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  • Switching to SUBOXONE Monday for Pain Management

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    Old 10-06-2009, 02:26 PM   #16
    mark76
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    Re: Switching to SUBOXONE Monday for Pain Management

    Actually, doctors only need a special license in the US to prescribe subutex if it's for the primary purpose of addiction treatment (i.e., a patient who seeks to be treated with bupe not for pain, but as a result of an addiction to opioids). In this case, the doctor would be using bupe to stabilize the patient, and then might taper the bupe or maintain the patient on bupe depending on what's best for the patient. In this case, there are all sorts of rules about how many patients the doctor can treat with this method, etc. However, if the patient is using bupe to treat the patient for pain, they can do so without any special license beyond their normal DEA registration, etc. An analogy would be methadone. Addiction treatment with methadone requires a special license, but pain doctors routinely use methadone without having the special license because they are treating pain patients.

     
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    Old 10-06-2009, 04:52 PM   #17
    Lovemydegus
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    Re: Switching to SUBOXONE Monday for Pain Management

    Okay, some people here seem very confused about the whole Buprenorphine thing. Buprenorphine comes in many forms, like Buprenex for pain and Suboxone and Subutex for opioid depenence (you should never say the word addict/addiction, it's very demeaning because your labeling a person by their illness). In the US, Buprenorphine in the forms Suboxone and Subutex is only FDA approved for opioid dependence, but it is used off label for depression that isnt helped by anti-deppresants and chronic pain. The doctor must have an "X" in the beginning of his DEA number to prescribe it for dependence, and they can only have up to 100 patients at a time, but for chronic pain they dont need that "X" in their DEA number (but lots of pharmacists are confused about this fact). Buprenorphine is 25-50 times stronger then morphine, it's a very STONG narcotic, and it does have a 32mg peak, but 32mg is EXTREMELY stong. It's used in micrograms for chronic pain, They're right now in the US doing clinical trieals on the patch that will be FDA approved JUST for chonic pain. The Suboxone formula has the naloxone in it, and it's just their to stop abuse (it only activates when crushed and snorted or injected) otherwise it has no effect and just passes through as nothing with absorbed under the tongue. And when used for chronic pain it's taken in smaller doses more often during the day (like 1-4mg every 3-4 hours). They are planning on having oxycodone and morphine mixed with naloxone/naltrexone to stop abuse and tolerence in the near future.

    I really think people are put off by the the fact that it has nalxone in it, cause they think they will go into withdrawals, which they wont if taken properly. Chronic pain doctors are prescribing these meds more and more cause they love the fact it cant abused and you cant build a tolerence to it. I swear by it for my chronic pain, and I have used every other pain med under the sun (fentanyl patches with actiq, oxycotin, oxycodone, mscontin, kadian, methadone, diladid) and the only thing I've found for my pain to work wonderfully is Suboxone. IT works very fast, within 10-15 minutes I have releif since it goes straight into the blood stream from under the tongue. It is one of the most expensive pain meds out their, but worth every penny. And saying it's weak is beyond wrong, it is extremely stong, you have to remember that every 8mg pill equals around 200mg-400mgs of morphine, so it's nothing to play around with. You have to be in withdrawals to start it cause of it's strong binding abilities and it over powers other narcotics and can make someone go into withdrawals if they have other pain meds in their system when starting it for the first time and has nothing to do with the naloxone.

    I hope I cleared some stuff up, if theirs anymore questions just ask, I've done lots of research in Buprenorphine and know it forward and backwards. I think it's an awesome drug that has a bad reputation which is too bad. But I will always be an advocate for it cause it has helped turn my life around (I never misused my meds so I dont take it for opioid dependence) but helped my pain alot.

    -degus

    Last edited by Lovemydegus; 10-06-2009 at 04:58 PM. Reason: spelling errors

     
    Old 10-06-2009, 05:48 PM   #18
    mark76
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    Re: Switching to SUBOXONE Monday for Pain Management

    Lovemydegus, I think that all makes sense, but should note that I think it does make sense to separate opioid dependence from addiction in treatment with bupe because it affects whether or not the doctor needs to have the special license to prescribe it (e.g., not needed if it is being prescribed for opioid dependence secondary to chronic pain, but it the license is required if it is being prescribed for addiction). Also, I think when people consider it to be a weak opioid they mean that mean that above a certain amount (depending on who you ask, 2-8 mg), it has no increase in analgesic activity, and thus isn't suitable for anyone who needs, or could foreseeably require, more than 150 mg of morphine equivalent per day. For example, bupe is a poor choice for anyone who needs to have surgeries or other procedures on a regular basis. You're absolutely right that the naloxone component (unfortunately) really confuses people.

     
    Old 10-06-2009, 08:31 PM   #19
    Lovemydegus
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    Re: Switching to SUBOXONE Monday for Pain Management

    your right mark76. It would be a bad choice if you need several surgeries. But when someone is on suboxone and needs surgery, a planned one, then they susually discontinue the suboxone and give you other pain meds to help with pain and withrawal, and they continue the other pain meds til one is recovered from surgery. NOW an unexpected, emergency surgery is a whole diffrent situation. Theyhave to give you very large amounts of pain meds by IV and monitor your breathing til it rips the buprenorphine off the receptors, and that can be ALOT from what I've heard. I have to carry around as pecial card with me at all times that my doctor gave me incase of an emergency, in how I should be treated for pain and they have a 800 number the ER doctors can call to get more info on treatment including my doctor's phone number.

    And as with any pain med, it works for some, but not for all, thats a sure thing. But I guess I'm just the person that this med was perfect for, cause it gives such immediate releif, unlike with methadone, which I was taking before the Suboxone, I would have to wait up to an hour or more for any releif. But all the side effects are the same as any other pain med, actually exactly almost the same side effects.

    And people like me, who dont need any surgeries in the near future (I will need some eventually due to failing back prolly) so right now it's just pain releif I'm after.

    But I really wonder if their will be an outrage when the morphine and oxycodone come out with the formula mixed with naloxone/naltrexone. I can see people getting upset over it, I dont know why, but I can. I think this is a wonderful thing, something to help misuse and tolerence, but yet epople will prolly find a reason to freak out over it.....

    -degu

     
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