Buprenorphine For Opioid Dependency In The ED | Dr. Dylan Carney
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- čas přidán 10. 09. 2024
- Medication Assisted Therapy (MAT) for opioid dependency is often understood as an outpatient intervention. Emergency physician Dr. Dylan Carney teaches us about the increasing data and experience with buprenorphine in the emergency department and inpatient setting (as well as in pre-hospital care).
Incident Report #265
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Listened to this on my way into work yesterday. One of my patients was a gentleman who recently become dependent on heroin and opiates. The hospitalist had started him on buprenorphine and also referred his gf to an op clinic to get started as well. He is 3 days post last dose of heroin and is almost symptom free during his bacteremia tx in the hospital. Was soooo excited to see this in action so soon! And so happy to have hospitalists that are comfortable initiating this therapy.
I was on suboxone for 5 years while getting my degree at 48 years old. The day after graduation I began to taper down 30 days later I was off and in expected withdrawal that lasted about 90 days. Pure hell. That was 2013. I am still no longer dependent on subs nor opiates. It's been 8 years no relapses. I wanted off because it's so expensive. Otherwise I might have stayed on for life..Freedom from dependency is so empowering
Solid info.
Great video. Very informative. I start this as of Monday 20th September. Can’t wait to get my life back on track.
I am so happy to see two doctors taking this seriously.
When I was in horrible withdrawals from heroin, I took buprenorphine and it literally took about 20 minutes for it to kick in and stop my withdrawals. I’ve been clean but on bup for about 4 yrs now and getting my life back.
Can confirm. If used correctly. This can be a miracle drug. .
But obviously u also have to 'want' to stop.
Thanks for help de-stigmatizing the use of buprenorphine. It’s the best treatment available for this problem. It needs to be used.
When reporting drug tests for the ER over the years. I’ve seen a lot of judgmental reactions when the test is positive for drugs like methadone, buprenorphine/sub, some people in healthcare see that and seem to act as though any complaints the patient has is either due to drug seeking behavior, or a complication from abusing those therapies, which isn’t always true.
I’m sure that’s true in some cases, but people who are in that therapy can still get sick at the same rate as others , for reasons unrelated to that use . They aren’t necessarily abusing those therapies. I’m not sure why they seem to think that so often.
We just started being able to administer buprenorphine in the prehospital setting. Paramedics administering bupe in the field with followup the next day with followup care and counseling. The future is NOW! We are the third agency in the US to start a program. Cooper EMS in Camden NJ. Austin Travis County EMS in TX and then us... (Pittsburgh Bureau of EMS).
Hi! I'm from Kiev, Ukraine. Buprenorphine changed my life. After almost 20 years of opioid addiction. I've got to mention that i was doing all kinds of opioids: from natural home made(but less destructive for phys health) soviet-style "H" and lab-grade big pharma's fentanyl( fellow-anesthetist supplied me from time to time) to terribly poisonous desomorphine(krokodil)(when it was the only way to stop the withdrawal. I became psychologically addicted almost from the very first time, because since my 12, i suffered from regular episodes of bipolar disorder(mostly depressive phase). I was doing hard drugs as SuperSSIRI. So, you can imagine my situation.... But after 2 years on buprenorphine, i almost solved psych-addiction, 6 month ago i understood, that looking on syringe with heroin i feel almost nothing)
PS excuse my english
I am a pharmacist in the VA system and am titled a pain and palliative care clinical pharmacy specialist. I am dealing more and more with those who have complex opioid dependency and opioid use disorder. We have a scope of practice and work closely with the docs to initiate and follow those who qualify for BUP (not a magic drug for everyone unfortunately). I am SO happy that outside of the VA is pushing this for patients. I have seen many veterans get their lives back from the grips of opioids due to starting this drug. I am a HUGE advocate for BUP and those who say “trade one opioid for another” do not fully understand the condition they are treating OR the drug they are speaking of. I am hoping one day to give a talk during PAINWeek in Vegas that will hopefully give those providers a better understanding. THANK YOU both for what you are doing, together we can all make a difference in this crisis plaguing our nation!!
