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Chronic back pain and Butrans
An_243432 posted:
After a back injury, and several failed back procedures,spinal fusion L3-S1, I was on Opana, the equivalent of 450 mg morphine daily,at a cost of about 3800$ month. I switched to Butrans,which was like coming out of a coma.I like not having the side affects of the heavy opiates after 9 years and so much clearer! I started on the Butrans patch, but the FDA says only 20 mcg/hr 7 day patch is safe, while every other country allows 70 mcg/hr patches. I believe it's similar to the cancer cure problem,they won't allow it unless it involves chemo. The issue here, is a version of this can cure all addicts for about 10$ a week vs. whatever Methadone clinics make. There is some type of opiate blocker in the Butrans, which is great since it works on the pain, but 20 mcg/hr is too little for my pain level. This is the equivilent of 80-150 mg day morphine, but my Dr.'s alternative is to go back to Opana, which I never want to do again. The subject seems to be too much effort for my Dr. research and the new med. is steered more towards addiction clinics.There has to be something that works as well, but stronger, or do I need to leave the country to live a normal life?

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Is there an equivalent to Butrans 20/mcg/hr weekly patch that is stronger w/o the terrible side affects of the strong opiates?
  • yes, and what?
  • alternatives?
  • The only option given me now is to go back to Opana. NOT!
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David Maine, MD responded:
Butrans is a transdermal formulation of Buprenorphine. It is a partial agonist (binder) and the mu and delta opioid receptor but a blocker at the Kappa receptor. The clinical effects are because of it opioid receptor activity. Unfortunately there is not good data comparing Buprenorphine to other opioids (equianalgesic data). Thus, converting the medication is based somewhat on experience. That being said, you likely could be placed on a medication (alternative opioid) that is between the Opana dosing and the Butrans dosing you describe. Side effects can hopefully be managed by changing the dose but it sounds like the drop from high dose Opana to 20mcg of Butrans was probably a bit much as it is not providing effective pain relief. You should discuss these issues with your provider to come up with an optimal dosing (it does not have to be one or the other). Good luck.

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