Opioid Taper/Detox

[pmrmd]

I manage opioid medications. I'm not anti-opioid but don't love the things either. I like to think I take a reasonable approach with them. Anyway when trying to discontinue I slowly taper some people and switch others to buprenorphine when the patient doesn't seem like they can taper effectively. If on bup when down to the 2mg tablets or strips does anyone else switch to Belbuca or do you guys have the people just try to do 1mg then off? 1 mg bup can be quite tough.

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[kstarm]

So much seems to depend on what can get paid for. I usually have them cut the strips if possible to get to 1/2 a mg, or try to rotate to belbuca. I think a lot depends on the wiring of the person. I have had a couple of people go from 16mg + of suboxone to off in a very short amount of time with minimal to no withdrawals, and others that notices every small change of an opioid taper.

 

[lobelsteve]

If tapering, why switch to Belbuca? Trying to make them pay $$$ to quit?

 

[pmrmd]

If tapering, why switch to Belbuca? Trying to make them pay $$$ to quit?

The jump from 1-2mg bup to zero can be made easier with mcg dosing.

 

[mariajane]

Belbuca if needed (and good insurance coverage.)