Posted by pseudoname on November 3, 2005, at 19:50:58
(Or Ms, of course.)
I want to try the opioid buprenorphine (Subutex®, Suboxone®) for my treatment-resistant depression. It's normally used in treating addiction to the milder opiates. I mentioned it today with my pdoc. She said, "Yes, I thought about that for you, too, when you tried the naltrexone."
But she doesn't have the special waiver you need to prescribe it. I handed her a paper with next week's local Fed-approved training session (1 day, $100). She had a conflict that day but said she would try in the near future. Just for me! What a sweetie.
Until then, I'm trying to find someone willing to prescribe this stuff for a depressed guy WITH NO HISTORY OF ADDICTION. My initial results are not promising.
I got the list of bupe docs in my state from SAMHSA*. Then I started narrowing it down to
(a) psychiatrists
(b) in general practice – i.e., who don't just treat addicts in rehab
(c) within a day's drive of my house.That way, whoever I talk to will have fewer excuses to say No. But it turns out they don't need an excuse.
BUPE-DOC-1: Answers his own phone. (Nice.) Very calming voice. He says, "It is illegal to prescribe Suboxone for anything but opiate addiction."
Sigh. That's complete bullfeathers. (See http://www.dr-bob.org/babble/20051031/msgs/573784.html.) Where the heck do these professionals get their information?! Isn't that covered in the 8-hour training session?! Or med school?! Anyway, I deferentially set him straight on the law.
Then he says, "I specialize in treatment-resistant depression. I have never heard of buprenorphine being used for that."
Again, where the heck do these professionals get their information?! Don't they ever read Babble?!! I mentioned that there were a few published studies.
BUPE-1 says, "Well, I would not prescribe it for a non-addict. Have you considered Vagal Nerve Stimulation?"
Now, I know from my pdoc that the Cyberonics people have been out in force around here the last few weeks pushing their newly-approved VNS. She got visited herself. I'm guessing BUPE-1's recommendation is not based on years of personal experience with VNS but on the fact that he recently got happy-talked by a sales rep!
Sheesh! I wish I could send the Suboxone reps over to him, but drug companies are barred by regulation from promoting off-label uses.
Chairman MAO suggested pretending to have an addiction. I doubt I could pull that off, but I'm not ruling it out. Or, I could just become an oxy user, never mind the bupe. It would be easier to get.
I have a $250 appointment scheduled next week with BUPE-DOC-2, whom I have not spoken with but whose receptionist tried to dissuade me. I'm going in with copies of
(a) the 2 published depression studies
(b) a journal editorial decrying the neglect of bupe for depression
(c) the Fed publications that explicitly allow off-label uses of bupe.Any advice appreciated.
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*see http://buprenorphine.samhsa.gov/bwns_locator/index.html
poster:pseudoname
thread:575160
URL: http://www.dr-bob.org/babble/20051031/msgs/575160.html