As a psych major turned nursing student this is fascinating.
Thank you so much for doing this video. My hospital rolled out an inpatient buprenorphine induction protocol last year and I think it has gone really well. I still encounter a lot of stigma in the community but I think the tide will turn. We are studying the outcomes of our inpatient protocol and hoping we can prove that it reduces rates of AMA sign-outs and other outcomes. One thing that drives me crazy is that the NNT to prevent a death with MAT is like less than 10, I have seen the figure as low as 4 and I absolutely find that believable. If we had any other therapy that prevents death like this, we’d be shouting it from the rooftops and shooting it out of t-shirt cannons. But because of the stigma of opioid agonist treatment, it’s locked away behind the scary-sounding X-waiver. Never mind that anyone with a regular DEA number can write for all the OxyContin that their heart desires - but god forbid they try to save a life with buprenorphine!
One thing I think you did not mention is that there is some profit motive behind buprenorphine that is a bit morally gray. There absolutely are for-profit buprenorphine clinics out there that are basically selling it with the implicit business model that suboxone is cheaper than heroin. I still think it’s better to have more opioid users on MAT and the profit motive can definitely shift practice more quickly than warm fuzzy feelings, but some of these clinics can be problematic. I think that’s what the one commenter was maybe getting at.
blue997 please read my comment. You are 100% correct!!! The Dr I see is a pediatrician of all things. He charges me $100 per weeks worth of meds. If I need to go out of town he charges me $100/ 14 pills. I only need a quarter of a pill thankfully but he prescribes me 2-8mg pills a day. He is trying to get me addicted to this medication. He is an evil man. I would never take my child to that pediatrician office knowing he is in the next room hustling an addict. He said that if I could afford a Heroin addiction then I should be able to afford his fees on top of the medication cost. He doesn’t want me well. He just wants to get the money that my drug dealer was getting. When I don’t come the next week because I take a quarter of a pill a day and not the 2 pills he prescribes he gets all worked up because he’s not getting that money he has budgeted from me I guess. All he says is he doesn’t want me getting stuff off the streets because he doesn’t know what’s in it. He’s a joke but he’s where I get my meds.
buprenorphine is an excellent bridge that buys addicts time to work on their underlying anxiety, depression, ptsd,, get a stable job etc... and prepare for when they can taper off. Most people working in addiction medicine understand that people need more than just a medication. It is a damn good medication though. The ceiling effect and blocking effect it has due to its high affinity to mu receptors make it amazing. It is NOT just another opioid. Thanks for the discussion. I would like to see more ED's doing this. I have seen great success.
Buprenorphine saved my life. Wouldnt be as thriving as I am if it wasnt for MAT.
Thank you ZDogg for putting this gentlement on. It's nice to see people who dont view addicts as shit human beings. Love you Zubin!
As far as the stigma goes in my family at least was existent at first with them thinking that I was just trading one drug for another but after 4 years on bup, they’ve seen ME return and being responsible. The stigma they had at first is gone. I guess they’d rather see me living rather than pawing everything I (or them) own, pulling hustles and spending $200 a day on heroin. 🤷🏼♂️ Gave me my life back.
Thank you for informing people about this. I've been sober for 8 years this month thanks to suboxone and a fantastic addiction medicine practice and psychiatrist. It took forever to find help after asking for help with my painkiller addiction at my college health center ( absolutely no help, they gave an aa pamphlet and sent me on my way..) and then 2 different ERs that were also clueless and gave me zofran and sent me on my way with some more pamphlets and the instructions to stop taking my anti anxiety and anti depressants too(?!) While in withdrawal from opiods..because you know, that's what the body needs while already in the middle of full blown withdrawal while trying to taper off of opioids It took forever to get into a treatment and even then (9 years ago) there was very little opioid specific information Available in the treatment program; it was centered around alcoholism and the only opiate specific treatment was the addiction of subutex then later outpatient with suboxone. I still have to go every single month to see my addiction doctor so that I can get my 28 days of suboxone which is stressful as hell but it's better than so many people who never got the opportunity to start on suboxone and didn't survive their addiction or are still struggling years later because their insurance won't cover treatment or suboxone..the amount that my insurance pays per visit for me to get my suboxone is literally over a thousand dollars EACH MONTH..
