatens my vision.  I would like to know the answer ... Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 744708350 https://dev.medworm.com/728794102/addiction-treatment-science-and-dead-rats/ 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 of caution is necessary before anyone takes that path. Realize first that doctors don’t treat themselves or even their family members.  The saying that ‘a person representing himself in court has a fool for a lawyer’ applies double in healthcare.  Treating someone close to one’s self introduces a bias that is hard to explain, but easy to notice.  As an example, I see a doctor annually to monitor a progressive condition that threatens my vision.  I would like to know the answer ... Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 728794102 https://dev.medworm.com/541076537/addiction-treatment-science-and-dead-rats/ 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 of caution is necessary before anyone takes that path. Realize first that doctors don’t treat themselves or even their family members.  The saying that ‘a person representing himself in court has a fool for a lawyer’ applies double in healthcare.  Treating someone close to one’s self introduces a bias that is hard to explain, but easy to notice.  As an example, I see a doctor annually to monitor a progressive condition that threatens my vision.  I would like to know the answer ... Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 541076537 https://dev.medworm.com/744708351/buprenorphine-not-subbies/ I’ve been writing longer and longer posts on SuboxForum so maybe I need to write more here.  This blog archives twelve years of frustration over the ignorance toward buprenorphine, at least until I ran out of steam a year ago.  I grew used doctors refusing to treat people addicted to heroin and other opioids.  I became used to the growth of abstinence-based treatment programs, even as relapse rates and deaths continued to rise.  It isn’t all bad news; I enjoyed the past couple meetings of AATOD, where people openly spoke about medication-assisted treatments without hushed voices.  I feel like I’m the conservative one at those meetings! I don’t remember where I heard first – maybe in an interview with some reporter about addiction- that I was an ‘in... Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 744708351 https://dev.medworm.com/744708352/help-for-heroin-addiction/ A couple comments for regular readers…  first, watch for an upcoming change to a new name.  For years I’ve debated whether to adopt a name centered on ‘buprenorphine’, rather than the more-recognizable ‘Suboxone’.  I believe that time has come.   Second, I’m going to ‘reset’ with some introductory comments about the proper approach to treating heroin addiction, intended for those who are seeking help – starting with this post. I’m addicted to heroin.  Which treatment should I use? I’ve treated heroin addiction in a range of settings, including abstinence-based programs and medication-assisted treatment with buprenorphine, naltrexone, and methadone. My education prepared me for this type of work, and my personal b... Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 744708352 https://dev.medworm.com/744708353/the-other-opioid-crisis-hospital-shortages-lead-to-patient-pain-medical-error/ I came across this public-accesss story, and wanted to share the perspective: Pauline Bartolone, Kaiser Health News Even 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 health groups. The shortage, though more significant in some places than others, has left many hospitals and surgical centers scrambling to find enough injectable morphine, Dilaudid and fentanyl — drugs given to patients undergoing surgery, fighting cancer or suffering traumatic injuries. The shortfall, which has intensified since last summer, was triggered by manufacturing setbacks and a government effort to reduce addiction by restricting drug p... Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 744708353 https://dev.medworm.com/744708354/missing-the-point-of-buprenorphine-treatment/ A forum reader wrote about concerns over a partner on buprenorphine.  Her concerns pointed out a common misperception about the goals of treatment of opioid use disorder using buprenorphine, or using methadone for that matter. Her question, amended for privacy: I married the love of my life.  He is still he love of my life but has been an addict for 15 of them. Our children have been greatly affected by his addiction.  He made promise after promise that he was clean, and I dove back in with complete faith time after time only to get burned. His addiction started with recreational pills increasing over time, but now he is abusing Suboxone.   He was taking up to 12 mg depending on the day, but no pain pills for the last year. I suggested a Suboxone doctor and a plan to get off, and my h... Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 744708354 https://dev.medworm.com/744708355/brandeis-and-cdc-wrong-on-buprenorphine-pdmp-data/ 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 happened. A new law in Wisconsin requires all prescribers to check the prescription drug database when prescribing any controlled substance.  I’m surprised that no privacy advocates have complained about the database, which tells prescribers about the controlled substances used by their patients over the past 5 years, the pharmacies their patients used, and any suspicions of law enforcement about their patient in regard to controlled substances.  The database, or PDMP, is a significant tool for prevent... Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 744708355 https://dev.medworm.com/744708356/is-suboxone-potent/ We get about 5000 readers of SuboxForum per day who ask question, provide answers, or share their experiences with buprenorphine medications. If you’re a patient on buprenorphine, consider joining us. It is free, and you’ll find help for starting buprenorphine, tapering off the medication, and everything in between.  Or if you’re a buprenorphine prescriber consider joining to see what patients are doing and thinking, and to help answer their questions! Yesterday someone wrote about the high potency of buprenorphine. He also wrote that it is hard to get off buprenorphine medications. I ended up writing more than I intended, which occurs often and keeps me up too late most evenings. I decided to share my anwer, as the issue comes up often on the forum and in my practice tr... Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 744708356 https://dev.medworm.com/728794109/ten-gripes-of-buprenorphine-doctors/ 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 the latter group comes across this page, I’ll list a few things to do or to avoid when caring for someone on buprenorphine (e.g. Suboxone). 1. Buprenorphine does NOT treat acute pain, so don’t assume that it will. Patients are fully tolerant to the mu-opioid effects of buprenorphine, so they do not walk around in a state of constant analgesia. Acute pain that you would typically treat with opioids should be treated with opioids in buprenorphine patients. Pat... Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 728794109 https://dev.medworm.com/316974576/where-s-the-buprenorphine-asked-mr-obvious-thanks-cdc/ A quick note tonight, hopefully with a longer post to follow this weekend… 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 who works with the drug, but apparently difficult to grasp by anyone with the power to correct the database figures. Those people include, by the way, the folks at Brandeis University who give the numbers to Wisconsin, and the people at the CDC who give them to Brandeis. I’ve written to all of them; the bright folks at the CDC skimmed my explanation of their error and responde... Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 316974576 https://dev.medworm.com/299147301/buprenorphine-overdose-after-naltrexone-treatment/ 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 buprenorphine or naloxone allergy led me to look deeper into his history, and my conclusion differs from what he was told by his last treatment team. The patient, a man in his mid-50s, has a history of significant opioid use over the past 20 years.  He used a variety of opioid agonists over the past year, mostly prescription opioids, with an average daily dose greater than 200 mg of oxycodone per ... Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 299147301 https://dev.medworm.com/294586323/opioid-induced-hyperalgesia-prevented-by-buprenorphine/ “Buprenorphine is a kappa receptor antagonist. For these reasons, buprenorphine might be unique in its ability to treat chronic pain and possibly OIH.” The opioid crisis has been fueled by the use of opioids to treat chronic pain.  Practice patterns have changed, but doctors are still criticized for their roles in the overuse of opioids.  I’ve sat through community ‘heroin forums’ (sometimes on stage) as sheriffs, politicians, and ‘recovered addicts’ firmly pointed fingers at health professionals.  I, meanwhile, kept my finger under the table, but had the thought that some of the people pointing would be the first to complain if they were forced to stop pain medication prematurely for their own good or ‘for the good of the community.’ Doctors can’t see into... Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 294586323 https://dev.medworm.com/289823452/benzos-and-buprenorphine/ The high safety of buprenorphine, except when combined with a benzodiazepine, has been twisted in comments about the drug (and in the minds of regulators) to buprenorphine being 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 for buprenorphine if patients are taking benzodiazepines.  Medicaid recently sent a letter that described a ‘severe risk’ of using benzodiazepines in patients on buprenorphine.  And the state drug database contains a graph for each patient of the morphine-equivalent narcotic dose over time, and shades the data in red if benzodiazepines are also pres... Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 289823452 https://dev.medworm.com/278028096/cannabinoid-hyperemesis-how-rare/ Marijuana might cause pain and vomiting in the people who value the drug the most. Doctors should learn more about cannabinoid hyperemesis syndrome. (adsbygoogle = window.adsbygoogle || []).push({}); Source: Cannabinoid Hyperemesis: How Rare? (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 278028096 https://dev.medworm.com/262996169/make-sleep-meds-work-for-you/ 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 quality sleep.  Next week I’ll find another answer to share with readers. This patient asked whether her insurance would cover Lunesta.  She wrote at 2 AM that she is up most of the night tossing and turning. She now takes 10 mg of Ambien, and wrote that it ‘stopped working’.  She doesn’t think 20 mg of Ambien would be covered by insurance (although Ambien is very inexpensive when purchased for cash).  She takes gabapentin for a pain condition and wonders if increasing it would help with sleep.... Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 262996169 https://dev.medworm.com/214066850/congress-acts-on-opioid-dependence-ugh/ I won’t weigh in on the upcoming election, for fear of being barraged with insulting tweets by one candidate or ‘offed’ by the other.  But the current opioid dependence crisis provides a great chance to learn whether you stand on the side of ‘limited government’ or the alternative. The TREAT Act takes 5 minutes to read, that would have increased the cap on buprenorphine patients.  President Obama undermined the TREAT Act by announcing his own plans to raise the cap soon after the TREAT Act was presented in the Senate.  After 7 years without mentioning heroin or opioid addiction, it’s hard to believe Obama’s actions were a coincidence.   Only a master politician can ignore 200,000 deaths, and then claim to solve the problem single-handedly desp... Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 214066850 https://dev.medworm.com/214294646/this-suboxone-doesn-t-work/ 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 buprenorphine product wasn’t working because of the presence of crospovidone or povidone.  Others shared their experiences with different formulations of buprenorphine and questioned whether buprenorphine products are interchangeable, and  whether buprenorphine was always just buprenorphine, or whether some people respond better to one product or another... Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 214294646 https://dev.medworm.com/212097481/this-suboxone-doesnt-work/ 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 buprenorphine product wasn’t working because of the presence of crospovidone or povidone.  Others shared their experiences with different formulations of buprenorphine and questioned whether buprenorphine products are interchangeable, and  whether buprenorphine was always just buprenorphine, or whether some people respond better to one product or another... Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 212097481 https://dev.medworm.com/214294647/obama-s-lousy-suboxone-offer/ I was reading more about Obama’s executive order over at Dr. Burson’s blog.  