Opioid patients

[IYKYK]

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I started and took over much more med management than I wanted. The guy before me was a heavy prescriber. Some of the patients had tried everything, but some didn't even know we could do injections. A lot were open to the new procedures I could do that the other guy couldn't

My philosophy is simple: if you are old or had major trauma/surgery that you can't recover from, and doing injections won't help, then I am ok with leaving you on medications because cutting them off at that point can be dangerous. If you're young or are catastrophizing or have fibromyalgia then I'm weaning them off because in the long run opioids will do more harm than good.

For those that dont need to be on it long term and won't get off, SubL Buprenorphine is a great choice. Belbuca and Butrans don't work in opioid tolerant patients IMO

 

[kstarm]

I started and took over much more med management than I wanted. The guy before me was a heavy prescriber. Some of the patients had tried everything, but some didn't even know we could do injections. A lot were open to the new procedures I could do that the other guy couldn't

My philosophy is simple: if you are old or had major trauma/surgery that you can't recover from, and doing injections won't help, then I am ok with leaving you on medications because cutting them off at that point can be dangerous. If you're young or are catastrophizing or have fibromyalgia then I'm weaning them off because in the long run opioids will do more harm than good.

For those that dont need to be on it long term and won't get off, SubL Buprenorphine is a great choice. Belbuca and Butrans don't work in opioid tolerant patients IMO

I guess just different philosophies. Diagnosis is just 1 part of an evaluation if someone should be on opioids. I am not sure why you would cut anybody off unless they were diverting, or having active substance use where there was imminent risk. Tapering is not necessarily dangerous unless done too quickly, And many people benefit from lower doses or being off opioids especially the elderly where side effects can be more problematic and dangerous. I have had a lot of success with Belbuca and Butrans in patients on full agonist prior to coming in. It would of course depend on the dose they were on previous to starting these but I have so many old ladies that were on low-dose hydrocodone and oxycodone that are doing much better on Butrans.