Buprenorphine Post
Posts: 111

Postby fishdoc » Tue Jan 13, 2015 6:56 am

I have had more than 5 patients on Bunavail. Two were switched from film because of insurance and the others were new starts. My partner has started more than 10. Our patients all are happy with Bunavail and felt it was equal in dose. They all like the fact that it is easier to take and they can apply it to the cheek and drive to work. Obtaining Bunavail, though, has been difficult, to say the least.

I spoke to 2 pharmacists today who have ****ured me they will stock Bunavail after receiving the first prescription, but they would need 24 hours for the medication to arrive, so it seems it will be necessary to prescribe the first day as either Suboxone, Zubsolv, or generic.

CVS stated the cash price for 56 4.2mg patches would be $468 while a local chain indicated $508 for the same.

Posts: 187

Postby Dave » Tue Jan 13, 2015 6:56 am

I gave one patient half of his script for Bunavail and the other half his usual Suboxone film. He really did NOT like the Bunavail, which he said would not stick well to his buccal mucosa sometimes, and he could not get it to stick after trying to replace the patch. He wanted to cut it in half and that using the halves made it worse. He said he was in partial withdrawal while he was trying to use it and did not want to hear about Bunavail again. Cutting it sometimes made it difficult to tell which was the correct side to stick on his cheek. I think this was when he was trying to cut it into smaller pieces, which he did later in trying to make it last to get to his next appointment. Of course he used larger than prescribed doses when he found it wasn't working well. So this agrees with Dr. Passer's experience. At least one other I know of also did not like Bunavail. I haven't heard of a good experience yet at our office, but then I haven't heard a lot about it so far.

Posts: 1404

Postby drpasser » Tue Jan 13, 2015 6:56 am

Well, now there are two. (Bunavail rejects. I'm batting 600)

It would seem like, the dosing is wrong and the Bunavail is not really twice as potent, milligram to milligram, compared to, say the Film or the generic tabs.

The same thing happened with Zubsolv. The dosing was off, relative to what the manufacturer recommended. I am pretty sure, giving closer to a comparable dose of bupe of what pts are used to receiving, would likely do the trick. Two pts in a row, said the exact same thing about their response to Bunavail.

Live and learn. :-)

I'm going to dose my next pt with a greater amount, and see how that works.

Of course, it's not at all good for this stuff to happen, as a lower effect=>cravings=>relapse.


Posts: 1404

Postby drpasser » Tue Jan 13, 2015 6:56 am

So, I've started five pts on Bunavail. Just now, I had my first "reject." The pt said, she doesn't like it and is requesting to resume the generic tabs. I do not believe it's so she can snort the tabs.

She said, the Bunavail took 90 minutes to "go away," and all the while, it "clumped up." She also reported increased cravings, apparently due to lack of effects, and she became irritable and "snappy" over the few days she tried it. I think, I gave her an appropriately equivalent dose, compared to her 20 mg/day bupe dose.

I think, she did it correctly, and gave it the ole college try. I switched her back to the tabs. She even offered to give me the remainder of her Bunavail (which I do not want), which makes me tend to believe even more, that she just didn't do well with it.

Anyway, that's the dealio.



Posts: 64

Postby adavid » Tue Jan 13, 2015 6:56 am

Bunavail rep showed me a graph demonstrating that blood levels attained with Bunavail 4mg were slightly higher than those with Suboxone film 8mg.

Posts: 137

Postby deegee » Tue Jan 13, 2015 6:56 am

After the Zubsolv bio-availability issues, what have you found with Bunavail? I think they are comparing to tablets, so I wonder if a 50% dose reduction will really pan out to be the same as an 8mg film.
I agree that it's an exciting new development and I'm eager to start using it.
A good reminder for patients is "The writing is on the wall" meaning that the writing side goes against the wall of the cheek.
Or as I say, "up against the wall, #$@##@ #$%^^&"

Posts: 1404

Postby drpasser » Tue Jan 13, 2015 6:56 am

Good info
Good post

I've started four pts on it. I have yet to hear feedback, but I'm pretty sure, if it didn't work, I would have had pts call immediately. No call = a good thing.


Posts: 64

Postby adavid » Tue Jan 13, 2015 6:56 am


Ladies and gentlemen, boys and girls: As many of you have realized the jenny out of the bag. Buprenorphine has become a drug of abuse.
Ten years ago when I took then the course the get Xed I walked away with the belief that people could not get high on bup. Just as with the old formulation of OxyContin which was promoted to be less abuseable, because it was slow release, and which turned out to be highly abusable if snorted or dissolved and injected, the claim that bup is not abusable is totally dependent on patients taking the bup by dissolving it in their mouth. It is all too evident by now that if bup is snorted or injected people do get on it.
Furthermore, the claim that the naloxone is a deterrent to abuse has also proven to be a myth. Bup has an extremely long half-life whereas naloxone has a half-life of only 30 min. And furthermore it does not displace bup from opiate binding sites; it only competes with bup for the bindings sites. That explains the myriad of reports I heard over the years of people injecting both Suboxone tabs and Film to get high. In fact bup/Suboxone is now the preferred drug of choice in many neighborhoods. I have heard may patients report that with heroin they have to dose every four hours or so but if they inject Suboxone Film or snort Subutex they get a buzz that lasts all day long.
Fortunately we now have a White Knight: Bunavail! If you have as yet not looked at it you should. It is bup/naloxone painted onto a one cm sq biodegradable patch that adheres to the buccal mucosa. It has several antidiversion properties. First the plastic looking patch would be almost impossible to snort. Second, if it is dissolved with the intent of drawing it into a syringe the backing dissolves too and turns into a mush making aspirating into a syringe difficult. Third, Bunavail has twice the bioavailability of Suboxone or Subutex so to make the patch equivalent to the Suboxone 8mg the manufacturer had to put only 4mg of bup in the patch. So if a malefactor were to dissolve and inject an eight mg Suboxone strip they would inject 8mg of buprenorphine. But if this malefactor were to dissolve a Bunavail 4mg patch they most he would theoretically be able to get is 4mg of bup. BUT, the mush that the dissolving matrix will greatly interfere with aspiration process with the result that only a small fraction of the 4mg would become available for injection.
In addition, the price at the local pharmacy should be the same or less than that of Suboxone film. In addition, the manufacturer just informed me that they have made arrangements with a mail order pharmacy to deliver Bunavail from a mail order pharmacy. I checked and the cost per Bunavail 4mg patch and it is less than $5.40 for a 4mg patch. They FedEx the medicine to the patient's home overnight. Almost all the insurers have been covering it. The company also has a coupon so insured patients only have to pay a maximum of $10 for a months script
And there is more! Because the patch keeps the bup on the buccal mucosa and away from the taste buds the patient does not experience the bitter taste of the buprenorphine they all complain about.
For the past three months all my new starts have been on Bunavail. The only complainers have been those who obviously were only interested in diverting.

Posts: 70

Postby mack86 » Tue Jan 13, 2015 6:56 am

pharmacies can get it in a day or two if they have a script. I have written for a few subutex to cover until it gets in


Posts: 180

Postby entjwb » Tue Jan 13, 2015 6:56 am

I have not used yet but will when I know it is in most pharmacies in my area.

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