Some of you have asked when I’ll start adding to this blog. Seems like something pops up every time I get started! But I’ve collected posts from my old blog about addiction treatment using Suboxone, something I’ve been doing since 2006 or so. The medication is now viewed as an important lifesaver, but 15 years ago things were different. Even in the 2013 NYT front-page story about Suboxone was entitled “Addiction treatment with a Dark Side”. I’ll let you Google that one. Why but the NYT could paint controversy around a drug that almost never causes death, that saves tens of thousands of lives each year?

If you’re interested, there are 183 pages at this link.

Thanks for reading and sharing!

Dr. J


anon · January 24, 2024 at 8:10 am

Hi Doc, found you on Quora answering a question about suboxone vs subutex. Thank you for all you do. I’m currently in Florida and having the hardest time finding a place that will prescribe the buprenorphine tablets minus the nalaxone, I’ve been off of opioids since October of 2022 on suboxone but it started making me very sick, with intense headaches that I thought were migraines, stomach cramps and diarrhea to the point I thought I had lupus or something seriously! I could really add a lot more history here but, I wanted to say thank you so much. Just reading your blogs and your stories and knowing there is someone out there who ‘gets it’. Question – my prior treatment was online do you know of an online option that prescribes the generic subutex? I tried this and feel alive again, I have energy again, I feel normal, literally cried tears of joy as I thought I was going to just live a life feeling low and horrible forever now. But I see I don’t have to with this medication that actually works! Or another question as I’m new to all of this but quite willing to travel….do you have to live in your state to be a patient? If there was ability to travel for monthly maintenance appts as well? God bless you. Thank you again. · March 23, 2024 at 5:41 pm

    I just noticed this commment… I don’t know if you posted it at where I usually address med questions…. but while I’m here…

    I started working with buprenorphine in 2007, and I have always assumed that plain buprenorphine is ‘clinically identical’ to the combination meds. But over the years, so many people have asked for plain buprenorphine that I have to wonder, am I missing something?

    The data showed that naloxone does very little to the combination. The only difference it makes is a slight reduction in ‘liking scores’ when buprenorphine is given intravenously. Naloxone has a short halflife, so it is gone long before the buprenorphine has been metabolized. About 3% of the narcan in a dose of Suboxone Film is absorbed, and the rest is metabolized and swallowed.

    When I was an anesthesiologist, we sometimes administered a tiny dose of naloxone if a patient was narcotized after surgery. A dose of, say, 100 micrograms given IV had a dramatic effect. So I recognize that even a small fraction of the naloxone in Suboxone film might have clinical effects.

    I do prescribe plain buprenorphine, mainly because it is far cheaper than the combination. Local pharmacies sell buprenorphine 8 mg for about $0.60 (60 cents) per tab, where the film is more like $3 per strip. I do drug testing in my patients and I have never seen anything that suggests that one works better than the other. There is DEFINITELY no evidence that the naloxone provides any additional safety. Some pharmacists mistakenly think ‘without the narcan, it is more dangerous’. THAT belief is utter nonsense.

    There was one study that suggested that buprenorphine had higher ‘diversion rates’. The study was deeply flawed in my opinion; the two groups were far from identical. I try not to think the truth — that many of my patients come to me after buying ‘diverted Suboxone’ on the streets for years, at $20 per strip. Buprenorphine, whether injected or taken correctly, is not usually mixed with other opioids (because doing that will usually cause severe withdrawal). My point is that while drug diversion is a big deal, diversion of buprenorphine probably saves far more people than it kills. It is hard to find data on buprenorphine deaths, but my ‘googling’ repeatedly gives numbers of around 50 deaths per year — almost always when a non-opioid-user combines buprenorphine with a benzo, which the person also lacks tolerance to.

    I suspect that regulators lack good understanding of buprenorphine, and why the presence of naloxone doesn’t matter. But I do prescribe the plain product. Unfortunately, new telemed laws allow docs to treat ONLY people who live in states where they are licensed — only WI for me. Neighbor states might be OK in some cases, but unfortunately I cannot practice in Florida. I have had a couple wealthy people travel to see me, including one who had his own plane(!). But that is hard to arrange and pull off.

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