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
21st Century Scourge
The CDC recently put out apaperin their Morbidity and Mortality Weekly Report (MMWR) that studied the likelihood of long term opiate use after initial treatment with an opioid medication for acute pain. The results, for me as a regular prescriber of opioid medications, were fairly shocking. The study randomly reviewed 10% of patient records from the Lifelink database over the time period of 2006-2015. If a patient was given a prescription for an opioid for longer than 10 days, there was a 1 in 5 chance that patient would be a regular opiate user one year later. That's just staggering.Few are unaware of ...
Source: Buckeye Surgeon - March 25, 2017 Category: Surgery Authors: Jeffrey Parks MD FACS Source Type: blogs
Heroin in Vietnam: The True Story of the Robins Study
Editor's note: The famous Robins study on heroin use among Vietnam veterans has been sooften —and so recently—misinterpreted that I felt motivated to reprint an older post on the subject.[Originally posted 7/24/10]In 1971, under the direction of Dr. Jerome Jaffe of the Special Action Office on Drug Abuse Prevention, Dr. Lee Robins of Washington University in St. Louis undertook an investigation of heroin use among young American servicemen in Vietnam. Nothing about addiction research would ever be quite the same after the Robins study. The results of the Robins investigation turned the official story of ...
Source: Addiction Inbox - March 25, 2017 Category: Addiction Authors: Dirk Hanson 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
LITFL Review 273
LITFL: Life in the Fast Lane Medical Blog
LITFL: Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog
Welcome to the 273rd LITFL Review! Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chunk of FOAM.
The Most Fair Dinkum Ripper Beauts of the Week
Steve Mathieu from Portsmouth ICU shares his hot topics for the UK FFICM slides, from a great cours...
Source: Life in the Fast Lane - March 12, 2017 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: LITFL review LITFL R/V Source Type: blogs
When A Loved One Dies
At first you'll query reality. You will hear your own words, but they will be foreign; apart from you. The ground will still reassuringly push back against your toes when you walk out the room, but you will wonder if they are your feet-your ground. Like in a movie, you will negotiate the world convincingly. Yet, you are an actor playing a part. A role. It is not the real you. Be assured that this will pass. Life has changed incomprehensibly in a fraction of a moment. It will take a few more moments for your psyche to advance accordingly. This is not disconnection. This...
Source: In My Humble Opinion - March 6, 2017 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
When A Loved One Dies
At first you'll query reality. You will hear your own words, but they will be foreign; apart from you. The ground will still reassuringly push back against your toes when you walk out the room, but you will wonder if they are your feet-your ground. Like in a movie, you will negotiate the world convincingly. Yet, you are an actor playing a part. A role. It is not the real you. Be assured that this will pass. Life has changed incomprehensibly in a fraction of a moment. It will take a few more moments for your psyche to advance accordingly. This is not disconnection. This...
Source: In My Humble Opinion - March 5, 2017 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
Medications that Increase the Risks of Falling
Falls are the leading cause of both fatal and non-fatal injuries for adults 65 and older, and research suggests that those taking four or more medications are at an even greater risk than those who don ’t.ByAlzheimer's Reading RoomWhat ’s the Difference Between Alzheimer’s and DementiaHow to Test Your Memory for Alzheimer's and DementiaHow to Get Answers To Your Questions About Alzheimer's and Dementia“Falls are the leading cause of both fatal and non-fatal injuries for adults 65 and older, and research suggests that those taking four or more medications are at an even greater risk than those who don’t – perhap...
Source: Alzheimer's Reading Room, The - February 1, 2017 Category: Neurology Tags: alzheimer's care care of dementia patients dementia care health help alzheimer's help with dementia care medications falls Prescription Medications Risks risk of falling senior care Source Type: blogs
Changing Treatment Options in Delirium - No More Antipsychotics?
by Drew RosielleIntroductory CommentsThis is a post to share my thoughts about therandomized, controlled trial of haloperidol, risperidone, or placebo for delirium in ' palliative care ' patients, published recently in JAMA Internal Medicine.Big hat tip to my fellows - Drs Amanda Hinrichs, Elena Wahmhoff, and Alison Feldman, whose discussion of the paper at a recent fellows ' rounds helped me think through the study, as well as theAAHPM Connect communities bulletin board ' s discussions (BTW, have really appreciated these bulletin boards the last couple years and am grateful to AAHPM for pulling it off so well!).Geripal, a...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 28, 2017 Category: Palliative Care Tags: antipsychotics delirium journal article MDAS NuDESC rosielle 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
Oxycontin: America ’s next new export
The health care system has been devastated by the opioid epidemic. Addictive opiate medications have not been shown to benefit patients with chronic pain, yet they are the most prescribed pills in the United States.
As a pain management physician, I have seen opiates, when in the wrong hands, destroy lives. As doctors and health care organizations scramble to treat more than 2 million Americans suffering from opioid addiction, drug companies look to expand their brand. Recently, Mundipharma, a global network of pharmaceutical corporations, began a worldwide marketing campaign for Oxycontin, the drug at the heart of America...
Source: Kevin, M.D. - Medical Weblog - January 26, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/ankur-dave" rel="tag" > Ankur Dave, MD < /a > Tags: Meds Medications Source Type: blogs
Chronic Pain and the Opioid Epidemic: Wicked Issues Have No Simple Solutions
Written By Myra ChristopherMy mom was a steel magnolia (i.e., southern and perfectly charming), but she had a steel rod up her back. After her first surgery for stomach cancer at age 53, she refused pain medication because she said that she “could take it.” She was young and strong and committed to “beating cancer.” After nearly two years of chemotherapy, radiation and two more surgeries, the cancer won. Eventually, I watched her beg nurses to give her “a shot” minutes before another was scheduled and be told they were sorry but she would have to wait. I could tell by the expressions on ...
Source: blog.bioethics.net - January 23, 2017 Category: Medical Ethics Authors: Practical Bioethics Tags: Health Care chronic pain Opioid addiction Opioid Epidemic Opioid prescriptions syndicated Source Type: blogs
I ’m sorry your mom died, but I cannot help you now. Here’s why.
Dear Mrs. J,
I would like to express my deepest condolences on the passing of your mother. She was a magnificent woman, and I had the pleasure of being her doctor for almost a decade. It was a pleasure. During our short visits, she regaled me with stories of childhood and often gently sprinkled in advice gleaned from years of experience. Even as she began to decline, we would sit together in the nursing home, and she would reach out to hold my hand. She was a gift, your mother. A gift that I in no way deserved.
I’m sorry she got cancer. As a physician, there is no word worse than the word “metastases.” It...
Source: Kevin, M.D. - Medical Weblog - January 12, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/jordan-grumet" rel="tag" > Jordan Grumet, MD < /a > Tags: Physician Palliative care Source Type: blogs
America ’s love affair with opiates
Current reports from the International Narcotics Control Board (INCB) suggest that the United States is second on the list of countries with the highest per capita consumption of opiates. Data from 2014 quotes U.S. use of opiates at 700 mg per capita per year. The only country that has a higher per capita use is Canada at 967 mg per capita both in ME (morphine equivalents). This suggests that in 2014 the amount of prescription opiates consumed in this country was equivalent to providing seventy 10 mg morphine tablets to every American including babies and children.
Opiates are a class of painkillers closely related to he...
Source: Kevin, M.D. - Medical Weblog - January 4, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/dr-leonard-a-sowah" rel="tag" > Dr. Leonard A. Sowah < /a > Tags: Meds Pain management Source Type: blogs