I guess she is a ‘competitor’ in the blogging world, but I have to admit that her blog has a lot more detail about the issue than I do.  If you haven’t been there yet, check it out.  Keep coming back here too of course! She wrote recently about the rules that would be required by the Feds, in order for them t o allow us the ‘right’ to treat people with buprenorphine.   I wrote to Dr. Burson after reading her post that she is providing the facts, and I can’t help but provide the emotion.  And after reading the baggage tied up with the ‘right’ to treat heroin addicts, I am.. ‘pissed’!  I realize that isn’t a word that doctors should... Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 214294647 https://dev.medworm.com/212097482/obamas-lousy-suboxone-offer/ I was reading more about Obama’s executive order over at Dr. Burson’s blog.  I guess she is a ‘competitor’ in the blogging world, but I have to admit that her blog has a lot more detail about the issue than I do.  If you haven’t been there yet, check it out.  Keep coming back here too of course! She wrote recently about the rules that would be required by the Feds, in order for them t o allow us the ‘right’ to treat people with buprenorphine.   I wrote to Dr. Burson after reading her post that she is providing the facts, and I can’t help but provide the emotion.  And after reading the baggage tied up with the ‘right’ to treat heroin addicts, I am.. ‘pissed’!  I realize that isn’t a word that doctors should... Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 212097482 https://dev.medworm.com/212097483/obama-and-the-treat-act/ I just read an article in the Daily Beast that reads like a better version of something I would write about the value of medication-assisted treatment of opioid dependence.  I appreciate Christopher Moraff telling a story that has been untold far too long, and I hope the story raises questions across the country. But I have something else on my mind that deserves a story of its own.  I am just a small-town psychiatrist in the Midwest, of course, and so I could be missing something.  I watch Veep and House of Cards, but I assume that the political games in those shows are grossly exaggerated.  I’ll offer a bit of background… but if you already understand why people opposed to increasing the buprenorphine cap are idiots, just skip the next few paragraphs. The Recover Enhance... Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 212097483 https://dev.medworm.com/212097484/prince-missed-suboxone-lifeboat-by-12-hours/ One of the links from this page connects to the ‘OD Report‘.  I set up the connection to highlight the epidemic of overdose deaths, not to sensationalize the issue.  But the Prince story is sensational and tragic at the same time. And the connection to buprenorphine only magnifies the tragic circumstances that are wrapped around the use of a potentially-life-saving medication. I read some time ago about Prince’s chronic pain problems, primarily involving his hips and secondary to years of dancing in high-heeled shoes.  Shortly after his death, TMZ reported that Prince’s plane made an emergency stop in Moline Illinois on his way home from Atlanta.  They reported that he received Narcan at the airport after landing, and then was treated and released at the hospita... Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 212097484 https://dev.medworm.com/212097485/counseling-schmounseling/ I just noticed a couple of my recent posts….  these people have it wrong, and that person has it wrong.  One of these days I really need to print something positive and uplifting.  But not today. Excuse the self-flattery, but I like to think of myself as a physician scientist.  That concept motivated my PhD work, and cost me friend after friend in the years that followed!  A physician scientist isn’t all that difficult to be from an educational standpoint, especially in the age of the internet.  The one thing that is necessary is the willingness, or need, to question every assumption by the media, the government, physicians, laypersons, and other scientists.   Ideally, the questions are guided by a knowledge of p-values, the process by which scientific grants are awarde... Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 212097485 https://dev.medworm.com/212097486/addiction-treatment-has-it-all-wrong/ Today on SuboxForum members discussed how long they have been treated with buprenorphine medications.  Most agreed that buprenorphine turned their lives around, and most are afraid they will eventually be pushed off the medication.  Most buprenorphine patients described a reprieve from a horrible illness when they discovered buprenorphine.  But most have new fears that they never anticipated– that their physician will die or retire, that politicians will place arbitrary limits on buprenorphine treatment, or that insurers will limit coverage for the medication that saved there lives. I joined the discussion with the following comment: I give lectures now and then about ‘Addiction, the Medical Illness.’  Once a person thinks through the topic several times with an open... Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 212097486 https://dev.medworm.com/44532148/suboxone-withdrawal-is-killing-me/ A recent Q/A with a reader: I was on opioids for several years, for chronic pain and surgery.   I was taking up to 400 mg of MS Contin per day. Two years ago, my doctor suggested Suboxone to get me off opioids. I said yes. The first two weeks were hell, actually throwing me into […] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 44532148 https://dev.medworm.com/20022118/subutex-vs-generic-buprenorphine-french-smell-a-rat/ An article in Google’s Newsfeed for buprenorphine caught my eye today, for a couple reasons.  The article described a decision by the French Competition Authority (FCA) to fine Schering-Plough 15.3 million EUR, for unfair business practices related to Subutex back in 2006.  The article used the term ‘HDB’ for ‘high dose buprenorphine’, a phrase that […] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 20022118 https://dev.medworm.com/19438357/qa-video-ceilings-half-lives-brands-of-buprenorphine/ Below is the latest video from the questions/answers series at SuboxForum.  Comments welcome.   (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 19438357 https://dev.medworm.com/18354184/suboxone-talk-zone-gets-one-right/ Working on my own in private practice, it is hard to know for certain whether I’m always on track with my thoughts about treating addiction, or whether, sometimes, my isolation has caused me to drift out of the mainstream– sort of like the ladies with blue hair who have nobody around to tell them, “YOUR […] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 18354184 https://dev.medworm.com/17813731/suboxone-controversy-brattleboro-reformer-gets-a-c/ In their story about buprenorphine, Suboxone, and opioid dependence, the Brattleboro Reformer gets it about 60% right.   They describe the shortage of physicians certified to treat addicts with buprenorphine, correctly identifying most of the diversion of buprenorphine as desperate attempts at self-treatment.  They lose points, though, for allowing an ill-informed legislator to suggest getting rid […] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 17813731 https://dev.medworm.com/17294049/suboxone-controversy-brattleboro-reformer-gets-a-c/ In their story about buprenorphine, Suboxone, and opioid dependence, the Brattleboro Reformer gets it about 60% right.   They describe the shortage of physicians certified to treat addicts with buprenorphine, correctly identifying most of the diversion of buprenorphine as desperate attempts at self-treatment.  They lose points, though, for allowing an ill-informed legislator to suggest getting rid of buprenorphine altogether, without pointing to the example of Georgia, the former USSR republic, where the ban on buprenorphine resulted in the birth of krokodil, a nightmare drug now found in parts of the US. Cost concerns The story makes a big deal of the costs spent on buprenorphine by state medicaid agencies, but fails to identify the reasons for such high costs—and the simple measures... Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 17294049 https://dev.medworm.com/16728668/suboxforum-qa-video-dopamine-reuptake-and-addiction/ (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 16728668 https://dev.medworm.com/15713120/suboxone-side-effects/ I’ve received questions over the years from people claiming a range of symptoms from Suboxone or buprenorphine, from back or muscle pain to fatigue, depression, or irritability. I didn’t invent Suboxone, so I don’t take it personally when people blame commonly-occurring symptoms on the drug. But I get bored by the non-scientific thinking behind such claims— that since they started buprenorphine at some point in the past ten years, every symptom or illness that comes along must somehow be related to buprenorphine. No matter, apparently, that people who DIDN’T start buprenorphine often develop the same symptoms. And no matter that they themselves have done a number of things over the past few years BESIDES start buprenorphine. But over and over, people insist that they know, wi... Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 15713120 https://dev.medworm.com/15713134/vivitrol-versus-buprenorphine-video-qa/ I’ve been doing question and answer sessions at SuboxForum for a few weeks now.  This week included a number of questions about Vivitrol, a monthly injectable form of the opioid blocker naltrexone.  I decided to share the video below.  If you want to see the original questions, go to www.suboxforum.com , the ‘QA’ section.   (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 15713134 https://dev.medworm.com/15713141/calling-all-buprenorphinesuboxone-doctors/ Help!  I am hoping to create a list of people who have a real understanding of buprenorphine, in an attempt to reduce the stigma associated with buprenorphine and addiction.   I’m not ready to take my efforts public, so I need to be a bit cryptic at this point.  I ask that buprenorphine-certified physicians, or people with doctorates in the field of neurscience, neurochemistry, or psychology, send me an email, and I will reply with more details. Rest assured that I am NOT looking to create a mailing list, and I will not be asking for any personal information.  I am looking for help with a narrow, specific issue.  I need to hear from those who work with patients who are prescribe buprenorphine;  who have a sense of how those patients do on buprenorphine.  Your assistance will ... Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 15713141 https://dev.medworm.com/17813761/suboxone-film-cutting-guide/ Sorry about the last post…  but I was so excited by stumbling across that bird that I had to share it with somebody! Something else I recently stumbled across is the ‘Suboxone Film cutting guide’, a better mousetrap for people wishing to taper off buprenorphine.  Regular readers know that my general advice to people addicted […] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 17813761 https://dev.medworm.com/7908994/does-suboxone-stop-working-over-time/ I’m taking a few moments before the New Year to answer a question I received by email.  For reader WisdomQuest in the comments section– NO.  For others, I’d like to wish you all a Happy New Year, and thank you for stopping by SuboxoneTalkZone now and then. Buprenorphine is relatively unique among opioids in having… (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7908994 https://dev.medworm.com/7902527/toward-understanding-ibogaine/ Paul Dessauer, Outreach Coordinator at WASUA, the Western Australian Substance Users’ Association, often adds insight to issues that come up on my blog.  He shared a few comments in response to my post about ibogaine, and at my request gave permission to post his remarks here. His comments include a summary of the receptor actions… (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7902527 https://dev.medworm.com/7897193/opioid-dependence-treatment-with-ibogaine/ I would have posted this sooner, but I held back to avoid ruining a reader’s Showtime Homeland experience.    Spoiler Alert…  Viewers of Homeland should be aware that reading the following will take away some of the surprise in Season 3, episode 9 (aired 11.24.2013). I’ve written about ibogaine before, but I’ve assumed that the reported effectiveness… (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7897193 https://dev.medworm.com/7897194/suboxone-zona-de-charla-en-espaol/ Con perdón , estoy confiando en el traductor de Google para llegar a una versión española precisa de mis comentarios sobre la adicción a los opioides y Suboxone ( buprenorfina) . Miro a la distribución de los lectores de mi blog, y aunque tengo lectores en Egipto, Jordania , Suecia, Francia y Alemania , que… (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7897194 https://dev.medworm.com/7876436/health-privacy-at-the-pharmacy/ In the middle of an already-hectic schedule, my office received a call from a pharmacist at Roundy’s Pharmacy, Sheboygan WI saying that he couldn’t fill a script for oxycodone without the patient’s ICD-9 number.  