Switching to a shorter duration agent FOR PAIN should not raise ANY issues. Then changing to bup would be okay. Off-label use for pain is not a problem, and IF he then exhibits criteria for dependence, it is even 'ON LABEL' prescribing. The problem is that they screwed-up the laws about prescribing narcotics to addicts. I used to do outpatient detox from opioids (even methadone) many years ago.
Who is prescribing the MTD? I cannot see a problem with simply moving to a shorter acting agent to help with the gradual discontinuance. I'm just thinking out loud with this stuff, so beware!
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