I've been on 8mg buprenorphine for 16 months,the doctor didn't want to reduce me and had no interest or knowledge about the drug,thankfully I decided to reduce myself,I did a heart 8-4 in one go and it was horrific,aboit 5 weeks of feeling awful shakes sweats weakness etc,butnit stabled so I was on 4mg for about 2 months,this time I've decided to go down .4 at a time,so currently sitting at 3.04 will wait to stable again then reduce,till I'm off completely,it's been a very very difficult battle from opiods to this but I'm nearly clean,would be the first time in 5 years since I've had a clean system
In county jails, the use of substance abuse disorder (SUD) treatment such as with medication assisted treatment (MAT) programs and other behavioral interventions is increasing dramatically in most parts of the U.S. The underlying demographic that is typically arrested generally has a much higher instance of drug use and abuse. Many of these folks arrive in jails either high or already in withdrawal. In general, jails will then send to an emergency room for a welfare/health check prior to booking. This is one factor contributing to the rise in withdrawal cases in the ER setting.
To pay for these services, many jails are seeking assistance from Jail-Based Behavioral Health (JBBS) grants funded via local, state and federal sources. What I find interesting about JBBS grants is that the jails are required to integrate with an external behavioral organization for MAT Continuation services and mental healthcare services. In ACA expansion states, you will find integration with local health plans and regional accountable care organizations for healthcare services. Finally, many grants provide funds for other integration activities such as employment assistance, housing services and food/clothing.
It is a slow long slog up a steep hill, but at least we are moving in the right direction.
Our county in progressive western Washington had to be sued to allow inmates access to their already prescribed BUP. Some county jails allow docs in to prescribe it to inmates in withdrawal.
'Opioid Use Disorder is way better than 'Drug addicted person'. Doing a Buprenorphine transfer now....Riding out the methadone..31 hrs since last Methadone..Muscles twitching in legs already..Runny eyes/nose yawning.
I’m a first year BSN, RN student and my patient at clinical this week was taking this for her opioid use since an injury/surgery from the late 80’s. Neither my clinical instructor or the nurse I was following had seen this before. Pretty neat and fascinating medication system.
This is amazing. As a pharmacy technician, I have distributed bupenorphine without any thought. I know what it's for but that was about it. With this information, I feel like I know my patients a little better and able to help them in the future, if the cause arises. Thank you for all you do, the both of you!
PS. I know it's nitpicking but Suboxone is bupenorphine/nalaxone combination. Bupenorphine does come alone, I just haven't seen it brand since nobody so far has requested brand.
The brand name for buprenorphine alone is Subutex.
Thank you 😊. We fill generic unless there's a DAW
it is not nitpicking. The naloxone part is crucial to the effectiveness of suboxone (trade name for ease of typing out the whole thing). naloxone is the same drug you give to someone when they OD to save their life. buprenorphine is an opiate that binds to the receptor sites of the cells replacing other opiates ex fentanyl, hydromorphone, heroine, etc. Naloxone free floats outside the cells eliminating any opiates building up around the cells. That's why a high is avoided and the risk of overdose is negligible. Also, socio-politically and as a public health iniative it's beneficial because suboxone is not desirable to use intravenously (shoot up). It will put the user into instant and brutal withdrawal because of the naloxone in it. It has less street value reducing diversion of the medication to the black market.
@@rsantos627 In school, pharmacology was my favorite. Learning about this excites me so thank you.