The ICD-9 is soon to be replaced by ICD-10, a system that applies numbers to every medical illness under the sun. … (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7876436 https://dev.medworm.com/7859278/how-and-when-to-stop-buprenorphine-or-suboxone/ People know my bias—that many people should think of buprenorphine as 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;… (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7859278 https://dev.medworm.com/7852530/celebrities-with-addictions/   I came across a list of celebrities with known histories of addiction on a different web site.  Sharing the list does not disclose private information or betray confidences (believe it or not, I haven’t been invited to the Academy Awards even once!).  I don’t share the names to ‘shame’ anyone.  I’m sharing it because I was… (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7852530 https://dev.medworm.com/7852531/buprenorphine-odds-and-ends/ Bummer…. I recently had an SEO expert review my blog and forum, wondering why my hundreds of pages about buprenorphine and Suboxone are a page or so further down the Google lists than a single-page web site offering rapid detox.  I learned that the theme I used for the blog, while fresh with features 6… (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7852531 https://dev.medworm.com/7818422/odds-and-ends/ Bummer…. I recently had an SEO expert review my blog and forum, wondering why my hundreds of pages about buprenorphine and Suboxone are a page or so further down the Google lists than a single-page web site offering rapid detox.  I learned that the theme I used for the blog, while fresh with features 6 […] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7818422 https://dev.medworm.com/7852532/bangor-to-maine-too-much-suboxone-treatment/ As I read about the moratorium on buprenorphine treatment programs in Bangor, Maine, I thought about the scene from the movie Titanic where the people who found safety in lifeboats struggled to keep those in the water from climbing aboard. The Bangor city council recently voted to impose a moratorium on expanding buprenorphine treatment programs for… (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7852532 https://dev.medworm.com/7795237/bangor-to-maine-not-in-my-lifeboat/ As I read about the moratorium on buprenorphine treatment programs in Bangor, Maine, I thought about the scene from the movie Titanic where the people who found safety in lifeboats struggled to keep those in the water from climbing aboard. The Bangor city council recently voted to impose a moratorium on expanding buprenorphine treatment programs for […] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7795237 https://dev.medworm.com/7787797/a-new-suboxdoc-in-town/ claimtoken-5292e33e9a6f5 The name ‘SuboxDoc’ created an online identity, but I’ve always realized the moniker was a double-edged sword.   Once when I testified for a young man linked to an overdose death, the DA undercut my testimony by asking ‘Is it true, doctor, that sites on the internet refer to you by the name SUBOXDOC??!!!’ (Insert dramatic music here).  […] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7787797 https://dev.medworm.com/7775594/buprenorphine-diversion-beyond-a-superficial-understanding/ In ‘Addiction Treatment with a Dark Side’, Deborah Sontag of the New York Times shared her observations of the clinical use of buprenorphine for treating opioid dependence, warts and all.  Readers of the Talk Zone know my bias—that buprenorphine/Suboxone is one of the only effective treatments for opioid dependence, and many patients are best-served by […] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7775594 https://dev.medworm.com/7852533/killing-the-suboxone-gift-horse-with-naltrexone/ I received an email update today with important news from the world of psychiatry and addiction.  The email highlighted a study from the October issue of Jama Psychiatry, entitled ‘A Randomized, Double-blind Evaluation of Buprenorphine Taper Duration in Primary Prescription Opioid Abusers’.  The study compared relapse rates in opioid addicts who were tapered off buprenorphine… (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7852533 https://dev.medworm.com/7765015/killing-a-gift-horse-with-naltrexone/ I received an email update today with important news from the world of psychiatry and addiction.  The email highlighted a study from the October issue of Jama Psychiatry, entitled ‘A Randomized, Double-blind Evaluation of Buprenorphine Taper Duration in Primary Prescription Opioid Abusers’.  The study compared relapse rates in opioid addicts who were tapered off buprenorphine […] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7765015 https://dev.medworm.com/7744687/better-mousetraps/ I’ve written about the need for competition in the market for opioid dependence treatment medications.  Reckitt Benckiser had a monopoly with Suboxone, and then Suboxone film.  Readers know that I’ve also questioned some of the methods that RB used to hold onto that monopoly, including spreading fear about the use of other formulations and asserting a moral […] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7744687 https://dev.medworm.com/7740063/pregnant-cps-diverting-suboxone/ I recently saw a new patient who described treating her own opioid dependence with diverted Suboxone.  She sheepishly described reading everything she could find about buprenorphine and meticulously using half of her friend’s medication to avoid other opioids, without fail, for four years. She would likely be treating herself now, if she hadn’t become pregnant […] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7740063 https://dev.medworm.com/7713860/a-new-way-to-stop-suboxone/ I usually have my wife/business partner review my posts and provide her opinion whether my arguments are sound.  For the record, she tells me that this post is technical and boring.  I disagree, but we aren’t planning to separate over the issue.  A valid criticism, I think, is that I’m doing a lot of guessing […] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7713860 https://dev.medworm.com/7704762/closing-a-gateway/ Today I heard that the FDA approved moving hydrocodone products (e.g. Vicodin, Norco, Lortab) to ‘schedule II’ status.  