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Nick Kashey

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Everything posted by Nick Kashey

  1. Full transparency - I'm not a pain expert, just a PCP with a waiver who has moved a handful of persistent pain patients over to bup. I think the MED equivalents you propose seem like a good starting point, but I've also been struck by how variable their needs are. I suspect that it just emphasizes that most patients don't fall neatly into the OUD vs. Pain bucket, but live somewhere in between. I also find that I can let patients figure out what works for them, they are pretty good about backing off if it's too much. I don't see the >90 as a limit, and actually think those are the folk
  2. It seems I’ve been getting 2 email notifications every time someone posts a question. Is that something n my settings, or is this happening to others? not the end of the world, but it is one more click, and you know how we docs love to count clicks....
  3. Is anyone out there using suboxone (or other buprenorphine formulations) as a first line med in the post-op setting? I haven't seen any literature on it, but having seen several chronic pain patients do very well on it, I wonder if there is a movement to consider it right out of the gate? Could it help prevent some patients from developing OUD as a consequence of opiate exposure post-op? Thanks for any info!
  4. I’ve been taught not to make the switch to buprenorphine straight from Fentanyl, due to the long half-life and the risk of precipitated withdrawal, just like with methadone. I’ve made the switch to bup in a few patients by putting them on morphine first for a couple of weeks and then doing the induction.
  5. Hi everyone- our primary care practices are working with some of our higher dose chronic pain patients to switch them to Suboxone. (recognizing that it is off-label, but a good alternative, especiallyso in light of people being limited on their opiate coverage by their insurances) Does anyone have good examples of patient handouts that cover the use of Suboxone for chronic pain? We find we have to do a fair bit of education in this population (as opposed to the OUD patients, many of whom are familiar with it already). It would be helpful to have a good, simple, one-pager to start the c
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