Belbuca

Buprenorphine Post
tmagro
Posts: 1

Postby tmagro » Wed Oct 28, 2015 11:54 am

This is a tricky situation. Non-addiction doctors commonly prescribe opiates to keep patients from going in withdrawal. If a patient is being treated for pain and and has a physiologic dependence on opiates, the pain resolves but the physiologic dependence continues, a doctor typically continues to prescribe opiates in a taper over several weeks. Technically, this is illegal since it is treating withdrawal, but this is an acceptable medical use. For a patient with opiate dependence in remission, I dont see how prescribing them Belbuca or Butrans would be any different. I havent done it. Frankly because it hasnt been a major problem splitting the films into very small doses, but Belbuca would be more convenient. When a Suboxone patient has to hold Suboxone for a scheduled surgery, I frequently prescribe a 24 hour supply of Oxycodone to keep them from withdrawing prior to the surgery. This is technically illegal, but what else am I supposed to do? Force the patient to go through withdrawal, likely leading to a relapse? That could be disastrous.

I will likely prescribe Belbuca to chronic pain patients, especially those with depression, as buprenorphine is often an effective antidepressant. Does anyone know how the dose relates to Butrans? I do use Butrans some, but I find that the dose is too low for most patients.

MChaplin
Posts: 183

Postby MChaplin » Wed Oct 28, 2015 11:54 am

entjwb- my point exactly!

entjwb
Posts: 180

Postby entjwb » Wed Oct 28, 2015 11:54 am

MChaplin, it is illegal to use any no approved med to treat addiction. It is frowned upon to use Suboxone, etc. for pain but not illegal. Any physician should be able to write Rx for Belbuca it doesn't require the X number because it is approved for pain and not for addiction. So cannot use to treat addiction.

drpasser
Posts: 1404

Postby drpasser » Wed Oct 28, 2015 11:54 am

It's not particularly difficult, to cut films into eighths.
My pts do it all the time, especially to save money.

An eight twice a day=7 to 8 Suboxone Film 8/2-per month.
Half twice a day of the 2/0.5 films=30 per month.

:-)

MChaplin
Posts: 183

Postby MChaplin » Wed Oct 28, 2015 11:54 am

but "offlabel" use of buprenorphine products is illegal is it not?

mattkeene
Posts: 32

Postby mattkeene » Wed Oct 28, 2015 11:54 am

Correct. Belbuca is delivered at a dose range from 75mcg to 900mcg. Those are certainly small doses that may not seem to jive with the dosages required by many of our opioid dependent patients who also have legit pain...but the data on this low dose Belbuca is pretty compelling nonetheless. Perhaps the "addicted" brain has a different pain threshold than the "dependent" brain. Or perhaps pain can be well controlled on lower doses, but cravings cannot.

Either way, my interest in Belbuca is the "off label" potential to help those rare patients who simply cannot get much lower than a 1/4 tablet of a 2/0.5 mg suboxone tab/film. I've had patients come up with very creative ways to taper to near microscopic doses of buprenorphine. This present a different option.

Dave
Posts: 187

Postby Dave » Wed Oct 28, 2015 11:54 am

I just read a report of Belbuca on Medscape that indeed said it was indicated for chronic pain and there was no mention of treatment for addiction.

Dave
Posts: 187

Postby Dave » Wed Oct 28, 2015 11:54 am

I am not at all sure what mattkeene means by writing "Belbuca which will be straight buprenorphine ... with an indication for chronic pain management. This sentence could be ONLY pain management or ALSO pain management. The fact that the dose is much smaller than what they use for Bunavail for addiction suggests that it may not relieve much pain. The patients I have seen with addiction and chronic pain say a higher dose of buprenorphine helps the pain more than lower doses.

MChaplin
Posts: 183

Postby MChaplin » Wed Oct 28, 2015 11:54 am

I am thinking we can't legally prescribe Belbucca for patients trying to wean off buprenorphine products if they are taking bup for addiction- it would be illegal. Per DATA 2000, there is no "off label" use of any opioid product for the treatment of addiction.....this is why folks got in trouble back in the early 90's for prescribing buprenex to people with opioid dependence. I am guessing belbucca is only approved for chronic pain. it is legal to prescribe suboxone off label for pain, but not the other way around (pain meds for addiction). Correct?


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