Buprenorphine/NX for pain

[lobelsteve]

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I unserstand there are potential products coming to market containing Bup/Nx as implanted delivery systems in the subQ space. Could last 6 months.

I do not use Suboxone and refer addiction patients to addiction psych.
I am not a fan of partial agonists and mixed agonist/antagonists.

Anybody using any partials or mixed drugs for pain. The new product(s) are going to be marketed to pain specialists.

I see the problem that if they get in an accident and need acute pain relief- they have all receptors blocked. I also would rather have full agonist (but moreso based on training than on literature).

What do you all think?

 

[drusso]

I unserstand there are potential products coming to market containing Bup/Nx as implanted delivery systems in the subQ space. Could last 6 months.

I do not use Suboxone and refer addiction patients to addiction psych.
I am not a fan of partial agonists and mixed agonist/antagonists.

Anybody using any partials or mixed drugs for pain. The new product(s) are going to be marketed to pain specialists.

I see the problem that if they get in an accident and need acute pain relief- they have all receptors blocked. I also would rather have full agonist (but moreso based on training than on literature).

What do you all think?

I love them! 😍 I save them for my most recalcitrant chronic pain patients with annoying aberrant behavior or psuedo-addiction. Suboxone works for them. You can overwhelm the mixed agonists/antagonist with a sufficiently high dose of agonist, so in for acute pain relief those patients can be treated.

What do you do for your addicts who have bonafide pain issues?

 

[lobelsteve]

I love them! 😍 I save them for my most recalcitrant chronic pain patients with annoying aberrant behavior or psuedo-addiction. Suboxone works for them. You can overwhelm the mixed agonists/antagonist with a sufficiently high dose of agonist, so in for acute pain relief those patients can be treated.

What do you do for your addicts who have bonafide pain issues?

Interesting study. Who can tell me the biggest flaw? Anyone, anyone?
These were pain patients referred to addiction psych- and actually went. They were the ones sufficiently motivated to get better. How many patients at the 3 pain clinics were referred and did not go, but wound up at either of the other 2 pain clinics in town. The selection bias makes the paper worth reading, but probably not believing.



And I send my aberrant folks to addiciton psych, though I've had a few refuse to go and come off all narcotics and begin interventional, PT, and counselling with a MSW.



Also, it is restricted for DEA-X for addiciton, but only off-label for pain. So if we use it for pain, it looks more like a PA hassle than a regulatory on. Comments welcome.

Starting doses, frequency, observed first dose in office? Use in withdrawal to end symptoms? ANyone have a handout with the brief pharmaceutical detail?

 

[Mister Mxyzptlk]

There must be something in the air this week because I was just about to post a question about if we can use suboxone for pain management w/o getting the special ticket.

It sounds like you can but I can't find it spelled out anywhere. And for those who are using it, does the pharmacy balk when they get a script for bupe from a non-anointed doctor?

 

[drusso]

Interesting study. Who can tell me the biggest flaw? Anyone, anyone?
These were pain patients referred to addiction psych- and actually went. They were the ones sufficiently motivated to get better. How many patients at the 3 pain clinics were referred and did not go, but wound up at either of the other 2 pain clinics in town. The selection bias makes the paper worth reading, but probably not believing.



And I send my aberrant folks to addiciton psych, though I've had a few refuse to go and come off all narcotics and begin interventional, PT, and counselling with a MSW.



Also, it is restricted for DEA-X for addiciton, but only off-label for pain. So if we use it for pain, it looks more like a PA hassle than a regulatory on. Comments welcome.

Starting doses, frequency, observed first dose in office? Use in withdrawal to end symptoms? ANyone have a handout with the brief pharmaceutical detail?

Your points are well-taken. I guess I just I'm just a push-over...

I RX it clearly "for pain" thus getting around all the DEA-X issues. I mean, yeah, it is technically "off label" for pain, but please...they use this stuff all over the world for post-op pain, neuraxial analgesia, etc. I feel like I'm on solid footing.

The cost is actually not a lot different than other LA opioids. Again, this is not my first-line choice. It's my Hail Mary.

I have people people come to their first appoint in Stage I withdrawal--a little piloerection, feeling a little edgy, and a mild case of the sniffles. 95% of people do well on 8 mL SL. You should play with it. You'll be surprised as the results you can get.

 

[Sneezing]

I'm a psych resident possibly considering addiction fellowship. In the past 2 years since this thread was started, has there been a change in suboxone use in chronic pain? More? Less? Evidence suppporting or refuting?

 

[hyperalgesia]

Someone just showed me a glossy brochure on transdermal suboxone patch. It said it is only approved for pain and not addiction.

 

[Aether2000]

Butrans patches deliver 1/10 to 1/20 the amount of buprenorphine compared to suboxone, and the receptors are not completely blocked with butrans. Suboxone has a place in the management of pain but it is out of pocket for most patients since their insurance will not pay for it. It is also out of the affordability range for most patients.