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PostPosted: Wed Mar 29, 2017 4:04 pm 
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Hi. I have only been on Suboxone for a few months and trying to stabilize my dose still, but currently taking 8mg. My doctor has been talking about and starting to push using Probuphine- the implant that gives out steady doses of buprenorphine for 6 months at a time. I see many pros and cons to this and would love to hear what other people think of this implant, especially long term maintenance people. Wondering also why my doctor is so into it- just because it's new and exciting, to prevent diversion, or just because he really thinks having steady levels of buprenorphine are advantageous to patient? It's hard to tell.

Here are some questions: anyone tried this, or thought about trying? If so could you share your experiences?

Others- would you consider this? Pros I can think of are steady buprenorphine throughout the day, fewer doctor appointments, fewer pharmacy/ insurance headaches, no pills/films to keep track of, just buprenorphine (if naloxone gives you problems), not sure how you could abuse it- although I'm sure someone will find a way, no diversion issues, no pee issues- if the thing is in your arm you are obviously taking it

Cons-seems weird to have rods inserted into my arm, people may be able to see them, it takes a minor surgical procedure- I hate all procedures and fear pain even if not a real risk, there is only one dose- wouldn't be able to adjust dose- so if you feel like you have too much or too little, not too much you can do for that time period, and the cost- insurance would pay for medication but not procedure or doctor fee- like $800. That money may be offset by fewer appointments though.

Questions- would it be better absorbed than sublingual? If you were in an accident or needed emergency surgery, would the steady dose make it harder for other stronger painkillers to override buprenorphine? How much buprenorphine per day would you be getting? I could go on and on . .

Docs- I would LOVE to hear your opinions on this mechanism and if it would be beneficial for patients- and any problems you would anticipate. I'm not sure what I think and I don't have to decide for several months, but never too soon to start thinking!

The majority of life situations can be seen as either tragedy or comedy, and usually if you look you can see both
-tragicom

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PostPosted: Wed Mar 29, 2017 8:07 pm 
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i think it would be awesome for people already on a higher maintenance dose. i'm not sure i would have wanted to start out on it? fewer dr appts and bills are definitely a plus though.
looking forward to other responses and the drs chiming in.
i posted an article about it a while back.

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PostPosted: Wed Mar 29, 2017 10:59 pm 
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I was scheduled for the training but cancelled after learning more about it. My concerns are a bit different, perhaps, than patient concerns, and even than concerns by other doctors.

I do my best to prevent diversion, but I am angry that buprenorphine diversion is used to create so many headaches for prescribers. Almost nobody dies from diversion. I write these numbers all the time, but deaths in people who have taken buprenorphine occur at the same frequency as deaths from lightning-- about 40 per year. In those cases, the deaths are almost never FROM buprenorphine; they are in people who OD on heroin, and happen to have traces of buprenorphine in the blood. When you look at the numbers it becomes clear that buprenorphine diversion prevents overdose deaths. Nobody will ever recognize that fact, and just saying it is like saying something dismissive about global warming. But in at least the buprenorphine case, it's true. 30,000 overdose deaths with NO buprenorphine, and 40 WITH buprenorphine-- if people would open their minds, they would see the obvious.

I realize there are other concerns; we don't want buprenorphine to be a gateway drug. But so far, it isn't.

Another issue... probuphine implants are intended for people who are stable on a low dose of buprenorphine. It creates low blood levels, similar to someone taking less than 8 mg total per day.

The cost is very high for people with deductibles-- each dose is $5000. A cash patient can get an equivalent dose of buprenorphine for $700 per year in Wisconsin now (30 of the 8 mg tabs are about $65). So the injection is more than 15 times the cost of the pill, NOT counting the cost of implanting it.

The implantation is easy, so any doc charging $800 to implant it will make a lot of money, much more than he would seeing patients. I'll let people decide if that is good or bad. When I was in med school in the 1980s we talked so much about trying to reduce costs; now, as rates skyrocket, doctors seem to care little about costs. I don't really understand what the heck is happening with that!

Wisconsin just passed a rule that any patient on more than a certain equivalence of morphine must be seen every 3 months. They have incorrect data for buprenorphine that says that all bupe patients are on doses that meet that requirement. I don't know if they will have to be seen; the law does not separate out people with implants vs. pills. But if I implant the drug every 6 months, how do I get the patient to return in 3 months? And if counseling is required for all buprenorphine patients, how do I get them to go? I suspect many people will get the implant and think, 'I'll be ready to be off this in 6 months, so I won't pay the $100 per week for counseling. I'll just take it out myself in 6 months.'

It will still block opioids used for post-op pain, so there is no real pro or con on that issue.

With all that in mind, I don't plan to use it at this point- mainly because I don't have the type of practice where I can put out the $5000 for each dose ahead of time, and hope that patients show up for it. I'll see how things play out, and maybe look into it again in another 6 months or so.


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PostPosted: Wed Mar 29, 2017 11:22 pm 
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thanks doc!
i knew you would have more info.
remember the article i had posted before about this being used in prisons?
not sure how that can be justified at that cost though!

