Do you know David Cisewski? He’s incredible and he’s written an incredible review on buprenorphine (http://www.emdocs.net/bupreno
rphine-where-do-we-stand/) that I’d like to tell you all about.
Buprenorphine marketed as Suboxone (but soon to be generic) is a mu-opioid receptor partial agonist that will fulfill cravings for opioids and suppress withdrawal symptoms, but also has a “ceiling effect” that makes abuse difficult.
How do you dose it? Dosing in a withdrawing patient can be quite high to stave off withdrawal, while still avoiding side effects and intoxication. But keep in mind that Buprenorphine will induce withdrawal in a patient who is currently “high.”
Some folks, including Reuben Strayer, have endorsed prescribing Buprenorphine for 2-3 days as a bridge to rehab or PCP follow up. A certification is needed in order to prescribe, but some EDs are encouraging. According to NY State DOH (https://health.ny.gov/statist
ics/opioid/data/pdf/nys_ opioid_annual_report_2017.pdf) , opioid-related deaths are on the rise. Should we start prescribing Buprenorphine?
For more sweet tweets follow David @Dhcisewski and @painprofile