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Comparing medications to treat opioid use disorder

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January 03, 2018

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Comments

Debra Kate
February 01, 2018

Just a comment. NPs who complete additional 24 hour training can also prescribed buprenorphine which increases the number of providers offering this service.

Daniel Mccarty
January 06, 2018

Wish it helped people like me that have all my medical records of spinal injury’s and how it has effected. I’ve had a perfect record taking my meds and never took anything my doctor didn’t give me. One pharmacy is all I ever use an my records clean there too. But my doctor told me he can’t write my pain medication anymore. I’ll have to go to a pain clinic. I’ve already been to those had 9 steroid or whatever they are called. No relief. Had all kinds of therapy. Test MRI milagram exrays I can’t count how many. But still my doctor refused to write meds. So I eat Tylenol and ibruprofen and suffering with constant pain. I don’t want anymore shots in my back I had a headache 2 yrs after the last rounds and hole in my tailbone that leaked when I got home! The clinic is 30+miles away I can’t ride that far without getting out 2 times for relief and all they say is have to do shots. No more just another point of view from a 55yr old disabled man. Sorry to take all the space here thanks for reading my story! DM

Eliot
January 08, 2018

Dear Mr. McCarty,

I thank your for your post. It highlights the difficulty actual patients have and must work thru and endure regardless of factors as varied as the exigencies of local,state, Federal regulators and the “current climate” – a cheap and blanket term I despise.

Physical assault left me in 2011 with bi-lateral Renal Calculi that painfully pass or do not pass on their own, along with a spinal fracture. As you alluded to, OTC ibuprofen and Tylenol only do so much (which is not enough) to live pain free or “pain functioning” . NSAIDS also required me to receive more than 3 transfusions in 2017 as they affected the gastric lining, bleeding ulcers and anemia, as well as drive down renal function.

Newer Medications, such as Nucynta, are even In the current months Issue and discussion of Men’s Health, purportedly showing less potential for misuse than traditional meds such as Hydrocodone, or Oxycodone generics. Unfortunately, a months supply of Nucynta (the non Extended Release formulation) Is several thousand U.S. Dollars with even the free of charge GoodRX 70% off.,

Physical assault left me in 2011 with bi-lateral Renal Calculi that painfully pass or do not pass on their own, along with a spinal fracture. As you alluded to, OTC ibuprofen and Tylenol only do so much (which is not enough) to live pain free or “pain functioning” . NSAIDS also required me to receive more than 3 transfusions in 2017 as they affected the gastric lining, bleeding ulcers and anemia, as well as drive down healthy Renal Function.

Epileptic nerve blockers such as Gabapentin made me gain 30-40 pounds in less than a Fiscal Quarter – and I would not advise -ever – that medication. There is one consistent and much worse side effect to Gabapentin that a cursory Google search would reveal to be a tragically common occurrence. Tramadol affects Serotinin levels in the brain and very rapidly can cause symptoms of serotonin toxicity so do be careful regarding that medication… A known contraindication to Tramadol is Zofran, (for nausea) and it is shocking to see the the frequency with which they can be sent to patients in a busy E.R.

I don’t believe anyone truly wakes up one day having envisioned themselves with such health/conditions to navigate either personally or with a loved one.

Advocacy, Understanding, and Dialogue is a responsibility of a patient to provider, and reciprocal honesty is a patients right as well. Communication should never be stigmatized or erroneously threatened as a label of “drug seeking” behavior or dialogues in approach to care.

I am blesssed to come from a family of good genes with no hereditary correllations or health issues before a physical assault In Jan. 2011. i share my thoughts for others, and was inspired to do so and again i thank you Mr. McCarty, and to Harvard Health for hosting this forum.

To All,
Best In Health In 2018, and forever more…

Sincerely,

Eliot Carr, Tennessee, 32y.o.

James
January 05, 2018

You’re review fails to acknowledge the disadvantages of buprenorphine, which is one of this most significant sources of contraband in prisons, given it too is an opioid.

Matthew Keene, MD
January 04, 2018

This is an excellent review of X-BOT, that cuts through the PR sound-bites and dives into the actual data and how that impacts real-world clinicians.

My only suggestion is that the author lists every available buprenorphine product approved to treat opioid use disorder with the exception of Bunavail. Perhaps this was an oversight, or perhaps Bunavail was excluded as it has a relatively small presence in this space. But for those of us knee-deep in treating this population, it is perhaps the best option available, as it uses the least amount of buprenorphine per dose to achieve similar plasma levels, allows patients to speak and swallow while dosing, and has a much lower likelihood of abuse/diversion.

Kurt
January 04, 2018

Thank you for this nice review of X-BOT. I’m always happy to see scientific and evidence-based reporting in this space since there is so much misinformation being purported by patients and physicians alike.

Commenting has been closed for this post.

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