Tomorrow, I'm doing an induction on an 87yo F.

Buprenorphine Post
compchat57
Posts: 35

Postby compchat57 » Mon Nov 16, 2015 11:34 am

@peterorrin,

Checking your link this doctor, psychiatrist has been prescribing Adderall and Xanax. Nothing mentioned about Bup.

medic2109
Posts: 22

Postby medic2109 » Mon Nov 16, 2015 11:34 am

I have a 65 year old who started misusing her opiates for pain control due to some dementia. Induction went great and pain was totally controlled. She is now communicating more and far more interactive when she comes in. I just use the suboxone films.

I am curious, how did you get it approved. Did you stick the label of opiate dependency?

compchat57
Posts: 35

Postby compchat57 » Mon Nov 16, 2015 11:34 am

She doesn't need bup for 4 10 mg tabs of lortab per day, IMHO. While you have a lot more experience with Bup then do I, as an internist my practice has alot of geriatrics. I'm****uming she was started on the hydrocodone for RLS ? Mirapex is a disaster waiting to happen in terms of side-effects. I suggest to patients that they try a low dose cannabis product (edible or trokie) just before they go to bed the kind that has little to no THC. That seems to help a lot of people without the adverse daytime somulence, dizzyness, vertigo (etc.) that is mirapex.

Anyone do a cardiac workup ?

peterorrin
Posts: 267

Postby peterorrin » Mon Nov 16, 2015 11:34 am

Hi All, I have a patient in her mid 80's who takes Zubsolv 5.7mgm q8hr..a real 'live wire'

On another subject: a Milford CT doctor was arrested last week for providing 'drugs for cash. He had about 80 buprenorphine patients

http://www.ctpost.com/news/article/Feds-Milford-doctor-prescribed-drugs-for-cash-6629476.php

Do any of the states represented in this list have some provisions for waivered docs who suddenly stop prescribing for health or legal reasons. The thought of 80 people walking around in withdrawal is pretty scary. Our state list of waivered docs is not reality; the real number is much smaller, many of their practices are either full or they dont even prescribe buprenorphine.

Peter


NoDrugs4u
Posts: 198

Postby NoDrugs4u » Mon Nov 16, 2015 11:34 am

Well done Dr Passer! I guess you don't have to worry about her being on long-term Bup therapy, on the contrary maybe she will live to be 100!

MChaplin
Posts: 183

Postby MChaplin » Mon Nov 16, 2015 11:34 am

I am interested to hear- my oldest patient is 65- used heroin(!) for 50 years....

drpasser
Posts: 1404

Postby drpasser » Mon Nov 16, 2015 11:34 am

It worked out great!

The pt is an almost 88 yo WF, h/o taking Lortab 10s, at least 40 mgs day. She was becoming tolerant c WDRL Sxs incl restless legs. (FYI-that's the origin of the term: "Kicking the Habit,) as well as restlessness in general. Also, she had a lot of itching with the hydrocodone, so she was Rxed hydroxyzine. For insomnia, she was Rxed 50 mgs of amitriptyline at HS, as well as Mirapex for the RLS.

She was referred to me due to frequent falling episodes (duh? Ya think? :-)

I stopped her hydroxyzine, Mirapex, amitriptyline and hydrocodone. Her daughter, who just happens to be a Nurse Practitioner, did a great job of waiting until her COWS was at least 14 a starting the bupe. Because I wanted something which would most easily dissolve, I started her on 1/2 of a Zubsolv 1.4/0.36 SL. This was at home, because she wasn't in enough WDRL when she was in my office.

She did wonderfully. Her daughter says, she hasn't been this alert in three years. Her pain, so far isn't worse. I've tried her on one dose of the whole 1.4/0.36 Zubsolv, and it kinda conked her out.

I saw her in my office today. She walked in briskly with her walker and was a "real pistol." I'm sticking with the 1/2 Zubsolv BID. I decided not to use Bunavail, as I was afraid she may choke on the part which doesn't always completely dissolved.

Everyone is happy. I love it when stuff works out.

Best,
Kevin :-)


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