I am a physician and I am in with 15000 shares. My specialty is PM&R (Physical Medicine and Rehabilitation). I have been treating pain and addiction for many years. I have been prescribing Suboxone for 10 years. In my opinion, Probuphine is a major step forward and it has a very important new aspect that will make it very usefull for many if not the majority of all current Suboxone patients. I will try to explain. Suboxone is a great therapy that has enabled millions of opioid dependant patients to stabilize and regain their lives. I have witnessed this probably more than a thousand times over the past 10 years. However, the problem with Suboxone is that it is very difficult to taper down and discontinue it once the patient is stable. In my experience, more than 90 percent of all stable Suboxone patients experience big time difficulties and struggle to discontinue Suboxone while they have been stabilized and free of other opioids for years. Very few (less than 10 percent) are able to discontinue Suboxone. The majority will give up and accept the status quo called maintenance.
Probuphine has an inherent new advantage over Suboxone. If left in place for longer than 6 months it will gradually and naturally taper down slowly over a long period of time. There will be no acute withrawl syndrome. Essentially, this patient may actually be almost cured. If the patient has no cravings, feels stable, has strong family support, has a job, all that will be needed is to remove the device at some point. If the situation is still unstable, patient has cravings but is still committed to abstinence from opioids, I would most likely follow with Vivitrol untill stable. For those who chose to relapse after the 6 month period, it's their choice. However, based on my experience, I doubt it that that there will be many in the last group. Most people learn from experience.
To be continued...
What about the S/A artical and the points the author pointed out of which I know some are truley valid
Who will install the devise who will pay for the devise. The doctors usually dont accept insurance I know this to be absolutly true As I have first hand knowledge to this what about the possible lost revenue to the doctors office ?? As I agree this has huge potential and will likely recieve approval getting doctor to subscribe it with possible risk and lost revenue to themselves could be a real challenge.. These are serious valid points what is you view the points of the artical ???
well shows you don't know much of the field scottad, for one most of those using it won't be using insurance it will be paid for by govt. and on govt. formulary. As, for who will implant(install? seriously?) maybe you should tune into the ADCOM meeting or at least a CC or two.
A trained medical provider will do the procedure. Google how it is done. It's honestly a slap in the face to insinuate that a doctor of medicine, who went to medical school for 4+ years, can't do the procedure after being trained for 8 hours.
Insurance will pay for the procedure. If not, it can be worked out. If Titan accepts the REMS from the FDA, the patient will have to pick up the implants and take them to the doctor, so it will be the same as Suboxone at the pharmacy. Each implant has ~80mg of the drug in it, so there is no reason to get them and not have them inserted. Get the pills if you want to divert it(5 16mg pills is equal to 1 implant). What is your first hand knowledge?
Patients will go back. A doctor can offer a patient 5-10 rescue pills a month. That will do the trick and it will be cheap thanks to those brand new generics we have on the market.
Thanks Doc, I totally get your point about the very gradually diminishing output of a rod beyond six months. I also thought this would be a huge advantage and a way for an addict to slowly forget he isopiate dependent. The actual act of taking suboxone is a daily affair and even when the addict is down to 4 mg, it still is difficult to go to 0 mg. The probuphine system will avoid that dilemma. In addition, an addict who is on the rods is already receiving a low but constant plasma level, there are not the ups and downs that the addicts associates with the use, withdrawal, use again cycle. By providing an absolutely constant amount, the addict is not getting the triggers that he will get with suboxone. Its nice to get the perspective of both a medical doctor with experience in the field. It has been long appreciated that the more constant an opiate level can be maintained, both the better the pain control of that opiate as well as the decreased likelihood of abuse. Probuphine is tops in that regard and should definitely become a go-to choice in the field of addiction and eventually pain.
Sentiment: Strong Buy
And yet another Dr. expresses reason.... It's very sad there aren't more like you consulting on FDA panels topop88. As the crisis grows, I imagine this discussion will become popular in both the medical and governmental communities. By then, hopefully Probuphine will have saved thousands of addicts, their families, friends and neighbors from lives of anguish and despair. The circle of horror around an addict extends far beyond the individual, so I view Probuphine from that perspective in that it won't just be helping those addicted. Thanks for taking your valuable time to comment here doctor. Please do so again.
To conclude, I believe that Probuphine is a major new therapy for Opioid Dependence that has an inherent advantage over Suboxone. It holds the potential to become the standard of care in the future. Time will tell but based on my experience in the field, I can see its potential. And I think that I am not alone. The physicians who treat Opioid Dependence will recognize that immediately. We are in the midst of a big epidemic and a crisis. The Government knows that better than anyone. I have no doubt that it will be approved and I cann't wait to start using it.
Hey Doc, thanks for your insight and perspective; it's much appreciated. I had a question: I've read that it usually takes longer than six months to beat an opioid addiction, so it seems to me, because the patient needs follow-up treatment, the logical step would be to produce implants with lesser amounts to continue the tapering off until it's whipped. I've also read some posts from alleged admitted addicts who contend that you can't use a one-size fits all model anyway - each user takes different doses of their drug, and their bodies have a set tolerance level so using the same amount for everyone might work for one person but might cause severe withdrawals to another patient tolerant to heavier doses. Wouldn't that be where the doctor steps in and decides how much probuphine the patient needs to begin their program? I haven't heard this aspect of the treatment discussed from either side, by Titan or the FDA - is this being overlooked? Or is the amount of dosage determined by the number of rods implanted? And then would the physician prescribe the amount needed?
Thanks Doc, Anyway you can get a petition going with all the other physicians you know and around the United States that would be willing to sign it for the Approval of Probuphine. Yes it sounds silly but if petitions help and or work for New Laws and Proposititions that people are trying to push. I say go for it! If it works for school boards, and unions, and used in Washinginton. Lets push it on the FDA too! We have nothing to lose, this is a fight that we must win!