MME and opioid wean

[paindoc007]

Is there a MME amount where it’s okay to stop meds without a wean? Say they’re on oxy 10 TID or 4x/day, and UDS is inappropriate. Are you providing one month wean, or just stopping the meds? Didn’t know if there was a cdc “recommendation” on this.. thanks

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[lobelsteve]

Is there a MME amount where it’s okay to stop meds without a wean? Say they’re on oxy 10 TID or 4x/day, and UDS is inappropriate. Are you providing one month wean, or just stopping the meds? Didn’t know if there was a cdc “recommendation” on this.. thanks

UDS inappropriate means no more Rx for opiates.

 

[Ferrismonk]

Depends on what "inappropriate" means. If repeated THC, I'll either give them a full month for them to find someone else (it's "legal" in my state) or I'll give them the choice to wean down. If so, I'll wean down 25% per week. If it's cocaine, non-prescribed opiates, etc. No more Rx and given referrals to drug rehab or I make a suboxone provider list available upon request. I'll give a week of clonidine/zofran for withdrawal symptoms if requested.

 

[deleted131481]

No one knows the correct rate. If stopping because you just think it's better it will be different oxy 10 QID past 20 years vs past 2 months. The 2nd will generally tolerate a rapid taper and the first will not.

Agree with the above inappropriate UDS - no meds.

 

[bedrock]

except in california. Some bleeding heart pushed through a law several years ago that a provider can't just stop opiods. You have to give them a 15 day supply by law. Which is completely BS as they could use that to OD.

 

[drusso]

UDS inappropriate means no more Rx for opiates.

Meanwhile, in Seattle, they are decriminalizing heroin and illicit opioids. Instead of abandoning them why not offer MAT or on-label buprenorphine for pain? The molecule won't know the difference. Isn't the abnormal UDS a cry for help? Better off keeping them in your exam room than under a bridge...

Opinion | Seattle Has Figured Out How to End the War on Drugs (Published 2019)

While other cities are jailing drug users, Seattle has found another way.

www.nytimes.com

So Seattle is undertaking what feels like the beginning of a historic course correction, with other cities discussing how to follow. This could be far more consequential than the legalization of pot: By some estimates, nearly half of Americans have a family member or close friend enmeshed in addiction, and if the experiment in Seattle succeeds, we’ll have a chance to rescue America from our own failed policies.

In effect, Seattle is decriminalizing the use of hard drugs. It is relying less on the criminal justice toolbox to deal with hard drugs and more on the public health toolbox.

 

[Ferrismonk]

West coast is crazy. I love the weather/ocean/mountains, but politically, it's nuts.

 

[Ferrismonk]

Meanwhile, in Seattle, they are decriminalizing heroin and illicit opioids. Instead of abandoning them why not offer MAT or on-label buprenorphine for pain? The molecule won't know the difference. Isn't the abnormal UDS a cry for help? Better off keeping them in your exam room than under a bridge...

Opinion | Seattle Has Figured Out How to End the War on Drugs (Published 2019)

While other cities are jailing drug users, Seattle has found another way.

www.nytimes.com

So Seattle is undertaking what feels like the beginning of a historic course correction, with other cities discussing how to follow. This could be far more consequential than the legalization of pot: By some estimates, nearly half of Americans have a family member or close friend enmeshed in addiction, and if the experiment in Seattle succeeds, we’ll have a chance to rescue America from our own failed policies.

In effect, Seattle is decriminalizing the use of hard drugs. It is relying less on the criminal justice toolbox to deal with hard drugs and more on the public health toolbox.

Any chance you can copy/paste the article for those who don't want to sign up for the NYT?

 

[lobelsteve]

I'm not trained as an addictionologist. I make that referral to those who are as well as counseling.
I'm also not in Seattle.

 

[drusso]

I'm not trained as an addictionologist. I make that referral to those who are as well as counseling.
I'm also not in Seattle.

Why should anyone’s zip code determine their healthcare?

 

[Ferrismonk]

Why should anyone’s zip code determine their healthcare?

To be fair, because of taxes.

 

[drusso]

I'm not trained as an addictionologist. I make that referral to those who are as well as counseling.
I'm also not in Seattle.

It seems like chronic pain and addiction are basically the same. It’s like a cardiologist saying “I don’t treat COPD,” and a pulmonologist saying “I don’t treat hypertension.”

What’s the sound of one hand clapping?

 

[lobelsteve]

It seems like chronic pain and addiction are basically the same. It’s like a cardiologist saying “I don’t treat COPD,” and a pulmonologist saying “I don’t treat hypertension.”

What’s the sound of one hand clapping?

You mentally masturbating.
Our cardiologists do not treat COPD and our lung docs do not treat HTN.

Addiction and pain are not the same thing.
Oh, Friday, you are bored and screwing with me. Touche.

 

[Aether2000]

Generally, use of non-methadone/non-buprenorphine sublingual opioids can be weaned relatively quickly if not simply stopped at low doses such as 20mg MED. Methadone however is a different beast, and even low doses (5mg/day) given chronically, may require protracted weaning from that point since methadone may be detected months later in the urine after cessation. Buprenorphine cessation from 2mg/day may cause protracted moderate withdrawal symptoms in some segments of the population.

 

[painfree23]

What about patients that say they can’t tolerate opiate wean (norco) even at 50 mmeq. I’ve had some luck doing tapers over a few months , at least they won’t go use illicit drugs

 

[BobBarker]

Certainly, they can tolerate weaning or conversion to Butrans.

 

[Aether2000]

There are some that claim there is a basal level of opioid saturation of receptors under which levels they cannot tolerate. However, no one "requires" opioids to live. Moving down steadily from this point may make them uncomfortable but is possible if the patients are told this is what will happen in your practice, that you will work with them on alternatives (esp. graduated exercise and flexibility programs), and that they are free to find another physician if they absolutely believe opioids are necessary for their survival. A 2/3 taper from virtually any dosage is possible over 3 months without any population increase in pain, decrease in pain relief, decrease in ADLs, or increase in anxiety. The only exception is methadone- requires a 6 month wean.

 

[Bsb2015]

Depends on what "inappropriate" means. If repeated THC, I'll either give them a full month for them to find someone else (it's "legal" in my state) or I'll give them the choice to wean down. If so, I'll wean down 25% per week. If it's cocaine, non-prescribed opiates, etc. No more Rx and given referrals to drug rehab or I make a suboxone provider list available upon request. I'll give a week of clonidine/zofran for withdrawal symptoms if requested.

Are you doing clonidine po or patch for the week?

 

[DODOCSS]

i use patch, zofran, gaba

 

[Ferrismonk]

Are you doing clonidine po or patch for the week?

I write for PO used TID prn. #21 That way they can titrate as needed.

 

[mazinger]

Is there a MME amount where it’s okay to stop meds without a wean? Say they’re on oxy 10 TID or 4x/day, and UDS is inappropriate. Are you providing one month wean, or just stopping the meds? Didn’t know if there was a cdc “recommendation” on this.. thanks

Inappropriate meaning other non prescribed opioids? Meaning coke or meth?
If positive for illicits then stop immediately prescribing. Nothing you can do will have a positive effect unless the patient truly wants to change.
If it is other opioids, then don’t fire the patient. See whether the patient has OUD, maybe this is a golden opportunity that will lead to suboxone therapy?
Patients get hurt with self righteous postures. Compassion goes a long way.