Buprenorphine patches for tapering

Buprenorphine Post
m_kaylor
Posts: 22

Postby m_kaylor » Wed Jun 24, 2015 5:32 am

I don't have any experience using butrans to taper but your theory makes sense and I'm sure others have tried it. The only flaw I can see in your plan is that oral absorption vs transdermal are going to have different bioavailability so it might not be as easy as simply calculating dosages. I suspect a good pharma-D may be able to give more insight. The other thought is there is less flexibility with the patches then the strips. Cutting strips seems to work well for people. Document carefully you are treating pain and not opiate dependence as butrans isn't approved for opiate addiction. Seems like you have a good test patient. You could discuss with him/her and then experiment a bit. Let us know how it goes

MChaplin
Posts: 183

Postby MChaplin » Wed Jun 24, 2015 5:32 am

I have not tried it because I am not qualified to treat chronic pain. if you are treating his addiction with butrans even if you are "detoxing" or simply "tapering" you are unfortunately breaking the law. If you are treating his chronic pain that is not illegal. I did have a chronic pain patient who successfully weaned off suboxone films- his pain worsened and I advised him to ask his pcp for butrans- unfortunately, he did not like the way it made him feel and he is now dealing with his pain without any medication. I have had about half a dozen folks including him taper off the 2mg films- this is what we did- first we reduced to 1/2 film by alternating 1 film with 1/2 film for a month- then we used 1/2 film daily for a month- then 1/2 alternating with 1/4 for a month, then 1/4 for a month, then 1/4 every other day for a month, then 1/4 every 4th day for a month then 1/4 once a week for the final month. takes 7 months but it has worked.....and doesn't require splitting smaller than 1/4 film.

fishdoc
Posts: 111

Postby fishdoc » Wed Jun 24, 2015 5:32 am

I have had patients use the Butrans patch for pain, both as additional medication while still taking Suboxone after surgical procedures and also to treat pain. I have not used it off label in the way you suggest, although I have thought of it many times. Most patients, even with insurance, cannot afford Butrans as most insurance companies inthis area do not cover it.


On the other hand, since this patient does have chronic pain, you might just document that pain is breaking through on the lower levels of Suboxone and therefore treat him as a pain patient with Butrans. Just document everything well and let us know how it works!

drpasser
Posts: 1404

Postby drpasser » Wed Jun 24, 2015 5:32 am

The 20 mcg per hour patch = about one half, 0.5 mgs of bupe per day.

Also, please look back in the previous threads about thus topic. This topic has been discussed previously and fairly recently. I think you will find the info you seek by just looking back a bit. In fact, this applies to most topics here as many have been previously covered. One can search for topics previously discussed, using the search icon on the upper right of the home page for this site.

Here is just one, of several prior threads about Butrans:
http://bup-webboard.samhsa.gov/topic.asp?TOPIC_ID=658&SearchTerms=Butrans

Best,
Kevin

tdbailey
Posts: 9

Postby tdbailey » Wed Jun 24, 2015 5:32 am

I had two patients recently who left my practice as their PCP offered to use the patch to treat both their pain and addiction, and their insurance would pay for it. One was an epic fail as he was on 14mg Suboxone at the time and was back to see me right away. (He was wearing all 4 of the patches when he came to see me. Was kinda funny looking really) The other is still in his PCP's practice and I believe and he was on 8mg Suboxone at the time. So he "seems" to have done well even though I would not have expected it given his dose.

I realize that also does not exactly answer your question either but is as close as I can get.

timuse
Posts: 6

Postby timuse » Wed Jun 24, 2015 5:32 am

My question remains unanswered. Has anyone had any experience using the buprenorphine patch for tapering?

I understand that it is not approved for use in addiction. But it is approved for pain control, and there are many people with chronic pain who are addicted to opiates.

I also understand that the drug company that makes Suboxone is interested in us keeping our patients on it and not getting below the 2mg film.

I am just wondering about what makes sense. I see that the 20mcg patch could serve as a nice step-down from the 2mg film, allowing patients to get off the daily habit and oral gratification of pills and films, and from there one could progress down the patches to taper off, if one were motivated to do that, which most are, given the right context.

I have a patient who (a) has insurance, (b) has chronic pain problems, and (c) wants to taper off, so I wondered if anyone has had experience with it.

tdbailey
Posts: 9

Postby tdbailey » Wed Jun 24, 2015 5:32 am

The DEA specifies the DATA waiver is for using forms of bup "approved" to treat addiction. The patch is not. Whether it makes sense is irrelevant, I would be very careful using the patch for addiction.

http://www.deadiversion.usdoj.gov/pubs/docs/dwp_buprenorphine.htm

drpasser
Posts: 1404

Postby drpasser » Wed Jun 24, 2015 5:32 am

I am sorry, but that is just not true. The waiver, part of DATA 2000, only applies to Suboxone and Subutex.

It does not apply to all buprenorphine products.

http://buprenorphine.samhsa.gov/titlexxxv.html

Best,
Kevin

mack86
Posts: 70

Postby mack86 » Wed Jun 24, 2015 5:32 am

The waiver we have is a waiver so we can treat opiate addicts with buprenorphine, which is approved for this.

SL, buccally, IV or transdermal, buprenorphine is buprenorphine. I have prescribed the patches in a patient with chronic pain. Worked great. Then I turned him back over to his regular doctors. A pharmacy can fill butrans without the X number, because it's approved for pain.

Butrans is very expensive, so won't work for everyone. I have had a patient who dissolve his buprenorphine in alcohol and took it by the drop under his tongue. (He was a science teacher so I trusted him on the mixing, other patients would probably need specific instructions.)

drpasser
Posts: 1404

Postby drpasser » Wed Jun 24, 2015 5:32 am

For pts with documented chronic pain, one could probably be justified in Rxing it. I don't usually mess with it.


Return to “Clinical Use of Buprenorphine”

Who is online

Users browsing this forum: No registered users and 8 guests