Buprenorphine/Naloxone

[Anasazi23]

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How long are you generally keeping people on it? I know it varies by case..just looking for a general ballpark from docs here.

 

[OldPsychDoc]

How long are you generally keeping people on it? I know it varies by case..just looking for a general ballpark from docs here.

It's bimodal for my patients--either I use it for a short detox (or they fail d/t noncompliance in the first month or two) or I have them on long-term maintenance--going on 2 years for a few.

 

[Anasazi23]

Thanks for the quick reply DS. I moonlight at an outpatient "higher end" addiciton treatment center, and my suboxone caseload is increasing. I'm finding much good happy success with an in-between scenario vs. what the package and suboxone company recommendations are. i.e. 1-3 months. The protocol for non-inpatient taper is quite short according to the company ("Flexible dosing schedule" lasting 8 days with the following regimen):
Day 1 - 6mg
Day 2 - 8mg
Day 3 - 10mg
Day 4 - 8mg
Day 5 - 4mg

The remaining days (up to 8) are given upper and lower limits ranging from 0-8mg. I've simply felt uncomfortable doing this in practice.

Do you do the endpoint naloxone challenge with naltrexone dosing for the precipitated withdrawal? The literature seems mixed thus far, though empirically, the benefit would make sense.

 

[Doc Samson]

Thanks for the quick reply DS. I moonlight at an outpatient "higher end" addiciton treatment center, and my suboxone caseload is increasing. I'm finding much good happy success with an in-between scenario vs. what the package and suboxone company recommendations are. i.e. 1-3 months. The protocol for non-inpatient taper is quite short according to the company ("Flexible dosing schedule" lasting 8 days with the following regimen):
Day 1 - 6mg
Day 2 - 8mg
Day 3 - 10mg
Day 4 - 8mg
Day 5 - 4mg

The remaining days (up to 8) are given upper and lower limits ranging from 0-8mg. I've simply felt uncomfortable doing this in practice.

Do you do the endpoint naloxone challenge with naltrexone dosing for the precipitated withdrawal? The literature seems mixed thus far, though empirically, the benefit would make sense.

We'll just pretend that you didn't just mix up your assistant mods there Sazi.
I agree with OPD though, it's completely variable - I too have doen the long term maintenance thing with no plan to d/c the med at any point. I also agree that an 8 day outpatient taper is too fast - the whole point of doing this as an outpatient is that you can take your sweet time about it and minimize post-acute withdrawal symptoms.

 

[Anasazi23]

We'll just pretend that you didn't just mix up your assistant mods there Sazi.

Whoops! My sincerest apologies. It's just that you're both so universally helpful and competent, that you just sort of...blend together after a while.
😀

I agree with OPD though, it's completely variable - I too have doen the long term maintenance thing with no plan to d/c the med at any point. I also agree that an 8 day outpatient taper is too fast - the whole point of doing this as an outpatient is that you can take your sweet time about it and minimize post-acute withdrawal symptoms.

Good, this helps reduce my guilt a little. Thanks!

 

[Ffinnian]

I usually keep the mid-class pill addicts on the Sub about 3-4 months before they want to wean, but the hardcore addicts need much more time.

 

[Chrismander]

I usually keep the mid-class pill addicts on the Sub about 3-4 months before they want to wean, but the hardcore addicts need much more time.

Do you guys ever keep people on it indefinitely? I've only had brief exposure to the addiction service, but in the methadone clinic their philosophy was that some people might need to be on methadone for life, and they were okay with that.

 

[OldPsychDoc]

Do you guys ever keep people on it indefinitely? I've only had brief exposure to the addiction service, but in the methadone clinic their philosophy was that some people might need to be on methadone for life, and they were okay with that.

I want to keep people on it until they've established a sober lifstyle. That may take a LONG time, but the bupe gives them a fighting chance. So yes, I'm OK with that.