One of my readers asked me to write something how the following medication differ:

Buprenorphine/(Subutex):  Is administered sublingual (Under the tongue)

Buprenorphine/(Sublocade): administered as a SubQ injection monthly

Buprenorphine/Naloxone (Suboxone): Administered sublingual/buccally film strip

The common ingredient Buprenorphine interacts with three different opiate receptors (Delta, Mu,Kappa) and according to this article … there is NO MME EQUIVALENTS for this medication

Neither the CDC nor Medicare cites buprenorphine as having an MME

The Naloxone/(Narcan) also interacts with various opiate receptors and is suppose to help make Suboxone abuse resistant

Prescribers are required to go thru special training in order to legally prescribe these medications and their DEA license number will be altered to start with a “X” so that pharmacists will know that the prescriber has the legal authority to prescribe these medications.

I checked two difference references and one only lists Buprenorphine is to be used for addiction and the second had a small mention of it being used for mod-severe pain.

I have read reports of the DEA starting to raid practitioner’s offices that are prescribing one or more of these products and there has also been reports of people selling these on the street so that they can get money to buy the drug of choice to abuse.

I have read reports from chronic pain pts across the spectrum of working well, to working for a short period of time, to working very poorly or not at all

My major concern of chronic pain pts using this medication for pain management is that when they change doctors or get admitted to a hospital or go to ER… that regardless of what diagnostic codes are on the pt’s records.  The practitioner will jump to the conclusion that the pt is being treated for has been treated for substance abuse and even worse add the ICD10 code to the pt’s electronic medical records that they are a substance abuser.

Many hospitals systems, that own numerous office practices have a electronic medical record system that works off of central server and what is put on the pt’s electronic medical record by one staff practitioner will show up not only on that particular hospital system but also showing up on all other hospital systems that use the same system.

Looking at the Electronic Medical Records that our local hospital system uses… it shows a list of OVER 100 other hospital systems that use the same system and a pt changes doctors, moves their electronic medical records can be quickly retrieved … including all ICD10 diagnostic codes anyone the pt has seen has added to their medical history.

A pt that has had a SUD (Substance Use Disorder ) incorrectly added to their medical records may be damn near impossible to get it off their medical records.

Likewise taking one of these medications and the pt is in a accident or in need of surgery – especially emergency surgery – may not be able to get adequate anesthesia or pain management because this medication(s) has all the opiate receptors all “tied up” because it has a mean half-life of 31-35 hrs and they claim that for the body to totally eliminate a medication that it can take up to SIX HALF LIVES…  With this medication that could be up to 9 days.

Filed under: General Problems