Reckitt's Suboxone Strategy Is Really About Patients Or Profits?

[Jabberwocky]

Please forgive me if this has already been posted. It's what you might call a two-part-er

Late last month, Reckitt Benckiser created a stir by unexpectedly announcing that its Suboxone tablet for treating opioid dependence will be withdrawn from the US market sometime over the next six months. The reason? The drugmaker, which is based in the UK and actually best known for household cleaning products, expressed concern that children could be accidentally harmed by easy access to tablets that are marketed in bottles.

In making its case, Reckitt cited specially commissioned data showing “consistently and significantly higher rates of accidental unsupervised pediatric exposure” with Suboxone tablets than with Suboxone Film, a newer version of its drug that dissolves under the tongue and can only be accessed by tearing open individual blister packaging. Specifically, the rates for Suboxone tablets were roughly eight times greater (please read here).

Reckitt Benckiser Pharmaceuticals has a moral obligation to act as quickly as possible on safety data relating to its products,” a spokesman wrote us, noting that a risk management strategy, which included patient education, was in place since 2003 in an effort to minimize accidental exposure to children. But data indicated a rising rate of pediatric exposure in recent years, at least until the film version was introduced in 2010.

“…Based on the safety and public health issues raised by the recent findings and the availability of treatment advancements in the United States that have shown reduced pediatric exposure, such as Suboxone Film, Reckitt Benckiser Pharmaceuticals believed it would be unethical to continue supply of Suboxone Tablets and therefore informed the FDA of its decision,” he continued.

The very same day, though, Reckitt also filed a Citizen’s Petition with the FDA, asking the agency not to approve any generic versions of Suboxone tablets unless the manufacturers implemented “national public health safeguards involving pediatric exposure educational campaigns and child-resistant, unit-dosed packaging to reduce the risk of pediatric exposure” (here is the statement and here is the citizen’s petition).

To generic drug makers, some physicians and Wall Street analysts, however, the moves amounted to a transparent one-two punch designed to delay lower-cost generic tablets from reaching the market. The patent on Suboxone tablets, in fact, expired two years ago, while patent on Suboxone Film expires in 2022, according to the Reckitt spokesman. “If Reckitt is so concerned about safety,” says one industry source, who asked not to be named, “then why not take the tablets off the market right away? Their tablets are still on the market without blister packing, which they themselves say is unsafe.”

Meanwhile, Reckitt has gradually raised the price of Suboxone Tablets in order to switch patients. The current wholesale average cost (WAC) for a bottle of 30 Suboxone Tablets is $161.70 for the 2 mg dose and $289.80 for the 8 mg dose, according to the Reckitt spokesman. In July, however, the same bottle of the 2 mg dose cost $140.00 and the 8 mg WAC was $252.00, industry sources say. Meanwhile, Suboxone film pricing has held steady: WAC pricing for a carton of 30 Suboxone Film strips remains $117.85 for the 2 mg dose and $211.15 for the 8 mg dose.

More recently, sales of Suboxone tablets fell 19 percent between August 2011 and August 2012, to $658.5 million, according to IMS Health, while sales of Suboxone film doubled to more than $764 million during the same period. “They are (removing the tablets) because generics are expected in 2013 on the tablet,” says Sanford Bernstein analyst Ronny Gal. “The critical question is whether their argument that film is always safer for children will convince FDA not to approve any oral solid generic.”

For these reasons, the back-to-back announcements have been met with outrage. “They have known for years that a generic tablet could destroy their golden calf — and Suboxone is Reckitt Benckiser, from an earnings standpoint. If they do not destroy the tablet, it destroys them,” Jeff Junig, a psychiatrist at the University of Wisconsin Oshkosh Student Health Service and an assistant clinical professor of Psychiatry at the Medical College of Wisconsin, wrote in a letter to Alcoholism & Drug Abuse Weekly.

“I’m sure I sound… paranoid? Cynical?,” wrote Junig, who also authors a blog about Suboxone. “But it is so frustrating when you see marketing trump science. This will discourage generics from making buprenorphine, which will keep the price high, which will cause deaths. Shame on them.” Buprenorphine is one of two active ingredients in the Suboxone medicines; the other is naloxone. About 20 percent of profits are reportedly derived from pharmaceuticals, although this is dwarfed by household products.

