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 Post subject: QA Video 2.23.14
PostPosted: Sun Feb 16, 2014 6:54 pm 
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Post questions for the last weekend of February. Spring, anyone?


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 Post subject: Re: QA Video 2.23.14
PostPosted: Mon Feb 17, 2014 5:34 pm 
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Hi Dr. J,

I'm not certain this question qualifies for the video session, but I'm asking it anyway as I'm very curious what you think about it? I asked this on my thread, but only received one response to date, so I'm asking here.

Here goes...

I recently accompanied a friend to induction at her sub doctors office. I talked with the doctor and he told me he kept all patients on Suboxone for 6 months. At that time he re-evaluated each patient and together both he and the patient decided whether to remain on bupe longer, or perform a taper. He also gave them the opportunity to switch to the Vivitrol injections. And he believes hard-core addicts need to stay on bupe for extended time, up to life in some cases.

I asked him why the Vivitrol, and he had several reasons, but very little time to elaborate. He did say that the monthly shot helped deter "addictive tendences" or thinking by taking away the need to take "something" every single day like addicts feel the need to do, and was required with bupe pills or film. He said it also help take away the thoughts of many that daily dosing caused quite a few "symptoms" as many report happening.

I was very curious by this doctors thinking and it got me to wondering if it would indeed be beneficial to have once per month dosing to those considering extended time on bupe therapy? I know the cost is rather high in most cases, and insurance may or may not cover some of it. But I was also wondering if there could be potential problems if the patient required any kind of medical procedure? Suboxone can be dealt with in most every case to those needing medical help like surgery. But does the Vivitrol injections present it's own set of problems and/or issues?

Thank you, and if you would rather send a personal response, or answer on my thread that would be fine.

Karen


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 Post subject: Re: QA Video 2.23.14
PostPosted: Tue Feb 18, 2014 4:35 pm 
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Great questions! I'll be back this weekend!


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 Post subject: Re: QA Video 2.23.14
PostPosted: Wed Feb 19, 2014 6:01 pm 
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Hey Karen! (*waves*)

I missed your original question in your thread, apologies. I'm just curious, because I wasn't sure after reading above, but are you asking if it would be beneficial to have a once monthly dose method of bupe? Or if the Vivitrol shots adequately replace bupe maintenance? I'm a little confused but I do have baby brain right now. :lol:

I don't think Naltrexone alone holds most addicts unless they are "ready" to work it (ie all the stars have aligned and the want, need and support is all there for them to take advantage of.) But as for replacing bupe maintenance in general, it's kind of a scary thing. A lot of the feedback I've read from people who are on the shot, talks about how it wears off early and the addicts know when this happens. It gives them kind of an opportunity to use quickly before their next shot. Others know how to break the barrier to get high. I have read some good reports also, though.

If I'm mistaken, and you're talking about the possibility of a once a month bupe injection, well that's an interesting thought. It certainly would be convenient. I'd be concerned with the meds running out and also, what all the bupe at once would do to your system. Would have to be a clever little time release function.

Anyway, I'm not the Doc, but wanted to pop in. I'm sure he'll add way more insight.


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 Post subject: Re: QA Video 2.23.14
PostPosted: Wed Feb 19, 2014 6:44 pm 
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Hi Tiny!

"Baby Brain" - BaHahahahahahahaha! :lol:

Actually, I was asking about ALL the situations you describe.

1. Would/could it be beneficial to have once-monthly dosing of bupe? Injection?
2. What kind of medical issues does Vivitrol present compared to Suboxone?
3. For those on entended time up to life on bupe, would it be more practical for them to have a monthly injection verses having to take a pill or film every single day?

I'm just curious if the Vivitrol injection offers any meaningful advantage over daily dosing? If a person is going to be on suboxone for say, 3-6 months only, then the bupe pills or film may be the way to go. But if the patient plans on using bupe long-term, would it make more sense to switch to once per month dosing of vivitrol shots?

Taking pills or film everyday continues to be addictive behaviour of the sort. Would switching to a monthly injection help to take away this tendency?

I sure hope that makes some kind of sense? Now I'm having baby brain! :D

Karen


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 Post subject: Re: QA Video 2.23.14
PostPosted: Wed Feb 19, 2014 7:11 pm 
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Brown Eyed Girl wrote:
If a person is going to be on suboxone for say, 3-6 months only, then the bupe pills or film may be the way to go. But if the patient plans on using bupe long-term, would it make more sense to switch to once per month dosing of vivitrol shots?



Therein lies my confusion. If the patient plans on using bupe long-term, they'd need to take bupe then. That's the advantage. Vivitrol doesn't have bupe, only naltrexone. It's apples and oranges (IMO) until they invent a once monthly bupe shot. That's just my opinion, some may swear by the vivitrol shot, but I know it wouldn't have helped me back in the day. I needed straight opiate replacement therapy.

Good questions though!


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 Post subject: Re: QA Video 2.23.14
PostPosted: Sun Feb 23, 2014 6:41 pm 
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 Post subject: Re: QA Video 2.23.14
PostPosted: Wed Feb 26, 2014 6:46 pm 
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As always, thanks for giving us your time and knowledge Dr. J!

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" Each relapse starts with one thought— maybe, just maybe, this time will be different… that little thought has killed thousands and thousands of opiate addicts over the years."
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 Post subject: Re: QA Video 2.23.14
PostPosted: Thu Feb 27, 2014 12:42 am 
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Outstanding! The only rational way to look at the Naltrexone Vs. Buprenorphine argument in my mind.

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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

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