Diversion potential for Suboxone

Buprenorphine Post
Posts: 64

Postby adavid » Fri Mar 04, 2016 10:44 am

Buprenorphine in all its forms can be a drug of abuse. Yes, people can get high by taking excess Suboxone Film sublingually but that can be expensive. The preferred method of getting high on bup is to crush and snort the Subutex or the generic Suboxone tablets. With a half life of only 30 min and only competing with bup for receptors, naloxone is of dubious deterrent to abuse. Injecting Suboxone Film to get high is also wide spread. I have also been educated on how to snort the Suboxone Film. One way is to dissolve the film in a small amount of water then snort the solution through a straw. Another way is to microwave the Film until it gets brittle and then one can crush and snort it. Bunavail on the other hand is much harder to abuse. The backing of the patch makes it impossible to snort and if one tries to dissolve the patch the backing turns into a gelatinous mush making it difficult to draw into a syringe. Also, Bunavail contains only 4mg of bup. If one dissolves and injects an 8gm Suboxone Film one gets the full 8mg of bup.

Posts: 32

Postby mattkeene » Fri Mar 04, 2016 10:44 am

I suspect the diversion of suboxone is much higher than we are willing to admit. Take a look at what has happened recently with Tenncare. The managed medicaid system there recently transitioned all patient from generic suboxone to Bunavail. In doing so, nearly 50% of the patients who were coming to these State funded clinics simply stopped coming. You have to ask why? Either Bunavail was so ineffective that patients simply walked away from free treatment, or some were getting their suboxone for less than honorable reasons. I've used Bunavail with frequency and find it to be quite effective, so I don't think it is an efficacy issue. But most patients simply have not heard of Bunavail, and as such, it's street value is much much less. Furthermore it's in that gummy matrix that makes it much more difficult to extract into solution compared to other forms of bup/nal.

I agree with Dr. Passer. I seldom will call in additional meds for patients. The 2 exceptions are:
1. When I begin to taper a patient off their med, I let them know if they have difficulty with cravings/withdrawal to contact me and if appropriate, I would call in the "delta" to get them back to their prior dose.
2. When patients go in for significant dental work and/or outpatient surgery where narcotics would typically be prescribed, I will speak to the dentist/surgeon to make certain they know not to RX narcs, but instead I will temporarily up there bup/nal dose along with a good dose of an NSAID...you would be surprised how effective that actually is.

Posts: 1404

Postby drpasser » Fri Mar 04, 2016 10:44 am

He or she would only have to take one dose of bupe, appropriately timed before a monthly drug test, to test positive for bupe.

No early refills. Any pt of mine who calls after running out of bupe, needs to come in for a UDS before I Rx more.

No exceptions.


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