Patient Prefers Subutex

Buprenorphine Post
drpasser
Posts: 1404

Postby drpasser » Tue Jun 02, 2015 1:04 pm

The cool thing about science is, it's true whether or not you believe it :-)

finkelmd
Posts: 24

Postby finkelmd » Tue Jun 02, 2015 1:04 pm

As with global warming: with so much scientific data available, personal opinions are irrelevant!

finkelmd
Posts: 24

Postby finkelmd » Tue Jun 02, 2015 1:04 pm

I appreciate everybody's candid comments. However some of the MMTP(Methadone) statements are so inaccurate and dangerous that at this point in this discussion I would recommend to some of our colleagues to educate themselves about Methadone use before they take further care of these population. You are risking people's life with your lack of experience and knowdlege. Coming from "an expert" this is absolutely UNACCEPTABLE and again very very dangerous to patients.
Totally crazy!!!

drpasser
Posts: 1404

Postby drpasser » Tue Jun 02, 2015 1:04 pm

You can search above for various topics previously discussed here on this webserve.

Many on Methadone are available now,

Put Methadone as the key word in the subject line of the search.

Here is one: http://bup-webboard.samhsa.gov/topic.asp?TOPIC_ID=248&SearchTerms=Methadone

Best
Kevin

m_kaylor
Posts: 22

Postby m_kaylor » Tue Jun 02, 2015 1:04 pm

It seems like a methadone thread would be helpful and I apologize if I led this thread off course. Like many aspects of medicine it certainly seems there are large variations in both practice and the effectiveness of outcomes. Based on some peoples experiences OTPS have not been a good option for their patients, for others they haven't had such negative experiences. Dave, I agree with your comment that you can't compare methadone to buprenorphine as buprenorphine wasn't even available when the study I quoted was done. My point was simply that methadone has a good track record and has been shown to work and we shouldn't simply dismiss it.

To respond to fishdoc I think there is a bit of selection bias. My buprenorphine patients are usually more stable in general. The cost alone of buprenorphine often dictates whether people will use buprenorphine vs methadone. In general the people at OPTs often have hit a lower rock bottom, have less employment, have already failed buprenorphine either on the street or in clincs (or don't have the resources to use bup) and often have complicating medical, psychosocial and legal issues compared to the patients I see on buprenorphine. As a whole, they may do "less well" then the buprenorphine patients but I don't think that is necessarily a fault of methadone vs buprenorphine. With both groups I see successes and with both groups I see failures, but we just keep swinging and hope to someday hit it out of the park or at least get on base.

Keep up the good work everyone, hope you all have a great weekend

NoDrugs4u
Posts: 198

Postby NoDrugs4u » Tue Jun 02, 2015 1:04 pm

adavid, very interesting about the DOT physicals. I used to do them but dropped it when the all-knowing feds changed the law requiring physician certification (obviously 12 years of college, medical school and residency, board certification + 15 years of experience does not provide us the skill to do a driver physical) smirk. Just one more way for them to collect yet another fee and spawn another cottage industry to certify (at cost) physicians.

It is good that they will allow drivers to use bup.

What happened to the original poster of this thread, euphony, it would be nice to hear some follow-up from people?

Dave
Posts: 187

Postby Dave » Tue Jun 02, 2015 1:04 pm

Kcairns, I appreciate your kind words and I know you are doing what is right given the world we live in. Yes, I know "meth" is often used for methamphetamine, and I wouldn't want to confuse anyone that might have thought I was talking about meth labs, instead of methadone clincis. :-)

Dave
Posts: 187

Postby Dave » Tue Jun 02, 2015 1:04 pm

Fishdoc, thanks for sharing your experience with both methadone clinic and OBOT. I can believe everything you said because it is what patients have told me in my OBOT and my experience with bupe. The former methadone patients said they did not function well in the methadone clinics and their lives changed little. It was not until they started OBOT that their lives really changed for the better. It has been very satisfying for me to share their recoveries, their new and better jobs, their marriages and families. It seems that only the ones with police records have trouble getting decent jobs. I feel sorry for them that their past history holds them back and doing well now is just not enough. How long do they need to be punished? So sad.

adavid
Posts: 64

Postby adavid » Tue Jun 02, 2015 1:04 pm

I am certified to do CDL medical exams. Recently the feds came out with lengthy new criteria under which drivers can be certified fit for duty. They have listed a litany of medical conditions with often lengthy descriptions of the criteria under which the drivers can be certified. There is a reasonably lengthy discussion of the circumstances under which a driver on bup can be certified. But under methadone the discussion is short and sweet: The Federal Motor Carrier Safety Administration has determined that a drivers may NOT be certified fit for duty if taking any amount of methadone for any reason.

fishdoc
Posts: 111

Postby fishdoc » Tue Jun 02, 2015 1:04 pm

Probably need a new topic for this but the last few messages got me thinking.
I work in a methadone clinic as well as OBOT.

The major differences I see are:
1. Methadone patients require increasing amounts, very few seem to taper off and stay off in contrast to bupe patients who taper well and seem much more "normal."

2. Methadone patients, because of the system, spend hours standing in lines EVERY DAY and never seem to be able to obtain quality jobs. Bupe patients seem to get better jobs and promotions which seems to result in higher pay. Their quality of life in general seems better.

3. Methadone patients seem to remain in treatment longer; Bupe patients seem to be able to taper dose and even SUCCESSFULLY discontine Rx. I have not had the same experience with methadone patients.

My observations may be biased by private bupe practice vs. public methadone clinic. I would love to hear what others have observed.


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