MedWorm provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest medical blog items that have been tagged with 'actions'. Sat, 03 Sep 2011 02:17:28 +0100 http://www.medworm.com/index.php?rid=5174866&cid=t_103487_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2Fb7cMgoHVGao%2F Discussions about chewing or crushing buprenorphine provide examples of the doublespeak that only confuses people.  My own recent discussion with another Suboxone prescriber went like this: “I don’t want patients to crush or chew the tablet because that will make it get absorbed too quickly.  In fact,  I usually recommend the film, because it dissolves much more quickly than the tablet.”  Say what?  Do we want it to dissolve more quickly or not?  The truth is that it really does not matter.  The dissolving of buprenorphine— or the film– is the LONG part of the process. The veins under the tongue absorb the drug in Suboxone. Actually, buprenorphine passes through all of the surfaces in the mouth, eventually entering capillaries under the surface.  The veins under t... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=5174866 Sun, 28 Aug 2011 23:20:49 +0100 5174866 http://www.medworm.com/index.php?rid=5140184&cid=t_103487_136_f&fid=37846&url=http%3A%2F%2Fhealthinfoispower.wordpress.com%2F2011%2F08%2F16%2Fadvanced-mri-scan-may-predict-chemotherapy-benefit-in-late-stage-ovarian-cancer-patients-after-just-one-cycle%2F Scientists at The Institute of Cancer Research and The Royal Marsden Hospital have developed an advanced type of magnetic resonance imaging (MRI) scan that can detect whether late-stage ovarian cancers are responding to chemotherapy treatment after just one cycle. Scientists at The Institute of Cancer Research (ICR) and The Royal Marsden Hospital have developed an [...] (Source: Libby's H*O*P*E*) Libby's H*O*P*E* blogs http://www.medworm.com/rss/comments.php?id=5140184 Tue, 16 Aug 2011 19:34:49 +0100 5140184 http://www.medworm.com/index.php?rid=5057721&cid=t_103487_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fone-physician-learns-to-efficiently-manage-her-electronic-medical-records%2F2011.07.23 My practice has been using the EPIC electronic medical record for 5 years now, and it’s taken about that long for me to figure out how to tweak the system to make myself more efficient, and for the system to evolve to a place where I could tweak it myself. Case in point – Quick Actions. EPIC’s most recent upgrade includes little self-made macros called “quick actions” that turn repetitive tasks into a mouse click. I’m using quick actions to manage my results in basket in much the same way you may be using Rules in Outlook to manage your email. Some of my macros are actually little work-arounds for a system that is not yet entirely integrated and a patient population that has not yet embraced online results communication. About half of my patients sign up for online results – ... Better Health blogs http://www.medworm.com/rss/comments.php?id=5057721 Sat, 23 Jul 2011 19:00:03 +0100 5057721 http://www.medworm.com/index.php?rid=4952800&cid=t_103487_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FofDEWKTgXJc%2F By Walter OlsonIn today’s decision in Wal-Mart v. Dukes, the Supreme Court unanimously found that the Ninth Circuit had jumped the gun in certifying what would have been one of the largest class actions in history, a job-bias action against the giant retailer on behalf of female employees. A five-justice majority led by Justice Scalia found that the plaintiffs had clearly not met the requirements needed to have the case certified for class treatment; four dissenters led by Justice Ginsburg would have sent the case back for more consideration. While some press commentary simplistically treated this case as a “Which Side Are You On” parable of workplace sexism, both the majority and the dissent spend much time grappling with more lawyerly issues specific to class actions a... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=4952800 Mon, 20 Jun 2011 16:57:44 +0100 4952800 http://www.medworm.com/index.php?rid=4771349&cid=t_103487_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FCXOtxFUDhh8%2F I’ll often joke with others who have histories of addiction over the ingenuity of addicts when it comes to finding or using drugs.  If that amount of creativity and work ethic were ever harnessed for legitimate reasons, the opportunities would be limitless! I have similar thoughts when I read the story about several county inmates at a New Jersey jail, who smuggled Suboxone into jail disguised as watercolor paint on cartoon images! Dope Smugglers The story has a humorous side, of course– but after we stop laughing, we are all sobered by the memories of the living hell created by opioids, detox, and withdrawal.  I’ve met many, many people who went through detox in jail or prison, and I realize that being in such a state is no laughing matter.  I assume that the exp... