SINGAPORE : A general practitioner has been fined $5,000 and censured for failing to exercise due care in the management of patients with Subutex. Dr Soo Ing Choong of Familycare Clinic and Surgery at Block 85C Toa Payoh Lor 4 faced 32 charges in all.
He was convicted for offences committed between September 2002 and August 2006. The Singapore Medical Council's disciplinary committee found that Dr Soo had inappropriately prescribed Subutex on an indefinite basis to his patients and that this was not an accepted medical practice.
He also did not exercise an acceptable standard of diligence and care in relation to these patients who were prescribed Subutex on an indefinite basis. Dr Soo had also failed to properly maintain the relevant patients' records as required of registered medical practitioners.
He will have to give a written undertaking to the Medical Council that he will not engage in such conduct and pay costs of the inquiry. In making its decision, the disciplinary committee also considered several mitigating factors, including the absence of a breach of the Ministry of Health's October 2005 Guidelines.
There was no persistent practice by Dr. Soo to co-prescribe Subutex with other potentially addictive medicines, and that he had practised as a physician for about 15 years without any prior complaints. Subutex was banned in 2006 following rampant abuse. - CNA/jy
Buprenorphine, sold under the trade name Subutex, is a long-acting opiate primarily used to treat narcotic (opioid) dependence. It is most commonly sold as a pill that dissolves under the tongue. Its main purpose is to prevent withdrawal symptoms from occurring in an individual, by stimulating the opiate receptors in the brain. Subutex has a greater attraction to the opiate receptors than other drugs such as heroin and methadone, which reduces or removes the desire to take such drugs. <table border="0" cellpadding="0" cellspacing="0" width="100%"> <tbody><tr> <td width="57%">Subutex binds so tightly to the opiate receptors, that taking heroin or methadone will have little or no effect. This drug is generally used in narcotic drug treatment programs, and prescribed in varying doses. The effects of subutex are less pronounced than those of other opiates, giving the individual the feeling of being somewhat "normal" once more. Suboxone is a variant of subutex, containing an additional ingredient called naloxone. It is the form generally given to patients. Its effects are the same as Subutex.
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</td> </tr> </tbody></table> Now, crack is being sold at prices low enough that even adolescents can afford to buy it. But, this is misleading, since once a person is addicted to cocaine, his "habit" often increases, and so does his expense. Side Effects
Subutex (buprenorphine) can cause a drug dependence. If the use of subutex is suddenly stopped, the individual may experience withdrawal symptoms and/or the desire to relapse and consume the addictive drug once more. Subutex is usually administered in daily doses ranging from 12mg to 16mg per day. Subutex is not for occasional use. It is to be used as a continuous treatment method and may become dangerous if usage is stopped too quickly. When mixed with other drugs (antidepressants, alcohol, sleeping medicine, etc.), subutex may enhance their effects and cause serious health hazards. Subutex can cause death from overdose if injected with a tranquilizer. Do not take any other medicine that is not approved by a health professional while on subutex.
Subutex received a less restrictive classification than other opiates. It is also less expensive, and becoming increasingly easier to obtain on the black market. Theses factors are contributing to amplify the number of drug addictions to subutex. The worldwide community is already beginning to feel the repercussions of subutex, as related in the International Herald Tribune: <table border="0" cellpadding="0" cellspacing="0" width="100%"> <tbody><tr> <td width="55%">"Consumption of buprenorphine nearly tripled globally from 2000 to 2004, according to the UN's International Narcotics Control Board, increasing to 1.7 billion DDD, or defined daily doses, a World Health Organization statistical measure of drug consumption. "In some countries, such as Finland," the board's 2005 report said, "buprenorphine has become the most important illicitly used substance for opiate addicts; in some illicit markets, it has almost totally replaced heroin."
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</td> </tr> </tbody></table> The fact that buprenorphine costs less than heroin and is more accessible has hastened the development of illegal markets in various countries. Buprenorphine manufactured in India, for example, is smuggled into Nepal and Sri Lanka, as well as Bangladesh, where it is used by 90 percent of the country's intravenous drug users, according to a UN Drug and Crime report last year. A 2004 report from the U.S. National Drug Intelligence Center lists "lucrative" black markets for Subutex in Britain, Germany and New Zealand."
Fined $5k for Subutex lapses Four doctors convicted since Jan 2010
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SMC said Dr Soo, while practicing at the Familycare Clinic and Surgery, was too lax when prescribing Subutex tablets, which could be used by heroin addicts to get high. He failed to draw up proper management plans for his patients and to keep detailed records of them. -- ST PHOTO: MALCOLM KOH
