Search found 24 matches

by mattkeene
Tue Apr 12, 2016 8:22 am
Forum: Clinical Use of Buprenorphine
Topic: New rules in WV
Replies: 13
Views:

Tell me how on earth this Bill would survive court challenge? Shoot, even when I was doing Gen Psych, I didn't take insurance. Why should a Doc be forced to then take insurance for an even more challenging population. As I have said before, the data coming from TennCare makes a pretty compelling arg...
by mattkeene
Mon Apr 11, 2016 10:02 am
Forum: Clinical Use of Buprenorphine
Topic: Tramadol has unique properties in buprenorphine to
Replies: 9
Views:

I have yet to encounter a dental procedure that cannon be managed by doing as described above:
- increase bup dose and take in 4 divided doses
- add 800 mg motrin TID.

From root canals, to wisdom teeth, to more complex extractions...this works as well as anything.
by mattkeene
Wed Apr 06, 2016 8:11 am
Forum: Clinical Use of Buprenorphine
Topic: opioids and alcohol
Replies: 10
Views:

Yep...certainly see it in practice but by no means a universal finding. Some good theory/findings here:

http://www.ncbi.nlm.nih.gov/pubmed/16533497
by mattkeene
Fri Mar 04, 2016 10:44 am
Forum: Clinical Use of Buprenorphine
Topic: Diversion potential for Suboxone
Replies: 2
Views:

I suspect the diversion of suboxone is much higher than we are willing to admit. Take a look at what has happened recently with Tenncare. The managed medicaid system there recently transitioned all patient from generic suboxone to Bunavail. In doing so, nearly 50% of the patients who were coming to ...
by mattkeene
Fri Feb 19, 2016 5:53 am
Forum: Clinical Use of Buprenorphine
Topic: recovery workbooks
Replies: 2
Views:

Look into Smart Recovery. They have some nice workbooks as well as some online meetings and forums
by mattkeene
Fri Feb 19, 2016 5:52 am
Forum: Clinical Use of Buprenorphine
Topic: inducing patient with negative UDS
Replies: 10
Views:

I think it depends on the scenario. I've had plenty of patients presenting with negative UDS several days after leaving a residential "detox" program who are white-knuckling it with severe cravings and impending relapse. I have no concerns inducing them. Your scenario is a little different. Anyone s...
by mattkeene
Fri Jan 22, 2016 10:14 am
Forum: Clinical Use of Buprenorphine
Topic: cutting the films
Replies: 1
Views:

It is done all of the time...absolutely no issue doing that. Same holds true for cutting the generic tablet or Bunavail. The only real exception may be Zubsolv which has a tendency to disintegrate when cleaved.
by mattkeene
Thu Dec 24, 2015 7:38 am
Forum: Clinical Use of Buprenorphine
Topic: Precipitated Withdrawal coming off Heroin
Replies: 2
Views:

I wonder if perhaps you are going to slow with your induction and seeing a continuation of withdrawal vs precipitated withdrawal. Any patient I have doing 1 gm or more heroin has pretty much required a full 16 mg the first day to avoid feeling lousy.
by mattkeene
Wed Oct 28, 2015 11:54 am
Forum: Clinical Use of Buprenorphine
Topic: Belbuca
Replies: 8
Views:

Correct. Belbuca is delivered at a dose range from 75mcg to 900mcg. Those are certainly small doses that may not seem to jive with the dosages required by many of our opioid dependent patients who also have legit pain...but the data on this low dose Belbuca is pretty compelling nonetheless. Perhaps ...
by mattkeene
Mon Sep 21, 2015 9:25 am
Forum: Clinical Use of Buprenorphine
Topic: Patient cap being lifted?
Replies: 80
Views:

The only mention of nurses in the 95 page proposal is in the context of providing ancillary support/education to****ist Docs, but NOT to RX Bup

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