A nurse from CRAN answers your questions

4. I’m a family physician and I’d like to know if opioid medications can be prescribed for pain relief for a person who is on methadone treatment.

Yes, for acute pain, for example, postoperative pain, a fracture or tooth extraction. A user who is receiving methadone treatment often needs a higher-than-usual dose of opioid pain medication because of his higher tolerance and because the pain may not be relieved by the usual dose. The dose of the opioid will then have to be tapered to prevent withdrawal. In this type of situation, the patient may relapse and abuse the tablets prescribed for him.

3. I’m having methadone treatment and I’d like to transfer to buprenorphine, but I’m afraid to because I heard that if I have an accident such as a fracture, buprenorphine will make pain medication ineffective.

If the dose of buprenorphine is less than 8 mg, pain can be effectively relieved with opioid medications.

At a higher dose, buprenorphine’s properties effectively reduce the efficacy of other opioids in relieving pain. In this case, buprenorphine will be discontinued temporarily. It is recommended to plan to have a short-acting medication that will make up for the buprenorphine, while relieving the pain.

2. I’ve just started my treatment and I have to leave in six months for Western Canada. I’ll be spending three months in a place that’s a long way from any large urban centres. What are my options?

It’s important to clearly understand that opioid addiction treatment has a number of restrictions, including medication management. The Collège des médecins du Québec’s guidelines do not authorize more than one month of take-home doses for stable patients. You can change pharmacy provided the new pharmacy dispenses the medication and accepts prescriptions written in Quebec. As a last resort, you can be weaned off the medication. However, it would be an enormous challenge to apply this solution in such a short period of time.

1. I’m a community pharmacist. It’s Monday and I’m calling you because on Saturday, Mr. X came to the pharmacy after missing his doses at the counter four days in a row. He said that he hadn’t missed any because he had some of his own, that he had collect

Yes. A pharmacist should not provide buprenorphine after three missed doses even if the patient says he took his own medication. The same applies to methadone. It’s important to refer the patient to his health care team, which will have to reassess the patient before restarting the prescription. The dose will be lower, to be safe. The team will also look into the matter of the hoarded doses doses.