Patient cap being lifted?

Buprenorphine Post
Posts: 64

Postby adavid » Mon Sep 21, 2015 9:25 am

People on Methadone are supposed to be high. People can get high by injecting or snorting both Subutx and Suboxone(pills or strips). Bunavail is the least abusable.

Posts: 187

Postby Dave » Mon Sep 21, 2015 9:25 am

I have one patient who has been on Subutex for several years. Now the boss says we must convert him to Suboxone, which he says he has tried in the past and it did not prevent his cravings or relapse. He says he will have to go back to the methadone clinic after all these years, something he regards with extreme repulsion. Both drugs are being misused by some, so why send this guy off to the methadone clinic? How does one keep his job when patients have to report to the methadone clinic so frequently? Why do many of these patients tell me they hate to go back to that because they do NOT feel normal with methadone. If they are not getting high with methadone, then why do they so much prefer buprenorphine, which you say is much more expensive? If they are not getting high, what is it they are feeling that is so unpleasant in comparison to bup?

Posts: 104

Postby jmosby1469 » Mon Sep 21, 2015 9:25 am

AND he said: Democracy is the worst form of government, except for all the others.

Posts: 84

Postby DrBallester » Mon Sep 21, 2015 9:25 am

Methadone is cheaper, but buprenorphine is safer!

Posts: 16

Postby BrianPierce » Mon Sep 21, 2015 9:25 am

@kcairns- "methadone maintenance is much less expensive than bup" ?

Here in Maine we currently have several legislative proposals concerning addiction treatment and costs are a big part of the debate so this would be useful information. However, I've also recently spent a lot of time estimating labor and test costs for a buprenorphine practice with counseling inhouse, it isn't cheap and I'd be very surprised if a methadone practice was less expensive per patient.

Please cite evidence/data.

Rockport, Maine

Posts: 571

Postby kcairns » Mon Sep 21, 2015 9:25 am

enjoying chatting w both Dave and Peterorrin seamlessly and paragraphlessly, I contribute - seamlessness cannot be in absence of economic access for all which cannot happen in absence of reversal of process of expanding US economic inequality and I will take the position here of not blaming government per se but quoting Winston Churchill " to understand why democracy doesn't work all one need do is spend 5 minutes w the average voter"...PS methadone maintenance does not make people high but even if it did could we not get over it for the sake of their being alive? Methadone maintenance is much less expensive than bup and affordable for many thousands of Americans for whom bup is not and in these long times time of more and more Americans unable to find work or a roof over their heads this may not be important to all but it is to me

Posts: 267

Postby peterorrin » Mon Sep 21, 2015 9:25 am

Happy New Year everybody!! Let's continue in 2016 do the best jobs we can for the opioid use disordered patients in our care, so when the cap is finally raised, our programs will seamlessly expand to meet the demand. Think: How would I do that?


Posts: 187

Postby Dave » Mon Sep 21, 2015 9:25 am

tstinson, I agree with you that bup is enough to get rid of all other drugs used. But the ones who choose methadone will still want that until they get tired of being high all the time. Bup is the only drug that makes addicts feel normal, not high. I too doubt that the patient limit will be raised, but edibill raises a good point that the drug company lobbyists may have an effect.

Posts: 101

Postby edibill » Mon Sep 21, 2015 9:25 am

Give the Orexo, Reckitt Benckiser,and BDSI lobbyists time to do their thing. The cap will be at least raised.

Posts: 16

Postby tstinson » Mon Sep 21, 2015 9:25 am

I will be extremely surprised if this comes about in the foreseeable future. I have some guesses asto who may oppose this obvious change, namely everybody who "trying" to ameliorate the heroin epidemic with any means other than buprenorphine. Busp is simple and effective enough to kibosh all other means that are being used, including methadone, drug-free treatment, interdiction, incarceration, etc.

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