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PostPosted: Thu Mar 30, 2017 1:05 am 
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Thanks Sister and Dr J! Great, great information. I see some advantages but I don't like that he seems to be pushing it.

I totally agree about the diversion issue also. The more I read on here the more the more I want people to know the information- like how much safer buprenorphine is than other opioids- the difference between life and death and some people (and maybe some doctors) think that Suboxone is the new OxyContin. People dont understand how the drug should be used, the ceiling and the safety profile.
We have to look at harm reduction strategies- and there is no doubt that buprenorphine is safer

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PostPosted: Thu Mar 30, 2017 4:41 am 
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There are some possible concerns should patients with poor recovery motivation taking out their implants. This has happened around the world with heroin addicts being mandated to be given naltrexone implants. Of course that risk will be diminished compared to naltrexone given buprenorphine having some agonist effect.

Also its low dose equivalency of 8mg is a cause of concern, given many people need doses above 8mg. One of the big differences between sublingual and implant is the lack of peak and trough plasma levels. Theoretically this won't be an issue given the ceiling effect, but the dose required to hit the ceiling effect can vary a bit from person to person. Some people may require "top ups" on top of their Probuphine which may defeat the purpose.

I'm personally going to wait and see how it goes for others before I make a switch. It's wise to be cautious. I still have a "bump" under my skin from my naltrexone implant from back in 2013!


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PostPosted: Thu Mar 30, 2017 10:49 am 
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.
Quote:
..and just saying it is like saying something dismissive about global warming.



Oh yes. I've actually lost a an old friend partly over this issue. Also gone to war at the family dinner table.
People who have no understanding whatsoever of the science are nonetheless sneeringly intolerant. I'm learning to keep my mouth shut!

I can just imagine how difficult it is to say something unpopular about bupe related issues to other professionals who really don't understand how ignorant they are.


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PostPosted: Thu Mar 30, 2017 8:50 pm 
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godfrey wrote:
.
Quote:
..and just saying it is like saying something dismissive about global warming.



Oh yes. I've actually lost a an old friend partly over this issue. Also gone to war at the family dinner table.
People who have no understanding whatsoever of the science are nonetheless sneeringly intolerant. I'm learning to keep my mouth shut!

I can just imagine how difficult it is to say something unpopular about bupe related issues to other professionals who really don't understand how ignorant they are.


i mostly just go on a rant about big pharma causing the whole epidemic.

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PostPosted: Fri Mar 31, 2017 2:22 am 
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Hey Tragicom,

I'm adding some info from your prior thread 'Right Dose' here bc its worth it for a reminder. Your Dr puts you on the wrong med, Butrans (only contains tiny microgram doses of bup) so you're miserable and beg your therapist to relapse. You finally force your Dr to put you on a higher dose bup product, which he does, but at a too low dose of 1 mg 2Xs/day so your run thru your pills too fast and are devastated. Your husband and therapist and you finally force your Dr to increase bup, which he does to 2mg 2X's/day but not at a high enough dose to your cover cravings bc you have withdrawal before the 2nd dose. So you came here and learned you weren't crazy and at your recent appt asked for an increase which turned out to be 8mg/day and he switched you from generic bup/nal tabs to suboxone film, which is taking time to get used to. And NOW your Dr. is pushing you to be on the Probuphine implant??? This soon? I cannot understand your Dr. or find any logic here... Imo, you've had wonky care from him and you've had too much change occurring to consider an implant in a couple months. You maybe found all these links thru the cool search function at the top of page. I put in ' implant +pro* ' and these links came up. Wishing you my best, P

inmates-dying-from-opiate-withdrawal-t13320.html
buprenorphine-implant-any-experience-t13123.html
slow-dissolve-suboxone-implant-t12751.html
question-about-new-suboxone-implants-t12691.html
Poster who was in the implant trial
not-exactly-new-but-t12452.html
Poster who was in the depot (monthly injection trial)
the-era-depot-and-implant-buprenorphine-t12242.html
buprenorphine-month-implant-coming-soon-t12231.html
new-product-t11630.html

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PostPosted: Fri Mar 31, 2017 8:17 am 
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I agree pelican (I feel like I say that too much lol sorry pelican) Imo u should just adjust to ur new dose and finally get relief after this long process of being jerked around. I wouldn't be thinking about the implant yet, ur still adjusting to ur dose that's been changed so much. It took me at least a good month to get good and adjusted to my suboxone dose. So ur still adjusting, take ur time :)

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PostPosted: Fri Mar 31, 2017 11:39 am 
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jennjenn, I always appreciate hearing agreement which means knowing I'm on the right track. I don't have the depth of experience and knowledge here that you and the other mods do so its definitely nice to hear. Thank you.
I'm discouraged this morning bc of the wide and deep misinformation out on bup, which mean some folks get no bup care and some of which ends up w prescribing Drs. so tragicom and many others end up w wrong/bad care. Tragicom's outcome is good so far but what if she could have easily said - screw it - and gone back out - and collected a few felonies or ODd or lost her relationship...or... Real life losses happen as you and I well know, both from our own experience and reading of so many losses of others here. May I will be 6 yrs off bup. When I'm on this site I realize how damn lucky I am to have found bup, saved and turned my life around where I'm doing really well and then get sad to realize so many others don't get my same chance. Headshaking... Thanks for all you and the other mods do here - everyday - even when its hard.

