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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by desertflower on August 9, 2001, at 16:18:48
We just moved back to the states from France, where my husband gradually got clean using Subutex. It is fantastic, and reduces all the painful withdrawal symptoms and cravings one would have. His doctor would prescribe it to him-now that we are here, doctors have never heard of it. We are worried. Does anyone know where it can be found? (Pacha?)Thank you.
Posted by Elizabeth on August 9, 2001, at 17:13:03
In reply to buprenorphine, posted by desertflower on August 9, 2001, at 16:18:48
> We just moved back to the states from France, where my husband gradually got clean using Subutex. It is fantastic, and reduces all the painful withdrawal symptoms and cravings one would have. His doctor would prescribe it to him-now that we are here, doctors have never heard of it. We are worried. Does anyone know where it can be found? (Pacha?)Thank you.
Subutex isn't available in the U.S. We do have buprenorphine, but only in a solution intended for IM or IV injection, and it's labelled for pain but not for addiction. It's mainly used in hospitals.
At present, it's not legal for doctors in the U.S. to prescribe opioid agonists for treatment of opioid addiction except in the setting of a special clinic (methadone is the main drug used for this purpose; I think that LAAM might be used as well in some cities). Although it is only in Schedule V (minimal abuse potential), buprenorphine is considered an opioid for this purpose.
Sorry to be the bearer of bad news. I hope the info helps you figure out what to do, at least.
-elizabeth
Posted by jojo on August 9, 2001, at 17:16:25
In reply to buprenorphine, posted by desertflower on August 9, 2001, at 16:18:48
>
> We just moved back to the states from France, where my husband gradually got clean using Subutex. It is fantastic, and reduces all the painful withdrawal symptoms and cravings one would have. His doctor would prescribe it to him-now that we are here, doctors have never heard of it. We are worried. Does anyone know where it can be found? (Pacha?)Thank you.If "Subutex" is indeed Buprenex (buprenorphine), it can be ordered, with a prescription, at Wall-Mart, or possibly any pharmacy. It may take a day for delivery from the Distributor.
jojo
Posted by desertflower on August 9, 2001, at 17:28:40
In reply to Re: buprenorphine » desertflower, posted by jojo on August 9, 2001, at 17:16:25
> > thank you for the information,elizabeth! yes, JOJO, subutex is buprenorphine. We can't find a doctor who caresor is even slightly informed to give the preescription. i am so frustrated. any valid online pharmacies?
> > We just moved back to the states from France, where my husband gradually got clean using Subutex. It is fantastic, and reduces all the painful withdrawal symptoms and cravings one would have. His doctor would prescribe it to him-now that we are here, doctors have never heard of it. We are worried. Does anyone know where it can be found? (Pacha?)Thank you.
>
> If "Subutex" is indeed Buprenex (buprenorphine), it can be ordered, with a prescription, at Wall-Mart, or possibly any pharmacy. It may take a day for delivery from the Distributor.
>
> jojo
Posted by Elizabeth on August 9, 2001, at 22:02:04
In reply to Re: buprenorphine, posted by desertflower on August 9, 2001, at 17:28:40
> thank you for the information,elizabeth! yes, JOJO, subutex is buprenorphine.
True, but Subutex is a sublingual pill. We don't have it here; we only have the injectable solution. If you're going to ask a doctor about it, use the generic name (buprenorphine). It's in the PDR (the big book of drug monographs that all doctors have). The brand name is Buprenex; there is also at least one generic (it's still expensive though).
> any valid online pharmacies?
Buprenorphine is a controlled substance. I'm not sure if it would be legal to get it without a prescription, or for a U.S. doctor to prescribe it as maintenance treatment for opioid addiction. Is anyone here more clear on these issues?
I get buprenorphine as an antidepressant; it's also used for pain (although retail pharmacies won't stock it -- they'll have to special order it). Maintenance treatment of opioid dependence is a very charged political issue in the U.S.A., and people who want to get treatment have to go through a lot of hassle.