“Doctors are questioning Reckitt’s motives, because there are tons of kids who die from ingesting other narcotics, including methadone, and these aren’t required to be (packaged) in film or are in film,” says Alison Knopf, editor at Alcoholism & Drug Abuse Weekly, which is read by policymakers, addiction treatment specialists and government agencies. “They think eliminating generic competition is the real reason this is being done and they’re concerned because they know there’s demand for a less expensive medication” than the film.

“Because there are numerous NDA and ANDA products in the buprenorphine class, in the interest of public health and to reduce the burden on the healthcare system of multiple unique REMS programs, we have determined that a single, shared system to implement these REMS programs is needed. You must contact the sponsor of the reference listed drug for your ANDA, Reckitt Benckiser Pharmaceuticals Inc., regarding the development of the single shared system,” the FDA wrote to generic drugmakers last year (here is the excerpt).

For months, though, this effort has stalled, according to industry sources, who tell us Reckitt has not given any indication that it will cooperate in designing such a REMS and has not shared some of the specifics with the generic drugmakers. “There are many components in their REMS, and these can be very stringent, but Reckitt won’t tell us what they are. They’ve seized upon this and used the situation to their advantage. And no progress has been made,” says a source.

The Reckitt spokesman, however, denies this. The drugmaker “has been diligently participating in discussions with both the FDA and other constituents on the development and structure of a joint REMS program to address the risks associated with the misuse, abuse and pediatric exposure of buprenorphine products for the treatment of opioid dependence. While the company cannot discuss specific details about the program, Reckitt Benckiser Pharmaceuticals has been actively engaged in these multiparty discussions,” he wrote us.

Nonetheless, a single, classwide REMS has yet to emerge. And by filing the Citizen Petition last month, Reckitt will likely delay generic competition for several months more. Why? The FDA can take up to 180 days to respond. Between the lack of a unified REMS and the agency obligation to review the citizen petition, generic rivals will likely remain on the sidelines. Meanwhlie, Reckitt will continue to sell both versions of Suboxone.

At the same time, questions have also been raised about Reckitt’s willingness to design blister packaging for Suboxone tablets. Experts say blister packaging is preferable to bottles. “Child resistant caps on pill bottles help, they are a deterrent, but are far from perfect,” says Rick Dart, director of the Rocky Mountain Poison and Drug Center and executive director of the RADAR System, which Reckitt retained to analyze Suboxone safety data. “There are other ways of making products resistant to children… Blister packs are one way.”

Reckitt actually sells the tablets in blister packaging in other countries, such as Canada (see page 22 of the monograph) and the UK. Critics say the drugmaker should have been able to do the same in the US and note that the company has acknowledged pursuing such packaging, but a Reckitt spokesman maintains there were several reasons this was not pursused, including a different formulation in the US.

“Any changes to the packaging would require a new submission with supporting data to the FDA and would take an extended period of time,” he writes us, adding that Reckitt tried to package the Suboxone Tablets into blister packs and “faced many challenges, including stability. With the development of Suboxone Film, the company was able to introduce child resistant, unit-dose packaging with the same active ingredient before it was able to identify and resolve the packaging issues experienced with Suboxone Tablets.”

In a footnote in the citizen’s petition, Reckitt also stated the company did not develop unit-dose packaging for their Suboxone tablets due to “technical issues involving the integrity of the tablet when attempting to remove it from the packaging.”, and that “later studies revealed that unit-dose packaging of Suboxone may be feasible” but “RBP focused its resources on the development of Suboxone Film” (this is footnote 57 on page 22.)

To Junig, the debate over packaging is a side show. “If it is impossible to produce the tabs in unit-dose form, they are essentially blocking generics if unit-dosing is required, since only (Reckitt) can make the film,” he writes us. “And if they can convince the FDA that they pulled the tab for safety reasons, that kills any new application for generic Suboxone. If they just stopped making the tab for any other reason, they would lose that ‘protection.’ It’s pretty tricky.”

From: http://www.forbes.com/sites/edsilve...gy-is-really-about-patients-or-profits/print/

 

[Jabberwocky]

The Other Side of the Tracks

This is the article I found the Forbes one referred to in.

Opiate maintenance treatment is a tale of two cultures. People who can afford Suboxone get to keep their addiction private. People who are restricted to methadone clinics pay the price of stigma.