@@rsantos627 the naloxone isn't needed for it to be effective. Buprenorphine is effective for "blocking" other opioids because of its higher affinity to the mu receptors. The naloxone portion is only there to deter people from injecting or snorting suboxone., and when used properly (under the tongue) the naloxone is not absorbed enough to have any significant effect.
This was some very informative, amazing stuff.
Great topic! Unfortunately I am dealing with this personally with my adult son. He is currently in his 4th rehab. I’m afraid his heart/mind is not wanting to stay clean. I plan to do some research .
Thanks again!
He may well be better off on a daily dose of prescribed meds..No shame in that, and it could well keep him safe.
Rehabs DON'T work in my experience unless someone really , really, really {by a factor of 100} wants to quit.
Just a good way to waste shedloads of money.
If you are in UK, doctors can prescribe methadone/buprenorphine to collect from local pharmacy.
Other countries, /I'm not sure..but must be doable, surely in the 21st Cent.
Good luck with your boy.
Thank you for pointing out the lack of stigma for lifelong insulin users. There is still a stigma for anti-depressant and anti-anxiety use, and heaven forbid a person with chronic pain approach a physician for pain relief once the OTC meds fail to do the job. The reception is often a note on the chart indicating "drug-seeker", as if we're lying about the extent our quality of life is affected and are looking to get high.
The lawsuit pendulum has swung in the opposite direction, with doctors fearing for lawsuits and loss of licenses for prescribing these drugs. I have lived through at least two cycles of this, from the scheduling in the 1970s through the more generous treatment of pain in the late 1990s, to the current crackdown, and the problem keeps getting worse.
Buprenorphine has helped my pain better than fentanyl and dilaudid ever did, and all without the high!
Better than CME I could have taken.
I have used subutex for years now and I have taken massive massive dosses I have taken over 120 mg in less than 6 hours I’ve taken 6 8mg tables at the same time no bad experience and still no high to sleek of .
That's cause there is a ceiling effect so you can take 2mg are 120mg all your doing Is just wasting your money
So I work in the Nicu. We have many pregnant women who go to clinics or buy this drug on the street and they all are told that the baby will not withdraw from subutex or suboxone. So not true.
I know this is a little off topic I just wanted to add what happens in a inpatient setting with these babies. These babies are so miserable and these moms really need to be educated
I have seen babies withdrawal from subutex and it was horrible. I remember feeding the baby and they would have horrible massive dumping when you feed them. They would cry and cry just horrible.
Hey, ZDogg! It was awesome running into you in my city, San Carlos, the other day! It really made my day and thanks for being so happy to take a selfie!
To clarify-what are the guidelines to treat acute pain in a Suboxone patient? How do we provide the appropriate standard of care(that may include narcotics) for these patients?
awesome Z! thank you
Thank you so much for this discussion and advanced education.
Throughly agree with the opinion that addiction cannot be considered from a moralistic point of view.
As someone who was a heroin and fentanyl addict, suboxone has absolutely been a life saver. However, it SUCKS that I'm stuck on a new addictive medication and I've been struggling with depression because I feel like I've just moved from 1 substance to the next. This is why I'm starting my graduate degree to study new methods to get people off of drugs without withdrawal and to help people who are currently facing this problem. It's a life saver, but it's extremely expensive, hard to come off of, and doesn't fix the underlying problems that caused addiction in the first place. We need better protocols in place to help addicts A) avoid withdrawal (it is the worst thing I've ever experienced in my life and I've broken bones with less pain than withdrawal) B) work through any psychological issues C) make it AFFORDABLE (A huge problem I see in addiction is that people can't afford help, so they just steal to stay on the drug. If you dont have insurance, suboxone can cost up to 800 dollars per month depending on how much and what dosage you need. Not to mention rehab is even more expensive and if you don't qualify for assistance like I didn't, you're fucked). Too many people struggle making payments for required medication, rehab, therapists, etc. D) there needs to be places that provide additional resources to people struggling at an affordable cost such as financial counseling, rehabilitation back into life, therapy, job transition help, family counseling, resources for single parents, etc. Addiction affects everything in your life, so some meds and once a month expensive therapy/doctor definitely isn't enough in my opinion of course.