The final decision has to go through the DEA, and they are expected to support the change. The change has been argued back and forth for years, with a push more recently from PROP, Physicians for Responsible Opioid […] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7704762 https://dev.medworm.com/7699953/surgery-without-pain-control-where-is-the-outrage/ I have received MANY messages over the years from patients on buprenorphine/naloxone (Suboxone) who required surgery, but whose doctors refused to provide post-op analgesia.  Those of you not on Suboxone– can you imagine having surgery, and being told that ‘it is too much hassle to give you any medicine for pain relief’? Below is a […] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7699953 https://dev.medworm.com/7674590/the-court-asks-how-long/ A person in my practice was stable on Suboxone/buprenorphine for several years, until he developed a painful injury.   During the time the injury was treated, the person experienced significant pain.  I worked with his surgeon to provide adequate pain relief, which for patients on buprenorphine or Suboxone  consists of a high dose of an opioid […] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7674590 https://dev.medworm.com/7656782/suckers-bet/ I attended the US Psychiatric and Mental Health Congress meeting last week and actually attended the meetings (the event was held in Las Vegas), but I was disappointed by the absence of lectures about addiction.  There are other mental health groups geared more toward addiction, but one would think that psychiatry would maintain a strong presence […] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7656782 https://dev.medworm.com/7632883/snyder-drugs-ishpeming-mi-lousy-pharmacy-of-the-month/ Because of this blog, I frequently receive emails from people describing outrageous behavior by pharmacists.  I don’ intend to argue that pharmacists as a group are any more annoying than doctors, nurses, or plumbers for that matter.  Every specialty has practitioners who do their best to provide safe and effective services…. and practitioners who are always out […] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7632883 https://dev.medworm.com/7604822/suboxone-scam-artists/ I’ve mentioned the problems with heroin use and buprenorphine/Suboxone diversion in Wisconsin and the UP of Michigan.  There are rumors circulating about a doctor prescribing Suboxone in that area—an area where street Suboxone is easier to find than a buprenorphine-certified physician.  I’ve called a few pharmacists, but haven’t fully verified the story.   But the people […] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7604822 https://dev.medworm.com/7604823/not-on-the-affordable-care-act-faq/ I’ve written the first two parts of a three-part column about unintended consequences.  Part one described why discounts demanded from insurers for front-line services (e.g. office visits) create challenges for independent primary care practices that don’t have other sources of revenue, particularly revenue from procedures.  Part two explained why physicians employed by health systems are […] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7604823 https://dev.medworm.com/7590755/not-on-the-faq/ I’ve written the first two parts of a three-part column about unintended consequences.  Part one described why discounts demanded from insurers for front-line services (e.g. office visits) create challenges for independent primary care practices that don’t have other sources of revenue, particularly revenue from procedures.  Part two explained why physicians employed by health systems are […] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7590755 https://dev.medworm.com/7585871/new-abusediversion-section/ Yes– I realize that I have two stories that aren’t completed. ADD, anyone? (actually I have some things to say about ADD– But I think I’ll limit myself to two unfinished posts at a time!) I Googled Suboxone and buprenorphine abuse and diversion today. I have been aware of the diversion problem for some time, […] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7585871 https://dev.medworm.com/7554963/suboxone-is-flooding-the-streets/ One reply to my last post said I go ‘on and on’ about things that could be said with fewer words.  I asked the person to send me his/her version, and I hope he does—not to prove anything, but because I appreciate the chance to learn.  He wrote that his problem is the opposite– that […] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7554963 https://dev.medworm.com/7547782/unintended-consequences-part-35/ I realize that I am halfway through a post called ‘Suboxone Abuse Part I’.  This is poor form, but I am now going to get halfway through a second topic before finishing the first one.  Sorry. I recently came across a problem relating to the new healthcare law.  I was thinking about writing ‘How the […] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7547782 https://dev.medworm.com/7537400/breaking-bad-is-killing-me/ A little dramatic, I guess.  but have you ever seen anything so intense… so gripping…on a television set? Or at a movie, for that matter? I’ve loved the show for years.   I  almost pulled my youngest from her sophomore year of highschool a few years ago, when it appeared that she couldn’t catch up with […] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7537400 https://dev.medworm.com/7506894/search-about-suboxone/ Discussions are divided into categories and cover a wide range of topics, including patients’ personal experiences during pregnancy and childbirth, surgery, and buprenorphine induction and withdrawal.  We try to prevent discussions from degenerating into […] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7506894 https://dev.medworm.com/7500701/taking-buprenorphine-having-surgery/ I will get to ‘Part II’, but today I talked with a patient about something that happens too often, that deserves to be pointed out.  The person was in the ER with an injury that resulted in tib/fib francture.  The ER doc provided no analgesia, in the ER or at discharge, telling the patient “you […] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7500701 https://dev.medworm.com/7500703/suboxone-abuse-pt-i/ We’ve all read articles about the epidemic of opioid dependence during the past ten years.  We’ve heard the concern over pain medications being overly-prescribed by some physicians.  Some of us older docs even remember the claims, by the Joint Commission on Hospital Accreditation and other medical watchdogs, that physicians were undertreating pain and were in need […] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7500703 https://dev.medworm.com/7491779/new-suboxforum/ After a series of fits and starts, the Forum is up and running.  