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Bupe New to addiction medicine with Kaiser So Cal

areros18

areros18

Bluelighter
Joined
Sep 10, 2012
Messages
154
Location
So Cal- Lost Angeles
I had my interview with Kaiser addiction medicine today with an RN. Tomorrow I see the MD who specializes in drug admits ration of suboxone. I have been in Pain management hot 2.5 years and now my pM dept has dropped me and referred me to addiction medicine. According to kaiser AM RN pM cannot prescribe suboxone for pain and it is only used for opiate withdrawal. If I am to get on suboxone it will be for a period of no longer than ten days. My concern is this: I will detox. Be fine. Pain will kick in and within six months ill be back in pain management on Opana, morphone, Norco fentanyl. Makes more sense to go back to Pm and get on a regimen of methadone for pain than do a ten day thing cuz ill be back to where I started 2.5 years ago. In bed in pain.
What has your experience with pain management and addiction med been? I am in so cal. I wonder if other kaisers, Orange County, Antelope valley have different policy's?
Thx
 
I recently started opiate replacement therapy and also had to make the same decision, buprenorphine or methadone? Just a side note, if you do end up deciding on bupe, try and get Subutex instead of Subuxone. Subutex has a generic form which is a lot cheaper and doesn't have naloxone in it.

10 days is not long enough.. and if you don't taper successfully you'll have a much higher chance of relapse. And if you have legitimate pain then you're probably going toend up taking opiates again anyway. What opiates have you been taking the last 2+ years? And why injury/medical condition causes your pain?

I'm currently on methadone. I live in northern California so I don't know how different it is up here compared to down south. I initially wanted to take Subutex since it's only a partial agonist whereas methadone is a full agonist. I do have some issues with my back and started taking Oxycontin for work but the reason I stayed on opiates for so long was because I may have an endorphin deficiency and opiates have really helped me.. unlike the other medications I tried in the past. Subutex has been used off label for depression and it's been very effective. And regardless of my back issues Subutex is easier to get off of. Unfortunately the only doctors in my country who prescribe it don't take MediCal. I went to a local clinic and they prescribe it but my insurance won't cover it there unless I try methadone first and it doesn't work.

I've been on methadone 3 weeks now. It's actually been for effective for my back and neck pain. It's also a mood stabilizer. It can be really sedating initially, I've been napping a lot in the afternoon. It should go away after a month
or two though and that's really my only complaint. You do have to be careful about your dose... Stay on the lowest possible dose that still makes you comfortable. Because otherwise the methadone will take sooo long to taper off of.

You don't have to go to Kaiser, go to a methadone clinic, you don't need a referral. I have to wake up early so I have to go, but feel free to PM me if you have questions. Or post here. I know about both medications.
 
Thanks so much for your reply. I'm going to see the big cheese this morning and I'm going to ask about subutex. It annoying because they act like they know it all. When I asked why I was on suboxone for ten days only RN rolled his eyes. Yup. That's my answer.
I have degenerative disk disease (arthitis) in my spine, neck, shoulder& hip. Also sciatica and SI joint pain. I also have panic attacks and anxiety disorder. I take Prozac and Valium for but I hate Valium. Opiates not only rid me of physical but mental pain. Cravings will be my worst symptom.
 
There's really not much difference between suboxone and subutex, the naloxone really has negligible effects.

I'm not sure how you're going to get back on full agonists after seeing an addiction medicine doctor and getting RX'd suboxone, you do realize that most doctors feel uneasy prescribing pain killers to addicts right?

If you are really worried about your pain management, seeing addiction medicine doctors might ruin that.
 
I'm wondering if there is more to the story here? Why did your PM doctor drop you and send you to an addiction specialist? If you don't have a personal desire to get off your meds, then I can only assume your doctor thinks you are addicted or mis-using them. As tricomb said, that will severely limit your chances for future PM drug treatment.

If you have no intention of quitting opioids, then I don't see how a 10-day Suboxone detox is going to help. It could be good if you wanted to get off opioids and try other meds or non-drug approaches to dealing with your pain. But if you don't want to stop opioids or even give it a shot, then I think your only choices would be to go on buprenorphine (Suboxone/Subutex) or methadone, and ideally at the same time consider non-opioid meds and non-drug therapies to deal with your pain. There are many different clinics and doctors, many of which do long-term maintenance therapy with bupe or methadone, not just detox.
 
^Exactly. If you're actually serious about pain management, how the hell is 10 days of buprenorphine going to help you?

There's definitely more to the story here than we've been told....

A) it's a SHIT pain killer
B) it jacks up your tolerance soooooo high
C) it effectively ruins your future possibilities of obtaining legit narcotics in the future, you'll be condemned to Tramadol and Butrans for the rest of your life. So if you SERIOUSLY have a pain condition, AND you need professional help with addiction.... Well.... Unfortunately the current state of things means two options.

1) Treat your pain
OR
2) Treat your addiction.

Can't have your cake and eat it too. In the State of California where we have a statewide prescription monitoring program in place to deter doctor shopping, it will be extremely difficult, not to mention often illegal, to try to see another doctor and get full-agonists after being treated for addiction. The pharmacy will call your prescribing doctor(s) and be like, "heyyyyy did this person tell you that they're addicted to opioids, which you appear to have prescribed this patient?"
 