Brava! Great
Why is is so expensive? It must be greed of pill manufacturers.
This was so GREAT!! I loved this! More more more.
I love that this treatment is finally making it to the front lines of medicine! I chose to go into medicine recently specifically because of how the opioid crisis has affected those in my own life. Along this journey I have fallen in love with emergency medicine, and have just wished for a way to merge the two interests, especially with the amount of substance use disorders we see in the ED on a daily basis. I would love to get involved somehow if at all possible!
We have been using Buprenorphine for pain management (butrans patch) for maybe 10 years now? It’s a great medication when needed. Great podcast!!!
All long term opioid users are physiologically dependent but not all are addicts. Addiction is a psychological need for the drug. This change in language is disturbing to me as it seems we are no linger making that distinction.
Has anyone ever considered that 'addiction' and the addictive personality might be a primary physiological condition that lesds to a search for dopamine, not to feel euphoric, but merely normal? When comfort is found, it will be sought again through any means, whether it is from opistes, alcohol, compulsive shopping, or even obsessive religion. Psychology might have little to do with it.
As a pain patient who decided to taper off my pain meds, I went through some withdrawal. It was unpleasant rather absolutely horrible. Why? Because I took the meds for pain control; I was physically habituated so yes, withdrawal sucks, even if it's "gentle".
I went off dilaudid, oxycodone and hydrocodone. After awhile, I needed to start using hydrocodone again. I only use 1-2 a day. Great progress for me.
I know over 20 people
Had a few friends with substance use/abuse disorder who did find ways to “cheek” their Suboxone and then use it as a drug of abuse. These patients may also,(sadly), “fake” clean urine that is required in order to get the daily dose of Suboxone from a clinic that requires a drug-free urine sample to administer the medication. Question-is there a population that is vulnerable to creating an alternate pattern of abuse when Suboxone is administered?
As stated in this presentation, there is definitely a risk of being labeled when a patient is on Suboxone. Many docs are then very reluctant to treat pain in a condition that would otherwise be treated in a non-Suboxone patient-what are the implications of treating pain in those on Suboxone?
Sublocade is a long acting injection. I’m not sure but I think the doctor was confused.
4k views only?! Let's hype this guys!
What would be wrong with prescribing a full opiate agonist for MAT? Several countries have tried it successfully.
I wonder if this treatment can be administered in the setting of a case involving a poly-substance overdose. Such as opioid-alcohol or opioid-benzodiazepines. FACINATING.
NO, absolutely not. suboxone is very dangerous mixed with benzos or alcohol. It could treat the opiate use disorder but the patient would have to stay away from benzos and alcohol. If they cannot, then methadone might have to be used. idk. With alcohol though there are medications that can help and they are so rarely used. I found that surprising. benzos I'm not sure if there is a medication-based treatment......
So, what happens if someone with chronic intractable pain runs out of meds?
That would be the fault of the physician who failed to taper the pain patient down in the first place. As a new intractable chronic pain patient, they no longer prescribe opoiods in the first place. The therapy is take your gabapentin and suck the pain up.
@@erynlasgalen1949 crushed nerves. the doc IS a dick, held the script for ten days, and cut the level by 30%.
@@erynlasgalen1949 but gabapentin is now is considered a drug of abuse. They yanked stable patients off opioids and, without evidence of efficacy, threw gabapentin at people regardless of the cause of pain.
@@pat2562 Great. The only person getting abused by gabapentin was me. I immediately suffered brain fog like no opioid pian pill ever gave me, suffered gastric trouble, and gained weight like crazy while never feeling much pain relief. I was really trying for the whole physical therapy and gabapentin to work on my poor aged scoliotic back, but it never did. I finally decided that being told to keep trying what had not worked and come back for another expensive appointment to be told the same thing wasn't cutting it and decided to save my money and leave. If I was going to be pushed into an ever more sedentary life, so be it.
