Forget about the Aesthetics of Buprenorphine

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 our first video on the common inpatient pain mistakes, you can check it out here. Stay tuned!

I’ll start off being a bit vulnerable. Last week I picked up a new audiobook called How to Keep House While Drowning. Growing up in Hong Kong, I never had to deal with a lawn mower because a lawn wasn’t a thing for most people. I never had to deal with a leaking toilet either, because my dad or the apartment manager always took care of it.

So when I finally had to face something called “home ownership,” it felt like a learning curve. I sometimes got beat up by the fact that things don’t look the way I imagined they would before I moved in.

In the introduction of the audiobook, something really stuck with me:

Something that looks nice doesn’t always mean it’s functional for you.

This wasn’t just another saying about managing expectations. It was a reminder to actively ask whether something actually serves its purpose, or if it’s just nice to have.

I may still be figuring out home ownership, but I can share with you what’s “aesthetic” and what’s “functional” when it comes to buprenorphine.

You don’t need to fully understand ceiling effects or G protein pathways before you start prescribing buprenorphine.

If you’re struggling with the working knowledge of buprenorphine, forget about ceiling effect and partial agonism. Those are just the extras—the aesthetics. And chances are, even if you understand them perfectly, you won’t be explaining them to a patient anyway for 2 reasons:

1. Most patients get more confused after hearing “partial agonist.”

2. You’ll end up going in circles trying to explain what ceiling effect means.

So let’s focus on the functionality of buprenorphine. Here are five quick things to know:

1. Buprenorphine can be dosed in micrograms or milligrams.

2. If it’s in micrograms, it’s usually for pain.

3. If it’s in milligrams, it can be for opioid use disorder or off label pain.

4. For patients already on chronic opioids, starting with a microgram dose is wise.

5. Patients on buprenorphine can still use conventional opioids like oxycodone.

If you can keep these five principles in mind, start noticing how they apply to the cases in front of you. Take your time.

And only when you have extra time, you can dive into the rabbit hole of partial agonism.

PS: Next newsletter is a birthday special edition. 😉 Stay tuned because I want to celebrate this with you.

See you next time,

SP