-elizabeth
Posted by jojo on August 9, 2001, at 23:48:41
In reply to Re: buprenorphine, posted by desertflower on August 9, 2001, at 17:28:40
> > > thank you for the information,elizabeth! yes, JOJO, subutex is buprenorphine. We can't find a doctor who caresor is even slightly informed to give the preescription. i am so frustrated. any valid online pharmacies?
> > > We just moved back to the states from France, where my husband gradually got clean using Subutex. It is fantastic, and reduces all the painful withdrawal symptoms and cravings one would have. His doctor would prescribe it to him-now that we are here, doctors have never heard of it. We are worried. Does anyone know where it can be found? (Pacha?)Thank you.
> >
> > If "Subutex" is indeed Buprenex (buprenorphine), it can be ordered, with a prescription, at Wall-Mart, or possibly any pharmacy. It may take a day for delivery from the Distributor.
> >
> > jojoI don't think that there must be bad news here. It is perfectly legal for a physician here in the U.S. to prescribe buprenorphine for depression, or actually any reason the physician sees fit, with the exception of opioid addiction withdrawal. Your husband might possibly fit into some category other than opioid withdrawal. The only published reference that I have seen regarding its use as an antidepressant was a reference on this board. It was an Editorial from the Journal Biological Psychiatry, I think.. Elizabeth may know more about it.
jojo
Posted by shelliR on August 9, 2001, at 23:54:39
In reply to Re: buprenorphine, legal issues » desertflower, posted by Elizabeth on August 9, 2001, at 22:02:04
> > thank you for the information,elizabeth! yes, JOJO, subutex is buprenorphine.
>
> True, but Subutex is a sublingual pill. We don't have it here; we only have the injectable solution. If you're going to ask a doctor about it, use the generic name (buprenorphine). It's in the PDR (the big book of drug monographs that all doctors have). The brand name is Buprenex; there is also at least one generic (it's still expensive though).
>
> > any valid online pharmacies?
>
> Buprenorphine is a controlled substance. I'm not sure if it would be legal to get it without a prescription, or for a U.S. doctor to prescribe it as maintenance treatment for opioid addiction. Is anyone here more clear on these issues?
>
> I get buprenorphine as an antidepressant; it's also used for pain (although retail pharmacies won't stock it -- they'll have to special order it). Maintenance treatment of opioid dependence is a very charged political issue in the U.S.A., and people who want to get treatment have to go through a lot of hassle.
>
> -elizabethI think it's legal to get a three month supply of drugs from out of the country. I haven't read the law, but I have gotten meds from Europe with no problems. I think buprenorphine is available from http://www.healthcarepharma.com/: sublingual pills; at least they used to be available.
Shelli
Posted by desertflower on August 10, 2001, at 7:42:25
In reply to Re: buprenorphine, legal issues, off the internet » Elizabeth, posted by shelliR on August 9, 2001, at 23:54:39
> > > thank you for the information,elizabeth! yes, JOJO, subutex is buprenorphine.
> >
> > True, but Subutex is a sublingual pill. We don't have it here; we only have the injectable solution. If you're going to ask a doctor about it, use the generic name (buprenorphine). It's in the PDR (the big book of drug monographs that all doctors have). The brand name is Buprenex; there is also at least one generic (it's still expensive though).
> >
> > > any valid online pharmacies?
> >
> > Buprenorphine is a controlled substance. I'm not sure if it would be legal to get it without a prescription, or for a U.S. doctor to prescribe it as maintenance treatment for opioid addiction. Is anyone here more clear on these issues?
> >
> > I get buprenorphine as an antidepressant; it's also used for pain (although retail pharmacies won't stock it -- they'll have to special order it). Maintenance treatment of opioid dependence is a very charged political issue in the U.S.A., and people who want to get treatment have to go through a lot of hassle.
> >
> > -elizabeth
>
> I think it's legal to get a three month supply of drugs from out of the country. I haven't read the law, but I have gotten meds from Europe with no problems. I think buprenorphine is available from http://www.healthcarepharma.com/: sublingual pills; at least they used to be available.