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=4771349 Sat, 30 Apr 2011 18:02:55 +0100 4771349 http://www.medworm.com/index.php?rid=4762746&cid=t_103487_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2F23_CKqjvSp8%2F By Ilya ShapiroA few readers have now asked me about the “libertarian” reaction to yesterday’s Supreme Court ruling that allows companies to use boilerplate contract provisions that require consumers to arbitrate any disputes individually rather than coming together as a class action for arbitration purposes (let alone being able to bring claims into court).  That is, where an individual claim isn’t worth that much money (about $30 in yesterday’s case of AT&T Mobility v. Concepcion), no lawyer will take the case and so only by having a class file collectively, the argument goes, will justice be served. The ruling broke down 5-4 on “conventional” lines, with an opinion by Justice Scalia, joined by the Chief Justice and Justices Kennedy, ... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=4762746 Thu, 28 Apr 2011 18:28:39 +0100 4762746 http://www.medworm.com/index.php?rid=4622509&cid=t_103487_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FJUCM1S6JwUs%2F I recently resumed writing for the expert forum on addiction at MedHelp.Org. One result of writing for MedHelp is that I receive a number of e-mails from people with questions about specific issues related to buprenorphine. The most common questions are from people on buprenorphine undergoing surgery, asking about the safety of anesthesia and about postoperative pain control. There are very significant problems with medical coverage for patients on buprenorphine undergoing surgery. Patients on buprenorphine will occasionally need surgery, and in such cases there are often no doctors willing and/or competent to manage postoperative pain. Psychiatrists, frankly, have little knowledge or experience in this area. Before psychiatry residency, medical school graduates generally complete a medica... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=4622509 Wed, 23 Mar 2011 01:35:08 +0100 4622509 http://www.medworm.com/index.php?rid=4275595&cid=t_103487_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FRyVWAhIqjcQ%2F Why buprenorphine? The partial agonist nature of buprenorphine is behind the usefulness of the drug for treating addiction and chronic pain.  Opioid agonists always cause tolerance, and the tolerance usually causes cravings for more and more drug– no matter whether the drug is being used therapeutically or recreationally.  Tolerance is unavoidable, at least for now (there are some chemicals that may reduce the development of tolerance, but they are not yet on the market). Buprenorphine, on the other hand, initially results in some level of tolerance, but the tolerance stops at a certain level so that cravings do not occur.  The ability of buprenorphine to eliminate cravings for opioids is the basis for its ability to induce remission of opioid dependence. The Drug Enforcement Agen... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=4275595 Tue, 21 Dec 2010 04:19:19 +0100 4275595 http://www.medworm.com/index.php?rid=3903137&cid=t_103487_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FngDKLFI5ha8%2F A reader’s question: I have been on Suboxone for 2 years. My addiction was Oxycontin.  I had knee replacement surgery and was successfully able to take pain meds and then get off them and go back to Suboxone. My medical Doc and I noticed that when I restart the Suboxone, I get 2-3 plus pitting edema in my legs, severe enough to require diuretics– and they don’t even work very wel. When I have stopped Suboxone in preparation for surgery, I immediately lose 15 lbs and the edema goes away. My Suboxone Doc says that there are no side efffects. I am 53 and have heart disease, and I know that this extra fluid is not good for my heart. My kidneys are normal. Have you heard other comments of this nature? Is it dose related?  This is a serious situation for me. Reply: I have h... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3903137 Thu, 26 Aug 2010 05:26:01 +0100 3903137 http://www.medworm.com/index.php?rid=3772473&cid=t_103487_151_f&fid=36896&url=http%3A%2F%2Fsuboxonetalkzone.com%2Fbuspirone.pdf I have written about this topic multiple times, but perhaps a summary is appropriate.  More and more evidence and clinical experience suggest that buprenorphine is best considered a long-term ‘remission agent’ for opioid dependence.  Such a conclusion would have been obvious years ago if not for the hesitancy to do what has been suggested by addictionologists for decades, and treat opioid dependence as a DISEASE.  While many people pay lip service to addiction being a chronic illness, the reluctance, particularly by AODA counselors, to fully accept a medication for the condition is clear evidence of the stigma that continues to force addiction into the realm of ‘character.’   AODA counselors would do well to do some serious soul-searching on this issue– ... