Buprenorphine patches for tapering

Buprenorphine Post
timuse
Posts: 6

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

Wha? I don't understand. We are talking about prescribing buprenorphine in any case, whether oral or by patches. I am talking about using buprenorphine patches for people who are in an established program, using buprenorphine/naloxone films, and motivated to taper off opiates altogether. We have a number, and many of them have great difficulty getting off the oral triggers involved in using pills or films. Just like nicotine patches can help those addicted to nicotine, buprenorphine patches should help those addicted to opiates.
Others have difficulty tapering below 2mg because cutting the films, to say the least, is not an exact science. The maximum iv dose for a healthy, nonaddicted, opiate-naive adult is 0.6mg iv buprenorphine, and oral buprenorphine is 30% absorbed, so a 2mg film is about the equivalent of 0.6mg, a maximum dose for an opiate-naive person. The biggest patch is 20mcg/hr which translates into 0.48mg buprenorpine per day, a little (20%) less than the 2mg dose, so it is a natural step down, and from there the patches can gradually decrease providing a nice way to get off the drug completely.
I think the real problem is that the pharmaceutical companies are way ahead of us in this. They know that we could have much greater success if we used patches rather than oral pills or films, and they have provided us no way to taper below 2mg, the maximum opiate-naive dose, which is presumably the dose in which all opiate receptors are filled. Anyone with experience in helping people get off buprenorphine knows that tapering from above 2mg is fairly easy for the motivated person, as long as it is slow and steady. The real difficulty comes below 2mg, when some receptors are no longer covered.

deegee
Posts: 137

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

I think it has more to do with prescribing an opioid to someone who is addicted to opioids. While some buprenorphine preparations are indicated for this purpose when used by qualified providers, Butrans is not one of them. You might as well prescribe oxycodone to someone who is complaining of withdrawal.
I thin it's flat out illegal.

timuse
Posts: 6

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

Title 21 Code of Federal Regulations, part 1306.04 (c) states: "A prescription may not be issued for 'detoxification treatment' or "maintenance treatment,' unless the prescription is for a Schedule III, IV or V narcotic drug approved by the Food and Drug Administration specifically for use in maintenance or detoxification treatment and the practitioner is in compliance with requirements in Part 1301.28 of this chapter."
If we are using the patch as an aid to taper off the medicine, just as we might use clonidine, is that considered "detoxification"?
I have phoned the DEA and left voice messages but they don't seem to answer me. Perhaps they don't know either.

deegee
Posts: 137

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

My understanding is that it's simply not allowed. I think this is a case where it's not just "off label" but actually illegal, but I'm sure someone will correct me if I'm wrong.
As far as your line of thinking, I agree, it seems a logical choice for tapering....


Return to “Clinical Use of Buprenorphine”

Who is online

Users browsing this forum: No registered users and 1 guest