>
>
> ShelliElizabeth,JoJo and Shelli:
Thank you all so much for your knowledge. Yes, it is a loaded political issue here;I wish the red tape would disappear and let people have the help and compassionate relief they need. Thanks esp. to Shelli for the address. desertflower
Posted by MB on August 10, 2001, at 11:00:43
In reply to Re: buprenorphine, legal issues » desertflower, posted by Elizabeth on August 9, 2001, at 22:02:04
> I get buprenorphine as an antidepressant; it's also used for pain (although retail pharmacies won't stock it -- they'll have to special order it). Maintenance treatment of opioid dependence is a very charged political issue in the U.S.A., and people who want to get treatment have to go through a lot of hassle.
This is totally true...getting on a maintenence program with anything other than methadone or one of it's longer acting derivatives is nearly impossable. I knew a shrink that lost his job as the head of a methadone clinic becasue he was giving some of the patients codiene (it worked better for them than the methadone). Codeine is even scheduled lower than methadone. His attitude was, "what the hell's the difference???" I guess methadone (and LAAM) is the only drug US govt. wants to see used for treating addicts.On the flip side, try to get a doctor to prescribe methadone for pain. Some of the more progressive docs might be willing to do it, but most will look at you like you're crazy. The pharmacy is likely to freak out on you too. It's as if they've divided opiates into two categories: those for addicts and those for pain.
It amazes me that a doc could prescribe buprenorphine to a patient for depression but if the same doc prescribes it to an addict for maintenence, that doc could get slapped by the DEA.
This country is so weird.
Posted by desertflower on August 10, 2001, at 12:17:02
In reply to Re: buprenorphine, legal issues » Elizabeth, posted by MB on August 10, 2001, at 11:00:43
>
> > I get buprenorphine as an antidepressant; it's also used for pain (although retail pharmacies won't stock it -- they'll have to special order it). Maintenance treatment of opioid dependence is a very charged political issue in the U.S.A., and people who want to get treatment have to go through a lot of hassle.
>
>
> This is totally true...getting on a maintenence program with anything other than methadone or one of it's longer acting derivatives is nearly impossable. I knew a shrink that lost his job as the head of a methadone clinic becasue he was giving some of the patients codiene (it worked better for them than the methadone). Codeine is even scheduled lower than methadone. His attitude was, "what the hell's the difference???" I guess methadone (and LAAM) is the only drug US govt. wants to see used for treating addicts.
>
> On the flip side, try to get a doctor to prescribe methadone for pain. Some of the more progressive docs might be willing to do it, but most will look at you like you're crazy. The pharmacy is likely to freak out on you too. It's as if they've divided opiates into two categories: those for addicts and those for pain.
>
> It amazes me that a doc could prescribe buprenorphine to a patient for depression but if the same doc prescribes it to an addict for maintenence, that doc could get slapped by the DEA.
>
> This country is so weird.I totally agree. Finally, though I have seen some press releases and some articles that say buprenorphine as a sublingual tablet will finally be authorized next year.We can't wait for next year, so will try to find an informed and compassionate doctor, try the depression route, which is what I am anyway. thanks. desertflower
Posted by Elizabeth on August 10, 2001, at 16:32:45
In reply to Re: buprenorphine » desertflower, posted by jojo on August 9, 2001, at 23:48:41
> I don't think that there must be bad news here. It is perfectly legal for a physician here in the U.S. to prescribe buprenorphine for depression, or actually any reason the physician sees fit, with the exception of opioid addiction withdrawal.
That's true, but finding a doctor who's willing to do it -- particularly if the person has been in maintenance treatment for opioid dependence -- is not trivial.
> Your husband might possibly fit into some category other than opioid withdrawal.
That seems like the best way to approach it, although I can see it being questioned if it came to the attention of the authorities.
> The only published reference that I have seen regarding its use as an antidepressant was a reference on this board.