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3772473 Wed, 21 Jul 2010 05:00:13 +0100 3772473 http://www.medworm.com/index.php?rid=3683884&cid=t_103487_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FpTi9YcGtKZk%2F A person wrote about feeling ill after taking Suboxone, thinking that naloxone is to blame and frustrated that her physician would not prescribe Subutex: I first read your blog last week as I was going through the despair and misery of withdrawal from Percocet, and considered suicide. I didn’t want to die, or create anymore suffering for my family; I just didn’t see any options or hope. Your well written words (I thank you deeply) about the hell of withdrawal got my attention & brought me to tears. I continued to read, found out about Suboxone, which led me to message boards from others like me. For the first time I felt hopeful. I found a doctor and made an appt, and after the initial, office administered dose I found myself feeling the best I had in years– no withdrawal and ... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3683884 Mon, 31 May 2010 05:00:56 +0100 3683884 http://www.medworm.com/index.php?rid=3683885&cid=t_103487_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2Fms1h_PKIXto%2F A question and answer session with someone who is considering stopping buprenorphine.  His message first, with identifying information removed: Hi, I just sent a donation through PayPal. I used Norco 10/325 since 1999, about 20-40 per day for the past five years.  A month ago I went on 2 mg Subutex but don’t like the feeling of being drugged.  The next day I went down to 1 mg/day, and have been at that dose since.   I liked the Norco because I could still function, and could “feel”, including joy.  Now I have no feelings of joy at all, just feel drugged all the time.  I meditate and exercise 30 min/day, have done that for years, so maybe that kept me grounded. Q:  What is the quickest and most comfortable way for me to taper?  Should I use Ativan to help with rest... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3683885 Tue, 18 May 2010 21:33:37 +0100 3683885 http://www.medworm.com/index.php?rid=3577663&cid=t_103487_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F05%2F19%2Fan-accidental-form-of-control-when-mindfulness-produces-happiness-acting-well-living-well-iv%2F I’ve had some success while working with a man I’ll call Peter.  He’s got chronic pain, and has been incredibly fearful of what it might mean – in fact, you’d probably call him a classic catastrophiser because each time his pain flared up he immediately thought it was something like cancer and he would rush off to his GP or the Emergency Department to have it checked out.  Luckily any scans he’s had haven’t shown anything operable because I’m sure with the amount of distress he was been experiencing, he would have been able to persuade a surgeon to operate had there been anything odd-but-common found. We’ve been using mindful breathing as a way to get in touch with the sensations, emotions and thoughts that occur to him, and especiall... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3577663 Tue, 18 May 2010 19:58:08 +0100 3577663 http://www.medworm.com/index.php?rid=3549591&cid=t_103487_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F05%2F10%2Fact-ing-well-living-well-ii%2F The second in a series about ACT and its use in pain management from an occupational therapy point of view. My last post (here) talked about ACT and ‘doing what matters’, or ‘valued action’ – this involves identifying what is important to a person, then helping them do it, while being careful not to encourage ‘experiential avoidance’, or avoiding coming into contact with experiences we’d rather not. Here’s the ‘hexaflex’ or diagram that provides an overview of ACT.  What ACT tries to develop in people is ‘psychological flexibility’, or the ability to be in the here and now, open to experiences (even negative ones) and do what matters to live a life in alignment with what is important.  In people who lac... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3549591 Mon, 10 May 2010 06:23:26 +0100 3549591 http://www.medworm.com/index.php?rid=3502994&cid=t_103487_151_f&fid=36896&url=http%3A%2F%2Fwww.youtube.com%2Fv%2FlrqjJGoSQgc%26amp%3Bhl%3Den_US%26amp%3Bfs%3D1%26amp%3B In this video I explain why the ceiling effect is so important to the effects of buprenorphine for treating opiate dependence.      (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3502994 Sat, 24 Apr 2010 23:15:29 +0100 3502994 http://www.medworm.com/index.php?rid=3119075&cid=t_103487_151_f&fid=36896&url=http%3A%2F%2Fsuboxonetalkzone.com%2Fmedinteractions.pdf A note of follow up:  According to TMZ, a variety of medications were found in Brittany Murphy’s apartment under her name and under the name of her husband and mother.  Of course it is possible that the medications actually belonged to her husband and to her mother– but as you read in my last post, I am not surprised that opiates were included on the list.  THe medication list:   Was her death related to dangerous medication combinations? 1.  Topamax.  