Buprenorphine On UDS

[Dansk2011]

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I've started using quite a lot of belbuca and Butrans in my practice. A lot of my patients seem to do very well on it. The only issue that I am running into is that it doesn't seem to show up on uds including confirmation consistently. I spoke to the rep who said that was a known issue and that you have to ask the lab to drop the cutoff value. I've since asked the lab we work with to do that. I know the amount for pain is much less than the lowest dose of suboxone and I imagine that is the cutoff value that they are testing at. I was curious other people's experience with this and what you are doing about it if anything?

 

[Ducttape]

you have to ask for a separate specific LC/GS test for buprenorphine and request quantitative results, not qualitative.

 

[painfree23]

how often are u UDSing?

 

[Ducttape]

depends on risk assessment for abuse.

with minimal assessed risk of misuse, then once a year. with maximum assessed risk - why continue - then randomly 3-4 times a year or so.

and look at patch every time they come in to office.

 

[painfree23]

depends on risk assessment for abuse.

with minimal assessed risk of misuse, then once a year. with maximum assessed risk - why continue - then randomly 3-4 times a year or so.

and look at patch every time they come in to office.

What’s your ideal candidate for a butrans patch? Multiple pain generators? Any contraindications?

 

[drusso]

What’s your ideal candidate for a butrans patch?

Patient has skin.

 

[painfree23]

Patient has skin.

geez just askin'. ex: i have a few patients that use 1-2 tabs of norco a week (#15 tabs per month) consistently for the past year or so. should i convert them over?

 

[BobBarker]

No, leave them alone.

 

[drusso]

geez just askin'. ex: i have a few patients that use 1-2 tabs of norco a week (#15 tabs per month) consistently for the past year or so. should i convert them over?

Can you just label them as Mild OUD with prescription opioid physical dependency and flip them to Suboxone?

 

[painfree23]

Can you just label them as Mild OUD with prescription opioid physical dependency and flip them to Suboxone?

With the way some “pain docs” prescribe, I’m not sure if ur serious.

 

[Agast]

What’s your ideal candidate for a butrans patch? Multiple pain generators? Any contraindications?

I like it for the autoimmune population, especially since many of them seem to have stomach issues. So a patch or dissolving film gives them more consistent pain control over their rheumatoid arthritis.

 

[SommeRiver]

geez just askin'. ex: i have a few patients that use 1-2 tabs of norco a week (#15 tabs per month) consistently for the past year or so. should i convert them over?

Absolutely not. I have a good bit of those pts, and I have one dude on Butrans. There is very little risk in Norco a few times per week, and Butrans isn't perfect.

 

[lobelsteve]

Can you just label them as Mild OUD with prescription opioid physical dependency and flip them to Suboxone?

I assume you are just messing with him. Not even on daily opiate. Would never offer change in regimen with such low dose therapy. Keep going with due diligence and enjoy the easy visit.

 

[Dansk2011]

I spoke to our local Belbuca rep who said that if the lab you use has a higher cutoff for buprenorphine and metabolites, I guess more geared towards suboxone patients, it will likely not show up on the uds as belbuca/Butrans are mcg vs mg. The practice I work for (just joined a few months ago) does monthly analyzer and then confirms 2 times per year for low risk and at least 4 times for high risk. Not sure how I feel about the monthly analyzer.

 

[Ferrismonk]

I spoke to our local Belbuca rep who said that if the lab you use has a higher cutoff for buprenorphine and metabolites, I guess more geared towards suboxone patients, it will likely not show up on the uds as belbuca/Butrans are mcg vs mg. The practice I work for (just joined a few months ago) does monthly analyzer and then confirms 2 times per year for low risk and at least 4 times for high risk. Not sure how I feel about the monthly analyzer.

Yeah, that's considered inappropriate by modern guidelines.