As I give my last post more thought…. I wonder if there is ANY clinical difference between $uboxone at $7 per dose, vs. generic buprenorphine at $2.33 per dose? Researchers out there– can anyone send me a reference? A review of the science shows that Suboxone is clinically identical to buprenorphine.
Read my last post for details– but the essence is that naloxone is destroyed when Suboxone is taken properly (orally, sublingually), and has no action whatsoever– on that issue there is scientifc agreement (although there is a great deal of ignorance among prescribers about this fact). The ONLY think naloxone does, is to supposedly serve as a deterrent to IV injection of buprenorphine.
Sounds good, but… we know that people divert Suboxone intravenously, naloxone and all. Buprenorphine binds opioid receptors very tightly- so tightly that the naloxone doesn’t effectively compete with buprenorphine.
The State of WI requires Medicaid patients to take expensive Suboxone Film, whereas in other cases they require prescribing the generic. What is the argument for requiring the film? RB would argue (now that the tablet has lost the luster of being on-patent) that the film is harder to ‘divert’– i.e. to inject. But frankly, the intravenous diversion of buprenorphine is a tiny issue compared to things like heroin addiction and a budget crisis. Most of the diversion of buprenorphine, either Suboxone or generic, is not injected, but rather taken orally to ward off withdrawal– and the film makes no difference in that case.
Insurers, likewise, are wasting millions of dollars (literally) by paying for Suboxone— sometimes exclusively(!) Have the bean counters fallen asleep on this issue?
I have nothing personal against Reckitt-Benckiser, beyond the fact that they refuse to engage in conversation with me. If the good Brits at RB have discovered a way to suck millions of dollars from the weakest members of society, more power to them. But I am a big fan of intellectual honesty, particularly in regard to the science behind medical practice. So if someone has evidence that $uboxone is clinically different than generic buprenorphine, whether used properly or injected, please send it my way.
3 Comments
jimW · October 27, 2011 at 7:34 pm
My sense from the medical literature is that in countries where pure buprenorphine is the norm, abuse by injection is frequent enough to be an embarrassment for the treatment / medical community. I am thinking of France, New Zealand and Italy.
I am equally concerned about the cost, and see patients struggling. I am also worried that if rx a lot of pure buprenorphine we may see something a shift in the culture and a rise in injection.
Incidentally we use SL buprenorphine in the hospital where I work. I had one patient get IV buprenorphine, low dose, due to protracted vomiting. It was clear that when his vomiting cleared up he a little manipulative to remain on the IV moving over the SL. It seems the “liking” for IV was significantly higher than SL bup.
SuboxDoc · November 2, 2011 at 9:18 pm
There are anecdotes of greater diversion of buprenorphine in Europe– whether that is true or not is not clear. The studies I’ve seen on that issue are largely from a time when ONLY buprenorphine was available, as the pain med Temgesic. But if European physicians are better ‘thinkers’ than their US counterparts and don’t fall for the scam, there will naturally be higher proportionate use of the generic– meaning that ANY diversion there will include buprenorphine, as well as Suboxone.
I think that you miss the point– that there is no clinical difference between plain buprenorphine vs Suboxone. I do not share your fears, nor even do I find your fears logical– since injecting buprenorphine has the same effect as injecting Suboxone. Greater use of buprenorphine has no reason to impact IV diversion– as it has no greater utility as an IV agent than does Suboxone.
I am constantly frustrated, and amused, as I witness prescribers refusing to allow this fact to ‘compute.’. Patients who have taken both medications KNOW it, and GET it– but for physicians, the combination of ego, hubris, and effective marketing has seemingly turned off any ability to think critically. Crazy!
Matt2 · October 30, 2011 at 12:24 pm
I’m still blown away by how little most nurses and doctors I’ve encountered know about buprenorphine treatment/maintenance. It still seems as though most of them think buprenorphine is essentially the same thing as methadone or some other form of a more addictive opiate agonist. I’ve even come across a doctor who told me that since I was on buprenorphine I wouldn’t need any other medication when I had a tooth pulled lol! I could barely finish the conversation because of how upset I had become. I really wanted to ask him if he had the slightest idea of how “tolerance” works lol. My point is I have seen firsthand (as I’m sure we all have) of how important educating medical professionals really is. Keep on fighting the good fight Dr. Junig