Brandeis and CDC Wrong on Buprenorphine PDMP Data
I’ll share an interesting story about the data used for the prescription drug database in Wisconsin and other states. I’ve been holding back on writing about this issue in hopes that the reason for the story would be corrected, and I would have no story to tell. But that hasn’t happened.
A new law in Wisconsin requires all prescribers to check the prescription drug database when prescribing any controlled substance. I’m surprised that no privacy advocates have complained about the database, which tells prescribers about the controlled substances used by their patients over the past 5 years, the pharmacies the...
Source: Suboxone Talk Zone - April 28, 2017 Category: Addiction Authors: admin Tags: Addiction Buprenorphine pharmacology Public policy risks Brandeis University CDC drug database PDMP Source Type: blogs
Brandeis and CDC Wrong on Buprenorphine PDMP Data
I’ll share an interesting story about the data used for the prescription drug database in Wisconsin and other states. I’ve been holding back on writing about this issue in hopes that the reason for the story would be corrected, and I would have no story to tell. But that hasn’t happened.
A new law in Wisconsin requires all prescribers to check the prescription drug database when prescribing any controlled substance. I’m surprised that no privacy advocates have complained about the database, which tells prescribers about the controlled substances used by their patients over the past 5 years, the pharmacies the...
Source: Suboxone Talk Zone - April 28, 2017 Category: Addiction Authors: Jeffrey Junig MD PhD Tags: Addiction Buprenorphine pharmacology Public policy risks Brandeis University CDC drug database PDMP Source Type: blogs
Is Suboxone Potent?
We get about 5000 readers of SuboxForum per day who ask question, provide answers, or share their experiences with buprenorphine medications. If you’re a patient on buprenorphine, consider joining us. It is free, and you’ll find help for starting buprenorphine, tapering off the medication, and everything in between. Or if you’re a buprenorphine prescriber consider joining to see what patients are doing and thinking, and to help answer their questions!
Yesterday someone wrote about the high potency of buprenorphine. He also wrote that it is hard to get off buprenorphine medications. I ended up writing mo...
Source: Suboxone Talk Zone - April 26, 2017 Category: Addiction Authors: admin Tags: Addiction Source Type: blogs
Is Suboxone Potent?
We get about 5000 readers of SuboxForum per day who ask question, provide answers, or share their experiences with buprenorphine medications. If you’re a patient on buprenorphine, consider joining us. It is free, and you’ll find help for starting buprenorphine, tapering off the medication, and everything in between. Or if you’re a buprenorphine prescriber consider joining to see what patients are doing and thinking, and to help answer their questions!
Yesterday someone wrote about the high potency of buprenorphine. He also wrote that it is hard to get off buprenorphine medications. I ended up writing mo...
Source: Suboxone Talk Zone - April 26, 2017 Category: Addiction Authors: admin Tags: Addiction Source Type: blogs
Is Suboxone Potent?
We get about 5000 readers of SuboxForum per day who ask question, provide answers, or share their experiences with buprenorphine medications. If you’re a patient on buprenorphine, consider joining us. It is free, and you’ll find help for starting buprenorphine, tapering off the medication, and everything in between. Or if you’re a buprenorphine prescriber consider joining to see what patients are doing and thinking, and to help answer their questions!
Yesterday someone wrote about the high potency of buprenorphine. He also wrote that it is hard to get off buprenorphine medications. I ended up writing mo...
Source: Suboxone Talk Zone - April 26, 2017 Category: Addiction Authors: Jeffrey Junig MD PhD Tags: Addiction Source Type: blogs
Ten Gripes of Buprenorphine Doctors
I recently gave a lecture to medical students about opioid dependence and medication assisted treatment using buprenorphine, methadone, or naltrexone. I was happy to see their interest in the topic, in contrast to the utter lack of interest in learning about buprenorphine shown by practicing physicians. In case someone from the latter group comes across this page, I’ll list a few things to do or to avoid when caring for someone on buprenorphine (e.g. Suboxone).