The two main references on the subject are
(1) a small, open-label study:
Buprenorphine treatment of refractory depression. Bodkin JA, Zornberg GL, Lukas SE, Cole JO. J Clin Psychopharmacol. 1995 Feb;15(1):49-57.and (2) the letter to the editor you mentioned:
Buprenorphine for depression: the un-adoptable orphan. Callaway E. Biol Psychiatry. 1996 Jun 15;39(12):989-90.Some articles discuss the antidepressant effects of buprenorphine in dually-diagnosed addicts; for example:
Buprenorphine responders: a diagnostic subgroup of heroin addicts? Resnick RB, Resnick E, Galanter M. Prog Neuropsychopharmacol Biol Psychiatry. 1991;15(4):531-8.
Buprenorphine responders. Mongan L, Callaway E. Biol Psychiatry. 1990 Dec 15;28(12):1078-80.
(can be read online at http://www.geocities.com/HotSprings/9740/buprespond.html)There are also some other references regarding the use of opioids other than buprenorphine as antidepressants.
Desertflower, I hope that the rumour that SL buprenorphine will be available in the USA next year is true. It would sure make my life a lot easier.
-elizabeth
Posted by Elizabeth on August 10, 2001, at 16:43:21
In reply to Re: buprenorphine, legal issues » Elizabeth, posted by MB on August 10, 2001, at 11:00:43
> This is totally true...getting on a maintenence program with anything other than methadone or one of it's longer acting derivatives is nearly impossable.
I think that's pretty bizarre. I mean, the clinics mainly use methadone and maybe LAAM, but is there some reason why they couldn't use something else?
> I knew a shrink that lost his job as the head of a methadone clinic becasue he was giving some of the patients codiene (it worked better for them than the methadone). Codeine is even scheduled lower than methadone.
Actually, pure codeine (with no Tylenol or aspirin or anything added) is Schedule II, the same as methadone. Of course, plain codeine is rarely used for anything.
> On the flip side, try to get a doctor to prescribe methadone for pain. Some of the more progressive docs might be willing to do it, but most will look at you like you're crazy.
That's true. Methadone is probably the single most carefully-watched controlled substance in the US.
> The pharmacy is likely to freak out on you too. It's as if they've divided opiates into two categories: those for addicts and those for pain.
As though the molecules could tell the difference!
> It amazes me that a doc could prescribe buprenorphine to a patient for depression but if the same doc prescribes it to an addict for maintenence, that doc could get slapped by the DEA.
I can sort of understand the twisted, sick reasoning here: addicts are deemed to be likely to abuse any drug that is prescribed to them, whereas a nonaddict who is depressed or has chronic pain can potentially be "trusted" with these drugs.
What I think is screwy is that psychiatrists claim to embrace the disease model of addiction, but they still treat addicts as though that "disease" is a moral failing.
> This country is so weird.
"Weird" isn't quite the word I'd choose, but yes.
-elizabeth
Posted by desertflower on August 10, 2001, at 17:03:28
In reply to Re: buprenorphine, posted by Elizabeth on August 10, 2001, at 16:32:45
> > I don't think that there must be bad news here. It is perfectly legal for a physician here in the U.S. to prescribe buprenorphine for depression, or actually any reason the physician sees fit, with the exception of opioid addiction withdrawal.
>
> That's true, but finding a doctor who's willing to do it -- particularly if the person has been in maintenance treatment for opioid dependence -- is not trivial.
>
> > Your husband might possibly fit into some category other than opioid withdrawal.
>
> That seems like the best way to approach it, although I can see it being questioned if it came to the attention of the authorities.
>
> > The only published reference that I have seen regarding its use as an antidepressant was a reference on this board.
>
> The two main references on the subject are
>
> (1) a small, open-label study:
> Buprenorphine treatment of refractory depression. Bodkin JA, Zornberg GL, Lukas SE, Cole JO. J Clin Psychopharmacol. 1995 Feb;15(1):49-57.
