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Addiction medicine specialist/emergency physician Ken Starr takes issue with using buprenorphine for managing acute pain in undifferentiated patients in the ED
Hans R. - September 1, 2015 4:12 PM
Dr. Orman asked people to share their thoughts on Buprenorphine in other countries so just wanted to let you know that on EM:RAP the Canadian edition I had a great conversation with an Emergency Physician and Opioids Addictions expert Dr. Jeffrey Freeman on the topic. Sorry for the shameless self promotion but I thought some people might be interested. =D
James M., D.O. - September 16, 2015 7:46 PM
What do you do with the patient who comes with an acute painful injury, let's say a tibia fracture who is on buprenorphine.
Do you have them discontinue the buprenorphine and begin an opiate sometime after that. What if they need to go to surgery? Extra strength Tylenol
Ken S. - September 19, 2015 6:47 AM
I would simply treat with traditional opiates. They will be less effective but I think the buprenorphine is surmountable. The usual recommendation for a suboxone patient getting surgery is continue the medication and add onto it. Don't discontinue it.
James M., D.O. - September 23, 2015 5:03 PM
Thanks for the reply
J. B. L. - October 27, 2015 2:44 AM
Here in Israel we do use this medicaiton - although it has no good antidote- and is a n option for acute pain when given sublingually. Not sure why you need a waiver to use in in the States when similar drugs - when I was in the States-- like Nubain and Stadol did not need a waiver.
Ken S. - December 2, 2015 6:35 PM
The waiver is required because the indication for treatment is for opiate dependence. If an MD were to use it for pain, I don't think they need a waiver. But the reality is the pharmacist probably won't fill it without a waiver.