Buprenorphine Plus Hydrocodone

I often receive emails with requests for my opinion about various aspects of buprenorphine treatment.  A recent exchange, for what its worth:

Hi Dr. Junig,

I hope you are well.  I know you have written a lot about this, and I have read most of it.  But I still needed to ask your advice on my particular situation.  I will give you all the pertinent details and you can feel free to keep the answer succinct.   I know you do not have a lot of time on your hands. 

I have been successfully using Suboxone for over a year. My current dosage is three 8mg strips of Suboxone a day.  

After a recent traumatic injury I was given an Rx for  20 x 10/325 norcos.  I knew it was tricky to implement this into my Suboxone routine, but I also knew that it WAS possible to do so successfully, and that I really needed to try for purposes of comfort.   

Anyhow, my last doses of Suboxone were yesterday: 1 strip @ 7am, 1 strip @ 1130am.  

I then waited 4 hours and took 2 of the norco, followed by 2,   later, and another 2, 4 hours after that.   I took 2 at 9am this am today, followed by 3 at 1pm today.  And now I am having some serious concerns and reservations about this.  I just feel like shit now. 

Newborn Buprenorphine Abstinence: Standard of Care

First Posted 2/1/2014

The topic of newborn abstinence syndrome from buprenorphine provokes strong emotions.  Expectant mothers anticipate harsh attitudes from doctors and nurses.  They worry that their use of buprenorphine will cause their babies to suffer from withdrawal.  They hear about the experiences of women reported to CPS after delivery, or whose babies were kept on inpatient opioid tapers for weeks.

A member of SuboxForum recently wrote that the hospital she planned to use, in downstate NY, required mothers on buprenorphine to sign a formal policy regarding the care of their newborn infants.  The policy stated that all babies of mothers on buprenorphine must go to the NICU for at least 10 days after delivery, regardless of condition. Mothers were not allowed to refuse that level of treatment for any reason.

Last week, one of my buprenorphine patients came to her appointment with her 5-day-old baby, after both she and her baby left the hospital less than 48 hours after delivery.   Her discharge struck me as premature, not because of anything to do with buprenorphine, but because new moms are frequently anemic and sleep-deprived and can use a bit of rest before taking on an infant’s schedule.

Rapid Opioid Detox from Suboxone

First Posted 1/26/2014

I recently answered a post at SuboxForum by a member who asked what to expect from rapid detox from opioids, and specifically from buprenorphine.

My reply:

Several of my current buprenorphine patients have been through rapid detox at some point in their past.  Their stories are so similar that it becomes difficult to distinguish one from the next.   A typical history would go something like this:

“I started pot and alcohol by 16, but discovered pain pills when I was about 17 when I had surgery. My doctor gave me pain pills when I hurt my back, and when he stopped, I started getting them from my aunt’s house. She had cancer so she had tons of them. Then she died, and I was getting them from friends at work until they got more expensive. I switched to heroin a couple years ago.”

I’ll ask, “have you been through treatments?”

“Yep– detoxed 3 times, twice to rehab, once for 30 days and once for 3 months…. I did NA on and off, and was on methadone for a couple years. Oh, and I did rapid detox in Florida 5 years ago.”

I’ll ask, “what is the longest you stayed clean?”

Questions and Answers about Opioid Dependence and Buprenorphine