It is humorous when companies do what Reckitt-Benckiser recently did– make a small change in their product, then trash the old product in favor of the new, more expensive product. “The OLD formulation is GARBAGE! It poses huge risks! It is reckless and irresponsible to prescribe that tablet (the one that we’ve been marketing for years, that is…)” Is buprenorphine film a step forward or marketing gimmick?
For people who are confused, here is what happened…. Reckitt-Benckiser, the makers of Suboxone and Subutex, used to have a stranglehold on the market for buprenorphine. Profits poured in from selling buprenorphine at ridiculous prices; $6 per tablet in the Midwest for Suboxone, and over $11 per tablet for Subutex. The prices were particularly obnoxious given that the company didn’t invent buprenorphine– in fact, buprenorphine has been around for 30 years, and could be purchased cheaply in bulk quantities. All that RB did was come up with a sublingual formulation, and from that point forward they were essentially printing money. Suddenly a cleaning product company is raking in the big bucks!
Of course at some point, patents expire. Companies often sue to stretch out patents– and profits– as far as possible, but at some point the party comes to an end, and such is now the case with Reckitt-Benckiser and Suboxone. The generic version of Subutex costs as little as $2.80 in my area; RB has been stemming the bleeding from that generic by warning doctors that patients will dissolve and inject buprenorphine if naloxone is not mixed in– something that is exceedingly rare, given the long half-life of the medication, the aversion that most addicts have for needles, and the fact that most diversion of buprenorphine is by people seeking a way to stop using– not by people looking for a ‘buzz.’
More recently Teva, a large manufacturer of branded and generic medications, received approval for their version of sublingual buprenorphine. I have not seen it in pharmacies in the Midwest, at least not yet, but it will be more difficult for RB to deal with this form of buprenorphine– which will essentially be the same as branded Suboxone, only cheaper.
Some states, including Wisconsin, REQUIRE pharmacists to substitute less-expensive generics unless specifically blocked by the prescriber. Insurers, both private and government, also require use of generics in the absence of a compelling reason to use the branded product. That means that to get brand Suboxone, doctors will have to fill out paperwork explaining their reason for requesting the brand. Doctors, of course, hate paperwork, and so I anticipate a huge shift to the generic product once it appears in pharmacies.
RB, then, is in a pickle. So some marketing guy gets the idea to put buprenorphine in a listerine-style breath strip, sell it indiviually packaged, and tell everyone that individual tablets of Suboxone are a huge risk to the public. They tell us that little kids put them in their mouths, that the packaging isn’t safe enough, or that the tablets absorb moisture, making their sublingual dissolution rate unpredictable. Better use the strips intead, they say.
I tried one of the strips– one that was a ‘dummy strip’ that did not contain buprenorphine. The instructions are to put it under your tongue, but as I have written here many times, there is nothing special about the under-the-tongue space, and they can be put on top of the tongue if that is easier; the point is to get the molecule in contact with the mucous membranes that line the mouth. I like the idea of the strip in theory; the absorption of buprenorphine is driven by the concentration gradient of the molecule, and the film helps deliver a highly concentrated dose of buprenorphine to the surface of the oral mucosa.
The film could also conceivably be cut into small pieces using an exacto knife, to help with tapering the drug. But in practice, the film was unpleasant to use. It was thicker than I expected, sort of like a cross between a Listerine strip and a gummy worm. It took longer to dissolve than I expected, and the taste was nasty.
So what is the conclusion? Is the strip a leap forward in safety and convenience? Or is it just an attempt to hang onto a brand? I suppose that answer depends on how you see the world, and how you see a cleaning products company from the UK that struck it big on the backs of US opioid addicts.