Topamax is an anticonvulsant that is also used to treat migraine headaches, and sometimes prescribed as a mild ‘mood stabilizer’–  say for someone who has symptoms of bipolar disorder but who instead has borderline personality or just ‘mood swings’ that don’t quite qualify as full blow... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=3119075 Thu, 24 Dec 2009 01:30:05 +0100 3119075 http://www.medworm.com/index.php?rid=3084827&cid=t_103487_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2009%2F12%2F14%2F5-ways-to-show-you-care%2F Wondering how you can show someone in your life that you care about them? Here’s a few suggestions that may help you do just that. 1. Do It, Don’t Say It. You know that old common wisdom, “Actions speak louder than words”? Well, it’s true. While you can apologize for not doing something until you’re blue in the face, you’ll gain so much more appreciation by another in your life by simply doing it in the first place. Yes, it means you have to work harder to keep on top of things to begin with, even with simple things like taking out the trash or running that errand you said you would. But the reward is that your loved one will know you care because you just did it without being asked or reminded to do so. 2. Refuse to Argue and Pick Your Battles. Ar... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=3084827 Mon, 14 Dec 2009 10:35:31 +0100 3084827 http://www.medworm.com/index.php?rid=2800375&cid=t_103487_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FwXo02MyF5Uo%2F In response to yesterday’s post making the case against the Google Book Search Deal, I had spirited conversation with Google policy analyst Derek Slater, who helped me understand Google’s perspective on the case and some of the issues I discussed. He raised a reasonable objection to my claim that “the settlement would give Google carte blanche to use these orphan works without making a serious effort to contact their owners.” He points out that the settlement stipulates that the Book Rights Registry will make an effort to locate orphan works holders and hold funds in escrow for five years to be paid to any orphan work holders who surface. Describing this as “carte blanche” was probably too strong. I think my basic point—that Google won’t be requi... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=2800375 Tue, 15 Sep 2009 19:24:27 +0100 2800375 http://www.medworm.com/index.php?rid=2734013&cid=t_103487_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FOZLe-5aTXOA%2F Following in Mexico’s footsteps last week, the Supreme Court of Argentina has unanimously ruled today on decriminalizing the possession of drugs for personal consumption. For those who might be concerned with the idea of an “activist judiciary,” the Court’s decision was based on a case brought by a 19 year-old who was arrested in the street for possession of two grams of marijuana. He was convicted and sentenced to a month and a half in prison, but challenged the constitutionality of the drug law based on Article 19 of the Argentine Constitution: The private actions of men which in no way offend public order or morality, nor injure a third party, are only reserved to God and are exempted from the authority of judges. No inhabitant of the Nation shall be obliged to perform what ... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=2734013 Tue, 25 Aug 2009 17:35:21 +0100 2734013 http://www.medworm.com/index.php?rid=2513213&cid=t_103487_151_f&fid=36896&url=http%3A%2F%2Fsuboxonetalkzone.com%2F%3Ffeed%3Drss I have been wrapping up the book I have referred to– I have decided to self-publish under the name ‘Terminally Unique Publishing’, so watch for it in the future.  The name will be ‘Dying to be Cleaner: a Psychiatrist tells the truth about addiction, recovery, and the controversial medication that COULD save lives’.  I might change the last part of the name… I will have to see what the focus groups say (focus groups?  WHAT focus groups?!). The other thing I have been doing is practicing psychiatry, including treating addiction with and without Suboxone.  I have had a frustrating stretch of time, the last month or so;  I have about 5 openings right now for Suboxone patients, and have had a heck of  a time with the appointments.  I have no shortage o... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2513213 Fri, 19 Jun 2009 05:07:31 +0100 2513213 http://www.medworm.com/index.php?rid=2424531&cid=t_103487_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F05%2F21%2Fgoals-or-actions%2F Goals seem to work best when they’re important to the person, and the person has sufficient confidence that they’re going to be achieved. But…’there is many a slip betwixt cup and lip’ – while the goal might be set, actually getting there depends on many things. I wonder whether we can inadvertently slip up when we’re working to help someone set goals by focusing on outcome goals rather than process actions. Let me clarify. Outcome goals are things like ’sleep for 8 hours a night’. That’s what the person wants to achieve – but sleep might be disrupted by a child crying, a storm outside, or even a partner snoring! Sometimes the goal isn’t achievable not for lack of trying but because external factors intervene. Process ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2424531 Wed, 20 May 2009 19:25:20 +0100 2424531 http://www.medworm.com/index.php?rid=2424506&cid=t_103487_151_f&fid=36896&url=http%3A%2F%2Fsuboxonetalkzone.com%2F%3Ffeed%3Drss A couple people have written to me saying that while I sound a bit ‘defensive’ and as if I am taking things personal, they like it when I let my true feelings out– including my anger.   