duration of treatment with buprenorphine

[msimson1]

I like the recent comments. Been doing this since 2003 if that seems possible. Nothing compares to seeing pts regain their lives, families, jobs, and health. Certainly some do not; but how many of your uncontrolled diabetics' severe peripheral neuropathy and retinopathy goes away with lowering the A1c? I'm betting none. Nothing is quite as powerful as having someone in recovery speak to a medical student or Resident about what it was like, what happened, and what it is like now on buprenorphine.

[fishdoc]

I advise patients to save some of the money they are not spending on drugs and to open a 529 college fund for their kids and to save in a special account for themselves. They are told at the end of a year to buy something they would not ordinarily buy for themselves, or go on a vacation. One patient took me to the parking lot to see his second year gift to himself: a new TESLA! His first gift to himself was a new Harley Davidson.

[NoDrugs4u]

Bravo Dr Passer! Well said. I do not tolerate whining about med/treatment cost when the patient reeks of tobacco or is carrying a cell phone that is newer than my Galaxy SII!

[entjwb]

Gordon, when that comes up I usually asked how much a day they spent on street drugs. Then calculate to how much a month. Most of the time the monthly cost of my office visit is 2-7 days of street drug use. I had one patient with no insurance. He paid the office visits and for the medication and told me he still came out about $1000 a month ahead. He told me he felt he saw more value to the program because he is paying for it and it is allowing him to keep he job and family. I feel one of my responsibilities to the patient is helping them to become financially responsible along with helping them get their self worth and self value back. The opiate addicted people I treat feel they lost that when they were using. Getting those things back is a big part of the total recovery.

[drpasser]

No money for treatment usually means, always money for tobacco. And around $2K/year for most.

Pts need to keep their priorities straight. I make sure they understand, their treatment is an INVESTMENT in themselves, in NOT DYING!

Hey pts-get real.....this ain't a game.

Best,
Kevin

[gordon2441]

My patients always complain about lack of money, but I try to explain to them that the only shortage they really have is time.

Bup buys them the time they have lost being sick, stoned, or in jail, as well as some of the money they spent buying drugs and risking their lives on the street.

With their receptors partially satisfied, they have time to repair family problems, get a better job, get off probation, etc. None of these things are possible with the heavy opiates.

It's such a kick for me when a patient tells me he's able to buy a new car, better apartment, spending more time with his kids, back with his ex, not missing work anymore because of withdrawal.

This is the real advantage of Bup, I think

Gordon

[Dave]

NoDrugs4u, Since drug addiction is a real disease like diabetes mellitus, it needs to be treated that way. A diabetic may lose weight (often very difficult for most) and not need treatment. Others cannot cure themselves and may need insulin for life. An opiate dependent person is rather like many insulin dependent persons. They cannot live a normal life without their medicine. If a diabetic simply stops treatment, he soon dies. If an opiate dependent patient stops treatment and survives the rigors of withdrawal, he may not feel well for months or years but he doesn't die until he is too driven to get high again with the same dose of heroin he used in the past. That dose is now an overdose for him. Result -- death. In order to deal with the current epidemic in drug use and ODs, one must consider how important it is to treat the disease as long as necessary, perhaps for life.

[peterorrin]

Anti MAT groups are becoming organized by town in my region. They will not allow the mother of a son who has flourished in life on MAT to speak at their meetings. In contrast, the son of the founders of an anti-MAT group disrupted a Regional Action Committee (a public drug prevention, treatment and recovery group) meeting last month to say buprenorphine is addictive, that it has a street value, that you cant trust the motives of opioid researchers. These anti MAT groups are hostile to science, and guess what, in the history of addiction recovery, that is nothing new. But it is sad.

Alcoholics Anonymous knows all about these oppositional people. Example: Stanton Peele.

As for the opioid epidemic, in my state there is no comprehensive, integrated, timely response.Lots of conversations are begun, but action is often window dressing. Other states differ on this. The problem in part is that there is not enough buprenorphine available. Im in solo practice and am the only large buprenorphine provider in a region with 150,000 people. That is wrong. Shameful.

Replacing one addiction with another? No way. Look how your MAT patients thrive in the world, they live, they develop stable relationships. We practice what I call ADULT OBSTETRICS!!

[mattkeene]

NoDrugs...I would point out the difference between addiction and dependence. With the "drug dealer" dose escalates, jobs, relationships, and often lives are lost. With OMT, at least with Bup, dose either remains the same or decreases, folks return to work, family dynamics improve, and lives are saved.

Rick...I've had many patients successfully wean and discontinue bup/nal completely. Some have been kind enough to call months or years later to again thank us and report they are still doing well. I do taper quite gradually and often get as low at 05.mg daily (sometimes less), before they stop completely.

[NoDrugs4u]

To play the Devil's Advocate - the anti-OMT groups will simply claim that permanent OMT is just perpetuating addiction by replacing one opiate with another opiate, and replacing the drug dealer with a physician. Thoughts?