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PostPosted: Sat Nov 05, 2016 10:59 pm 
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Folks come here and wonder why their Dr. will not prescribe an opioid taper to stop opiods? Or can their Dr. prescribe Butrans w its small dosages as a way to taper off Suboxone, Bunavail, Zubsolve etc...?

What meds are legally allowed to U.S. Drs to treat opiate addiction? Excluding psyche and comfort meds, etc...

Not asking for all the laws and regs bc that's likely a long story. I am asking which meds can be legally used to treat addiction - whether its to start treatment, maintain treatment or taper off?

Looks like the diagnosis does matter. If the diagnosis is addiction vs pain? I'm confused tho... This is how it legally looks to me...

For ADDICTION Diagnosis (are only these 3 approved?)
1) Methadone CII: Methadone oral tabs. Available at Opioid Treatment Programs (OTP). Not available by prescription or via Dr's office.

2) Buprenorphine CIII: Suboxone sublingual film, Bunavail buccal film, Zubsolv sublingual tab, Probuphine implant, generic buprenorphine/naloxone tabs, generic buprenorphine tabs. Available by prescription at Dr's offices who carry a X waiver designation and at OTP programs.

3) Naltrexone not controlled: Vivitrol, Revia, Naltrexone tabs, injectables


For PAIN Diagnosis
1) Methadone CII: Requires written or electronic prescription: Methadone oral tabs

2) Buprenorphine CIII: Requires oral (phone) written or electronic prescription: Belbuca buccal film, Butrans skin patch, Buprenex injectable.

3) All other opiates/opioids CII to CIV depending on med, requires oral (phone) written or electronic prescription: too many names to list.

Any ideas? Thx, Peli

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PostPosted: Fri Nov 11, 2016 3:19 pm 
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These are good questions that might have been overlooked. Maybe a one of the Dr. will see this and share their thoughts. Great questions Pelican.


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PostPosted: Fri Nov 11, 2016 9:30 pm 
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Laws governing medical practice are rare. But the Harrison Act was passed in 1913, placing a prohibitive tax on doctors who treated symptoms of opioid dependence or withdrawal using opioids. At the time, many doctors treated 'female complaints' with opioids, and many 'patent medications' contained opioids.

The Harrison Act was correctly seen as an effort by the Federal Government to control medical practice, and was challenged in the courts. It was upheld by the US Supreme Court-- I think that was in 1921.

The Harrison Act is still in place, prohibiting the use of opioids to treat opioid dependence (now called Opioid Use Disorder in the new DSM psychiatry manual). There are no LAWS that prohibit doctors from treating pain using ANY medication. Doctors can legally treat pain with oxycodone, methadone, Suboxone, or any other opioid. But 'laws' are only part of the picture. Medical boards will discipline doctors for 'unprofessional conduct' if their practice is substantially different than other doctors. Many things that were considered 'normal medical practice' 10 years ago are now considered to be BAD medical practice. A doctor using only opioids to treat minor pain problems would be at risk of disciplinary action by the state licensing board. It isn't because the doc broke any law. But still, the doctor could face fines and suspension of his/her license.

As I wrote above, the only 'law' is the Harrison Act, and that only applies to the treatment of addiction and withdrawal-- not to the treatment of pain or other conditions. So it is not 'illegal' for a doctor to use Suboxone to treat depression, or any other illness. But again, a doctor who treats depression with Suboxone COULD be disciplined by the medical board, if that treatment is deemed 'unprofessional' and outside of normal practice.

There are 2 exceptions to the Harrison Act. One is methadone treatment for addiction. Methadone can be used to treat pain without breaking any laws-- but again, it may be deemed to be 'unprofessional'. But using methadone to treat addiction is legal ONLY within very tightly regulated programs. In those programs, methadone is 'dispensed', not 'prescribed'.

The other exception to the Harrison Act is DATA 2000, the law that allows for buprenorphine treatment. Again, buprenorphine products can legally be used to treat any condition... EXCEPT addiction. In the case of addiction, a doctor can use buprenorphine ONLY if the doc has met the requirements spelled out in DATA 2000--- i.e. a training course and a few other requirements.

Hope that clarifies things a bit!!


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PostPosted: Fri Nov 11, 2016 11:17 pm 
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For ADDICTION Diagnosis (are only these 3 approved?)
Yes, that is it. Unless you want to count the comfort drugs used during detox or withdrawal, which I don't.
Folks come here and wonder why their Dr. will not prescribe an opioid taper to stop opiods? Or can their Dr. prescribe Butrans w its small dosages as a way to taper off Suboxone, Bunavail, Zubsolve etc...?
It is illegal, Harrison Act from early in the 20th Century. Opioids can not be used to treat addiction, even to taper.
If a person is dependent, not addicted, their doctor can prescribe full agonists for a taper. Generally dropping by 10% every 2-4 weeks until low enough to stop.
Butrans can be used if a person has a pain diagnosis. I have tried it twice, changing the Opioid Use disorder to 'in remission' and making the primary diagnosis the original pain problem. Psoriatic Arthritis or Spinal Stenosis for example. Did not work all that well and after a few weeks we went back to low dose Suboxone where they continue today.
Butrans could not be used if the only diagnosis has been a substance abuse disorder. It is only approved for pain management.
Suboxone can be used off label for pain management but Butrans cannot be used off label for Substance dependence. Confused? After 5 years I'm still befuddled by the rational that has gone into our current labyrinth of laws and regulations.
I had started this then left for supper, in the meantime Suboxdoc has posted, a more thorough explanation than mine.


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PostPosted: Fri Nov 11, 2016 11:50 pm 
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Thank you both, Suboxdoc and docm2.


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PostPosted: Fri Nov 11, 2016 11:53 pm 
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Dr J and docm2!!

Really appreciate both your detailed and great posts!! Helps a ton! Once we dig down into the details of both posts, I think we can help answer scenario questions of folks here by referring them to this thread. We get questions/complaints on why the Dr. does/doesn't do certain things and this helps tons!! And yes, odd confusing laws/restrictions tho... head shaking on how crazy hard it is to treat addiction...
Many thanks Bama for bumping this post!! MercĂ­. Pelican

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Did well on Suboxone. Stopped May 2011.
Stopping went well -- its the staying stopped -- where the real work begins.
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PostPosted: Sat Nov 12, 2016 2:51 pm 
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Hey, can someone correct my title misspelling? Only 2 not 3 d's needed. I think that is one word I would know how to spell!! Maybe the extra d meant ad damn diction!

Also, thanks to Dr J for this incredible site and for providing important accurate info. And docm2, so happy you post and provide important accurate info as well. Lots that only a Dr. can answer. Much appreciated by all of us here! Best, Pel

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Did well on Suboxone. Stopped May 2011.
Stopping went well -- its the staying stopped -- where the real work begins.
Coming here 'keeps recovery green'.


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PostPosted: Sat Nov 12, 2016 4:35 pm 
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Thanks!! I feel a tiny less foolish now! Appreciate it!! Pel

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Did well on Suboxone. Stopped May 2011.
Stopping went well -- its the staying stopped -- where the real work begins.
Coming here 'keeps recovery green'.


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PostPosted: Sun Nov 13, 2016 9:44 am 
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I edited the very first post but unfortunately it didn't change the rest of them :/ So I'll edit the rest lol. No worries though, I think everyone knows by now that ur definitely smart enough to spell :)

edit... Oh I guess it did change most of them cause I didn't edit them all but it's showing up ok......it's still to early for me lol.

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