If you are one of those people…. read on.  I will say, though, that I realize that there are times to maintain one’s composure.  I’m not the type of person who will excel in that environment.  When I worked in the prisons there were the inmates– people who had great difficulty holding back their anger– and the administrators– the shy, quiet people who would smile and shake your hand and then write you up for acting too ‘aggressively’ and hurting their feelings… or, if they read the manual would say that the work environment was &#8... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2424506 Wed, 20 May 2009 04:30:27 +0100 2424506 http://www.medworm.com/index.php?rid=2341900&cid=t_103487_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F3vHWFoXQFnE%2F Thanks, all of you who wrote comments to my last post.  I remind everyone once again to consider taking your comments here and after writing them, also taking them to SuboxForum.com.  I am going to put up a new category to discuss topics that were initiated here;  it would be great to get a spirited, respectful ‘give and take’ on some of these topics.  As I have mentioned before, the only thing that I will block on that site would be debating whether people on Suboxone are ‘in Recovery’– just because there are plenty of other sites for that, and I want the forum to be for people who have made their decision– and don’t want to be harassed over it.  I will be upgrading that site shortly and changing the hosting account;  hopefully I will pull i... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2341900 Mon, 13 Apr 2009 04:27:30 +0100 2341900 http://www.medworm.com/index.php?rid=2227723&cid=t_103487_151_f&fid=36896&url=http%3A%2F%2Fsuboxonetalkzone.com%2F%3Ffeed%3Drss One thing I enjoy so much about the blog is that I receive comments from people around the world… hello to my new friend in Holland, and California, and New York… I have also mentioned before how the miserable disease of opiate dependence affects people from all jobs and socioeconomic groups. I receive messages from members of the underground world of opiate dependence, and so often I think about how surprised people would be to know what a huge problem this is!  Writers, stockbrokers, artists, businessmen, doctors, lawyers, factory workers, photographers, teachers, students, IT professionals, waitresses, realtors, landlords, welders, professors, home-makers, mothers and dads… I have talked to opiate addicts from all of these occupations, and more.  And in all of them,... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2227723 Mon, 02 Mar 2009 04:38:42 +0100 2227723 http://www.medworm.com/index.php?rid=2211577&cid=t_103487_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2FPXPCZvTz9ts%2F I received some feedback after writing about tapering Suboxone here and on my site Sober after Suboxone (soberaftersub.com), and I would like to share the information and suggest a new way to think about buprenorphine during the tapering process. First… it has already become clear to me that Zofran, or odantreson, is not the big answer for opiate withdrawal that everyone is hoping for.  Oh well…  maybe some day.  As I have said a number of times, some day there will be a medication that prevents tolerance, and I would expect such a medication to affect withdrawal as well, as the two processes are closely related.  On the other hand it is possible that such a medication would actually prolong withdrawal, by preventing the plasticity required for the receptors to return to no... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2211577 Mon, 23 Feb 2009 05:18:52 +0100 2211577 http://www.medworm.com/index.php?rid=2078894&cid=t_103487_151_f&fid=36896&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F503100328%2F The questions: I am having surgery and my doc was unaware of some things and I thought that you could confirm them for him?  Could you advise him to take me off the Suboxone 10-14 days prior to surgery?  I have been researching this religously and I have come to the conclusion that it would take 2 weeks to get the Bupenepherine 100% out of my system so that there is no blockage, unless you think otherwise?  Also could you tell him about the oxycodone to keep me out of withdrawal and to help me cope with the pain? Note: I had also received a note from the doctor, saying that he was going to change the patient from Suboxone to Subutex before the surgery, and then back again at a later point.  