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  3. In addition to a lack of effectiveness data, regulatory restrictions preclude the use of Belbuca for opioid use disorder treatment, even off-label. However, the bup-products FDA-approved for opioid use disorder treatment may be used off-label for non-OUD indications, such as for pain. If the primary treatment indication is opioid use disorder, and the patient is transitioning from full mu opioids, treatment with a bup/nx-product would likely lower overall risk including in cases of severe COPD. The recent JAMA-IM article (ref below) suggesting sustained-release morphine tolerability with refra
  4. At what point would you recommend Belbuca over Zubsolv or Suboxone for patients at higher risk of opioid induced respiratory depression (such as severe COPD) but who also have opioid dependence? Studies excluded patients with serious illness, but many patients with serious illness also have opioid dependence and chronic pain. It appears for buprenorphine, our choices are Butrans (very low dose, slower to titrate given once weekly patch changes), then maybe Belbuca up to 900mcg q12h, then Suboxone 1mg (half of 2mg film).
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  6. Hey Andrew, Where are you located in CA? Happy to point you in the right direction. In the meantime, check out the CSAM locator tool here: https://csam-asam.org/search/custom.asp?id=4861
  7. Hello! I am so thrilled to have stumbled upon this resource. I received my DATA 2000 waiver about 4 years ago but have not had a need to use it since moving to a new practice 2 years ago. Recently, I have been getting phone calls as I was unaware my cell phone is published on the opioid treatment program directory. I have been able to refer the patients to local clinics but I am taking this as a sign that MAT is becoming more challenging to maintain or start in my area. I would like to get connected with a collaborating MD to provide these services locally but though a virtual format
  8. Welcome to the PCSS Discussion forums!
  9. Good afternoon my name is Martha Alvarez and I am new to MAT. I work at an FQHC as an FNP-BC and also work as the Director of Quality. I have been seeing MAT patients for about a month now and I am glad to have found this group for questions and answers I know I will have. Looking forward to learning from you all. Martha
  10. I’m not aware of specific data on treating pain with buprenorphine among patients with COPD who lack a DSM diagnosis. Patients with severe COPD would typically have been excluded from studies examining bup/nx maintenance treatment of DSM-IV opioid dependence or DSM-5 opioid use disorder. Here’s link from a prior Listserv question on using buprenorphine for air hunger and COPD, which might have some useful information for your case: http://pcss.invisionzone.com/topic/1221-does-bup-help-with-air-hunger-in-copd-patients/. In general, if after weighing the pros/cons with the patient you elec
  11. This question was submitted through pcssNOW.org: For a patient with severe COPD in chronic pain, i think suboxone or other buprenorphine would be safest, and if the Butrans patch is not affordable, is there another regimen that could be tried, even is off label but accepteable in the state of SC. Can that example of what i could use, what starting dose, and what I can titrate to be illustrated?
  12. Hello, I am Clara and interested in learning more about MAT and its challenges. In search of opportunities in the near future to serve in a Behavioral Health and Addiction agency or clinic. Currently working in Primary Care (FNP) and exploring options to transition as a PMHNP after boards. Look forward to discussions!
  13. I would expect that the worst phase of mu-opioid withdrawal has passed and it appears the patient has entered a more chronic, protracted withdrawal phase. Protracted withdrawal could persist for several more weeks or even months, especially the sleep disturbance. Age and possible co-morbidities can limit use of ancillary withdrawal medication, as you’ve alluded to with clonidine and Lucemyra, which is unfortunate as these medications might help with sleep as well as diaphoresis. Other medications to target anxiety and insomnia from opioid withdrawal can also have undesirable adverse effects in
  14. This question was posted on pcssNOW.org: Frail elder female suddenly self-stopped chronic use (200 mg/day for 9 years) of tramadol x 3 weeks ago. How long will withdrawal symptoms last? Still experiencing soaking cold sweats 3-4x/day, difficulty sitting still, anxiety, difficulty sleeping, difficulty voiding. Any safe suggestions to treat the sweats? Clonidine and Lucemyra have been discussed but not good options for patient. Very remote area here. thank you.
  15. If the distinction between pain and OUD needs to be made, one can consider referring to a published tool that adopts a rather liberal definition of what constitutes OUD in a patient taking prescription opioids for pain. This new article outlines an attempt to use EHR descriptions to identify patients who likely have OUD based on characteristics such as disability, early refills, multiple opioid prescribers, lost pils, medical issues, “drug seeking behavior,” difficulty tapering, etc. Each are directly mapped to one or more of the nine DSM5 criteria for OUD that apply to pain management patie
  16. From Greg Rudolf, certified in addiction and pain medicine: I usually preface the recommendation for bup with a discussion about typical unintended negative consequences of chronic use of commonly prescribed opioids. If they are on a short-acting opioid like oxycodone or hydrocodone I highlight the expected “ups and downs” in levels (you described it as going in and out of withdrawal in one of your prior messages) and I Iike to point out that this is never the intended use of short-acting opioids, which are most helpful in treating acute pain from injury or surgery, or when used epis
  17. [using the attached diagrams] When you first start taking a short-acting opioid like hydrocodone, it's like a miracle how great it works to relieve your pain. When it wears off, it's time to take another one. Every time you take it, though, it does a little less and, when it wears off, the pain comes back little more and a little sooner. Day after day, week after week, month after month this continues to progress. Eventually, you may experience not only pain but also anxiety and even some withdrawal symptoms. You take your opioid pain medication and get some relief. However, i
  18. When counseling patients without OUD on opioids for non-cancer pain, what are essential elements of that risk/benefit discussion? Hoping to use as a template to help train more providers to use bupe as an option for pain. Would love effective quotes you use for this discussion and feedback on what should or shouldn't be on this list. Thanks! The 2019 HHS Opioid tapering guidelines include using buprenorphine but don't detail this practical information (attached). · Buprenorphine is Effective for pain o Smoother longer lasting pain control § Explain
  19. Hi! I'm Rebecca, certified nurse midwife in Los Angeles. Pursuing my DNP right now; project is providing additional STI testing and treatment to MAT patients experiencing homelessness in downtown LA. Happy to meet you all!
  20. Tina... Great and new innovations you are doing there in Washington Court House, Ohio... I tried to look at your website and could not find it.. Blessings, Sonny
  21. Hi , I’m Tina Scharenberg from Washington Court House , Ohio . Myself along with a few others started a program in our community to assist OUD clients into treatment, housing etc. We are funded by RHOP grant , which we was one of the lucky 10 to receive considering our community was listed at 2 of most percent Opioid Overdose. Part of our grant is funded for Harm Reduction and Opioid Education to providers , our team consists with Certified Peer Support Specialist with Chemical Dependency License, any resources anyone would like to share with us we would be appreciated on the Opioid Epidemic.
  22. Welcome to the PCSS Discussion Forums!
  23. Hello... My name is Sonny. I am a Pharmacist looking to start a MAT program to help those in need. Great to meet everyone.
  24. Welcome to the Forums!
  25. Guest

    Nurse Practitioner

    Hello group. NP from Ohio.
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