Patient Prefers Subutex

Buprenorphine Post
adavid
Posts: 64

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

Methodone clinics serve a very important but very different purpose from bup treatment. The purpose of Methadone clinics is risk reduction. When addicts use bup properly they feel normal and must function normally in the world. Unfortunately many addicts are not ready for normality and if you put them on bup they will immediately relapse back to their drug of choice. Methedone allows them to be high in a controlled, legal environment. On methadode they are not on the streets causing US all sorts of problems. It's like the needle exchanges - no one wants people shutting up but at least they are doing it with a clean needle.

I know a lot of Docs are grumbling about the 100 pt limit but if you think it through this limit actually makes whole the DATA 2000 program possible. The reality is that communities have very strong opinions about seeing addicts congregate in large numbers - such as you see at methadone clinics. That is why methadone clinics need special zoning. A zoning change requires a public zoning hearing at which the community can decide if it wants a methadone clinic. No community wants these clinic in their midst. That is why methadone clinics are located in out of the way places such us industrial parks or lonely highway - places where there is no one around to complain. But most doctors offices are located in very public places; many times right in the center of town. Can you imagine what would happen if there were large numbers of addicts congregating in the centers of communities across the country. There would be a deluge of furious phone calls to congressmen who will have no choice but to repeal the DATA 2000 law. By keeping the numbers low it makes it invisible to the communities so they do not complain.

Dave
Posts: 187

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

I don't see much use for methadone clinics anymore. They seem to be merely legal substitutes for addicts who have trouble getting heroin. If there were enough bup docs around and the 100 patient limit were lifted, there would be no reason to continue methadone clinics. Why is it that these clinics don't have a 100 patient limit?

kcairns
Posts: 571

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

article on street bup abuse in "drug and alcohol dependence" march 31 2014 finds --"it serves a variety of functions - to get high, manage withdrawal sickness, as a substitute for more preferred drugs, to treat pain, manage psych issues, and as a self directed effort to wean off opioids...rarely preferred for its euphorigenic properties but rather serves as a substitute for other drugs, particularly heroin, or as a drug preferable to methadone to self medicate wdrl or wean off opioids"... no deaths in their series

Dave
Posts: 187

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

Kevin, I agree with the OTC Suboxone preferably in generic form. In fact I would go further with the legalization of all currently illegal drugs, which would empty out many of the jails, which are needed for real criminals who are dangerous to society. Alcohol is one of the most dangerous drugs and it is legal. Since prescription opiates are one of the most important causes of addiction, these should be prescribed with a maximum time limit with no refills unless there is no alternative treatment, and buprenorphine should be the first opiate prescribed for moderate to severe pain since it does not have the euphoria and mental obtundation that the other opiates have. Other dangerous drugs could be regulated like alcoholic beverages and cigarettes -- crossbones on the label, no sales to children, required signatures on documents like they do with pseudoephedrine, limits on purchase amounts, and pamphlets on what to expect from each addicting drug, including life expectancy and mental deficiency. This should put the drug lords out of business and those poor souls who want to be addicted would not be arrested but would feel free to go for treatment without a jail sentence.

drpasser
Posts: 1404

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

Exactly!

I have, at times thought , Suboxone should be free and OTC. If that were the case, I don't think most folks would kinda wake up one morning, and decide they wanted to become hooked on opiates. On the contrary, think of the lives that could be saved. Like the 100 every day who die from this disease.

Best
Kevin

Dave
Posts: 187

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

Bravo! Dr. Passer! It's about time someone pointed out that we are trying to help people, not worry about enforcing the laws. Of course we want people to follow the law, but our first consideration is helping people. Primum non nocere!

kcairns
Posts: 571

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

I see a lot of people in various phases of opioid addiction care work..I see an awful lot desperate to get off heroin morphine fentanyl oxy dilaudid...i see pts having hard times w wdrl in process of bup taper but never one desperate to get free of wanting/seeking it..nor hurting from taking it...what is wrong w people liking heroin and oxy? Well what is wrong w that is that they get sick and know they can die and want medical help and so we help them and work w them as our clients..but people using bup illegally/nonmedically dont need us or come to us and what they do doesnt concern us..people do get high and it is not surprising if some find and prefer to do so w less of a dark side.. Only our issue if they try to con us ...(bup mono I RX only for pregnancy period).so we just don't let them...end of case...doesn't help anyone to just accept letting such a life saving med become even more and cause people to lose the salvation so unbelievably described by a pregnant woman I just inducted

drpasser
Posts: 1404

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

I feel like adding here, that while bupe is available on the street, it is also known on the street for helping with wdrl sxs. So that's kinda a good thing, right?

Folks don't die from bupe. Drug dealers know it helps with wdrl.

Of course it's about supply and demand. But buying bupe off the street, while a bad thing, still ends up as harm reducing. Most people who take bupe off the street know, you really don't get high on it and one functions better, without intoxication, wdrl sxs and cravings.

People often say, regardless of their bupe source, that bupe helped them to decide to abstain from the opiates they were abusing.

Best,
Kevin

adavid
Posts: 64

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

Your observation that many people are now preferring Subutex is disturbing. It is self evident that buprenorphine in all its form has become a big drug of abuse. The preferred method of abusing bup is snorting Subutex. Multiple patients have told me that
subutex sells for $30 to $50 each on some streets. When Subutex went generic several years ago many of us started prescribing it to our patient who did not have insurance because it was cheaper than Suboxon. Well, that turned out to be a big mistake. Bup abuse is now rampant. Every day we get several calls from people looking for a "Subutex clinic". Every day there are emails through NAABT from people claiming intolerance to naloxone, Suboxone induced HA (but not from Subutex, etc, at infenitum This is a problem that you and I have created.
If you are still prescribing Subutex think again. Many physicians claim they can discern the good from the bad.
Actually, you cannot. No one can. No one that good.
And as far as cost, check with your pharmacy. In most cases the cost to the patient of Bunavail is about the same as a Subutex

drpasser
Posts: 1404

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

You know, I always encourage all pts, to spit out the juices from their Suboxone. I tell everyone not to swallow it. Not only does that decrease risk of a naloxone sensitivity (which is often made up, IMO); spitting emphasizes the fact that the bupe, is only absorbed via SL route.

Best
Kevin


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