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PostPosted: Fri Mar 31, 2017 12:33 pm 
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Thank u pelican! U do so much here and a huge asset. To be successfully off buprenorphine for 6 yrs and doing great in ur recovery..... that's a very valuable asset to this forum, I hope u know that!

I agree, tragicom had a very rough start but hung in there thankfully. I don't understand why that doctor took so many pointless turns, but that definitely says something great about u tragicom, u were willing to stick it out and try whatever necessary to get recovery. It could have very easily went the other way.

U know, when I first started buprenorphine, I was defeated because I'd tried everything to get recovery with no success. So I wasn't expecting suboxone to work because nothing else had and the cravings I'd always had really had a grip on me. If I had had all the roadblocks tragicom faced, I'm not sure I would have kept trying. I know that sounds awful but it's the truth. I pay cash and was already afraid that it wasn't going to help me and all my money would be gone at that moment to get any other opiate.... so in my mind I was taking a huge gamble because if it didn't work then I would just have to be sick for a few days until I came up with more money. I can still remember my anxiety and overthinking. So yeah, if I'd had to go through what tragicom went through in the beginning, I'm afraid I would have gave up and been like..... see I knew nothing was going to help me. Pelican, that's a very good point!

So tragicom, good job for sticking it out. It was definitely worth the effort :) but sometimes addicts have very little patience and are used to being let down. So glad everything turned out good in the end for u!

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PostPosted: Fri Mar 31, 2017 5:24 pm 
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Thanks for all the feedback! This place (this forum) is helping me learn, stay sane and gain new perspectives. I really want to learn all I can and share with as many people as I can. I'm putting all of my energy I've used obsessing about pills on learning about Suboxone! It is disheartening that so many doctors are as clueless (or at least not as clued in as we would like them to be. I doubt many doctors would appreciate me trying to teach them! Lol

Tee jay- did you want a naltrexone implant? Did it work for you? I'm just curious. I'm not interested in Naltrexone for myself, it is just interesting to me. I knew about the Vivitrol shot but I didn't know they had implants.

Pelican- you seem to have a wealth of information and experience. I appreciate your caring about me and others who may not get the best treatment. Seeing your summaries of my treatment thus far gave me a better perspective. It has been really chaotic and I'm looking forward to just adjusting to my new dose and new way of living. Thanks for the links- good stuff. I guess I should have done a better search. Looks like this has been discussed more than I realized. Glad your recovery has gone so well!

Jenn- I love your positive attitude and I totally get the overthinking thing. Thanks for your input and encouragement. It means a lot. Not once have I thought through this whole process that I have been strong. All my focus has been on my perceived failures. So it is great to have someone point out the positive things. And believe me, I have been so close to saying f-- all this I'm going back to pills several times. I am lucky to have A very supportive (for the most part) husband and a great therapist. Most of all I have 2 young children- they are what keep me going when I want to quit. They need me to be healthy, so I'm trying.

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PostPosted: Fri Mar 31, 2017 6:55 pm 
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Hey Tragicom,

Probuphine is new and hasn't been discussed much. I expect we'll see more and more here asking as well as on it and hope for their experiences to show up here. I'm glad for your post and and impressed w all your good analysis prior to knowing of the other links. I had an ulterior motive which was to include them in your thread so other readers seeing your header will also be able to click them.

jennjenn is right on w calling out your courage, strength and patience. Your bravery and perseverance. We see it. All of it. Your success, no failures. Your success. All you've been thru and how much you want this. Keep it up, know you can. P

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PostPosted: Sun Apr 02, 2017 8:22 pm 
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I want to echo Jenn and Pelican. You absolutely showed great perseverance and bravery to get to where you are today, tragicom. On top of that, you have shown your doctor, who needed to learn a thing or seven, what a person dedicated to being in recovery can do! We addicts can make all sorts of mistakes, but when we get to the point of really wanting recovery, once we take that step and turn that corner, Watch Out!

You were probably the best learning experience that doctor could have gotten.

Amy

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PostPosted: Sun Apr 02, 2017 8:42 pm 
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a remarkable bird is the pelican

his beak can hold more than his belly can

He can hold in his beak, enough food for a week...

And blimey- I don't know how the hell he can.


Aaarrgghh!


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PostPosted: Sun Apr 02, 2017 10:35 pm 
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Dr J!!

Never heard this before! Funny!! This prompted me to search YouTube. I watched pelicans eat fish and frogs. Seagulls stand on and peck the pelican's head to distract it, then steal food out of the pelicans semi open bill. Funny! Thanks for a good laugh tonight! P

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