1. Buprenorphine does NOT treat acute pain, so don’t assume that it will. Patients are fully tolerant to the mu-opioid effects of buprenorphine, so they...
Source: Suboxone Talk Zone - March 25, 2017 Category: Addiction Authors: admin Tags: Acute Pain Addiction Buprenorphine Chronic pain Suboxone surgery buprenorphine stigma Source Type: blogs
Ten Gripes of Buprenorphine Doctors
I recently gave a lecture to medical students about opioid dependence and medication assisted treatment using buprenorphine, methadone, or naltrexone. I was happy to see their interest in the topic, in contrast to the utter lack of interest in learning about buprenorphine shown by practicing physicians. In case someone from the latter group comes across this page, I’ll list a few things to do or to avoid when caring for someone on buprenorphine (e.g. Suboxone).
1. Buprenorphine does NOT treat acute pain, so don’t assume that it will. Patients are fully tolerant to the mu-opioid effects of buprenorphine, so they...
Source: Suboxone Talk Zone - March 25, 2017 Category: Addiction Authors: Jeffrey Junig MD PhD Tags: Acute Pain Addiction Buprenorphine Chronic pain Suboxone surgery buprenorphine stigma Source Type: blogs
Where ’s the Buprenorphine asked Mr. Obvious? Thanks, CDC!
A quick note tonight, hopefully with a longer post to follow this weekend…
I’ve been frustrated by the people behind the Wisconsin PDMP, or Prescription Drug Monitoring Program, for their mistakes related to buprenorphine. Whoever came up with the numbers made a rookie error when calculating the equivalent morphine dose of patients taking buprenorphine products. The error is easy to notice by anyone who works with the drug, but apparently difficult to grasp by anyone with the power to correct the database figures.
Those people include, by the way, the folks at Brandeis University who give the numbers to Wiscons...
Source: Suboxone Talk Zone - March 22, 2017 Category: Addiction Authors: Jeffrey Junig MD PhD Tags: Benzos Buprenorphine pharmacology Public policy risks benzodiazepines CDC PDMP Source Type: blogs
Buprenorphine Overdose After Naltrexone Treatment
Naltrexone induces mu-receptor hypersensitivity. Buprenorphine’s protective ‘ceiling effect’ may not prevent overdose in patients with this ‘reverse tolerance’.
A new patient described his recent history of respiratory failure several days into buprenorphine treatment. He was told by his doctors that he experienced an allergic reaction to Suboxone. The rarity of buprenorphine or naloxone allergy led me to look deeper into his history, and my conclusion differs from what he was told by his last treatment team.
The patient, a man in his mid-50s, has a history of significant opioid use over t...
Source: Suboxone Talk Zone - February 15, 2017 Category: Addiction Authors: Jeffrey Junig MD PhD Tags: Buprenorphine Induction pharmacology receptor actions side effects Suboxone tolerance buprenorphine induction buprenorphine overdose naltrexone treatment Suboxone after vivitrol Suboxone allergy Source Type: blogs
Opioid Induced Hyperalgesia Prevented by Buprenorphine?
“Buprenorphine is a kappa receptor antagonist. For these reasons, buprenorphine might be unique in its ability to treat chronic pain and possibly OIH.”
The opioid crisis has been fueled by the use of opioids to treat chronic pain. Practice patterns have changed, but doctors are still criticized for their roles in the overuse of opioids. I’ve sat through community ‘heroin forums’ (sometimes on stage) as sheriffs, politicians, and ‘recovered addicts’ firmly pointed fingers at health professionals. I, meanwhile, kept my finger under the table, but had the thought that some of the people pointing ...
