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Legal

What Should Doctors Risk for their Patients?

The LA Times ran a very interesting story a few days ago about deaths from overdose of narcotic pain medications.  I strongly encourage readers of this blog to read the story, which discusses the issue from the perspectives of doctors, patients, and family members.

The story reports that a small number of Southern-California doctors wrote prescriptions that have killed a large number of patients. Over the past five years, 17% of the deaths...
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Buprenorphine

Side Effects II

In my last post, I wrote about the work-up of a patient who experiences symptoms similar to opioid withdrawal that start about an hour after each dose of Suboxone.  We decided that the symptoms were signs of withdrawal— reduced activity of mu-opioid pathways—and that the symptoms were triggered by taking a daily dose of Suboxone (buprenorphine/naloxone).

Note that I wrote that the symptoms seemed to be caused by reduced mu activity, ...
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Buprenorphine

Side Effect Work-Up

I struggle with the length of my posts. I shoot for 1000 words—an amount of reading that most people can knock off in a typical trip to the bathroom--- but I find it difficult to limit posts to that size. So as I have done in the past, I will break this post into a couple of sections. In the first, I’ll lay the groundwork for investigating symptoms of withdrawal in...
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History

I Told You So

The FDA recently released a Drug Safety Announcement regarding the use of codeine in young children after tonsillectomy/adenoidectomy surgery for obstructive sleep apnea.  I was somewhat surprised to see a safety announcement on a medication that has been in use for decades, but the release underscores our improved knowledge of drug metabolism, and the broadening demographics of the United States.

Codeine has little activity at opioid receptors.  The analgesic effects of codeine...
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Addiction

(Un)Intended Consequences

A couple weeks ago the manufacturer of Suboxone, Reckitt-Benckiser, filed a Citizens Petition with the FDA, announcing a voluntary recall of one of the company’s signature products, Suboxone Tablets.  Suboxone was sold in tablet form for almost ten years, and the patent ran out on Suboxone Tablets last year.  A couple years ago the same company began making Suboxone Film; a rapidly-dissolving form of the medication that comes with each dose individually packaged.

Suboxone...
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Addiction

Enough Pain Regulations?

I’ve described the ongoing debate over the use of opioids to treat chronic pain.  To catch new readers up to speed, the country is in the midst of an epidemic of deaths due to overdose on pain medications or heroin.  The epidemic is evident to anyone who spends even a few minutes searching the internet using the keywords ‘overdose deaths.’   Another increasing phenomenon is the prosecution of physicians whose patients have died from...
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Addiction

Put Me In, Coach!

This morning, as I read the latest stories about opioid overdose deaths, I was struck by a common thread in most of the tragic stories.  One report after another had phrases like ‘she was in and out of treatment for years’ or ‘he died tragically one month after leaving treatment.’

I often wonder, if we treated opioid dependence as if we were treating any other fatal illness, would the death rate be...
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General

Compassion or Murder?

I subscribe to Google news alerts for the phrase 'overdose deaths.'  Google Alerts are a great way to follow any topic; subscribers receive headlines from newspapers and web sites for certain keywords from around the world. One thing that has become clear from my subscription is that there is no shortage of stories about deaths from opioids! Every day I see one article after the next, as news reporters notice the loss of...
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Addiction

Starting Suboxone

I received the following question earlier today:

Hello Dr. Junig, I am opiate dependent or rather an opiate addict. I want to seek treatment because I can’t continue this life style. I have questions about treatment. Do I have to be in full withdrawals when I go to see a doctor? Is it true that most doctors probably won’t see me because they have too many patients already? I know Suboxone works for my...
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