I finally did break down with another physician and agree to give Cymbalta a try even though it had a disastrous effect on my mother, and it has improved my mood a lot, although the back pain remains the same. For me, surgery to fix the root cause was not an option, and my sole reason for having my back evaluated by specialists was to remain as active as possible. Frankly, I would sooner die than take gabapentin again I was so miserable on it. I do not understand anyone abusing it.
@@erynlasgalen1949 Sorry to hear of your pain. Neurontin is the brand name and it is called morontin by users. It helps my nerve pain and I didn't experience issues but I was lucky.
Drink lots of water with this. Can be drying.
So I just took the live training portion of the MAT DATA waiver course to become a suboxone provider once I get my license. There's a couple of things that you're saying that were specifically countered by the trainers. I haven't actually gotten around to looking through all the references they provided, but I'm guessing it's probably more recent information than your band teacher in high school :-)
1) Opiate naive people can OD on suboxone. Opiate dependent people really can't unless they've been clean long enough to lose their tolerance. This is relevant because sometimes kids will get a hold of it, or sometimes people will try to get suboxone and sell it to buy their drug of choice. They don't always realize that pocketing the pill/strip in their mouth is how the med is actually administered.
2) The danger of benzos and suboxone is that suboxone competes with the same enzyme (forget the name) in the liver, which prolongs the effect of benzos. They still sometimes can be used safely together to stabilize a very complex patient -- probably not going to start that in a PCPs office, but if you need to use benzos and suboxone in the hospital you can.
I was hoping for some Vivitrol discussion.
I agree. We have been treating patients with Vivitrol or Sublicade monthly injections and they work fantastically well for many of our patients
Kristin Coble - Finally! I found someone else who has heard about this! A local judge started making this a ONE OPPORTUNITY to get on the right path and be on probation a few years ago and the change has been unbelievable. The drive people have after. For those who don’t know Vivitrol is a once a month shot!
No you haven’t blocked the receptors for 24 hours I have been off of my Suboxone for four effing days And I just took some Percocet and my receptors are blocked for days later
Dilauded?!? Uhh I’m pretty sure they don’t just give that out like tylanol
So as a former opiate addict, the idea that Buprenorphine isn’t abused makes me laugh... it’s not about euphoria, it’s that next pill. This is absolutely replacing one pill for another, the trick to getting people clean is breaking the bond with the pills by creating another bond. My personal experience is that our thoughts on addiction are all wrong.
orion khan but do you think that by using a non-euphoric medication to alleviate symptoms of withdrawal a patient has a better chance of seeking therapy and recovery to change their lifestyle and break the bond as you are saying? I can imagine it is near impossible to work on deep seated emotional issues in a therapeutic way when you are in withdrawal and can not cope with symptoms
Whoa! You mean some people in the world are not touched by it?
Kratom works much better in my opinion. I have used both for opioid dependency
You are making the assumption that they are going to follow up. Many times once someone is out of distress, they no longer have the desire to resolve their discomfort and be proactive in their own care. Wash, rinse, repeat...
I'm a little upset by the conflation of addiction and dependency.
I'm dependent on my prednisone for adrenal insufficiency. Without it, I'll die.
I'm not addicted to it.
There's a stigma on addiction for a reason. (ETA: Mainly because it's criminalized, not a moral failing imo.)
Please stop trying to save people's feelings by lumping us all in the same group.
Ironically, I was just as physiologically dependent on the gabapentin that was given to me in lieu of opiates, and I had to taper down on my own when I decided to stop taking the drug because of side effects and lack of pain control. This was at a pain management clinic that refused to prescribe opioids even within the new CDC guidelines. What are they trying to save us from? Untreated chronic pain leads to depression and lethargy, which makes a person just as ineffective as drugs are supposed to do.
@@erynlasgalen1949 There's a big difference between treating chronic pain and addiction. Addiction makes a person less functional. Treating chronic pain makes a person more functional. What's being done to the chronic pain community is a travesty. Too many suicides from lack of pain control...
