RSD Puzzle #088

H. Hooshmand, M. D.

DIPLOMATE AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY

BOARD CERTIFIED IN ELECTROENCEPHOLOGRAPHY

BOARD CERTIFIED IN ELECTROMYOGRAPHY

BOARD CERTIFIED IN AMERICAN BOARD OF ELECTODIAGNOSTIC MEDICINE

INTRACTABLE NEUROLOGY

EPILEPSY, PAIN, MS

An International Referral Center dedicated to Treatment, Education and Research

RSD PUZZLE #88
DETOXIFICATION FROM NARCOTICS

The question you had was in regard to the use of Buprenex. This medication is Classified as a Class V which is not a controlled drug. Class I being drugs such as LSD, PCP, Marijuana, etc. Class II being Morphine, Methadone, and Lortab, etc. Class III being Darvon group of medication and Class IV is limited to mainly morphine habitus antagonist medications with the least tendency for tolerance and physical dependence. Obviously that does not exclude abuse by the individual patient.

The latest literature has shown that Buprenex is quite effective in helping to detoxify the patient from strong Class II opiates. The Harvard Group, in April, reported successful application of Buprenex in detoxifying patients from Heroine, Cocaine, Morphine and Methadone.

Johnson et al [1] have successfully used Buprenex in detoxifying patients from opiate dependence. Ling et al [2] have successfully used Buprenex to detoxify patients from Methadone dependence. Through the Internet Communication, we have traced four sudden death from methadone use in RSD patients in the past six months. These sudden deaths have occurred with no previous warning. These are not simply due to respiratory arrest during sleep. Every one of the four victims dies while sitting up, eating, reading or watching TV. We are very concerned about excessive use of Methadone in a liberal fashion in the treatment of RSD. We are also very concerned about the excessive and indiscriminate use of Neurontin in the same patients.

Buprenex works similar to Stadol, but does not cause the problem of the psychological dependence the patient develop to Stadol. It also does not cause the side effects of excessive drowsiness and disturbance of psychological function caused by Stadol.

Our policy is to detoxify the patient with the help of Buprenex, and then gradually and simultaneously replace it with Naloxone reversible type of antidepressants (such as Desipramine or Trazodone).

H.Hooshmand, M.D.

References

1. Johnson RE, Jaffe JH, Fudala PJ: A controlled trial of buprenorphine treatment for opioid dependence. JAMA 267:2750-5 1992.

2. Ling E, Wesson DR, Charuvastra C, et al: A controlled trial comparing buprenorphine and methadone, maintenance in opioid dependence. Arch Gen Psychiatry 53:401-407 1996.

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