buprenorphine dosing

Buprenorphine Post
Posts: 187

Postby Dave » Fri Sep 04, 2015 6:58 am

I cannot make sense of this Cochrane database report. The conclusion seems to favor methadone, yet no one in our bupe office has ever wished to go back to a methadone clinic. The logical explanation is that methadone is like legal heroin, whereas bupe is like feeling normal, according to every patient to whom I have talked. Methadone keeps the victim high as if they were still using heroin. Naturally those victims who are more likely to stay with a methadone clinic are those who like to get high. Those victims who are really trying to have a normal life will stay with bupe. Simple.

Posts: 111

Postby fishdoc » Fri Sep 04, 2015 6:58 am

Once again we compare apples to oranges and call it scientific research.

Methadone treated patients are maintained at high doses and frequently need increases. They are rarely terminated from their programs and very rarely tapered down or off of methadone. Buprenorphine treated patients may start at low doses and taper down from there. They are encouraged to reduce their doses, often as a condition of entering the program. Methadone programs are intensive counseling inclusive daily attended programs usually free and run by governmental agencies. Buprenorphine programs are often privately run, expensive and counseling is an additional outside resource.

Each type of program works for some, but not all. Until someone opens a buprenorphine clinic run the same way as a methadone clinic, daily observed dosing, enforced counseling, maintenance on high dosing with no encouragement to decrease dose, we cannot compare the 2 drugs in this manner.

Posts: 180

Postby entjwb » Fri Sep 04, 2015 6:58 am

I think that there are other factors that need to be considered. Many Methadone and some Bup clinics involve court ordered cases. These should be compared to each other and programs that don't do court ordered cases should be compared to each other. The approach that is used in these cases are also different to obtain a good treatment program. DEA, state and federal overseers think everyone should be treated the same but then want individual treatment plans. I have been successful in treatment of many patients but like others have some who will fail in spite of what you do. I have one to five patients completing the program each month and about one each month falling out of care. Although I have noticed more patients not returning after first visit in past year. Maybe they weren't really prepared and ready to make that difficult transition. The rates of success in our setting is higher than the program's doing court ordered cases because of the attitude of the patients and not the capabilities of the physicians.

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