suboxone problems

--though milder and safer than other opioids (and counter to my initial training for suboxone prescribing), people can get high on subox, esp if relatively opiate-naive.
--in terms of safety, since 2003 there have been 420 subox deaths in the US (vs 3625 methadone deaths, and lots more from oxycodone, etc as per my recent emails)
--no surprisingly, some MD have been prescribing suboxone inappropriately (and many of them also have prescribed other opiates inappropriately)
--(again different from my initial training), subox is sometimes being used by injection (the naloxone incorporated is supposed to create withdrawal when given IV and thereby make injecting the drug a strong deterrent. turns out that the level of naloxone may not be high enough, and some people who do get a naloxone reaction find it to be relatively mild and transient). not sure what the real data are here in terms of %'s, but per this article, it is being injected at times.

so, my experience certainly confirms that suboxone (buprenorphine/naloxone) is a commonly used street drug, mostly used to prevent withdrawal, though also perhaps for some opiate-naive patients to get high. i find that it is a really great drug for the majority of my patients on it, often a very complex panel of patients with an array of psychosocial/behavioral problems. but more than 60% (my guess) do phenomenally well, function well, and really get their lives back.  this article tempers my enthusiasm a bit, but in perspective i really do find it a great drug for the majority of my opioid-addicted patients who want to/are ready to quit the other opioids.

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