Buprenorphine Treatment for Opiate Addiction-2017

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Emergency Buprenorphine Supply

Should you have an emergency supply of buprenorphine and how much?


Summary:

Many
unpredictable emergencies could leave you without medication
. People have committed suicide after being
suddenly cut off from opioid medication
. It pays to
be prepared
. Talk with your doctor about
creating an emergency supply
.

flood emergency
Houston - 2017

What if you can't get your buprenorphine?

stockpile of buprenorphine
Dear DEA, the boxes pictured
above are empty.

Should you have extra buprenorphine in case of emergency? This is an individual decision that must take into account how stable you are in treatment and how much risk there is for a medication interruption. For stable patients (meaning patients who are at a steady dose and are able to take the medication as directed) a 30 day supply is suggested. FEMA recommends a 2 weeks supply of medications1, but buprenorphine is more difficult to get in non-emergency times and will be particularly difficult to find a prescribing doctor in an emergency. At minimum, stockpiling enough to conduct a taper is advisable in the case future supplies are cut off indefinitely . Use this form to calculate how much buprenorphine you will need to taper from your current dose.

The stress of being near the end of your prescription and not knowing where the next refill will come from could be enough to trigger a relapse. Dealing with whatever the emergency is may already be stressful enough, adding in the not knowing where the medication will come from is unnecessary added stress.

You never know...

tornado damage

Consider just a few situations where you could find yourself without medication:

  • Your doctor suddenly:2
    • Dies
    • Retires
    • Disappears
    • Is arrested
    • Is closed by the DEA
    • Inexplicably stops treating you
  • Tornado
  • Wildfire
  • Hurricane
  • Flood
  • Mudslide
  • Blizzard
  • Heat wave
  • Drought
  • Tsunami
  • Volcano
  • Earthquake
  • Avalanche
  • Blackout
  • Nuclear accident
  • Chemical spill
  • Terror attack
  • Riot
  • Martial law
  • Curfew
  • Medication shortage
  • Pandemic
  • Bureaucracy/law
  • Cyber Attack

...and many others, although some rare, any of them could become between you and your medication. People suffered after Katrina and super storm Sandy, when doctor offices and pharmacies were wiped out leaving no record of their prescription.

CVS on fire
Baltimore -2015
What unknowns associated with the unfolding of the Affordable Care Act could turn into a problem getting your medication (like not being able to keep your doctor)? For these reasons and many more not listed, it pays to be prepared.

Even if there is no disaster, the piece of mind knowing that you have a cushion in case there's an interruption is a relief.

How do I get an emergency supply of buprenorphine?

First, ask your doctor to prescribe extra medication and discuss the reasons above. If your doctor is unwilling to prescribe more, and you have decided that you want the reserve anyways, try taking ½ your dose every 3 or 4 days and slowly build up a reserve. You may find you can skip a day occasionally without feeling any different whatsoever. Going against doctor's advice is not something we would normally suggest, but we strongly believe that not having a safety margin is the greater risk. People have committed suicide after being suddenly cut off from opioid medications. It's a choice you will have to make and take responsibility for either way.

Doctors: Given the reasons listed above, the desire to maintain a supply of medication is prudent preparedness rather than a manifestation of ongoing addiction. The motivation to acquire a margin of assuredness is in fact a desire to remain in compliant stable treatment, not a way to misuse or circumvent treatment. This should be encouraged and efforts to assist patients with this should be made.


References:
  1. FEMA - Government recommendations concerning emergency medication - Ready.gov
  2. Anecdotal evidence compiled from several social media sites over a period of several years

Notes:

  1. Brand names for buprenorphine/naloxone (bup/nx)

    combination products in the US:
    Suboxone Film
    ,
    Zubsolv
    ,
    Bunavail
    , and generic equivalents of the discontinued Suboxone Sublingual Tablets.
  2. Buprenorphine products in the US WITHOUT the added naloxone

    safeguard:
    1. Subutex Tablets
      (
      discontinued in 2009
      ) but the
      generic equivalents remain available
      .
    2. Buprenex®
      is an injectable,
      FDA approved for pain
      NOT addiction -
      illegal to prescribe for opioid addiction
      .
    3. Butrans®
      Patch, also
      FDA approved for pain
      and NOT addiction -
      illegal to prescribe for opioid addiction
      .
    4. Pharmacy-compounded bup or bup/nx
      preparations - NOT FDA approved for addiction -
      illegal to prescribe for opioid addiction
      .
  3. Probuphine®
    is an insertable
    buprenorphine rod
    which goes under the skin and releases bup over the course of 6 months. It
    was FDA approved in May of 2016
    , and is for the treatment of addiction.
  4. Belbuca™
    is a
    buprenorphine film
    which goes on the inside of the cheak. It
    was FDA approved in October of 2015
    , and is for the treatment of pain - NOT FDA approved for addiction -
    illegal to prescribe for opioid addiction
    .
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Disclaimer:

  1. Nothing on this site should be confused for medical advice. The information provided here should only serve to inspire you to find out more from credible sources. We hope to help you understand the disease better so that you know what questions to ask your doctor. Never take any online medical advice over that of a healthcare professional, assume it's all made up. Despite the links to peer reviewed studies all interpretations of said studies may be opinion, unreliable or erroneous. If some patients found something beneficial to them it's not an indication that it will be beneficial to you, on the contrary, it may be dangerous. You, not us, are responsible for what you do with the information you get from this site or any site.

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