Source: Suboxone Talk Zone - February 5, 2017 Category: Addiction Authors: Jeffrey Junig MD PhD Tags: Acute Pain Buprenorphine Chronic pain Suboxone treatment buprenorphine treats chronic pain chronic pain treatment opioid induced hyperalgesia opioid pain relief pain vs. addiction Source Type: blogs
Benzos and Buprenorphine
The high safety of buprenorphine, except when combined with a benzodiazepine, has been twisted in comments about the drug (and in the minds of regulators) to buprenorphine being uniquely dangerous when combined with benzodiazepines, which is not true.
I’ve heard more and more from insurers, regulators, and well-meaning agencies about the dangers of combining buprenorphine and benzodiazepines. Some insurers protest paying for buprenorphine if patients are taking benzodiazepines. Medicaid recently sent a letter that described a ‘severe risk’ of using benzodiazepines in patients on buprenorphine. And...
Source: Suboxone Talk Zone - January 27, 2017 Category: Addiction Authors: Jeffrey Junig MD PhD Tags: Benzos Buprenorphine pharmacology risks Suboxone tolerance buprenorphine and benzodiazepines suboxone overdose xanax and suboxone Source Type: blogs
Cannabinoid Hyperemesis: How Rare?
Marijuana might cause pain and vomiting in the people who value the drug the most. Doctors should learn more about cannabinoid hyperemesis syndrome.
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Source: Cannabinoid Hyperemesis: How Rare? (Source: Suboxone Talk Zone)
Source: Suboxone Talk Zone - January 4, 2017 Category: Addiction Authors: Jeffrey Junig MD PhD Tags: Addiction Source Type: blogs
Cannabinoid Hyperemesis: How Rare?
I recently read a CBS news story about CHS, or Cannabinoid Hyperemesis Syndrome, describing a 100% increase in cases in Colorado since the legalization of marijuana there. A search for ‘THC’ and ‘CHS’ pulls stories from a range of sources including High Times, Wikipedia, Fusion.net, and Current Psychiatry. A broader search reveals articles calling the disorder ‘fake news‘.
Most articles about CHS describe the condition as ‘rare’, but becoming less rare as the legalization movement takes root and grows (like a weed). The syndrome occurs in heavy, long-time users of marij...
Source: Suboxone Talk Zone - January 4, 2017 Category: Addiction Authors: Jeffrey Junig MD PhD Tags: Acute Pain Chronic pain pharmacology receptor actions abdominal pain and THC cannabinoid hyperemesis syndrome CHS marijuana nausea and THC Source Type: blogs
Make Sleep Meds Work For You
I’ve been busier than I like, and haven’t had as much time for posting. But I spend a lot of time answering emails from my patients, and some of my responses may be useful for others. Below I’ll share my answer to a patient who has been unable to get quality sleep. Next week I’ll find another answer to share with readers.
This patient asked whether her insurance would cover Lunesta. She wrote at 2 AM that she is up most of the night tossing and turning. She now takes 10 mg of Ambien, and wrote that it ‘stopped working’. She doesn’t think 20 mg of Ambien would be covered b...
Source: Suboxone Talk Zone - November 27, 2016 Category: Addiction Authors: Jeffrey Junig MD PhD Tags: pharmacology Research ambien best sleep medication insomnia treatments lunesta sleep medication no working sleeping pills Source Type: blogs
Congress Acts on Opioid Dependence (ugh)
I won’t weigh in on the upcoming election, for fear of being barraged with insulting tweets by one candidate or ‘offed’ by the other. But the current opioid dependence crisis provides a great chance to learn whether you stand on the side of ‘limited government’ or the alternative.
The TREAT Act takes 5 minutes to read, that would have increased the cap on buprenorphine patients. President Obama undermined the TREAT Act by announcing his own plans to raise the cap soon after the TREAT Act was presented in the Senate. After 7 years without mentioning heroin or opioid addiction, it’s ...
Source: Suboxone Talk Zone - July 21, 2016 Category: Addiction Authors: Jeffrey Junig MD PhD Tags: Addiction Buprenorphine Public policy Suboxone treatment buprenorphine cap nurse practitioners prescribe suboxone opioid legislation Source Type: blogs
