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  1. I've done a lot of reading on how to transition problematic chronic pain non-OUD patients and I think I've got a good one. There's not a lot written about outpatient transitions for community pain patients so I've borrowed from a lot of case series like the links below. Using a single Butrans patch for 5 days, tapering down full agonist opioids over 3 and starting sublingual buprenorphine on day 3 and increasing should do it! The varying fractions of flims for bernese-style protocols just confused my patients but slapping a butrans patch on seems like an elegant solution to slow microtran
  2. Could I get advice for transitioning a problematic legacy methadone pain patient to buprenorphine? he’s on 20mg TID methadone and the traditional approach will take months. I’ve never done bupe microdosing. Any advice or protocols? I was reading there are 3 week ones. Thanks!
  3. There is a recently updated PCSS guidance on diversion and adherence of buprenorphine: http://pcssmat.org/wp-content/uploads/2014/02/PCSS-MATGuidanceAdherence-diversion-bup.Martin.pdf David Fiellin
  4. How are programs around the country doing MAT during pregnancy? My local hospital is having terrible problems with neonatal abstinence syndrome. There is some evidence that bup is associated with less severe NAS. Should we be trying to get more of these mothers on bup instead of methadone? Why is bup preferred over bup/naloxone in pregnancy. Naloxone is not absorbed SL; how could it harm the fetus? J. Cockey Dr James Cockey PCSS-MAT has a module and a separate guidance on this issue: http://pcssmat.org/new-pcssmat-online-module-posted-opioid-dependence-in-pregna
  5. Hello all - so glad for this resource, and hope that it will gain momentum. Great idea. I am a pediatrician/adolescent medicine doc, just started as a doc in an outpatient and residential drug treatment program. I have clients asking for naltrexone as well as buprenorphine. I have been prescribing buprenorphine for one year, at the university health center. Hope to learn a lot here. Deborah Stewart
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