I first considered this move several years ago, and if I had known that I’d be around this long, I’d have done it long ago. I registered a number of domain names related to Suboxone and buprenorphine in 2006, when I first […] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7491779 https://dev.medworm.com/7477672/patience-please/ The forum should be up and running by tomorrow–  on Friday, Bluehost was down… and now the upgrade is in progress.    Expect improved performance when everything is back up and running; I also expect glitches and frustrations, as those things always occur, no matter how much you try to prevent them…. Hopefully by tomorrow at this we’ll […] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7477672 https://dev.medworm.com/7459387/the-ibogaine-cure/ Ibogaine, a drug long-rumored to treat opioid withdrawal, has become a hot topic for those taking buprenorphine.  Ibogaine is a complex molecule that comes from a group of plants that are known, in West Central Africa, as Iboga.  In native African culture the drug is used to induce psychedelic states that are part of certain rituals. [...] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7459387 https://dev.medworm.com/7455125/free-medic-alert-card-for-buprenorphinesuboxone/ As more and more people treat opioid dependence using buprenorphine, the odds become greater for interactions between hospital and emergency field workers and injured people who take buprenorphine.    I have placed a link in the lower right panel of this blog, to a web site that generates free medical ID cards that warns emergency workers [...] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7455125 https://dev.medworm.com/7446519/return-of-the-suboxone-haters/ I hear from the anti-buprenorphine people now and then, less than I used to.  I also hear from fans of this blog’s early days, when I routinely lost my temper in response to those people.  Their general line was that things on heroin weren’t all that bad, but now, on buprenorphine, things are miserable.  Starting buprenorphine [...] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7446519 https://dev.medworm.com/7435393/the-pain-clinic-your-moneys-worth/ Like most of you, I’m not thrilled with modern healthcare.  I miss how things were twenty years ago, when I had a sense of ‘having a doctor’ who actually knew me, who had my best interests in mind.  I remember my father, a defense attorney in a small town in Wisconsin, telling me about the [...] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7435393 https://dev.medworm.com/7427609/were-back-again/ Finally migrated, upgraded, trouble-shotted, and propagated….  looks like all of the sites are up and running on the new servers.  Things are SUPPOSED to be faster, eventually… but apparently it takes some time for all of the i.p. addresses to be spread throughout the internet, in all corners of the world– so there may be a couple hiccups yet. [...] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7427609 https://dev.medworm.com/7399496/suboxone-pain-treatment-etc/ It has been a while– too long– since my last post.  I’m trying to get back in the saddle, but in the meantime I encourage readers interested in Suboxone to read some of the posts from 5 or 6 years ago, when the arguments about buprenorphine and Suboxone were more heated.  To that end, I [...] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7399496 https://dev.medworm.com/7391030/suboxforum-down-temporarily/ Hi all— my apologies, but SuboxForum is currently offline, and I will do my best to get it running again (Jamez is much more knowledgeable about phpbb than I am, and I’ve sent out an SOS, in addition to contacting the support people at Lunar Pages. Apparently the forum is demanding too many resources for Lunar Pages, slowing the [...] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7391030 https://dev.medworm.com/7234777/its-getting-harder/ The forces of nature appear intent on reversing mankind’s progress toward better health.   An example is the ever-increasing resistance of bacteria to antibiotics.  A timeline of the existence of humans and bacteria shows that bacteria have been around for a very long time— much longer than mammals, and much, much longer than humans.  In fact by the dawn mankind, bacteria [...] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7234777 https://dev.medworm.com/7218643/fda-to-titan-no-on-probuphine/ A few weeks ago I described Reckitt Benckiser as a ship returning to port, after the FDA ‘bitch-slapped’ the company for a bit of trickery that was intended to block generics from making Suboxone. As an aside…  I wondered if ‘bitch-slap’ would be an offensive, misogynist term, or whether it was a fair way to describe what happened [...] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7218643 https://dev.medworm.com/7207604/wating-on-a-head-trip/ I’m always impressed by the power of our ‘unconscious.’  I realize that people have a range of models for conceptualizing how our minds work;  my own combination of education, analysis, and observation has led to an understanding that ‘works for me.’ My conscious mind works in series, holding one or two thoughts at a time [...] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7207604 https://dev.medworm.com/7187123/who-pays/ I realize that practice patterns differ between practices, even those treating the same condition (opioid dependence) with the same medication (buprenorphine).  Differing patient characteristics result in different regional standards of care, for example.  And some areas have access to services (e.g. group treatments or laboratory testing) that may not be as available somewhere else. Physicians [...] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7187123 https://dev.medworm.com/7138176/bye-dad/ My dad passed away two days ago, one day after his 89th birthday.  It doesn’t feel quite right to post something so personal.  But it feels more wrong to write about anything else. Writing was a source of tension between us in some ways.  My perspectives on myself, my parents, and my upbringing have changed [...] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7138176 https://dev.medworm.com/7138177/is-shame-always-a-bad-thing/ I generally write positive articles about the use of buprenorphine for treating opioid dependence, and my articles have been reflective of my attitude toward the medication. The field of psychiatry encompasses more conditions than it does effective treatments for those conditions, and my initial experiences treating people with buprenorphine were strikingly positive. My first buprenorphine [...] