KCTV: IT Opioid Micro-dosing for Opioid Addiction

[drusso]

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@ 2:30 "Microdosing cut down on the amount (of opioid) needed and completely eliminated the risk of addiction as the drug no longer passes through is blood or the brain..."

 

[Aether2000]

So if they are dosing with morphine or hydromorphone, the physician implanting the pump is incorrect, since these drugs are detectable in brain CSF. If sufentanil is being used, then ok, probably not getting into the brain via CSF. The idea the spinal opioid medications do not enter the bloodstream is also false (Intrathecal administration of morphine for the relief of pains in labour and estimation of maternal and fetal plasma concentration of morphine. - PubMed - NCBI). The statement about intrathecal pumps being less addictive because they remove the drugs from the addicts hands is also false given reports of pain patient addicts accessing the intrathecal pumps and then injecting the medications IV.

 

[Orin]

Science/medical reporting is difficult for the lay public

Comparing plasma/CSF/fetals levels from a 1 mg/seconds IT bolus in a spinal to 250 mcg/day pump delivery would be an interesting study, but the point is valid that IT medication can be detected systemically at low levels.

The point is valid that the amount of drug the blood/brain vs the spinal cord sees can be significantly different with IT vs PO/IV/TD formulations.

The addiction issue is a separate issue, but I would much rather they work to divert pump medication than easily move pills/films/etc around. I would be okay with pump makers providing a locking mechanism for the pump reservoir that required physician input prior to access..

 

[Ducttape]

not sure that not detecting serum levels is adequate "justification". location of action is in the CSF, spinal or brain. and addiction is not in the peripheral tissues.

second, while the locking mechanism seems helpful, it is insufficient. I personally know of a case of a physician (and addict) who managed IT pumps who was investigated, after losing his license, of turning on a pump (that had been turned off by a different pain doctor) on one of his addict patients "for a fee".

 

[clubdeac]

That’s funny you posted that. I personally know Dr Sayed. He’s quite smooth in every way...and makes more than most neurosurgeons