Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Suboxone for pain makes sense. Why don’t more doctors prescribe it?

Hans Duvefelt, MD
Meds
November 19, 2018
129 Shares
Share
Tweet
Share

Many patients who end up in Suboxone treatment have chronic pain. They were originally prescribed other opiates and ended up addicted to them.

Skeptics argue that is just substituting one opiate for another. But that isn’t quite accurate. More on that in a bit.

In my seven years of prescribing Suboxone for opiate addiction, I have often observed how potent a pain reliever this medication is, even in fairly low doses. More on why in a bit, too.

Now and then I hear about patients who are prescribed Suboxone for pain and not for addiction. I’m not sure exactly how that is done, since Maine law requires prescribers not only to include our Suboxone license number, but also the ICD-10 diagnosis code (F11.20, opiate use disorder) on the electronic prescription.

We also, in the case of some national pharmacy chains (Walmart) who don’t understand the Maine law, have to add “chronic,” which is only of relevance as opposed to “acute” when it comes to pain. Medication-assisted treatment is always chronic. Also, they require us to put “code D,” which is indeed a Maine exemption code for medication-assisted treatment, but only relevant when the Suboxone (or methadone) treatment exceeds 100 morphine milligram equivalents (MME).

Anyway, even though you have to indicate the diagnosis of addiction on scripts, I hear there are several Maine doctors who prescribe Suboxone for pain. The more I think about it, and the more I read up on it, the more sense it makes. But I’m not going to break any laws just because it makes sense.

This is what I know:

Buprenorphine, the opiate ingredient in Suboxone, is a partial (opiate) mu-agonist, which is the most obvious explanation why it has any analgesic properties at all. But it is also an ORL1 (nociceptin) agonist, which is another pain relieving mechanism. This one is among several proposed mechanisms for why buprenorphine has been shown to reduce opioid-induced hyperalgesia, a fibromyalgia-like state of generalized increased pain perception that paradoxically can make patients with, say, opioid-treated back pain start to hurt absolutely everywhere.

In fact, it has been observed that there is analgesic effect at lower doses than usually required for management of opiate cravings.

Buprenorphine is superior to traditional opioids for nerve pain and, because it also is a kappa-opioid antagonist, it has antidepressant and anxiolytics properties.

Buprenorphine has fewer side effects than straightforward opiates, specifically less constipation, less sedation, less immunosuppressant effect, less induction of gallbladder spasm (morphine is a bad choice for gallbladder attacks), less or even no decrease in sex hormones, less risk for heart rhythm problems (QT abnormalities) and it is even safe to use in older patients with chronic kidney disease.

But the law is the law. Suboxone is for addiction only. How soon will that change?

“A Country Doctor” is a family physician who blogs at A Country Doctor Writes:.

Image credit: Shutterstock.com

Prev

The joy of a successful blood draw

November 19, 2018 Kevin 1
…
Next

Gun control is our lane: Physician opinions on guns matter

November 19, 2018 Kevin 18
…

Tagged as: Pain Management, Primary Care

Post navigation

< Previous Post
The joy of a successful blood draw
Next Post >
Gun control is our lane: Physician opinions on guns matter

More by Hans Duvefelt, MD

  • The art of asking where it hurts

    Hans Duvefelt, MD
  • Thinking like a plumber when adjusting medications

    Hans Duvefelt, MD
  • The American food conspiracy

    Hans Duvefelt, MD

Related Posts

  • A paradigm shift in acute pain assessment and management

    Myles Gart, MD
  • Using low-dose naltrexone to treat pain

    Alex Smith
  • Why staying ahead of your pain with opioids is the wrong advice

    Myles Gart, MD
  • 3 reasons why doctors don’t unionize

    Baird Brightman, PhD
  • 5 things I wish I had known earlier about chronic pain

    Tom Bowen
  • Blame the pain, not the opioids

    Angelika Byczkowski

More in Meds

  • From Moscow Mule to the opioid crisis: Unveiling the tragic legacy and urgent solutions

    Osmund Agbo, MD
  • The deadly consequences of a shortage: The Pluvicto crisis leaves metastatic prostate cancer patients in limbo

    Matt Drewes
  • The real story of Xylazine contamination in street fentanyl and how we can manage it

    Julie Craig, MD
  • The cannabis education gap: Why patients are left in the dark

    Timothy Byars
  • Are doctors ready to discuss psychedelic therapies with patients?

