Search found 45 matches

by Bruni
Wed Jan 25, 2017 11:03 am
Forum: Clinical Use of Buprenorphine
Topic: BORDERLINE PERSONALITY DISORDER IN OPIOID DEPENDEN
Replies: 12
Views:

"Due process", I believe, applies to the state attempting to deprive someone of the basic constitutional liberties, as in criminal prosecutions. Medical licensure is considered a privilege, rather than a right, and states establish their own regulations for regulating the practice of medicine. NY St...
by Bruni
Wed Dec 07, 2016 7:08 am
Forum: Clinical Use of Buprenorphine
Topic: Buprineorpine Injection???
Replies: 5
Views:

Yes. I heard about it. It makes much more sense than a six month implant, but likely to cost more than the monthly prescription of Suboxone SLF.
by Bruni
Mon Dec 05, 2016 7:53 am
Forum: Clinical Use of Buprenorphine
Topic: Starting Suboxone to prevent relapse
Replies: 5
Views:

I recently began treating a 55 y/o North American who had lived in Southeast Asia for > 30 yrs, during the past couple years of which he smoked heroin several times per day, every day. I first saw him (outpt in my office) about fifteen days after his last heroin (or any opioid) and about three days ...
by Bruni
Wed Nov 30, 2016 10:39 am
Forum: Clinical Use of Buprenorphine
Topic: Non-Doctors Taking Over - Out of a Job
Replies: 4
Views:

The marketplace is changing, for sure. The future of insurance coverage (Obamacare) is unknowable and likely to worsen under Trumpcare. Independence has its merits. I practice independently (i.e. alone) and rent space inside a large behavioral health group, surrounded by diversely qualified therapis...
by Bruni
Thu Oct 27, 2016 1:08 pm
Forum: Clinical Use of Buprenorphine
Topic: Written documentation of when XR number is needed.
Replies: 7
Views:

Local state laws definitely make finer distinctions than the federal regulations in some cases. It seems ridiculous to require an X number for a Butrans script, for example, and it is NOT required by federal regs to the best of my knowledge. DEA only issues the X number for prescription of buprenorp...
by Bruni
Mon Oct 24, 2016 2:58 pm
Forum: Clinical Use of Buprenorphine
Topic: suboxone/subutex and testosterone
Replies: 3
Views:

Apparently significantly less suppression of gonadal testosterone production than methadone (sample PubMed titles below). -Bone mineral density and its determinants in men with opioid dependence. -New clinical implications of opiate maintenance treatments. -Hypogonadism and low testosterone levels a...
by Bruni
Fri Oct 14, 2016 8:11 am
Forum: Clinical Use of Buprenorphine
Topic: Max Dose Suboxone
Replies: 9
Views:

I have several people whose cravings and USE of heroin did not stop until we got to 32mg/day (which I only do over the course of weeks on lower doses). The benefit of this drug is that at sufficient dose it stops cravings. I also wonder why serum half lives (in however many studies) are quoted as a ...
by Bruni
Fri Oct 14, 2016 8:11 am
Forum: Clinical Use of Buprenorphine
Topic: Max Dose Suboxone
Replies: 9
Views:

I wonder why it seems inappropriate to treat a patient such as this one (and I have several) with buccal or transdermal buprenorphine for a diagnosis of chronic pain, rather than treating for 'opioid dependence'. [separate post on this subject]
by Bruni
Fri Oct 14, 2016 8:06 am
Forum: Clinical Use of Buprenorphine
Topic: Guidelines for Extended Take Home Doses
Replies: 9
Views:

New Inductions and Transfer Intakes from other bupe providers are diverse and determined by the specific presentation & history of the patient. Usually new patients return within 2-5 days and then again a week after that (with prescriptions to last until that return date each time). The first stage ...
by Bruni
Fri Oct 14, 2016 7:23 am
Forum: Clinical Use of Buprenorphine
Topic: Poppy Seeds
Replies: 8
Views:

"Opiate screening cutoff levels for DHHS were changed from 300 ng/mL to 2000 ng/mL of morphine in December 1998 to avoid false-positive results from poppy-seed ingestion. However, the sensitivity for detecting true opiate use can be a concern, and most clinical laboratories continue to use the lower...

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