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7138177 https://dev.medworm.com/7138178/suboxone-as-problem-suboxone-as-solution/ A local District Attorney wrote to me last week to express his concern about the increased diversion of buprenorphine.  I often sense an undercurrent of tension when I cross paths with attorneys, aware of the different attitudes that we hold that arise from our different roles in society. The DA wrote about the dramatic increase in [...] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7138178 https://dev.medworm.com/7138179/suboxone-makes-me-fat-and-boring-and-stupid/ A late post tonight, since my new exercise program has pushed my blogging back by an hour or so each night.  My suspicions about exercise were correct, by the way; it is much easier to suggest exercise to other people than it is to actually exercise.  I’ve been at it since the beginning of the [...] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7138179 https://dev.medworm.com/7138180/crazy-week-for-suboxone/ What a crazy week for buprenorphine.  I’ve written about the FDA slapping the face of Reckitt Benckiser by denying their Citizens’ Petition.  Adding insult to injury, the FDA then approved two generic formulations of Suboxone tabs (actually, the correct name is buprenorphine/naloxone combination tabs).  Stock in RB dropped about 5%, but shares regained most of their price within a [...] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7138180 https://dev.medworm.com/7102110/rb-citizen-petition-smack-treatment-smack-down-details/ Find a copy of the response here, or at this url: www.suboxonetalkzone.com/cpresponse.pdf (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7102110 https://dev.medworm.com/7102111/reckitt-benckiser-suboxone-citizens-petition-denied-by-fda/ I’ve written in detail about the bold move by Reckitt-Benckiser that few people outside the company saw coming.  In brief, the company has been cruising across the Atlantic for the past ten years, fueled by stellar growth of its flagship medication, Suboxone—even as the expiration of the patent on the medication loomed ahead (y’know– like an iceberg). [...] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7102111 https://dev.medworm.com/7086055/information-request-about-short-term-suboxone/ Readers know that because of the high relapse rate for people with opioid dependence, I am a fan of long-term buprenorphine treatment, sometimes referred to as ’maintenance.’   As an effort to keep myself from becoming dogmatic, I’m seeking information about the experiences people have had with short-term buprenorphine, used either as a detox, or to facilitate starting [...] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7086055 https://dev.medworm.com/7068901/urine-drug-testing-on-suboxone/ A recent exchange with a reader: I have been on buprenorphine for 5 yrs.  Recently my doctor stated that my u/a t looked like I have been ‘loading my meds.’  He said my levels where ‘backwards’ and that would happen if I took just a few doses just before my appt.   My doc had me [...] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7068901 https://dev.medworm.com/7058178/thank-you/ Thank you, so much, to those of you who have offered support and encouragement.  I can’t help but remember a time twelve years ago, when I felt so alone;  I only wish that you folks in ‘cyberspace’ (do they still use that term?) could stop by to share a laugh or two. I also think [...] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7058178 https://dev.medworm.com/7049694/limits-on-suboxone-coverage-by-state-or-insurer-info-needed/ Just a short request tonight. I need help gaining an understanding of how buprenorphine/Suboxone is covered, across geography, insurance carriers, and state Medicaid agencies. Please write to me and share what you know.  Does your state limit coverage for buprenorphine to a specific length of time?  Have you appealed that limit?  Did you win or [...] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 7049694 https://dev.medworm.com/6992606/wasting-resources-on-suboxone/ Readers of this blog know that I have often questioned whether there is any clinical difference between Suboxone and generic buprenorphine.  Naloxone is an opioid-blocking chemical added to buprenorphine, supposedly in order to reduce intravenous diversion of the medication.  The combination of buprenorphine plus naloxone is branded as Suboxone. I’ve pointed out over the years [...] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 6992606 https://dev.medworm.com/6943571/does-suboxone-cause-sids/ In a recent Google search about Suboxone and pregnancy, one of the top links included the frightening statement that Suboxone and buprenorphine have been linked to SIDS or sudden infant death syndrome, commonly called ‘crib death.’ The statement was from a health forum where a woman wrote about taking Suboxone during pregnancy.  She wrote that her [...] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 6943571 https://dev.medworm.com/6907724/suboxone-side-effects-pt-2/ We can now leave naloxone out of the discussion, and focus on the side effects of Suboxone that are caused by buprenorphine. Side effects are symptoms caused by a given medication that are not part of the therapeutic benefit of that medication.  Whether a symptom is a side effect depends on the reason for taking [...] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 6907724 https://dev.medworm.com/6899158/suboxone-side-effects-pt-1/ Side Effects pt. 1: Impact of Naloxone It has been a while since I’ve written about the more basic aspects of Suboxone treatment for opioid dependence.  I used to check the phrases used to search for Suboxone, and cover those topics one by one.  In that spirit, I’ll spend a little time talking about side [...] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 6899158 https://dev.medworm.com/6899159/treating-addiction-with-brain-surgery/ Today I read about the stereotactic brain surgery used to treat opioid dependence in China over the past ten years.   The procedure is relatively straightforward; the patient’s skull is clamped in place while small holes are drilled, guided by computerized, 3-dimensional maps of the brain.  Probes are inserted deeply through brain tissue to the nucleus accumbens, where [...] (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs Sun, 23 Jan 2022 22:38:19 +0100 6899159