Induction Advice
Induction Advice
If you need any practical advice, Im only near Derby. You can always call-in on the way by.
Have had a few cases like this.
Possibly they were also getting long acting opiates, after all, they are getting their opiates usually from unreliable sources. In that case, waiting longer is needed. I have heard of doctors writing Rx for short term opiates to transition off MTD. I usually give them a couple of days of clonidine, and rarely two 5 mg tabs of valium (given to a responsible family member) to help make it through.
Sometimes they are swallowing part of the dose, which exposes them to more naloxone. Some people generate a lot of saliva with sublingual dose, then they have to swallow, or spit out the dose in the saliva.. For these pt's, I tell them to place the tab or strip between their cheek and gum (like chewing tabbacco), to reduce the amount of saliva. One pt brought in her meds, and the pharmacy had a sticker on the bottle: "take with food"!
I have switched some to subutex for induction
Possibly they were also getting long acting opiates, after all, they are getting their opiates usually from unreliable sources. In that case, waiting longer is needed. I have heard of doctors writing Rx for short term opiates to transition off MTD. I usually give them a couple of days of clonidine, and rarely two 5 mg tabs of valium (given to a responsible family member) to help make it through.
Sometimes they are swallowing part of the dose, which exposes them to more naloxone. Some people generate a lot of saliva with sublingual dose, then they have to swallow, or spit out the dose in the saliva.. For these pt's, I tell them to place the tab or strip between their cheek and gum (like chewing tabbacco), to reduce the amount of saliva. One pt brought in her meds, and the pharmacy had a sticker on the bottle: "take with food"!
I have switched some to subutex for induction
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- Posts: 32
i don't use zubsolv but i think you are correct- i haven't seen cows go up but i have seen them stay the same and i always ask patients how they would have felt if they hadn't taken anything- most readily agree that they would be much more sick if they hadn't taken buprenorphine..... however the fact that pt refused the second dose suggests to me, that perhaps they did lie and now that they understand the implication, they don't want to make things worse...would be interested in any follow up- purely editorial comment that the list serve should maybe reconsider how monitoring is done since this post was attempted 9/21 and reached my inbox 10/14....
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