>
> and (2) the letter to the editor you mentioned:
> Buprenorphine for depression: the un-adoptable orphan. Callaway E. Biol Psychiatry. 1996 Jun 15;39(12):989-90.
>
> Some articles discuss the antidepressant effects of buprenorphine in dually-diagnosed addicts; for example:
>
> Buprenorphine responders: a diagnostic subgroup of heroin addicts? Resnick RB, Resnick E, Galanter M. Prog Neuropsychopharmacol Biol Psychiatry. 1991;15(4):531-8.
>
> Buprenorphine responders. Mongan L, Callaway E. Biol Psychiatry. 1990 Dec 15;28(12):1078-80.
> (can be read online at http://www.geocities.com/HotSprings/9740/buprespond.html)
>
> There are also some other references regarding the use of opioids other than buprenorphine as antidepressants.
>
> Desertflower, I hope that the rumour that SL buprenorphine will be available in the USA next year is true. It would sure make my life a lot easier.
>
> -elizabethElizabeth:
Thank you for your sharing of knowledge. It is so comforting to know there is understanding out there in the world. We are hoping the order from the online pharmacy will come through; in the meantime, waiting patiently and hopefully.
Posted by MB on August 10, 2001, at 17:31:25
In reply to Re: buprenorphine, legal issues » MB, posted by Elizabeth on August 10, 2001, at 16:43:21
> Actually, pure codeine (with no Tylenol or aspirin or anything added) is Schedule II, the same as methadone. Of course, plain codeine is rarely used for anything.
Ah Ha...I hadn't even thought of that. I wonder what he was giving the patients. Maybe it was the pure codeine, not the Tylenol preparation.
> > It amazes me that a doc could prescribe buprenorphine to a patient for depression but if the same doc prescribes it to an addict for maintenence, that doc could get slapped by the DEA.
>
> I can sort of understand the twisted, sick reasoning here: addicts are deemed to be likely to abuse any drug that is prescribed to them, whereas a nonaddict who is depressed or has chronic pain can potentially be "trusted" with these drugs.
Yeah, I see their point too. Giving an addict free reign over self-administration would be tantamount to telling the street junky, "just don't increase your dose." But my understanding is that buprenorphine doesn't get you "high."
> What I think is screwy is that psychiatrists claim to embrace the disease model of addiction, but they still treat addicts as though that "disease" is a moral failing.
Unfortunately, just because you're seen as having a disease doesn't mean you won't be looked upon with disdain by physicians for having that disease (**especially if the doctors don't know how to cure that particular disorder**).
Posted by Elizabeth on August 11, 2001, at 0:27:05
In reply to Re: buprenorphine, legal issues » Elizabeth, posted by MB on August 10, 2001, at 17:31:25
> Ah Ha...I hadn't even thought of that. I wonder what he was giving the patients. Maybe it was the pure codeine, not the Tylenol preparation.
It's possible. I like to say (about the opiate preps with APAP, ASA, ibuprofen, etc. added -- Tylenol #3, Percocet, Percodan, Vicodin, Vicoprofen, etc.) that they add a poison to the drug in order to make it safer. (In reality, of course, it's to make it less safe to use large amounts, thus increasing the already high odds that drug addicts will die a horrible and painful death.)
> Yeah, I see their point too. Giving an addict free reign over self-administration would be tantamount to telling the street junky, "just don't increase your dose." But my understanding is that buprenorphine doesn't get you "high."
Your understanding is consistent with my experience.
> > What I think is screwy is that psychiatrists claim to embrace the disease model of addiction, but they still treat addicts as though that "disease" is a moral failing.
>
> Unfortunately, just because you're seen as having a disease doesn't mean you won't be looked upon with disdain by physicians for having that disease (**especially if the doctors don't know how to cure that particular disorder**).The blame-the-victim attitude just strikes me as blatant hypocrisy. You can't say that someone has a disease and continue to blame them for it -- you can pick one or the other, but not both.
-elizabeth
This is the end of the thread.
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