Buprenorphine: A Reality Check

[Aether2000]

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The following excellent two article series published in 2013 give an in-depth view of the drug culture using Suboxone/buprenorphine, along with a history of the development of the drug. It is an eye opening account that shows the drug is approximately 1/6 as deadly as methadone, and that the death rate is not zero from buprenorphine. Of those dying from buprenorphine, approximately half have other drugs on board, 20% are suicides, and 15% are NAS babies.

Addiction Treatment With a Dark Side

At Clinics, Tumultuous Lives and Turbulent Care

 

[lobelsteve]

In his own special way, I think Algos was saying, "Merry Christmas"

 

[Aether2000]

lol...ok, I will say it- Merry Christmas

 

[drusso]

If you go through the archives, you'll see that a few years a go I warned people not to think of buprenorphine as "intrinsically safer" that full mu agonists. It is safer in one narrow respect: Respiratory suppression. In fact, and in my experience, in the setting of polypharmacy, buprenorphine is far more dangerous. For dual diagnosis/complex pain-addiction patients there is ALWAYS a substantial (ie latent or manifest) polypharmacy component to deal with--muscle relaxers, psychotropics, sedative/hypnotics, etc. Moreover, in patients with concomitant pain/addiction/AND serious medical conditions (CHF, RF, OSA, COPD) the risk is even worse.

Bottom line: Don't think that your complex pain/chemical coper/addiction patient is going to be "safer" by rotating them to Suboxone. You're trading different kinds of risks. These patients are all ticking time-bombs. There is no "algorithmic" solution to their problem. You need to tread carefully, slowly, and thoughtfully through the mind-field of their lives.

 

[DrCommonSense]

The following excellent two article series published in 2013 give an in-depth view of the drug culture using Suboxone/buprenorphine, along with a history of the development of the drug. It is an eye opening account that shows the drug is approximately 1/6 as deadly as methadone, and that the death rate is not zero from buprenorphine. Of those dying from buprenorphine, approximately half have other drugs on board, 20% are suicides, and 15% are NAS babies.

Addiction Treatment With a Dark Side

At Clinics, Tumultuous Lives and Turbulent Care

If you look back at Dr Tennant's career, he FIRST started as an "addiction specialist" that owned a bunch of Methadone clinics that had been fined due to its fraudulent activity and ultimately shut down.

This is before he became a specialist in "arachnoiditis" requiring huge amounts of narcotic medications and "hormones".

 

[Ducttape]

agree with these messages.

buprenorphine is still an opioid. as an opioid, it is safer than methadone, and most likely safer than any other pure mu agonist, but one cannot ignore the risks of polypharmacy. light beer still contains alcohol...

we all have to ask - does the patient really really need an opioid? imho, the answer is almost always no, not "lets write for buprenorphine instead of vics/percs/oxy"...