DEA Visit

Buprenorphine Post
drdavemcdowell
Posts: 24

Postby drdavemcdowell » Fri Jun 11, 2004 6:38 pm

We too have had quite good responses to chronic pain patients in using Buprenorphine.

asingla
Posts: 17

Postby asingla » Fri Jun 11, 2004 6:38 pm

At this link there is a copy of a letter addressing the use of suboxone for chr pain and the 30 patient limit. Essentially if the diagnosis is "opiate dependence" use your XS DEA number, if for pain, or whatever, use your regular DEA number. I have printed out this letter and have it in my office. Chronic pain,a ccoridng to the DEA does not count towards the 30 (at least in my reading). To quote

"...These limitations and requirements in no way impact the ability of a practitioner to utilize opioids for the treatment of pain when acting in the usual course of medical practice."



http://www.asam.org/news/DEA%20ARTICULATE%20POLICY%20ON%20BUPRENORPHINE%20FOR%20PAIN%202004.htm


Abhin Singla, MD

jdpatz
Posts: 28

Postby jdpatz » Fri Jun 11, 2004 6:38 pm

I've had patients come in with these smaller tabs (0.6mg I think) that they bought off the internet from overseas pharmacies

phoran34
Posts: 24

Postby phoran34 » Fri Jun 11, 2004 6:38 pm

I am trying to get Bup for chronic pain but was told the lowest dose was the 2 mg tab. Is that true It appears not Please inform.

sdaviss
Posts: 49

Postby sdaviss » Fri Jun 11, 2004 6:38 pm

It may be useful in addicts with pain, in that it is less prone to abuse and reduces the risk of "street augmentation" with a friend's Oxycontin, etc. Some sublingual bup-for-pain refs below.
=Steve

[url="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9190324,9172009"]sl bup (0.6mg/d) vs tramadol[/url]

[url="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8975564"]sl bup (up to 1.8mg/d) for post-op pain[/url]

[url="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=PureSearch&db=pubmed&details_term=%28%22buprenorphine%22%5BMeSH%20Terms%5D%20OR%20buprenorphine%5BText%20Word%5D%29%20AND%20sublingual%5BAll%20Fields%5D%20AND%20%28%22pain%22%5BMeSH%20Terms%5D%20OR%20pain%5BText%20Word%5D%29"]link to pubmed search (77 refs)[/url]


MichaelWShoreMD
Posts: 370

Postby MichaelWShoreMD » Fri Jun 11, 2004 6:38 pm

Bill: Yes - I'm in South Jersey! I already have a patient doing quite well for her chronic back pain on it (24 mg per day) who was interested due to , essentially a pseudoaddiction pattern of opiate use prior. Another woman who had gone through a lengthy detox program at Hopkins and found that the pain that remains is too much for her (and typical NSAIDS) doesn't want to go the route of typical opiates again and is interested. There are other issues as well. Thanks for your feedback. Mike

wgrass
Posts: 58

Postby wgrass » Fri Jun 11, 2004 6:38 pm

Michael: I didn't ask and they did not opine. But why would you want to use the tablet form? It's expensive, effective against only moderate pain, inconvenient route, non-linear dose-effectiveness, commits the patient to this one opioid and no others because of the blockade effect, and as far as I know, hasn't been trialed as an SL analgesic. The only advantage I can think of is the non-addicted patient in an addicted household or other environment, i.e., less diversion liability.

BTW Are you in Cherry Hill? I grew up in Collingswood. Still have family in SoJerz.
~Bill

MichaelWShoreMD
Posts: 370

Postby MichaelWShoreMD » Fri Jun 11, 2004 6:38 pm

Bill: Any idea what the response would be regarding prescribing buprenorphine to pain patients without addictive disorders?


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