Chronic Pain Forums of the Pain Relief Network (PRN)

John wrote:

Hey Doc;

As an aside, I'm now more confused then ever regarding Bup.
1 - CAN it be used in conjunction w/full agonists' [Morphine]? or does  it bring-on imm. w/d's?
2 - what resources, other than traditional detox and rehab, are available to the now large and growing population of ppl. adding what they thought of as a "silver bullett" to their list of addictions?
3 - Are there any studies proving "no ceiling effect w/analgesia"?

Thanks,
John

1. The Europeans say Yes and No, respectively. And they are amassing a huge experience treating chronic pain with bup while we have almost none.

2. Well, you make it sound like people have been duped. Substitution therapy is very highly successful for the treatment of opioid addiction, especially in motivated people. Outpatient buprenorphine just adds needed services to MMTP. Will opioid substitution therapy stop one from choosing to drink to excess, gamble, drop out on his/her family? Nope. The light bulb has to want to change. (How many psychiatrists does it take to change a light bulb? Only one, but the light bulb has to want to change.) Most MMTP and OBOT programs make an attempt at more comprehensive substance abuse services, by reg. The quality of these surely varies highly. The major problem with substitution therapy is that there is not enough of it, and people don't stay on it long enough to get otherwise straightened out. Substitution therapy is stabilizing and very safe compared to any other chronic prescription medication I can think of, and can be very helpful to people who want to rebuild their lives. And bup is an excellent treatment for chronic pain to boot! And bup had positive benefits over pure mu agonists for both addiction therapy and pain therapy. Hey, this research is good news.

But I understand that substitution therapy with methadone and now with buprenorphine is controversial. And I have major problems with the stifling regulation which surrounds them which degrades what should be, at core, a real doctor-patient relationship. Detox services are not very rare, and vary from outpatient procedures to "ultra-rapid" procedures under partial anesthesia , to short inpatient tapers, and all sorts of drugs can be used, and people can choose to end up on blocking agents if they want, and so on. If interested in detox, that is what I have most experience in in my career. And I've written more than a little in years past which is available. Suggest searching from google search box at upper right of right sidebar on every page of the War on Docs/Pain Crisis blog - the search will default to all of doctordeluca.com and find the older detox pages.

3. I am sure there are. I do not have the full text of these articles. If you go to the links provided to the actual official abstracts, often they make the References available, which you could then browse. Or just search from the Pubmed interface. Let me know what you find out. I'd love to get full text of these articles which would make it easy to track down the references to answer your excellent question. Let me ask my spys (docs still attached to major med centers with online medical libraries - damn I miss that access!). If I find out anything, John, I'll get back too (just not sure when I'll get to that)

Thanks John,

..alex...

..alex...