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 Post subject: Re: Suboxone for pain?
PostPosted: Thu Aug 10, 2017 12:22 pm 
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This subject gets me so very mad I see red. Yes, we here are addicts who cannot control our intake of pain medication or whatever opiate we used for enjoyment. Now, the government, DEA, whoever is making these decisions about who will get Vicodin, Norco, Oxycodone, etc., are not doctors! They are sitting behind a desk only looking at how many pills a person takes and does not care about the illness that patient is suffering from.

Your husband for instance, Dee. I know others who sorely need their Norco or whatever and are not addicts like us. Who's to say they can't take the medication that allows them to live a less painful life? At my local CVS, they got flagged because they fill 3,000 scripts for pain meds monthly. The pharmacist told me he was just going to cut the customers from their database and tell them to elsewhere. What???? I live in a neighborhood with mostly 55+ communities so it makes sense that these older patients need pain meds. Some have Fibromyalgia or severe injuries from an accident years prior. Now they're told to go to another pharmacy and get in the back of the line. That kind of thinking drives me nuts. No wonder people resort to illegal ways to find pain relief.

Is Buprenorphine the answer to all these patients problems? I think not. It works well for some but not all. My neck is a mess and it doesn't help much with that. My Aleve works much better than taking my Suboxone.

Sorry for venting like this and I really hope the Suboxone helps your husband, Dee. But he should be able to take the medication that works best for him and not something some nerd with a tie decides he should have instead.

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 Post subject: Re: Suboxone for pain?
PostPosted: Thu Aug 10, 2017 12:55 pm 
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Thank you for your response. I hesitated to share what is happening out there to pain patients. I'm very afraid. It is like a witch hunt. Pharmacies are now being asked to report doctors that prescribe opioids, so are insurance companies.

We had a problem with CVS years ago and found a small independent pharmacy. The problem is they will soon be drawn into what ever this is.

I'm afraid with the fentanyl that looks like pain pills killing people, that is the goal.

Take all the people who are in chronic pain management and kick them out, they will go looking take the counterfeit drugs from China and die.

When this first began I thought it was one doctor, now I find it is many. They are afraid so are kicking long term pain patients to the curb.
My husband has slowly come to the realization this is not just about him. He is willing to wean down and try suboxone but the doctor is weaning him too quickly.

As you can imagine it is awful!

Thank you for responding, I appreciate everyone responding.


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 Post subject: Re: Suboxone for pain?
PostPosted: Fri Aug 11, 2017 6:11 pm 
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I told my doctor about the CVS thing and he said they call him about three times a day asking why he is prescribing pain pills for his patients. The pharmacist wants to know the medical reason and if he can substitute something else other than narcotics. Talk about a witch hunt. I don't pretend to know the answer. What I do know is that the DEA or whatever agency is having a knee jerk reaction to the opiate crisis this country is suffering from. My hope is that smarter minds will prevail in the end.

That is so unfair for your husband. Think about writing a letter to the CEO of CVS or whichever pharmacy you use. Not an email. A real well worded letter with some medical studies included for your husbands illness. Maybe they'll notice that. Not much else a person can do w/o breaking the law.

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 Post subject: Re: Suboxone for pain?
PostPosted: Fri Aug 11, 2017 7:03 pm 
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Thank you. Yes, I heard the problem with CVS began with their Florida stores having problems, drugs stolen something like that. I think it is ridiculous for the pharmacist to try to talk the doctor in to something else.

I have also heard that pharmacists are being asked to report doctors that they feel prescribe too many narcotics. The same request for insurance companies. So, when people tell me to find another doctor, I would love to but there aren't any brave enough to take on new patients. Why risk their license for an unknown person?

Then CVS as a whole changed the way they fill prescriptions.
Several years ago my husband found a small independent that fills them.

Soon the pharmacies will want a diagnosis code like they do for my hubby's nebulizer treatments. They will not fill without a diagnostic code.

It is ridiculous that the government is taking over managing pain for the doctors in this country.

I understand that there used to be a problem of doctor shopping, they solved that with the data base that looks you up in the computer to see if you have gotten any prescriptions filled.

