- This website leads you to links that explore the opioid abuse epidemic in the United States and provides new perspectives and insights. This is possibly the most comprehensive online resource currently available on the subject.
Tapering off of buprenorphine and buprenorphine maintenance
Understandably, one often asks whether it is safe to taper off of buprenorphine. The link
provides evidence for significant relapse rates in those with moderate to severe opioid use disorders who stop using buprenorphine. Note: Most of these studies simply use clean urines or treatment retention as indicators of successful outcomes. In other words they just monitor fairly gross indicators of disease activity and consequences. I believe that if more sensitive quality of life measures were looked at there would no longer be any question as to the long term benefits of ongoing agonist therapy - Whether patients with moderate-severe opioid use disorders can ever do best on an abstinence based program is lacking evidence. I think the odds are similar to an insulin dependent person being able to eventually get off of insulin and thrive. Perhaps, 5-10% can get by without agonist therapy but it remains whether their health is as good as it could be as with agonist therapy. Close long term monitoring is warranted. Abstinence in addiction is not by itself a favorable outcome. It is only because it often is a strong "surrogate" marker and a rather objective one at that. In most substance use disorders abstinence is highly associated with good outcomes. In the case of opioid use disorders this is not the case.
Memo Regarding Specialized Care in Pain & Addiction through OPAS
J.K. Rotchford. This handout has references and pertinent information regarding the Washington State Guidelines and how they pertain to proper pain management in patients with co-morbid opioid use disorders. It also provides suggestions on obtaining and promoting necessary specialized care in the fields of pain management of addictive disorders.