re-examing diversion

Buprenorphine Post
Posts: 187

Postby Dave » Fri Jul 17, 2015 7:26 am

adavid, that story reminds me of the guy I showed you who had what looked like needle punctures on his arm. He denied using the needle. I left the exam room to get you to have a look, and when we came back, he had this red rash all around the needle puncture. If he had thought to scratch his puncture sight before I examined him, I could easily have missed it when the skin all around it was red. You have to be suspicious about "skin rashes" in these people. And then there are the red and blue tattoos that must be examined closely.

Posts: 1404

Postby drpasser » Fri Jul 17, 2015 7:26 am

Malingering (I love that word, BTW).


Posts: 64

Postby adavid » Fri Jul 17, 2015 7:26 am

Regarding rashes from these products which interestingly are only reported from Suboxone Film and Bunavail: never from Subutex. Not long ago I had a young lady make just such a claim. I dosed her with Bunavail which she very reluctantly accepted. An hour latter she showed me rashes on her forearms, legs and upper chest. I pointed to her that allergic drug reactions also typically affect the upper back but that she had no rash there. Fifteen minutes later she showed me a rash on her upper back - but only in areas she could reach.

Posts: 137

Postby deegee » Fri Jul 17, 2015 7:26 am

Just the same, Bunavail certainly is an improvement in deterring misuse. I've had good success with it and particularly like it for patients who have a history of misuse of buprenorphine products such as zubsolv and suboxone.
I agree that it's not a panacea, but it's nice to have choices and it is my first line choice currently.

Posts: 571

Postby kcairns » Fri Jul 17, 2015 7:26 am

kevin in re your request someone check the uds thing,i called just now r-b ,ed info unit,she said nothing national but different states doing different things so keep in touch w say state asam.... all out there are not like us, big "red flag --green flag divide" ...pharmacist yesterday hassled my pt till i called him, said she had many red flags, checking price diff between bup tabs vs film, her dose (24 d/t cravings), length of time on bup, "when you getting her off??" ...only we care re green flags, she done now w parole violations, taking great care of new baby, exemplary woman in life, and treatment duration say i will be as per AAAP, "as long as it is helping".., another young man since on bup now able to handle nonchemically all his insomnia/depression and anxiety thru hard biking (ignoring those running out to sell him stuff) and taking nature pics, another as soon as she arrived home for a visit someone came up in a car and offered her $5 discount on methadone and she said no and furthermore she was not ashamed anymore of coming for addiction tx even tho her daughter said she should be... hey out there .lets hear a little more re green flags... ps i will not be holding my breath...

Posts: 1404

Postby drpasser » Fri Jul 17, 2015 7:26 am

I am not convinced, that we will be prescribing with impunity from the DEA by using only Bunavail.

Based on what I know, there are vast inconsistencies across the country, relative to what the DEA's agents believe are inspection-worthy."

Bottom line, IMO, one size does not fit all, really, as far as any aspects of this business are concerned. That includes DEA inspections.


Posts: 198

Postby NoDrugs4u » Fri Jul 17, 2015 7:26 am

fishdoc, we dispose of the wrappers in our hazardous waste needle boxes, so they are very secure, just for that reason.

Re your other question, I don't use Bunavail.

Posts: 183

Postby MChaplin » Fri Jul 17, 2015 7:26 am

Ca-Ching is unfortunately the sound a cash register makes....

Posts: 111

Postby fishdoc » Fri Jul 17, 2015 7:26 am

I used to collect and toss wrappers in the trash until I caught a patient in the dumpster behind the office retrieving them, so yes there is a market for the wrappers.

As for Bunavail, I had a patient today with a rash on his arms and neck that started 1 week ago when he started taking Bunavail. He had previously taken Suboxone illegally obtained without problem. Has anyone else seen a rash from buprenorphine of any type?

Posts: 571

Postby kcairns » Fri Jul 17, 2015 7:26 am

I appreciate above info including the teaching re bunavail...I submit this post to continue to add to the clinical database re issue of diversion of bup in general...yesterday at OTP,(only way in this state people w disease of sud opioids can find access to mat-bup, and numbers travel over 100 miles daily till can earn privileges, one pregnant woman travels 600 miles weekly) .. I inducted a man who came to us saying re street bup that he first didn't like it because the first dose didn't give him what he was looking for and it wouldn't let other stuff work either -- but realized that he then did find he liked being able to feel normal and so came to us...(samples even unfree are good for business) I cant imagine how so many public judgment and decision makers out there diversionophobically hindering bup access can so strongly just not want to think or know on a fun note, I just now inducted an older ivdu who has been through all this a lot and c/o jokingly, "you pay the dealer all that money and he doesn't even give you counsellng"

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