Buprenorphine: A Key Ingredient in the Fight to Solve America'south Pain Crisis

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Source:   —  April 07, 2016, at 0:41 AM

S. Dept of Health and Human Services (HHS), and the president of the United States have all separately hit the emergency button over the subject of chronic pain treatment and opioid pain killers.

Buprenorphine: A Key Ingredient in the Fight to Solve America'south Pain Crisis

"If you don't modify direction, you may finish up where you are heading." -- Lao Tzu

Over the latest few weeks, the CDC, the U. S. Dept of Health and Human Services (HHS), and the president of the United States have all separately hit the emergency button over the subject of chronic pain treatment and opioid pain killers. Concerns over the rising tide of pain killer addiction, accidental overdose deaths, and a carryover effect causing a steep rise in heroin utilize have made this a "code blue" emergency for Washington. President Obama has made it clear that addressing the opioid epidemic is presently an administration priority, and he's requested $one.one billion in new funding to assistance treat patients with opioid addiction.

One treatment option that's risen to the surface of discussions is the medication buprenorphine, including the necessity to create it more accessible to more patients. Recently, HHS Secretary Sylvia Burwell requested a policy shift to expand the cap on the no of patients that appropriately licensed physicians can manage on buprenorphine from one hundred to two hundred. While I applaud the administration for recognizing the urgent necessity to crack down barriers love access to buprenorphine as a life-saving measure for a problem that's killing more Americans than car crashes, I can tell you that what needs to be done about buprenorphine runs much deeper than treating addiction.

Let me start by telling you about Patient #one. Back in two thousand-fourth, my practice partner, Dr. John Massey, decided to attempt treating one of his pain patients with buprenorphine. Patient #one was a youthful mother who'd failed miserably with the typical treatments of the time for a low back injury- spinal fusion surgery, spinal cortisone shots, and potent dosages of Oxycontin, which had become one of America'south leading designer pain medications. Her situation nose-dived into such despair and disarray that she became suicidal and largely bedridden. Prior to that, love many of us Patient #one had been a parent, a spouse, had a job, and had number history of addiction. When she was started on pain killers after her injury, she only took them as prescribed, never overused them, and did whatever her doctors asked of her. Nevertheless, her situation had become a tragedy, not because she was an addict, but because she'd chronic pain that she didn't know how to manage and she happened to also be stuck on opioids.

Patient #one stopped her Oxycontin, transitioned onto buprenorphine, and then went through our intensive outpatient pain program, and in a matter of weeks a miraculous metamorphosis took space before our very eyes. Her head cleared, the depression dissipated, and her body started to move and exercise. Within a matter of months, she was back to work again after being unemployable for years. (Most experts will tell you that the odds of somebody regaining employment who's been off for more than six months is extremely low.) Sure, buprenorphine alone didn't create this recovery, but along with the tough work of her treatment team, it played a key role in Patient #1'south resurrection back to living again.

The success we saw with Patient #1 quickly lead to triumphs for Patient #two, Patient #three, and so on, and we've presently treated hundreds of patients dependent on opioid pain killers with complex chronic pain problems using buprenorphine as portion of a comprehensive approach with mostly very positive outcomes. When our practice first started to utilize buprenorphine over a decade ago, it was a little-known drug introduced primarily for the treatment of narcotic addiction, but we quickly found that it'd cost beyond addiction. Buprenorphine became a grand tool for many of our patients who were struggling with chronic pain, dependent on opioid pain medications love hydrocodone, oxycodone, and fentanyl, and were motivated to obtain off of them but couldn't envision or tolerate a life without them. Suffice it to say, buprenorphine has been a life preserver that's helped us rescue countless of our patients who were sinking or just plain stuck.

The current rhetoric around increasing accessibility to medication-assisted treatment options love buprenorphine is for the treatment of what's been labeled "opioid utilize disorder," which can imply a lot of different things and is based on a patient having two of eleven possible different characteristics. But the opioids are just a portion of the clinical picture, and what we're really talking about is patients with many layers to their onion, including chronic pain of some variety, as well as related problems love depression, anxiety, relationship disruptions, insomnia, economic stress, and even PTSD. Even in cases where there is number misuse of medications, the situation can be beautiful bleak for the person suffering in pain and not knowing what else to do.

I can tell you from firsthand experience that we've a long way to go to empower physicians with what they necessity to assistance create meaningful modify in the lives of people struggling with complicated disabling chronic pain problems. It can be a huge challenge to obtain insurance approval to keep patients on buprenorphine and hold them on it, and even harder to obtain coverage for all of the needed integrated care on the back end. My office deals with the untoward consequences of "no" on a daily basis. Imagine being a patient who goes through the trials and tribulations of coming off of high dosages of something love Oxycontin and onto buprenorphine, only to be told a few months later by their insurance company that they aren't going to cover it any longer? Would you deny a diabetic their insulin or a cancer patient their chemotherapy? There are plenty of physicians out there who have taken the Hippocratic Oath that sit on insurance review boards who are pleased to declare "no" to patients like mine.

For many chronic pain patients who have landed on a daily regimen of opioids and perceive stuck in their skill to progress and improve, transitioning onto a medication love buprenorphine can be a game-changer in that process. I look examples of this in our own practice on a routine basis. It's time for insurance plans, doctors, patients, and presently the government to obtain their arms around the full scope of how buprenorphine fits in.

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