cocktail for transition from bup to naltrexone...

Buprenorphine Post
rfarmer
Posts: 38

Postby rfarmer » Mon Feb 06, 2012 7:27 am

The best way to detect the presence of opioids in the body is to use not naltrexone, but Naloxone HCL, IM or SC at dose of 0.4 mg/ml obtained from Hospira in a 1 cc single dose vial

edibill
Posts: 101

Postby edibill » Mon Feb 06, 2012 7:27 am

Here is a link to the module

http://pcssmat.org/wp-site/wp-content/uploads/2014/02/PCSS-MAT-Implementing-Antagonist-Based-Relapse-Prevention-Treatment-for-Buprenorphine-Treated-Individuals.pdf

MChaplin
Posts: 183

Postby MChaplin » Mon Feb 06, 2012 7:27 am

the link IS tempermental- sometimes it works and sometimes it does go to an error page- i ended up saving the module as a pdf- but i don't know how to attach it here...keep trying though because there is alot of helpful information- mayby Dr Bisaga can have someone take a look at the website...

abisaga
Posts: 25

Postby abisaga » Mon Feb 06, 2012 7:27 am

the link works, just make sure you do not put a period at the end of address
http://pcssmat.org/wp-site/wp-content/uploads/2014/02/PCSS-MAT-Implementing-Antagonist-Based-Relapse-Prevention-Treatment-for-Buprenorphine-Treated-IndividualsNOCME.pdf

fishdoc
Posts: 111

Postby fishdoc » Mon Feb 06, 2012 7:27 am

PCSS-mat.org seems to be offline and has been for at least the last 2 weeks. All links lead to a 404 error.

drpasser
Posts: 1404

Postby drpasser » Mon Feb 06, 2012 7:27 am

You can try going to PCSS.org, and look at the different offerings. If you haven't yet checked out the PCSS site, it is well worthwhile with lots of practice guidelines.

deegee
Posts: 137

Postby deegee » Mon Feb 06, 2012 7:27 am

Can you please check the link? I doesn't work for me. Not sure if it's my work computer or a problem with the link, but it looks like the link is not right.

Thanks.

MChaplin
Posts: 183

Postby MChaplin » Mon Feb 06, 2012 7:27 am

I found the module online at http://pcssmat.org/wp-site/wp-content/uploads/2014/02/PCSS-MAT-Implementing-Antagonist-Based-Relapse-Prevention-Treatment-for-Buprenorphine-Treated-IndividualsNOCME.pdf. It was very informative and exciting- thank you very much -

abisaga
Posts: 25

Postby abisaga » Mon Feb 06, 2012 7:27 am

I am happy to share our experience here, but you can find much more details in this review
http://informahealthcare.com/doi/abs/10.3109/00952990.2011.653426
(if you cannot access full text send us an email mishlen@nyspi.columbia.edu, and we will send you a reprint)
details are also incuded in the PCSS module you can find on this page http://pcssmat.org/education-training/webinars-modules/
we use klonopin anywhere from 1-3 mg for the first week and then down to 1 mg if needed.
As for naltrexone if you can wait a week then certainly start with 1/4-1/2 tab and then give a shot. But if people use during that time it may be difficult to bring them back so I do not want to wait. If you want to give a shot sooner then titration will smaller doses are necessary, Also, if they lie to you and you end up precipitating withdrawal then you can manage it if you only gave them 3mg otherwise you are looking at ER/delirium if you give fully dependent person 50 mg. Occasionally I tell families to crush the pill which makes it easier to dose 1/16-1/8th of the tablet. Obviously, if you have them in rehab you should wait 2 weeks and then do the shot, little if any protracted withdrawal (and need for klonapin) if you can do it.
I find the second shot important because many people continue not to feel well between the first and second shot and many will test the block so we really work hard to keep them engaged. After the second shot most everyone people feels very well, very few are still testing and majority stay in treatment for a long run. Whn this happens, it is one of the most gratyfying experiences in working with opioid addicts, who never believed they can be abstinent off all opioids



MChaplin
Posts: 183

Postby MChaplin » Mon Feb 06, 2012 7:27 am

thanks again for the additional details- when you say small amount of klonopin, what are you talking about? and when you push the dose from day3-6- how often are you dosing? do you think that if i started on day 5, i could start with 12.5 (1/4 tablet) to avoid the need for a compounding pharmacy? or is that titration necessary to tolerate the medication? also do you give the second shot after a month? and why is it a challenge to get to the second shot? and finally, how do you know the relapse rates are better after stopping naltrexone? how long do you have follow up data for?
again thanks ever so much and please advise as soon as the module is available online.


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