Search found 29 matches

by mattkeene
Mon Feb 13, 2017 10:01 am
Forum: Clinical Use of Buprenorphine
Topic: Revisiting generics
Replies: 6
Views:

Generics and Suboxone Film have a much higher street value than Bunavail, and are diverted with frequency. However, with the exception of Tennessee, most states don't seem to care and simply look for the least expensive option (not realizing that they likely would save $ by providing less divertable...
by mattkeene
Tue Dec 20, 2016 2:54 am
Forum: Clinical Use of Buprenorphine
Topic: But Discontinuation Syndrome ??? Studies
Replies: 7
Views:

I'm not sure that the Zubsolv 0.7 mg will really meet your needs. Recall that 0.7 mg Zubsolv is approximately 1 mg of Suboxone (purportedly due to better bioavailability). Zubsolv tablet are so fragile, that I can't see how one could cut them into quarters without most of the medication turning to d...
by mattkeene
Tue Dec 20, 2016 2:54 am
Forum: Clinical Use of Buprenorphine
Topic: But Discontinuation Syndrome ??? Studies
Replies: 7
Views:

My norm is to gradually taper far lower than the 2 mg dose every few days. I have far greater success having patients cut the 2 mg tabs or films into 1/4s or even 1/8s as a means to gradually reduce. The one interesting observation that I have found (though my n is still quite small), is that patien...
by mattkeene
Wed Dec 07, 2016 7:08 am
Forum: Clinical Use of Buprenorphine
Topic: Buprineorpine Injection???
Replies: 5
Views:

There are 3 different depots in the pipeline by Indivior, Braeburn, and BDSI. Indivior will be first to market. BDSI likely will have a more convenient delivery system but may be last to market. The biggest barrier I see (besides cost and patient willingness) is what hassle will be needed to keep a ...
by mattkeene
Mon Dec 05, 2016 7:53 am
Forum: Clinical Use of Buprenorphine
Topic: Starting Suboxone to prevent relapse
Replies: 5
Views:

Absolutely...do it all of the time for folks who are discharged from "abstinence only" programs, yet know they are destined to relapse. Obviously you would be stopping his ntx.
by mattkeene
Fri Dec 02, 2016 5:15 am
Forum: Clinical Use of Buprenorphine
Topic: Was there a data dump?
Replies: 4
Views:

What new webboard if I may ask?
by mattkeene
Thu Jul 14, 2016 10:19 am
Forum: Clinical Use of Buprenorphine
Topic: It is coming!
Replies: 8
Views:

The NP/PA prescribing is worrisome, but I am not sure how to prevent it now that CARA seems set to be signed. States have the authority to step in and make changes, but many will not, as there is a large movement to have unfettered access to buprenorphine based treatments. The trouble I have with th...
by mattkeene
Tue Jul 12, 2016 12:25 pm
Forum: Clinical Use of Buprenorphine
Topic: Probuphine
Replies: 13
Views:

More than anything I struggle with the labeling of "stable on 8 mg or less". I do have several patients who are stable on 8 mg or less. But the operative word here is "stable"! If they are already doing well on their current regimen, why would they wish to subject themselves to a surgical procedure?...
by mattkeene
Mon May 09, 2016 9:12 am
Forum: Clinical Use of Buprenorphine
Topic: Managing Constipation; Relistor
Replies: 15
Views:

No, I have not. The key to minimizing constipation with buprenorphine is to minimize the amount of bup that is "swallowed" vs absorbed. Once buprenorphine hits the gut, it is converted into norbuprenorphine which acts as a full mu agonist to the enteric nervous system...leading to constipation. I ha...
by mattkeene
Tue May 03, 2016 9:24 am
Forum: Clinical Use of Buprenorphine
Topic: brain zaps
Replies: 5
Views:

Sure...it is a relatively common description of what patients feel in their heads when abruptly stopping SSRIs/SNRIs. Seen quite commonly with Effexor, Paxil, etc. It is a manifestation of the discontinuation symptoms. The phrase has been repeated so many times by my patients to describe this phenom...

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