My fear now is that people in agony will go looking and will find the counterfeit drugs, will take them (fentanyl) and die.

My husbands pain management doctor is taking everyone off of pain meds and prescribing suboxone. My husband has resigned himself to this however needs the taper to slow down.

We are under a tornado watch. I wish everyone a good evening and again, thank you for responding to a stranger. Dee


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 Post subject: Re: Suboxone for pain?
PostPosted: Sat Aug 12, 2017 12:47 pm 
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At least your doctor is smart enough to know he can prescribe Suboxone for pain and not need the special DEA number for the patients like me who use it for addiction purposes. I didn't know they could do that until our good doctor here posted about it. I bet my doctor doesn't even know the rule about the waiver.

But it's good if the Buprenorphine is working for him. It is an opiate and by all reason should dull the pain. That is the one subject I know the least about. Using Suboxone for pain management. What I've learned was what I've read here from members who had to use it.

I wonder how all the pain management places are doing. Are they trying to get their patients off opiates?

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 Post subject: Re: Suboxone for pain?
PostPosted: Sat Aug 12, 2017 1:10 pm 
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Yes, I think this doctor wants to mainly prescribe Suboxone.
We didn't know that when my husband first started going there.

He had a pain management doctor who had to retire when his wife died. So hubby transfered to this doctor. Everything "seemed" to be going well until the CDC guidelines came out.

Now that the doctor is being so awful I have looked up his reviews and can see that he is a suboxone doctor based on others complaints. There are a few good reviews but they are several years old.

My husband has been watching as much as he can on utube videos re suboxone. He's not really up on computers so I am searching instead.

We have heard in Europe suboxone is used for pain management. In the US there are Butrans patches for pain.
I have read that at the lowest doses sub does act on pain. It is an opiate. I'm guessing the naloxone stops one from taking other narcotics?
I feel as if I am being a real pain. A dog with a bone however I am desperate for assistance. I apologize for bothering anyone here. You have all been so kind.
Thank you all
D


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 Post subject: Re: Suboxone for pain?
PostPosted: Sat Aug 12, 2017 1:11 pm 
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Oh, hubby still on methadone for pain right now, he will be inducted sometime in September. Not sure of date yet. Doctor said he would give husband some short acting opiates for a couple of weeks, then transfer him to suboxone.
And...you are right, I am reading horror stories of people just being cut off, no assistance.


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 Post subject: Re: Suboxone for pain?
PostPosted: Sat Aug 12, 2017 1:28 pm 
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DEE19
Not that I want to throw a monkey wrench into the works but:
Does the doctor know if Suboxone will be covered by health insurance?
In Minnesota most plans will not cover it if written 'for pain' and using a regular DEA.
They require a Substance Use Disorder diagnosis and some other verbiage on the prior
authorizations.


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 Post subject: Re: Suboxone for pain?
PostPosted: Sat Aug 12, 2017 1:59 pm 
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docm2, so who decides this for MN? State Pharm board? Medical board? Or is it insurers prohibiting? And does it affect all plan types: ACA? group employer plans? medicaid and medicare plans? Stunning news.

Dee "I'm guessing the naloxone stops one from taking other narcotics?" That may well sadly be a marketing ploy, IDK. The naloxone added to bup products has never been proven to work to stop folks from taking opiates. its a low dose that orally only gets a tiny bit absorbed and IV users report they can still get full effects from other opiates while taking the brand or generic bup/naloxone combo product. Bup itself at higher doses is the blocker keeping folks from feeling other opiate's effects.

What methadone dose was hubby at in May? And now? What dose does Dr plan to switch to short acting opiates (SAOs)? You're well read so stand your ground on demanding time to get methadone dose low enough. Hopefully your hubby has/is substantially dropping now, even tho that might make him feel sick/crappy. Better to get some of that crappy done now tho to avoid him being really sick at transition time.

