duration of treatment with buprenorphine

Buprenorphine Post
drpasser
Posts: 1404

Postby drpasser » Mon Mar 17, 2014 11:24 am

I've had three pts whom recently, I tried to taper their dose. All three have been on maintenance for several years and all expressed a desire to taper. All three are young people. All were very stable. As the taper progressed, all three had problems with either drinking or taking extra opiates from outside sources. None of the three had any problems with maintenance over at least the past three years.

Tapering clearly exacerbated their addictions. All three are now back on track and back up to the bupe dose they were receiving before beginning the tapers. They feel ashamed for taking other substances and violating their tx agreement with me, as well as frustrated that they don't seem to be able to effectively taper.

I plan to just keep them where they are for now. I taper very slowly, but I now know that for some pts, an even slower taper is indicated.

Best
Kevin

MChaplin
Posts: 183

Postby MChaplin » Mon Mar 17, 2014 11:24 am

http://archinte.jamanetwork.com/article.aspx?articleid=1916910. don't know if folks will be able to access the article BUT it showed clear separation of maintenance treatment (which does work) and taper (which didn't work so well). I think this is a really important addition to the data because i think there is still a mindset among doctors and patients as well as legislators and the lay public that treatment should be time limited in some way and i think what little data that is out there does NOT support this- The 100 patient limit encourages us to wean patients off so that we can treat the next 100 knocking at our door but in my mind we are potentially doing a disservice to the patients we taper. I know some folks on this list serve will disagree and will argue that they are providing life skills and education that will protect their patients post taper and this may well be true but i would encourage all of us to track the patients we are tapering and see how they are doing....because i haven't seen any actual data to suggest that folks do well after taper- of course that doesn't mean that they aren't doing well- they might be but they might not be and the stakes are high - This is a potentially fatal illness we are treating after all....thoughts? anyone have follow up data to share???

Jeremy K
Posts: 109

Postby Jeremy K » Mon Mar 17, 2014 11:24 am

Thanks for posting this. Been a while since I checked this forum, sorry for the delay in replying. I think I've asked elsewhere about length of treatment, recommendations, research, etc. There doesn't seem to me to be much out there, either in the way of recommendations from recognized 'experts', or research that addresses the question. That doesn't stop some docs/clinics/third-party-payors from enforcing their own ideas about it, typically a 2-year limit. Most of us however seem to keep it individualized and more open-ended; that's what I do anyway.

It would be great to have some good research that addresses this issue, but frankly the difficulties in crafting and executing a program that would provide meaningful data seem daunting to me. At best the info obtained would be suggestive I think.


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