@@PamelaCurtis I know that and you know that, but the the health provider network I find myself in seems not to understand that. When did patients change from adults capable of making informed choices about their own health and weighing risks versus benefits to being treated like humble petitioners at the altar of a physician (often a medical corporation) who decides what treatment we will and will not get? The arrogance seems to grow. My primary physicisn does little for me beside fill out the computer questionaire, thump my chest, and then refer me out for any actual care I might need. The last doctor who actually treated me like a human being was over a decade ago.
@@erynlasgalen1949 Over a decade ago should give you your answer. The best doctors were pushed out with Obamacare. I worked for an EMR at the time. The goal was to turn doctors into bureaucrats. That, and the power of the DEA got much worse. Our doctors can go to prison if *we* misuse the medication, which scared all the doctors into being non-prescribers. It's a nightmare, I agree. It's going to be a while before things get better. Stopping the cartels and China is the key, and that's a long way off.
@@PamelaCurtis I think the problem began before that, with the disaplearance of small independent private practices. The last doctor who practised the art of medicine on me was in 1986. He left private practice a few years later because of the workload and lack of family time. I spent most of the time from 1990 onward being uninsured, which somewhat masked the increasing lack of time spent with patients. They could afford to spend time with me because I was paying full ticket price for an exam or test. I noticed a big difference when I reached Medicare eligibility, although that was the same year that many of the provisions of the ACA went into effect.
Drug cartels and China's fentanyl voming into the US have nothing to do with the shutoff of legal prescription painkillers, or shouldn't. But the more legitimate pain patients are thwarted, the more the demand goes up for misdirected legal meds or outright illegal drugs.
I dealt with my mother's pain mansgement experience for her own scoliosis, and I can tell you that it is very hard for a person in actual pain to take too much or to misdirect their drugs. The prescriptions are rigorously doled out in limited supply, and I got used to bring treated like a potential criminal at the pharmacy while obtaining her meds for her. At the sge of 93, she barely made it onto hospice as her pain mansgement clinic was cutting her off opiates entirely. The more the legal pain relief is denied, the more pain patients will turn to illegal sources, with more accidental overdoses.
WOW. So you’re tellin me……… that I can take one of my moms Belbuca transmucosal films (administered for PM)……… to save a hapless soul in the grips of a life threatening overdose of opiates????!!
Holy frick Z.
The pain dose is usually much lower than the amount needed to reverse overdose. You need at least 8mg (I think, I'm not a doc). Suboxone or buprenorphine/naloxone also contains 2mg of Narcan per 8mg strip which may help with overdose reversal. Belbuca only contains 75-300mcg of buprenorphine.
You see more patients come to the emergency room due to fructose addiction instead of misprescribed opioids. WHen are you doctors going to come together and demand fructose be banned as a food additive ? As far as opioids, the prescriptive regimen, by not taking into account the half life of the drug, is what contributes to addiction. Say a drug has a half life of 4 hours. Prescribing the patient to take 1-2 every four hours results in a blood serum level going from 2 to 3 to 3.5 to 3.75 over the course of 8 hours. The correct prescribing method should be -2 first thing then 1 every 4 hours as needed. This would change the maximum daily dose from 8 a day to 6 a day which would be far less addicting. The math proves the pharmaceuticals knew they were creating a problem.
😍
More Pharma crap for old crap and medical complex excuses for the same old protocol.......
If people want Buprenorphine treatment I’m 100 percent for it. As a Nurse of 22 years I was even advocating for Suboxone OTC. Something has to be done. I got on Suboxone on line through a Dr. It saved my life and my cherished career.
But on the same hand it’s hard to get an ER doctor to give you a script for Ativan when in alcohol withdrawal for a pt who’s been sober for years, had a slip and just needs some Ativan or Librium to stop withdrawal and get him back on his feet. For some reason we give opiates to heroin users but we don’t dare give a script for Librium to an experienced alcoholic to get back in the game. Really sad.