Buprenorphine Post
Posts: 70

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

I completely agree with you about independently owned pharmacies. For many reasons I so much prefer to deal with them over the big chains, and I encourage my patients to go to them. I think it's a good topic for a separate post.

Posts: 267

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

Often, independent pharmacies, rather than corporate pharmacies, are more responsive to the needs of prescribers and their patients. I try to take the time to keep in touch with our local independent pharmacy personnel because I know who is at the other end of the line. For example, at my request, that pharmacy now provides naloxone with atomizer. I can ask them how the bup products are 'moving' and bring up new ideas like Bunavail.

Posts: 111

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

I have found that, at the first return visit, patients being switched from Suboxone to Zubsolv are more likely to be unhappy with Zubsolv than are patients who are being switched from Suboxone to Bunavail. Also, when patients learn they may continue normal routine, including smoking, with the Bunavail in situ, they are more willing to try Bunavail than they are willing to try Zubsolv.

On the other hand, I have had very few new start patients refuse or complain about either Zubsolv or Bunavail while there are many who complain about the taste of Suboxone.

For the most part, if they have a preference, I let the patient select which brand they desire. However, they are all informed that Suboxone is most expensive if they have to pay cash, and which brand will be approved by their insurance company if there is a preferred brand.

The biggest problem we have encountered is that many pharmacies still carry neither Zubsolv or Bunavail. They then hassle the patient rather than notifying me.

Posts: 70

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

Thanks for your replies.

Jmosby, after of years of neglectful oral/dental hygiene, some of my pts have severe gingivitis with bleeding gums. Some complain the sublingual bup tabs or films irritate their gums. Some others complain of nausea with suboxone but not subutex and I guess theoretically they may be absorbing some of the naloxone via the hyperemic surface of their gums - I have no way to be sure of this, just a hunch. This was the case for one of my N=2 bunavail pts, and he does not report nausea with bunavail.

Dave, I agree with you about Zubsolv. The first pt I prescribed bunavail looked really unhappy when he saw the dose. He was on suboxone 8/2 that he divided and took 1/2 bid (4/1 mg bid). So, he later reported, he decided to take a whole Bunavail as his first dose and immediately realized it was too much, so now he is taking 1/2 bid (2.1/0.3 bid). My rep would not tell me it was ok to cut the films, but did describe the delivery system so that you can see there is no reason not to. It usually seems cheaper for the pts to buy the larger dose and cut them then to buy twice as many of the lower dose.

I don't know how the cost compares to the others. I have some pts without insurance who must pay cash. The pt I mentioned above told me it was a lot of hassle, but his insurance eventually covered it.

Posts: 187

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

Mack86, we have been thinking about Bunavail but were concerned that what seems to be half the dose of bupe than Suboxone8/2 may be another claim like that of Zubsolv, i.e., a claim of equivalence that was not true. I am pleased to hear of your favorable experience, which will give us courage to try it out. The drug-free sample I tried was supposed to disappear after 10 minutes, but I still had sticky stuff on my cheek at 20 minutes. I don't know how that may work out with some people.

Posts: 104

Postby jmosby1469 » Tue Jan 13, 2015 6:56 am

I have no experience with it, but like the idea. Silly question: how does suboxone use differ in users with dental problems from those without?

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