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Induction Advice

Posted: Sun Sep 17, 2017 3:03 am
by JoshuaPep
If you need any practical advice, Im only near Derby. You can always call-in on the way by.

Posted: Fri Oct 14, 2016 7:21 am
by drpasser
FYI- I never give more than 2 mgs for first dose.
You can always repeat the dose in two hours.
I have all of my pts spit out the juices.

There are many old interesting threads to check out, for some excellent discussions about this topic.

Best
Kevin

Posted: Fri Oct 14, 2016 7:21 am
by mack86
Have had a few cases like this.

Possibly they were also getting long acting opiates, after all, they are getting their opiates usually from unreliable sources. In that case, waiting longer is needed. I have heard of doctors writing Rx for short term opiates to transition off MTD. I usually give them a couple of days of clonidine, and rarely two 5 mg tabs of valium (given to a responsible family member) to help make it through.

Sometimes they are swallowing part of the dose, which exposes them to more naloxone. Some people generate a lot of saliva with sublingual dose, then they have to swallow, or spit out the dose in the saliva.. For these pt's, I tell them to place the tab or strip between their cheek and gum (like chewing tabbacco), to reduce the amount of saliva. One pt brought in her meds, and the pharmacy had a sticker on the bottle: "take with food"!

I have switched some to subutex for induction

Posted: Fri Oct 14, 2016 7:21 am
by robertsonjon
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?

Posted: Fri Oct 14, 2016 7:21 am
by MChaplin
i don't use zubsolv but i think you are correct- i haven't seen cows go up but i have seen them stay the same and i always ask patients how they would have felt if they hadn't taken anything- most readily agree that they would be much more sick if they hadn't taken buprenorphine..... however the fact that pt refused the second dose suggests to me, that perhaps they did lie and now that they understand the implication, they don't want to make things worse...would be interested in any follow up- purely editorial comment that the list serve should maybe reconsider how monitoring is done since this post was attempted 9/21 and reached my inbox 10/14....

Posted: Fri Oct 14, 2016 7:21 am
by entjwb
I had this happen in one patient they were adamant the last dose of heroin was 24hrs before office visit. I had them wait for 8 hrs before second dose. The next day they were fine. Patient admitted they lied about last dose of heroin. They also exaggerated their symptoms.

Posted: Fri Oct 14, 2016 7:21 am
by kcairns
initial dose too small to suppress wdrl, I start w larger doses and do not see this problem