This is fine, but not enough– the naloxone isn’t the problem– the buprenorphi... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2078894 Mon, 05 Jan 2009 05:36:44 +0100 2078894 http://www.medworm.com/index.php?rid=2075350&cid=t_103487_151_f&fid=36896&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F500618749%2F An interesting case from a reader: Thanks Doc for your efforts. I appreciate you. I am a four year hydrocodone addict 55 years old. I became addicted when I used the drug for an injured cervical disc. A couple of years ago I found out about suboxone and got in touch with a Dr. in Tulsa who prescribed it for me. I waited until I thought I was in withdrawl..about twenty hours and took my first dose. I became dizzy, nausiated, numb and all I could do was make it to the bedroom where my nausea eased a bit…I never vomited. I lay there for ten hours in a numbed state half in and out of sleep. The next day I was fine. The Dr. said I took it too early. So, I waited a week without any hydros and took another pill and got the same results. The Dr. said to flush them and I did. Two years later ... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2075350 Fri, 02 Jan 2009 18:57:48 +0100 2075350 http://www.medworm.com/index.php?rid=2075352&cid=t_103487_151_f&fid=36896&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F499915851%2F A common refrain of the anti-Suboxone crowd is that ‘Suboxone is just replacing one drug for another.’  I have one question for the people who write those angry messages:  why do you care so much about people using Suboxone? Here is my next youtube submission:      (Source: Suboxone Talk Zone) Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2075352 Thu, 01 Jan 2009 03:02:46 +0100 2075352 http://www.medworm.com/index.php?rid=2067995&cid=t_103487_151_f&fid=36896&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F495006158%2F Coincidentally, just as I posted last night’s post about my excitement for capitalism’s new interest in addiction medication, a very interesting post appeared on Bluelight (a very interesting site about drug use and abuse) about the same general idea– but with a different perspective.  I am going to try to get the person who posted there to do a ‘guest post’ for us here, so that we can have a ‘point/counterpoint’ discussion about the topic.  I may be wrong, but I think the post I’m referring to takes issue with the money made by ‘big pharma’ as they produce these new medications.  I have probably made it clear that I don’t feel that way;  the companies that make our medications take huge risks when they choose to develop... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2067995 Thu, 25 Dec 2008 18:42:19 +0100 2067995 http://www.medworm.com/index.php?rid=2040541&cid=t_103487_151_f&fid=36896&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F485206379%2F I am going to share an interaction with a person who wrote to me about using the Naltrexone implant. I am always a bit suspicious about the motivations of people who want comments posted about a different type of treatment, or who come with pot-shots against Suboxone. I don’t go to methadone clinic sites or ads for rapid opiate detox and hound people for their choice of treatment—even though I don’t agree with their choices. But the point of my blog is to educate people (that better be the point, as it certainly isn’t a money-maker!), so I will share the material and let people decide what is right for themselves. I did make some comments at the end of the discussion—the owner of the blog gets the last word!– because there were some things written about Suboxone and Naltrex... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2040541 Mon, 15 Dec 2008 05:14:14 +0100 2040541 http://www.medworm.com/index.php?rid=2036007&cid=t_103487_151_f&fid=36896&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F483834026%2F I received a nice message today in a comment section;  I am posting the message and the thoughts that it generated.  The primary topic of this post is the anger that is often directed toward the use of Suboxone. The nice comment: Hi Dr. Junig, my name is Jane XXXXXX. I have been reading this blog for a couple hours now, and have been searching the whole site trying to figure out how to email you. So far no such luck, and I hope you don’t mind me writing this to you in the form of a comment on a completely unrelated subject. Anyway, I wanted to thank you, sincerely, for the understanding and insight you’ve provided to so many people, myself included. I’m 19 years old and have been struggling to keep myself clean for the past several months. I’ve battled a heroin ad... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2036007 Sat, 13 Dec 2008 18:06:38 +0100 2036007 http://www.medworm.com/index.php?rid=2028117&cid=t_103487_151_f&fid=36896&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F478113723%2F I saw this question on another board– I didn’t want to add my reply to the other five answers already listed, so I’ll put it here for hopefully the next unfortunate person in ‘precipitated withdrawal’ to find. For those who don’t know, precipitated withdrawal occurs when a person’s level of opiate stimulation is suddenly reduced by another medication blocking the receptor site.  