Magazine article Clinical Psychiatry News

The Dog Ate My Buprenorphine!

Magazine article Clinical Psychiatry News

The Dog Ate My Buprenorphine!

Article excerpt

During the nearly 6 years I have been treating opiate dependence with buprenorphine, I have heard a variety of explanations for requests for additional orders: It got wet. It was stolen. I lost it. It fell in the toilet. The police confiscated it.

A patient who has been taking buprenorphine regularly for an extended period can expect at least mild to moderate opiate withdrawal syndrome to follow abrupt cessation. In contrast, cessation of most drugs I prescribe for psychiatric conditions produces relief from side effects, occasional mild abstinence symptoms, and sometimes recurrence or worsening of the target psychiatric condition.

One would think that patients treated with the latter group of drugs might be less careful, and those who know they face the agony of opiate withdrawal would guard their supply. But in more than. 3 decades of practice, I have difficulty recalling a single request for replacement of nonaddictive drugs, while the number requests for replacement of buprenorphine in 6 years easily exceeds 10.

Possible explanations come to mind: The patient sells the additional drugs; the chaos of the addict's life contributes to neglect of adequate precautions; the addict's social contacts take it; the patient shares the drug with others who can't afford medical care. Police may confiscate controlled substances not contained in the properly labeled and dated pharmacy bottle. I tell my buprenorphine patients to keep most of the drug at home in a safe place, possibly hidden or locked. …

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