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 Post subject: Re: Suboxone for pain?
PostPosted: Sat Aug 12, 2017 2:41 pm 
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Thank you both for replying. My first objection to suboxone when first brought up was that we could not afford it. To be honest I believe this has to do with money. I see the doctor only made $300 from big pharma several years ago but last year got $36K in money and who knows what else in "dinners, travel" he received. I am seeing a switch to greed vs care of patients. I see it in Germany as well as stories of the NHS being dismantled.

The whole point of my husband getting on methadone for a long acting pain medication was that if that was a snafu we could possibly self pay for the methadone ourselves. Right now, in order for the insurance to pay, paperwork has to be submitted to the insurance company every 6 months for prior authorization. I am just guessing here that he would do the same for the suboxone. There is a generic as well.

In January this doctor stopped accepting Medicare for some new rules and regs coming out Jan 2017.
He originally said husband could stay on methadone as long as he got under 120, for some reason I think he felt a red flag would be raised on a higher dose.

In July, with the advent of new state rules, the doctor said, this taper is taking too long, I am going to switch you to suboxone September. My husband asked if he could get something in writing so he could explain it to me, of course he was given nothing.

I was shocked! How did we go from one extreme to another in 7 months?

My husband is now on 110 mg. I have read he needs to be down at or below 30 mg and stable before he can be inducted. I believe someone on here kindly mentioned. I double checked.

Again, thank you for your responses.


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 Post subject: Re: Suboxone for pain?
PostPosted: Sat Aug 12, 2017 2:47 pm 
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Pelican, I have been going back over my posts and see that it was you, back in May who told me that induction from 100 mg would not work.
Up until July the doctor mentioned it but didn't say he would just cut him off.
I know this story is so convoluted that I can't remember everything now.

I'm under tremendous stress to help my husband while still trying to live our lives, help my elderly parents. I'm not doing a very good job.

Again, thank you so much!!


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 Post subject: Re: Suboxone for pain?
PostPosted: Sat Aug 12, 2017 2:57 pm 
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Pelican
Strictly insurers. It is not just for Buprenorphine products. They will often deny coverage for medications unless it is for an FDA approved indication. This includes our State Medicaid and most commercial insurers. Part D Medicare depending on which pharmacy management company is being used.
Prazosin for nightmares related to PTSD - denied
Neurontin for anxiety disorders - denied
Ketamine infusions for depression - denied
the list goes on.
As you know Suboxone is not approved for pain, it can be prescribed off-label by anyone with a schedule 3 DEA registration.
Sometimes I can get approval by a peer to peer (after an appeal - physician to physician) consultation and they will approve an off label indication if I submit at least two peer reviewed articles or guidelines from national organizations.


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 Post subject: Re: Suboxone for pain?
PostPosted: Sat Aug 12, 2017 7:36 pm 
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Doc, thinking about what you said, I looked the doctor up. He is authorized to prescribe suboxone, in fact he is now advertising it. which he wasn't when I first looked him up. He is advertised as a pain management doctor but if I look up doctors/suboxone, he shows up.

I have a feeling that he is going to say my husband is addicted and that is how he will get around prescribing it for pain.


Pelican, I would have to check but I think the end of May hubby was on 140 down from 170, now 110. I think. I would have to take a look again. Gosh hard to believe I have been on here since May.

I did some additional searches for Suboxone for pain and came across quite a few people who are on it for pain, or so they thought, until someone told them they are at too high a dose for it to work for pain.

It is stated that it must be a low dose to work for pain. The more I learn the more confused I become LOL


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 Post subject: Re: Suboxone for pain?
PostPosted: Sun Aug 13, 2017 12:03 am 
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Thx docm2!

Dee, you are amazing.

No.. Do NOT count on any prior hopes or assumptions . That’s all gone. It’s a whole new world now. We hear you that methadone, an old drug, is cheap and if insurance failed to pay -- you would pay -- but that plan’s gone -- bc of new state opioid guidelines limiting dose.

What is his insurance?

