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  1. We have just started a new urine screen and it records gabapentin. What is the extent of abuse with gabapentin? Is it sold on the street? How does it interact with buprenorphine? Why should it be on the screen? It is not on OARRS. 2muellers@att.net An interesting review: http://www.ncbi.nlm.nih.gov/pubmed/24760436 CNS Drugs. 2014 Jun;28(6):491-6. doi: 10.1007/s40263-014-0164-4. Misuse and abuse of pregabalin and gabapentin: cause for concern? Schifano F1. Author information Abstract Gabapentinoids (e.g. pregabalin and gabapentin) are widely used in
  2. 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
  3. 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!
  4. Hi Everyone, How do you recommend starting someone on buprenorphine for chronic pain without OUD? Advising one of my colleagues on how to transition a 39y/o woman on Oxycodone 10mg four times a day, with diazepam, untreated OSA, depression, unintentional overdose after IV opioids in the ED. I've traditionally done the standard no opioids for 8-18 hours, start 4mg bupe, wait 2 hours, take another 4mg bupe, then ramp up 2nd day. My guess is she'll be on TID dosing 16-24mg/day. A colleague mentioned micro-dosing, which I haven't done before. What do you think about micro-dosing?
  5. The Question: I am a Family Medicine physician and faculty at community-based Family Medicine residency program. I am part of a group within our organization establishing more formal guidelines for use of opioids for chronic non-cancer pain. As we discuss parameters of a pain agreement with patients, we are stuck on the topic of early refills. I feel that early refills should not be permitted. My two physician partners in this group feel they can discern the veracity of individual patient stories and want the standard to be that the provider decides. I feel this is naïve and that the
  6. I am wondering if any programs are incorporating weight management into their pain management policies, especially for patients with weight bearing pain. If so, can you share how you included it in your policy & how you executed it. Thanks! Heather Weddle, PharmD We are somewhat lucky in the VA as all patients have access to weight management programs. We refer to weight management for all patients with a bmi of thirty or greater. There is some literature that obesity impacts inflammatory markers and headaches as well as pain related to weight bearing. In a different settin
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