Search found 30 matches

by robertsonjon
Wed Dec 07, 2016 7:08 am
Forum: Clinical Use of Buprenorphine
Topic: Buprineorpine Injection???
Replies: 5
Views:

The one from Indivior (makers of Suboxone) will be a monthly injection, not stored in our offices, but kept at the pharmacy. The details aren't worked out yet, but I think it's supposed to be either dispensed by the pharmacy for a pt to return to the office with, or the pharmacy injects it.
by robertsonjon
Fri Oct 14, 2016 8:44 am
Forum: Clinical Use of Buprenorphine
Topic: 'online' counseling
Replies: 7
Views:

In my area (Michigan's Upper Peninsula) there aren't a lot of psychiatrists available, so many patients (addiction and other) see a psychiatrist by Skype (many through the VA) and it seems to work well. I'm sure there are sketchy drug counselors out there who do it, but plenty of good ones, too. If ...
by robertsonjon
Fri Oct 14, 2016 8:11 am
Forum: Clinical Use of Buprenorphine
Topic: Max Dose Suboxone
Replies: 9
Views:

In general, I would say no. I am treating their addiction, not pain. I will switch people over to morphine for surgery and a few days after, but outside of that, I keep everyone at 16mg or less, for those that need more than that based on office induction, I start them at their needed dose, then tap...
by robertsonjon
Fri Oct 14, 2016 8:06 am
Forum: Clinical Use of Buprenorphine
Topic: Guidelines for Extended Take Home Doses
Replies: 9
Views:

Generally after a few visits (3-4) I let them go to monthly visits. They usually seem pretty stable after that first couple weeks. I require that they have seen their counselor first.
by robertsonjon
Fri Oct 14, 2016 7:23 am
Forum: Clinical Use of Buprenorphine
Topic: Poppy Seeds
Replies: 8
Views:

You have to ask the company that you do the testing through. I send mine to a lab, and poppy seeds will not give false positives from my lab.
by robertsonjon
Fri Oct 14, 2016 7:21 am
Forum: Clinical Use of Buprenorphine
Topic: Induction Advice
Replies: 6
Views:

I would think the first dose would decrease withdrawal, his symptoms should not progress, it's far more likely he way lying about when he last used, is it possible he was faking or overreporting some of his symptoms to get hsi first COWS score?
by robertsonjon
Fri Oct 14, 2016 7:20 am
Forum: Clinical Use of Buprenorphine
Topic: Buprenorphine Induction in Pregnancy
Replies: 4
Views:

Make sure the patient is told to be in at least mild withdrawal for their first visit. Make sure they are, COWS score of at least 6. Give them 2mg q45 minutes (until withdrawal symptoms are controlled) up to 16mg on day one. If that doesn't work, on day 2, you can go up to 24mg. I use the same metho...
by robertsonjon
Thu Aug 04, 2016 6:32 am
Forum: Clinical Use of Buprenorphine
Topic: detox from etoh while on buprenorphine
Replies: 1
Views:

Tough one. Here's my 2 bits (2 options): 1. I'd do the office induction of giving them 2mg of bup every half hour until COWS score is 2 or less, or they show no signs of opioid withdrawal. I'd then dose the benzos the same, and tell them not to go to bed within 4 hours of taking the last dose of ben...
by robertsonjon
Fri Jul 15, 2016 9:18 am
Forum: Clinical Use of Buprenorphine
Topic: CARA PASSES SENATE
Replies: 9
Views:

Ok, so, I'm sticking with the previous limit of 100, but I could get a NP practicing under me who could get the same 100 pt limit?

As long as I'm overseeing their work, it could be a good thing for the community where I practice.
by robertsonjon
Wed Jul 13, 2016 2:27 pm
Forum: Clinical Use of Buprenorphine
Topic: Buprenophine Taper
Replies: 5
Views:

I agree, from my reading on tapers, a decrease every 3 days is the fastest, but I read you decrease by 20% of the original dose the first decrease, then 10% thereafter, so it would take almost a month to get them off completely. Dr Passer's advice will give the patient the best chance to be ready fo...

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