Buprenorphine for neuropathic pain.

[martini1955]

Every doc I've asked for the Butrans patch says no because they don;t believe me when I tell them  they do not have the special training and license to prescribe as with Suboxone.  Even the pain specialist I saw believed he would have to have the "special: license".  How can I convince them?  They all (6 docs) refuse to read the documentation I'd brought to the appointment.  Or how do I find a doctor who will prescribe buprenorphine for my chronic, neuropathic pain.

[Foralwyzurz]

Come to nh and there's a bunch of doctors who perscribe suboxone.  There's pain management clinics in newington nh.  Somerworth nh and Merrimack nh. It's awesome cause they don't look at you like a drug addict they treat you just like everyone else. It's a nice environment and no discrimination.  I've been going for 5 years and no issues.   I love my doctor and i know I'll have to continue treatment for many years do to pain and migraines.  Hope this helps someone. :)

[martini1955]

Thanks.  Your comments were most helpful.  I did find a doctor who does use Buprenorphine for pain patients, but I have to go through a pain clinic to see him.  He is an Anesthesiologist. Apparently there are only 2-3 docs in Minnesota who are prescribing it.

[martini1955]

I was on Oxycontin, 160mg tid, with 30mg oxycodone for break-thru pain for 15 years when a doctor in the hospital offered me Suboxone (the oxy's were not helping my pain anymore).  After the first dose ALL my pain and depression were gone after two long decades of suffering.  I love it because I don't feel drugged up all the time.  He forgot to mention that I would be labeled an 'addict' just because I use Suboxone for pain. I can't even get an Rx for cough syrup.  Now my Suboxone doctor wants me to taper off it because that's what they do for addicts.  He doesn't care about my pain and refuses to prescribe it for pain!  The pain doctors refuse to prescribe it for pain because they believe they need the special license. I am terrified to go back to living in pain again.  Does anyone know where I can get official proof that they are wrong?    Thanks for your comments, kids.

[Jaybay]

The Butrans patch is not exactly the same as Suboxone and does not require any special licensing to prescribe.  The active ingredient in Butrans is buprenorphine - the same active ingredient in Suboxone.  Buprenorphine is also available in pill form under the brand name Subutex.  And yes, Suboxone requires a govenment-mandated seminar for its prescribers, but there is a loophole.  I understand that if doctors write "for pain" on the prescription, they can legally prescribe it.  

What Suboxone has that the patch and Subutex does not is naloxone.  The naloxone ingredient is there primarily to prevent people from crushing and injecting Suboxone.  If taken correctly, naloxone also blocks the effects of any further opiate intake because it takes up residence on certain opiate receptors in the brain.  That's why Suboxone isn't a great idea for pain management.  Breatkthrough meds are pretty much useless.  The patch on the other hand, allows for breakthrough meds since it doesn't contain naloxone.

Butrans has only been available since January of this year so I'm not surprised that many doctors are hesitant to prescribe it, if they are even aware it's on the market.  It's been used in Europe for many years.  You're doing everything you can by trying to educate your doctors.  Of course, many doctors resent patients who try to direct their own treatment and there's no way of knowing how such discussions will go until you try.  It also helps to approach it from a position of wanting to try something new rather than demanding that the doctor what you tell him.

Butrans, like any other narcotic, has its own pros and cons.  It's a powerful, long-acting, synthetic opiate and just as subject to abuse and misdirection as any other opiate.  Even Suboxone with its naloxone component is now being abused and has street value.  Because of the long half-life, buprenorphine is one of the most difficult medications to discontinue.  If you haven't already been on opiate therapy for some time and built up a tolerance, I doubt any doctor would jump right in and put you on Butrans.  Is it possible that's the issue rather than a prejudice on the part of the doctors toward Butrans?

[atonicat]

You do not need a special "license" to treat patients with suboxone for chronic pain. You do need a special "license" to treat patients with suboxone for opiate dependence. In order to treat addiction patients with suboxone, a doctor needs to complete an 8 hour class in addiction treatment and then they are granted a federal waiver in order or prescribe it for addiction treatment. A quick google search will tell you, or your doctor about this.

I'm guessing that either your doctors are not educated on suboxone or do not want to prescribe it. It's a fairly new drug to the chronic pain scene, so it's not really a surprise that they don't want to prescribe it. My advice would be to try to ask for something else that's longer acting. I don't think you're ever going to convince your doctors that they don't need the federal waiver. But you may be able to convince them to prescribe a longer acting medicine.

[namnam46]

Hi martint1955,

First, I want to welcome you to the PM (Pain Management) Forum and let you know that we are glad you found this Forum. We are all CP (Chronic Pain) Patients that help each other with our own expertise and experiences that we have developed through our own CP Issues.

I'm sorry that you are having trouble finding a Doctor to prescribe what you think you need for your pain.  From everything that I've read on the patch it is the very same medication that Suboxone is.  So it would stand to reason that if they need a "Special" License to sell Suboxone then they would most likely need it for the Butrans Patch also.  Now, I'm not a doctor so I could be very wrong.  :)  Maybe I misunderstood your post.  If I did I'm very sorry, but I think you were saying that the Doctor's are saying that they need a "Special" License to prescribe the Butrans Patch, is that correct?  If that's not correct, would you be kind enough to state what you were saying again.  Sometimes, I do read things incorrectly.  :(  

I know that there are Doctor's out there that do prescribe Suboxone and the Butrans Patches, so I'd just keep on searching for the Doctor's that do prescribe it for you.  I know how painful Neuropathic pain can be and I'm so sorry that you are having to put up with this pain!!!  I hope that you can find the medication that you need to help with you terrible pain.

Please let us know how you are doing...........Sherry  :)