This occurs when an overdose patient is given an opiate antagonist such as IV naloxone.  As soon as the naloxone hits the receptors in the brain, the oxycodone, methadone, heroin, or other agonist is ‘displaced’ and the receptor is ‘blocked’ by the naloxone.  I actually did this to myself on several occasions back in my using days; once by out of ... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2028117 Mon, 08 Dec 2008 05:00:59 +0100 2028117 http://www.medworm.com/index.php?rid=2018354&cid=t_103487_151_f&fid=36896&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F477196706%2F A bit of confusion over how Suboxone and Subutex work: Subutex gave me a strong buzz during detox…After a year of being on suboxone (which completely suppressed any high the buprenorphine might give, which it did) and being switched back to subutex, one might think subutex would give me that feeling again, with the naloxone being out of my body and all. Is it a matter of tolerance? I’ve been told that tolerance is reset by naloxone…I just don’t know what the real cause is here. I’m on straight subutex, 8mg and the magic is gone. perhaps…forever? Let me know if you have any clue, or if it is just tolerance. (email me at vespafly@gmail.com My Response: Suboxone and Subutex are interchangable;  there is no difference between the subjective experiences of them, save for the lack o... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2018354 Sun, 07 Dec 2008 04:28:55 +0100 2018354 http://www.medworm.com/index.php?rid=2018355&cid=t_103487_151_f&fid=36896&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F476764051%2F Another morning of Google Alerts about buprenorphine, and another list of new posts at SoberRecovery.com and Drugs.com about Suboxone.  The posts usually have one thing in common– the writers of the posts are seeking the easy way out from opiate dependence.  They were in a huge mess from their addiction to opiates, they started on Suboxone, life got better… and now they are complaining that they are ’stuck on Suboxone’, resenting the medication that saved them.  A post today suggests that Suboxone docs have a secret agenda, to keep them addicted to Suboxone– I’m no sure how one draws that conclusion at the same time there are waiting lists for the limited number of docs who are willing to treat opiate addicts, with or without Suboxone! I have taken on... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2018355 Sat, 06 Dec 2008 16:39:23 +0100 2018355 http://www.medworm.com/index.php?rid=2006602&cid=t_103487_151_f&fid=36896&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F470991446%2F An entirely logical question: Soboxdoc, I am taking 16mg of Suboxone a day - 8mg in the morning and 8mg at night. You state above that Suboxone has a ceiling effect of about 4mg. Does that mean I could take a half of an 8mg tab once a day and it would have the same effect as the 16mg that I am currently taking? Even after the three day half-life? Or should I still cut it down by 2mg a week until I get to 4mg? That would be great if I could do it right away with the same benefit! Either way I am still left speechless on how much this medication has changed life for me. Thanks again for all the wonderful info. My Best Guess: Thanks for writing! The 4 mg level for the ‘ceiling’ is an average for patients overall, and assumes that you are taking the Suboxone in an effective way. My... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2006602 Mon, 01 Dec 2008 06:28:01 +0100 2006602 http://www.medworm.com/index.php?rid=1999433&cid=t_103487_151_f&fid=36896&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F468629807%2F The topic of post-op pain control on buprenorphine is important enough to get top billing Many thanks to Dr. J Walsh in Seattle for the following post: I am a physician in Seattle.  In two c-section cases we have found that high affinity opiates (fentanyl or hydromorphone) delivered by PCA can provide adequate anesthesia even while sublingual buprenorphine is continued. To clarify, patients taking Suboxone, Subutex, or any other form of buprenorphine face a problem when they need pain control, particularly if the need is acute– after injury or surgery.  Buprenorphine is a ‘partial agonist’ at the mu opiate receptor;  it has a ‘ceiling’ to its effects, so that increases in dose of buprenorphine will not provide increased analgesia.  This is great for addic... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=1999433 Fri, 28 Nov 2008 19:22:16 +0100 1999433 http://www.medworm.com/index.php?rid=1985336&cid=t_103487_151_f&fid=36896&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F463364986%2F A question about addiction to Ultram (tramadol).  