^You really have to explain more details to us if we are to properly give you advice. This sounds highly unusual. Are you trying to say that they are just giving you Suboxone for pain but making you go through an addiction doctor because PM docs can't prescribe it, or what? What's the story? Why have you been on Subs 3 times? Why did your PM Dr drop you?

EDIT: Also as far as I've heard all Kaiser facilities only offer short-term detox using Suboxone, not long-term maintenance. I think it's a Kaiser policy, not a location policy.
 
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To tack on to what Tricomb was saying about the monitoring system here in CA; they will look you up and see what you've gotten and from whom before writing a scrip. Some doctors are looser than others but I have certainly run into the question of, "Hey, it says here that you just filled an Rx for oxy 10 days ago, what's up with that?" That was from my sub doc who frowned upon me talking other narcotics with subs and was confused how I even could, they really think any dose of sub will block out full agonist opiods...

Sub laws here are sometimes vague and the doctors do what they want, they few I have seen have varied wildly. Some even discourage the use of benzos if you're on subs. Crazy.

Not to flog a dead horse here, but if you need Px management, you're going to need it. I get an oxy scrip for pain and then fill in the gaps with subs so I don't wake up in WD and so I can take pills when I'm in pain, instead of needing to take them everyday to avoid WD. It's in a very grey area legally, and I'm surprised I got away with it as long as I did. But that's over. Subuxone carries a heavy price tag in more than a few ways. Don't venture into it lightly unless you want to get on, taper off, and stay away from anything to do with a poppy.
 
tricomb said:
There's really not much difference between suboxone and subutex, the naloxone really has negligible effects.
Click to expand...
I've always believed that there's no reason to put extra crap in your body if you don't need to.
And Suboxone does not have a generic version. Bupe is extremely expensive and most insurance nowadays makes you pay for at least part, if not all, of your prescriptions. The cheaper generic makes a difference.

If you have legitimate pain and don't plan on quitting narcotic pain relievers do not see an addiction specialist or do a 10 day detox. It will show up on your medical records and in the future doctors will be extremely hesitant to prescribe you anything stronger than 800mg Motrin. They will think you're trying to get drugs to get high, even if you're in excruciating pain. The shit that chronic pain patients have to go through is pretty fucked up.

The reason I suggested methadone is because it will help with pain. Also, unlike bupe, they do prescribe it for that reason. But if they won't prescribe you opioids for pain anymore just go to a methadone clinic. Technically, it's opiate replacement therapy and you are getting treatment for your addiction. But if you have pain issues the clinic will take that into consideration and dose you accordingly.

You have not explained why you were dropped by your PM doc though. Please give us the full story.
 
My kaiser did not technically drop me. She "quit" and I was transferred to a new Dr that refused to keep me on opiate pain killers because I'm only 39.
I then called the PM manager and requested a second opinion with another PM Dr. Who pretty much said she might consider giving me methadone. She'd have to talk to her supervisor and she'd call me back. That's when I got the lovely call about my upcoming appoinent with addiction medicine.
My Dr at addiction med is now trying me out on a Suboxone Maintenence therapy. I will also need to see a therapist because of my pain and anxiety issues.
I won't lie. I love my opiates. I've abused my opiates. I took 50 mg Norco today and my hips and spine are killing me. I'm exhausted. I really see no other way out. Thru kaiser only addiction med Dr can prescribe suboxone. But PM dr can prescribe Methadone. Addiction Dr said Canada prescribes Subs for pain but he USA not allowed to write that as part of my diagnosis. And to make things worse- addiction med Dr is retiring next month!! So, they know I'm in pain. They know I am physically dependant. And my medical history at addiction medicine has PAIN PATIENT in bold everywhere. Maybe if subs don work I can get back on methadone? But would I want to? The few times I took it I was so sleepy!
What if I were to change insurance. How would a new pharmacist know what kaiser have me since I cannot go outside of network?
 
mrflowers00 said:
if you're in pain then you definitely should not get subutex
Click to expand...

I'm totally In pain. Been popping ibu 800 & soma all day. Exhausted. Will probably start bupe sometime toningt because I'm out of everything else and I feel the WD's coming on. Dr said pain could be brought on by use of opiates. They are not really giving me a choice.
Maybe I should email PM and see if they'll take me back if all this fails.
 
Just an update. I've been on subs 4 days now. Feeling remarkable well. Pain is so far controlled by ibuprofen. Been doing a little more drinking than usual and I smoked a blunt tonight - something that usually makes me feel paranoid, felt nice. Not missing the pills too much. Missing the ritual of the Opana preparation more than the actual high since I was just maintaining.
 
About a week on subs and feeling emotions, anxiety. Now I realize why I abused opiates to begin with. I'm tired. I'm drinking but alcohol and suboxone seem to cancel each other out. I'm paranoid.
Curios to see where I'll be next week. I have counseling and drs appt lined up. I know all I have to do is make a call and ill be right back at opiate bliss. I want to ride it out and experience life for now.
 
sl1p609 said:
maybe methadone is better treatment option for you. have you ever experienced that
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Curios: why would you think methadone would be a better treatment option? From other addicts in recovery, I am told that I am lucky that I'm not on methadone. That methadone itself is very addictive and a pain to WD from.
 
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