Hey friends 👋🏻 You and I are probably thinking the same thing. What exactly is the patient withdrawing from? Do I need to start thinking about buprenorphine? In case you haven’t seen my carousel, I was once approached by an attending because they weren’t too sure what the patient was withdrawing from. All I knew at the time was this: SP! The patient said they were taking “pain meds” and are now withdrawing. The urine drug screen was negative for opioids but positive for ben

Hey friends 👋🏻 I’m being a bit selfish in this week’s newsletter because I want to do a quick reflection on some non clinical skills that I find helpful in navigating my job. And if I were to do another reflection later this year, I want to see if I would still say something similar, or if I would have changed my mind in some aspects. To give you an idea of the things I need to achieve in my job, here are a few tasks I usually do: Review the chart and pick out pertinent con

Hey friends 👋🏻 As I was preparing for the second episode of the Opioid Conversion Book Club Series over the last two weeks, I came across a very interesting piece from Fast Fact called: Opioid Orders: Good and Bad Examples 😬 That’s a pretty pointy title at first glance. Good and bad. So there’s going to be opinion involved. Judging something as good or bad has a lot to do with someone’s taste. And someone’s caviar can be someone else’s durian. So for this week, how about

Hey friends👋🏻 Burr 🥶 It’s cold even here in Florida today. I hope you’re staying warm wherever you are. I haven’t written about buprenorphine for a minute, and I told myself, How about going back to the very basics, the drug label, for inspiration? So there I was. I pulled up the Belbuca drug label and started spotting a lot of hidden gems. For this newsletter, let’s start with the very first sentence in section 2.3, Initial Dosing. https://www.belbuca.com/pdfs/belbuca-pre

Hey friends 👋🏻 I just finished reading my first book of 2026, and it’s called Unreasonable Hospitality . I picked this book because I was so impressed by the politeness and hospitality in Japan. If you haven’t read my newsletter about Japan, check it out . And it got me thinking- What is it about hospitality that left me with such a phenomenal impression of Japan? If I had to summarize this book into 3 takeaways out of so many good lessons, I’d say: Your team needs to want

Hey friends 👋🏻 I had a random question the other day- How does China practice pain management? Do they have an opioid of choice? To give you a bit of historical background, my birthplace, Hong Kong, was colonized by Britain after China lost the Opium War. The British ruled Hong Kong for 156 years. If there is one thing I know about Chinese culture growing up in Hong Kong, shame is one of the worst feelings a Chinese person or a Chinese family would avoid at all cost. China

Hey friends 👋🏻 First things first, I want to wish you a happy new year! Reflecting on what I do as a pain management pharmacist, a lot of the consults I deal with involve opioid management, especially doses that are considered “high.” I’m using quotation marks here not to be politically correct, but to acknowledge that we don’t really have a working definition of high or low dose when it comes to opioids. I say this because if I were to ask you, What dose would you consider

Hey there 👋🏻 I named this newsletter The Life of a Pain Management Pharmacist earlier this year because: If you’re here to read about pain meds all the time, it gets dull My life isn’t just about pain meds. There are perspectives and values I want to share too I’ve used life stories before to spin on a clinical idea, but I rarely just write about my life. So here I am. I’m going to write about the vacation I took over the last few weeks. Customer Service in Japan Is World

Happy Early Thanksgiving 🦃 Every now and then I would recommend using a different pain scale than a numeric pain score if patients are non verbal or having cognitive impairment. The scale is called Pain Assessment in Advanced Dementia Scale (PAIN-AD). It makes sense to use it if we look at some of the grading of this scale Breathing Negative vocalization Facial expression Body language Consolability All the grading are not self reported, so it relies less on the ab

Hey there👋🏻 I picked up an interesting book two weeks ago called When Everyone Knows that Everyone Knows . The core concept of the book boils down to something called common knowledge, which the author defines as: When A knows that B knows, and B knows that A knows that B knows, and so on. A good example is language. I’m writing this newsletter in English knowing my readers know English, and my readers know that I know they know how to read in English. So that got me thinki

Hey there 👋🏻 Remember that poll I did about the confusing morphine renal adjustment instructions? I started thinking, if I had to explain that to a first year medical, pharmacy, or nursing student, how would I go about it? What kind of context would I need to fill in for it to make sense? So let me try that this week. How to interpret “Administer 25–50% of the usual initial dose” if we’re referring to IV morphine? There are two technical steps here: a. You need to understa

Hey 🍂 We just moved the time an hour back, and I can feel the weather changing. I hope you’re excited if you enjoy wearing layers and having a cup of hot chocolate on a chilly morning. This is also around the time residency applications start. I remember back then everyone was doing one of these things: Comparing what programs others were applying to Reaching out to upperclassmen about their residency experiences Feeling excited yet overwhelmed about the application while st

Hey 🎃 Every now and then, I hear debates about how oral morphine equivalent (OME) or morphine milligram equivalent (MME) can be flawed. And I get it. But there are times you just can’t get away from the concept of OME/ MME, or you’d have no guidance. Maybe you could still guess the dose right without it. But there’s one principle that will instantly upset a patient: Start low, go slow. Here are 7 scenarios that have everything to do with OME/MME: A cancer patient on a stable

Hi there 👋🏻 I’ve always had a love hate relationship with patient controlled analgesia(PCA). It’s such a powerful tool, but the dosing can get complicated fast. One of the biggest reasons PCA causes problems is that many clinicians start it with this assumption: “Oh yea! Their pain isn’t controlled. The PCA lets them press the button whenever they want, and therefore they’ll have better pain relief.” Jinx? That’s why I wrote this week’s newsletter. Before starting a PCA, yo

Hey there 👋🏻 The other day I made a post about dosing the fentanyl 12mcg patch. Technically, I should really be calling it the fentanyl 12mcg/hr patch. But did you know it doesn’t actually deliver 12mcg per hour? If you look at the package insert, you’ll see two asterisks next to the 12mcg dose: Source: https://www.accessdata.fda.gov/drugsatfda_docs/label/2005/19813s039lbl.pdf Nominal delivery rate is 12.5 mcg/hr. That’s right! The fentanyl 12mcg patch actually delivers 12

Hi there 👋🏻 We just released our latest video on 7-OH. If you’re curious about the compound that’s been making headlines and want to...

Hey there 👋🏻 If you read the last newsletter, you know this week is the birthday special edition. 🎂 Yes, getting another year older as...

Hey there 👋🏻 We have something exciting coming up. We’re working hard on our next video about kratom and 7-OH. If you haven’t watched...