I see tramadol addiction now and then;  usually by the time the person seeks my help he/she has had a few seizures from taking too much of the drug: I saw your web page and was reading up on these drugs.  My sister is “addicted” to Ultram/Ultracet for about five years now.  She had tried to quit but said after trying several times and going into withdrawals, she would rather stand  in a puddle and get electrocuted - it would be less painful, so she just stays addicted.  I was wondering if the drugs Subutex and Suboxone would be of help here being that Ultram and Ultracet are not opioids.  If they cannot be of help - what would you suggest? Thank you for any help you can provide. XXXX My Response: Hi XXXX, I don’t have ... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=1985336 Mon, 24 Nov 2008 01:34:10 +0100 1985336 http://www.medworm.com/index.php?rid=1961439&cid=t_103487_151_f&fid=36896&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F452534491%2F Every day I receive several comments from self-identified ‘Suboxone experts’ who repeat the same comments over and over again. I am tempted to post a few here, and then pick them apart piece-by-piece, but I am afraid that somebody will pop in, read them out of context, and think that I am agreeing with something that I actually take issue with. The comments are generally something like this: You are wrong. You are replacing one drug for another. Suboxone is the same as methadone. Suboxone is the worst thing in the world to get off of. You should check your facts. Trust me doc—you don’t know what you are talking about.’ Then they often add something like ‘have a nice recovery’, or ‘may you rot in hell’, or ‘if you get defensive that only proves that you are wrong’ (my ... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=1961439 Fri, 14 Nov 2008 05:18:48 +0100 1961439 http://www.medworm.com/index.php?rid=660456&cid=t_103487_87_f&fid=34865&url=http%3A%2F%2Fwww.thecancerblog.com%2F2007%2F06%2F06%2Fthought-for-the-day-all-the-ways-we-say-i-love-you%2F Filed under: Thought for the DayIf there's one thing that I've learned about cancer, it's this: Life is too fragile to worry about the things we usually spend all our energy on, like deadlines, traffic, working late, making money and so on. Cancer isn't always a death sentence but it should always be a wake-up call. Whether it happens to you or someone close to you, it should always remind you of what's really important.When my dad passed away, I went through the anger stage of grief being angry at him because although he knew he was dying and I didn't, he never once told me he loved me, even though we had about a dozen conversations during that time. I took grief counseling shortly after and my counselor said something simple but profound and definitely thought-provoking: sometimes the wa... The Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=660456 Wed, 06 Jun 2007 04:00:00 +0100 660456 http://www.medworm.com/index.php?rid=552117&cid=t_103487_140_f&fid=35457&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FBattling-schizophrenia%2F%7E3%2F107109257%2F By Groshan Fabiola Diagnosing schizophrenia is quite a complicated procedure involving a lot of spent time observing the person’s actions and way of thinking. That person may start developing different symptoms like anxiety, confusion and starting to be suspicious on other people, mostly those that don’t agree with their view of things around; they may even refuse to admit the fact that they need help. Doctors have to put a correct diagnose so they will look for both positive and negative symptoms; strange thinking, hallucinations and delusions are positive signs and apathy, emotional flatness, inability to concentrate, wanting to avoid people or to be protected are negative symptoms. Strange thinking is also a major symptom in schizophrenic people. Their ideas might seem a bit strange... Battling-Schizophrenia blogs http://www.medworm.com/rss/comments.php?id=552117 Fri, 06 Apr 2007 14:13:23 +0100 552117 http://www.medworm.com/index.php?rid=480945&cid=t_103487_87_f&fid=34865&url=http%3A%2F%2Fwww.thecancerblog.com%2F2007%2F03%2F18%2Fsunday-seven-seven-ways-to-help%2F Filed under: All Cancers, Sunday SevenMy friend -- who has a friend newly diagnosed with brain cancer -- greeted me at the door the other day and asked with a sense of urgency, "How can I help?" "Help your friend?" I asked."Yes, she said, unsure of what she might say or do in this time of great difficulty for everyone involved.I told her a few things. And then I thought of some more. It wasn't terribly easy to come up with these ideas. Because even though I myself was on the receiving end of help during my cancer journey, it's still hard to imagine what an individual wants or needs -- or doesn't want or need. But here's what I've got to offer. I hope this helps my friend. I hope it helps you too. Allow your loved one to take the lead. If you sense this person wants to talk, then talk. I... The Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=480945 Sun, 18 Mar 2007 04:00:00 +0100 480945