Per docm2, Dee, you MUST MUST ASK IF suboxone is covered for pain !! Ask BOTH the Drs office what they can get approved AND ask your insurance what bup product they approve for pain???? Ask BOTH Will Suboxone, Bunavail, Zubsolv, or generic bup/ nalox combo be approved for pain? Or is it the other 2, Belbuca and Butrans, FDA approved for pain -- at FAR too low doses to work for hubby...
I know this is confusing bc its-- confusing… I’m so sorry… But you MUST check bc it matters as you can't afford to self pay for Sub.
Dee19 wrote:
I have a feeling that he is going to say my husband is addicted and that is how he will get around prescribing it for pain.
Addiction/ Opioid Use Disorder (OUD) , Substance Use Disorder, Substance Abuse Disorder - that diagnosis DOES matter bc an incorrect addiction diagnosis will be on his electronic health record and may hard to obtain future pain relief for surgeries, etc… it does matter…

So he dropped from Jan 170 mgs to May 140 mgs to Aug 110 mgs. Wowo -- Good work!!
Still WAY WAY too high for switch to suboxone in Sept where he needs to be at 30- 40 mgs of methadone. He needs to drop to 30-40 mgs, then several days off before bup -- OR -- he needs to be hospitalized w IVs for rehydration due to severe diarrhea/ sick stuff needing lots of correct amts of comfort meds. Stopping hubs at > 40 mgs -- is cruel. IDK which short acting opiate - or dose, quantity and days of use - his Dr is planning on - that makes a difference.

Edit - if hubs plan will not cover Suboxone for pain and you accept that Sub is hubs only option, then you may need to accept the OUD diagnosis or find another Dr for pain mgmt - so sorry...
You need ASAP to make appt w hubs Dr - BOTH of you go - say you've connected w families/folks in same situation and hubs needs more taper time.

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Stopping went well -- its the staying stopped -- where the real work begins.
Coming here 'keeps recovery green'.


Last edited by Pelican on Sun Aug 13, 2017 9:55 am, edited 1 time in total.

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 Post subject: Re: Suboxone for pain?
PostPosted: Sun Aug 13, 2017 9:17 am 
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I found this article, shows each state and what they are suggesting recommending or "requiring"

It's a witch hunt however the CDC is saying they never intended pain patients to just be cut off.

http://www.bendbulletin.com/topics/5342 ... -the-brink


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 Post subject: Re: Suboxone for pain?
PostPosted: Mon Aug 14, 2017 7:58 am 
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I see a question Pelican, so sorry I missed it.

The doctor said my husband could choose his choice of short acting opioid to take before transitioning. I am losing hope here. I appreciate everything everyone has said here.

I have learned quite a bit, I probably need to learn more. I am learning that the Vets have had it even harder than the general public. Evidently there was an experiment done with veterans where they started cutting them off of narcotics years before the general public. I am sad that our country has become so uncaring, judgmental.
It's like a new kind of bigotry against the damage,sick, weak. elderly

There won't be any marches from the pain patients. I did see one gentleman in a wheelchair, turned his back on his congressman as he gave a speech about helping veterans.

Maybe I will find a new calling, helping with veterans rights


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 Post subject: Re: Suboxone for pain?
PostPosted: Mon Aug 14, 2017 2:00 pm 
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This is one of the reasons I've always liked Bernie Sanders. He has always been an advocate for our veterans. There are other politicians who give lip service to supporting the vets and then vote against funding programs for them. I find that sickening.

Amy

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 Post subject: Re: Suboxone for pain?
PostPosted: Tue Aug 15, 2017 12:55 am 
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Buprenorphine works better for pain at the higher doses. One of the nation’s foremost experts on buprenorphine for pain, Dr. Howard Kornfeld, questions whether there is really a ceiling effect of the analgesic effect up to 300 MME/day.

https://youtu.be/v1YU3_LVxcw (discusses this about 13:30)


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 Post subject: Re: Suboxone for pain?
PostPosted: Tue Aug 15, 2017 1:40 am 
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Thanks for the link, StatCoder! Good Webinar on the subject.

Amy

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 Post subject: Re: Suboxone for pain?
PostPosted: Wed Aug 16, 2017 1:15 pm 
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Statcoder, thank you, I will go to this now.

Amy, thank you, I appreciate.


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