I have no experience with Belbucca. Used Butrans a few times and Suboxone quite a few times when it first became available. Reading the product literature they suggest tapering opioid naive patient down to 30 MED and then dosing based upon PRE-TAPER dose of opioid. Is that really how people are doing this. I'm thinking about it in a refugee left stranded on 100mg Oxycodone/day.
Belbucca initiation in opioid tolerant
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75 twice a day and go to 150 twice a day in a week if they’re still complaining
No transition. Just stop Oxycodone and start Belbucca at that dose?
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No you can’t go from 100mg oxy to belbuca on any dose belbuca. Wean the oxy to 40mg ideally.
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Belbuca is not strong enough to precipitate withdrawal from other opioids. I'm not sure what transitioning would look like with someone on that much oxycodone, though. You are a very good person for adopting this opioid refugee.
🎶In the aaaaaarms of the angel....🎶
🎶In the aaaaaarms of the angel....🎶
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Yeah I tell them to go to the lowest possible dose they can stand for 3 days and then completely stop all opioids for 24 hours, then start Belbuca 75 bid and tell them to call in 2 days, and at that point I say, “if you REALLY feel like tou need to go to three times per day, that’s okay,” and so on until they feel okay or get to 300 bid (occasionally will go to 300 tid)
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I switch over 40-50meq types directly to 300mcg bid after a day or two of holding opioids. They are fine by the end of the week.
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100 mg Oxycodone needs Subutex or Suboxone
Belbuca is not strong enough to precipitate withdrawal from other opioids. I'm not sure what transitioning would look like with someone on that much oxycodone, though. You are a very good person for adopting this opioid refugee.
In the aaaaaarms of the angel....
In the aaaaaarms of the angel....It’s not a done deal yet. She got booked as a stim candidate. I searched the local imaging database and she’s instrumented from the cervical spine to the pelvis.
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ugh. this will not turn out well. yes, needs suboxone. no addiction docs will not take. yes, she will be very unhappy with you and demand to be put back on her oxy a minimum of 15 times. any stim will not help
I would suggest that after seeing the patient that you let her know that you wont take over their pills and its up to the prescriber to decide what to do and that you wont interfere. call the prescriber, and tell him same thing, but you might consider getting her on belbuca if she were at a low enough dose.
the prescriber will either blindly ignore what you say and continue on the meds, or slowly taper (with your assistance). once the patient is down to <30 MED (preferably off) and saying she has excruciating unrelenting pain, talk to PCP about taking over the Belbuca.
I would suggest that after seeing the patient that you let her know that you wont take over their pills and its up to the prescriber to decide what to do and that you wont interfere. call the prescriber, and tell him same thing, but you might consider getting her on belbuca if she were at a low enough dose.
the prescriber will either blindly ignore what you say and continue on the meds, or slowly taper (with your assistance). once the patient is down to <30 MED (preferably off) and saying she has excruciating unrelenting pain, talk to PCP about taking over the Belbuca.
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Sounds like a perfect $tim candidate to me...
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Don't stim someone who is weaning opiates. It won't work.
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Many times patients are open to conversion to bupe products if you educate them about it. If you talk to her about bupe and she doesn't want to do it, then I would pass, and say something along the lines of "This is the only opioid I would recommend for you and I understand that you are not interested in it. I think it will be very difficult to find anyone that is going to continue your current regimen. If you change your mind please let me know and I would be happy to start/talk more etc." or if you don't prescribe bupe change it to "happy to refer to someone who prescribes...."
I agree with others, I would use suboxone/subutex. I don't think belbuca is going to be enough, especially if the 100mg of oxy has been a long time going. even if you wean it the tolerance doesn't reset that quickly.
I agree with others, I would use suboxone/subutex. I don't think belbuca is going to be enough, especially if the 100mg of oxy has been a long time going. even if you wean it the tolerance doesn't reset that quickly.
This is likely a long standing Rx as the “retiring” physician has been in a location about 45 minutes away for many years. A known heavy handed prescriber who in actuality “ volunteered” to surrender his state Controlled and Dangerous Substance license after being investigated for careless prescribing.
I’m not getting involved in prescribing Suboxone off-label for pain. Was willing to try Belbucca for the first time but you all have convinced me it will not be enough.
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I think it is pretty easy to get an OUD diagnosis for anyone on this much oxycodone. Often "Uncomplicated opioid dependence" will get suboxone covered. Ideally there is a pcp who does suboxone the patient could go to if you aren't the right person. Typically the addiction doctors don't touch anything with pain related to it, unless there is smoking gun type behaviors/issues.
