unusual pregnancy conundrum

Buprenorphine Post
jhartdo
Posts: 66

Postby jhartdo » Fri Oct 23, 2015 5:00 am

Like Dr. Passer said, the lowest dose that solves the problem.

m_kaylor
Posts: 22

Postby m_kaylor » Fri Oct 23, 2015 5:00 am

mchaplin makes a good point that the buprenorphine may give you "a hook" to encourage more engagement. I don't know if I would give much weight the the first 4 months of sobreity since she was inpatient during that time. I think the fact child protective is involved yet she doesn't attend groups is worrisome. I would expect her to be overly engaged in efforts to please child protective. However you guys end up going, it's great she is in your office and that she has made as much progress as she has. I hope she does well

deegee
Posts: 137

Postby deegee » Fri Oct 23, 2015 5:00 am

Thanks guys. As always, I very much appreciate your thoughts.

NoDrugs4u
Posts: 198

Postby NoDrugs4u » Fri Oct 23, 2015 5:00 am

Per TIP40 - "Patients who are not physically dependent on opioids but who have a known history of opioid addiction, have failed other treatment modalities, and have a demonstrated need to cease the use of opioids, may be candidates for buprenorphine treatment." ......... "Patients who are not physically dependent on opioids should receive the lowest possible dose (2/0.5 mg) of buprenorphine/naloxone for induction treatment." page 54


'Technically' you should refer her for methadone treatment during pregnancy even though we all know that bup is safe. I tend to shy away from the preggers because if the rug-rat doen't end up looking like George Clooney and as smart as Stephen Hawking, mom will sue you and your evil, nonstandardofcare buprenorphine. But, if you want to use bup in a non-active addict there is the precendent above.


peterorrin
Posts: 267

Postby peterorrin » Fri Oct 23, 2015 5:00 am

Group-resistant pts get their rx at the end of group.

MChaplin
Posts: 183

Postby MChaplin » Fri Oct 23, 2015 5:00 am

I think bup does add for two reasons- one, should reduce her cravings and two if you link it to requirement for counseling/meetings she will at least get in the door and maybe will find it helpful.

drpasser
Posts: 1404

Postby drpasser » Fri Oct 23, 2015 5:00 am

I would start her on a low dose of Subutex- like one mg BID. Go from there. I would tell her, the goal is to get her cravings decreased on the lowest effective bupe dose, to me minimize fetal exposure.

:-)

deegee
Posts: 137

Postby deegee » Fri Oct 23, 2015 5:00 am

Hi m kaylor
Thanks for your reply. I've been leaning the same way. In terms of absolute prevention of damage, it makes the most sense. I hope to hear more opinions on this.

To argue the flip side, she is finally drug free without mat, for a period of 5 months. She has a strong incentive to remain so since she's pregnant and also has had child services only recently return her three children to her. She knows that if she uses she will lose her children (1,2,6 yo). I'm sure this is much of what has kept her clean.
Further she has failed to follow through on meetings, counseling. Is she likely to not use if her only support is fear of child services and mat? Does bup add much to the strong incentive already in place and at what downside?
It would be nice if the residential program she was in had coordinated with the outside world to create a plan. I will call for their input too.

m_kaylor
Posts: 22

Postby m_kaylor » Fri Oct 23, 2015 5:00 am

In the last 10 years she only has 30 days of being sober without the isolation and structure of an inpatient program and has not established a great support system AND she is fighting cravings. I would definitely use buprenorphine. We know the downside of relapse during pregnancy and she is basically telling you she is going to relapse. I would keep her on a very tight leash with lots of oversight and start low and go slow but I think not using buprenorphine is setting her up for failure.


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