Dr. Roach: Is son’s slow withdrawal from opioid treatment too slow?
Dear Dr. Roach: Can you tell me the best way for a person to withdraw from Suboxone and how long it usually takes? My son was an opioid addict and has been on Suboxone films for four years for his recovery. He is now very gradually weaning off of it by reducing the amount he takes each week. This has been going on for months. His physician is overseeing it, and together they determine the percentage he is to reduce it by. I have since heard that this is a brutally painstaking way to do it -- not that all of this hasn’t been brutal -- and that he would be better off going to a hospital and going through the withdrawal there, in a much shorter time period. Also, I’ve read that four years is a terribly long time to be on Suboxone and that he never should have been on it for that long. Can you help to clarify?
Dear Anon.: Suboxone is a combination of two medications that partially block the effect of opioids. It is an effective treatment for opioid withdrawal symptoms. However, it is not, by itself, a treatment for opioid dependency, and should be used as part of a comprehensive treatment. This is done by an expert in addiction medicine.
Suboxone can be used for short periods of time, say four to 12 weeks. I have seen patients on it for as long as a year, and have read that it may be used for longer, but four years is beyond my experience. However, that does not mean it may not be appropriate. Stopping opioids suddenly leads to withdrawal symptoms, while slow tapering generally prevents these bad symptoms. Too-rapid withdrawal may make relapse more likely.
I am relieved to hear that the doctor is slowly reducing the amount, as most experts feel the goal is to be off of all opioids. As with methadone, some experts use Suboxone long term to prevent relapse. I can’t say whether this treatment has been ideal for your son, but it does sound like there is a plan and he continues to progress.
Dear Dr. Roach: I’m 83 years old, and had two stents inserted in my left artery. I have been on atorvastatin, atenolol and amlodipine. At my recent yearly cardiologist visit, my blood pressure and cholesterol were fine.
Your response in a recent column seemed to suggest that atorvastatin should be stopped at 85 years old. Is that true?
Dear M.C.M.: Statin-type drugs can be given for primary prevention — that is, when a person has no known illness and the doctor wants to prevent the first heart attack — or for secondary prevention, when a person is known to have blockages in the artery and may (or may not) have had a heart attack.
In the case of secondary prevention, the benefits from statin therapy are so great that it is appropriate to give them, even to the oldest patients, except in the cases where there has been a conscious decision to stop treatment (for example, in people with untreatable cancers who choose to do so). The benefits outweigh the small risks of statins, even though those risks may increase with advancing age.
By contrast, the benefits of statin drugs in primary prevention are smaller, and the potential risks are similar to or exceed potential benefits as people get older. There is no specific age cutoff when this happens, but most people 85 and older do not get a net benefit from statins when they do not already have a diagnosis of blockages in the arteries or history of heart attack.
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