    Thaís Salles Araujo, MD
  • The rise and dark side of fungi: Exploring health benefits and pathogenic threats

    Sandra Vamos, EdD and Deanna Lernihan, MPH
  • Most Popular

  • Past Week

    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

      Anonymous | Physician
    • The tragic story of Mr. G: a painful journey towards understanding suicide

      William Lynes, MD | Physician
    • The rising threat of lung cancer in Asian American female nonsmokers

      Alice S. Y. Lee, MD | Conditions
    • From Moscow Mule to the opioid crisis: Unveiling the tragic legacy and urgent solutions

      Osmund Agbo, MD | Meds
  • Past 6 Months

    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • An inspiring tribute to an exceptional radiologist who made a lasting impact

      Kim Downey, PT | Conditions
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Proactive risk management: a game-changer in preventing physician burnout

      Howard Smith, MD | Physician
  • Recent Posts

    • The alarming epidemic of physician burnout and how we can combat it

      Tomi Mitchell, MD | Physician
    • A retired physician’s battle with moral injury

      Hayward Zwerling, MD | Physician
    • Unveiling the secrets to effective resuscitation and overcoming obstacles

      Deepak Gupta, MD | Physician
    • Georgia’s new law promoting truth and transparency in health care credentials

      Carmen Kavali, MD | Policy
    • Physician employment contracts: the key to fighting burnout and improving working conditions [PODCAST]

      The Podcast by KevinMD | Podcast
    • A tense family drama unfolds as a young daughter pursues unconventional career path

      Osmund Agbo, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 9 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Wildfire Health Risks; An Rx for Love; Francis Collins' Graduation Serenade
  • Foot Doc's Second Murder-for-Hire Accusation; Doc Accused of Drugging, Raping Women
  • House Democrats, Republicans Spar Over Changes Needed for CDC
  • Drug Shortage Worsens; AI, 3D Printing Potential Grows; Cancer's Effect on Function
  • Trial Affirms Safety of Circulatory-Death Heart Transplants

Meeting Coverage

  • Extra Follow-Up Confirms Benefit of Nivolumab in Muscle-Invasive Bladder Cancer
  • Studies Question Role of CDK4/6 Inhibitors in First-Line Advanced Breast Cancer
  • For Some, Sex Is Better Sleep Aid Than Pill, Small Survey Finds
  • Skipping Radiotherapy 'Seems Safe' for PMBCL Patients in Remission
  • Promising Gene Therapy for Overactive Bladder
  • Most Popular

  • Past Week

    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

      Anonymous | Physician
    • The tragic story of Mr. G: a painful journey towards understanding suicide

      William Lynes, MD | Physician
    • The rising threat of lung cancer in Asian American female nonsmokers

      Alice S. Y. Lee, MD | Conditions
    • From Moscow Mule to the opioid crisis: Unveiling the tragic legacy and urgent solutions

      Osmund Agbo, MD | Meds
  • Past 6 Months

    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • An inspiring tribute to an exceptional radiologist who made a lasting impact

      Kim Downey, PT | Conditions
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Proactive risk management: a game-changer in preventing physician burnout

      Howard Smith, MD | Physician
  • Recent Posts

    • The alarming epidemic of physician burnout and how we can combat it

      Tomi Mitchell, MD | Physician
    • A retired physician’s battle with moral injury

      Hayward Zwerling, MD | Physician
    • Unveiling the secrets to effective resuscitation and overcoming obstacles

      Deepak Gupta, MD | Physician
    • Georgia’s new law promoting truth and transparency in health care credentials

      Carmen Kavali, MD | Policy
    • Physician employment contracts: the key to fighting burnout and improving working conditions [PODCAST]

      The Podcast by KevinMD | Podcast
    • A tense family drama unfolds as a young daughter pursues unconventional career path

      Osmund Agbo, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Suboxone for pain makes sense. Why don’t more doctors prescribe it?
9 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...