Butrans, new to US Buprenorphine Patch

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SoloCPhT
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Purdue Pharma was approved July 1, 2010 to manufacture and distribute Butrans, a transdermal Buprenorphine Patch. It is available in 5mcg, 10mcg and 20mcg per hour patches that are to be worn for 7 days. Butrans has been available in the UK for a few years now from Mundipharma a subsidary or partner of Purdue Pharma so Im sure with some searching one could find some good info about BuTrans effectiveness, etc. Apparently the 5mcg patch is for people that take 0mg-30mg of morphine or its equivalent per day and the 10mcg patch is for 30-80mg morphine or its equiv per day users. From reading the PI it leads me to believe that this patch is a good chronic pain medication for people that are not opiate tolerant. Also, it looks like the 20mcg patch would cover 80-120mg morphine daily use and if you take more than that per day you wont be able to use BuTrans since severe adverse effects are seen with more than 20mcg patch per day so the max indicated dose is the 20mcg patch. Well, I mean you could use it, but depending on how much more than 80-120mg morphine you take per day you would still need a lot of BT meds to go with the 20mcg patch. Also, it looks like in the US they are calling it Butrans and in the UK its BuTrans if you plan on doing more research on this med.

http://www.purduepharma.com/pressroom/news/20100701.htm

http://www.purduepharma.com/PI/prescription/ButransPI.pdf

Dr. Lois
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I am really excited about a

I am really excited about a weekly, transdermal, microgram buprenorphine for both pain and for tapering addiction patients!

SoloCPhT
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If you believe a patient is

If you believe a patient is addicted but honestly has pain requiring narcotics it's okay to Rx them, but if you are just prescribing narcotics to maintain an addict/dependent persons "need" for opiates, that's when it's not okay/ethical/legal right? Or are both scenarios illegal?
Also with butrans not being indicated for addiction I wonder if the man will get all bent outta shape the same way as when dr's. Rx suboxone off label for pain instead of addiction. From what I've seen/read/heard from people being Rx'd suboxone for pain the doctor & patient will have a "don't tell but if asked it's for addiction" type relationship when sub is actually for pain. Sometimes it's so insurance will pay and other times it's because the PI says it's not approved to treat pain whereas most PI's don't flat out exclude certain treatments which leaves the med open for off label uses.
Anyhow, main point was about prescribing to people addicted to there meds. Either way I guess it would be easy for the doctor to just say they thought the pt was dependant and not addicted...

Dr. Lois
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You bring up an excellent

You bring up an excellent point.  Hopefully, an addiction indication will follow soon to keep us on the side of the angels.  Unfortunately when I read the prescribing information it says absorption is increased by applying heat so the abuse potential is high since a weeklong resevoir is a lot of drug.

edited by me after my initial exuberance

subzero58
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hi doctor,are you saying a 7 day butrans patch is alot of

medication and has the potential for abuse in patients? the don't ask don't tell reason for its use will be no different then patients already receiving it for pain and or addiction at the present. with a 20mcg patch that could be used for duel purpose.prescribing 4-20mcg patches per month seems less likely to be diverted than 75-8mg pills/months...subzero58

allgood
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subzero58

If you read the PI for Butrans, you will see it is indicated for "moderate to severe chronic pain in patients requiring a continuous, around-the-clock opioid analgesic for an extended period of time.", but it mentions nothing about use for addiction.

http://www.purduepharma.com/PI/prescription/ButransPI.pdf

 

Also, four of the 20 mcg Butrans are NOT equal to 75 8mg pills.  I know you didn't say they were equal.  I do agree that the pills would be more likely to be diverted.


Timothy C
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Butran

I have been on both sides of the table. As a young man I abused drugs heavily in a very tough environment both emotionally and physically unstable. Growing older I married and had a child and left that world. Now in my 50's I have a variety of physically painful dilemmas. The mere mention of "pain" to almost all doctors  brings raised brows even though x-ray and MRI evidence supports many claims. It has become almost ridiculous that the "younger" abusive generation has brought  the  pain management branch of medicine to an almost inpeneratble wall of disbelief. Growing up during and through this opiate dilemma, I saw the dramatic change occur when codeine was replaced by lortab. Why this was so widespread is still a mystery to me. This was in the early 1990's. Since then the monster has grown into a variety of opiate variations, but the precursor of this "new evil" was in fact hydrocodone. I am not sure if codeine is still even prescribed, even though it is an excellent pain killer with as many if not less side-effects than hydrocodone and has a lot less abuse potential. Everyone is not out to sell their prescriptions or abuse them to the point of intoxication; relief is the greatest pleasure when one has chronic pain. It becomes a matter of functioning with some quality of life or falling short and being in constant unyielding pain. I have traveresed every avenue and option, and it is a fact that I need the relief to function. The illusion overwhelms the reality.