Traditional approaches to addiction recovery have championed abstinence as the “right” path. Maintenance treatment for heroin or opiate painkillers has been used very cautiously—typically to rapidly taper addicts off opiods rather than for long-term use. As a result, when Hazelden announced last month that it will begin using medication-assisted treatment indefinitely for appropriate patients, many traditionalists responded with incredulity.

Opiod maintenance in the US primarily relies on two drug options: methadone, which has been around since the 1960s, and buprenorphine, which came on the market 10 years ago. Both drugs work by triggering opiate receptors in the brain, easing withdrawal and reducing the euphoric effects of heroin. Buprenorphine (brand name Suboxone) also includes naloxone, the anti-overdose drug that is added to prevent abuse.

Experts generally agree that Suboxone is more effective than methadone, but not by much. Studies have found that the recommended dose of Suboxone is better than low-dose methadone, but no better than high-dose. Yet methadone poses a greater risk of overdose and is easier to abuse. All things being equal, therefore, bupe is the preferred treatment. But all things are not equal, and most unequal is a patient's ability to pay.

The cost of bupe maintenance varies: many private insurance plans cover the drug, together with prescribing doctor’s visit; for people who pay out of pocket, the cost ranges roughly between $250 and $500 a month, not including doctor’s visit. Long a cheap generic, methadone is much less expensive. It is also more likely than Suboxone to be covered by public health insurance—though this varies by state—and some nonprofit and government-funded methadone clinics use a sliding scale to set patient co-pays.

“Suboxone is a white-collar alternative to methadone and NA," Tom says.

The cheaper generic version of Suboxone expected in 2013 may be postponed. Manufacturer Reckitt began hiking prices on Suboxone tablets earlier this year, likely in an effort to migrate Suboxone maintenance patients to the costlier sublingual film version for which they hold a patent through 2022. Now, Reckitt has announced its intention to withdraw the tablet form over the next six months, citing an increased risk of accidental pediatric exposure and poisoning. (Oddly, Reckitt did not move to immediately pull the tablets.) As a result, cheaper generic buprenorphine that would likely expand access is set to be delayed for "safety concerns."

Compare the situations of Tom and Jenna, who in many ways exemplify our nation's two classes of opiate maintenance patients.

Tom, who lives in Atlanta and is 25, began using opiods as a freshman in college. Throughout high school he had experimented with “alternative” drugs like psilocybin mushrooms and LSD, and steeping an opiod tea seemed like the next step in his drug evolution. But when eBay began prohibiting the sale of the dried poppies he had been purchasing, Tom went into withdrawal for the first time. He moved from snorting heroin to shooting it, eventually dropping out of college to become, as he put it, a “full-time junkie."

By the time Tom decided to get a handle on his habit and return to school, he had defaulted on his college loans. His school has a hardship clause; if he could demonstrate that chemical dependency was at the root of his default—and agree to maintenance therapy—he would could go back to college and be granted partial forgiveness on his loan interest. His private psychiatrist wrote him a prescription for a 30-day supply of Suboxone. He’s been on the drug for the past two years and is set to graduate this spring.

Tom’s Suboxone regime is expensive—$500 a month with doctor's visit—but health insurance through his parents’ policy covers the entire cost. And he is happy with the treatment. It has allowed him to be more functional with no “druggy side effects.” He has gone off Suboxone occasionally to binge on other opiods, but infrequently, he says. For now, he has no plans to stop buprenorphine, and his parents are willing to foot the bill for health insurance after he ages out of their policy.

Tom has not gone to 12-step meetings or other addiction-related therapy during his maintenance treatment—such attendance is rarely a requirement for bupe. By contrast, most methadone maintenance programs are highly regulated and often require meetings for eligibility. Tom never considered taking methadone for maintenance, saying that he wanted to avoid daily clinic visits and registering with the government for a program for people who are chemically dependent. “Suboxone is a kind of white-collar alternative to methadone and NA," he says. "If you come from a family with money and have health insurance, you can take it and you don’t have to do any program.”

Jenna, a 34-year-old mother in Denver, has taken methadone almost continuously for 15 years. She is on Medicaid—public health coverage for low-income Americans—and her local methadone clinic has a special program for mothers. Her weekly co-pay for methadone is $27. She also attends 12-step meetings where her fellow members are generally accepting of her methadone maintenance. Jenna says that she and most of her friends on methadone would prefer to take Suboxone, but they can’t afford it: Colorado’s Medicaid program does not cover bupe, and private health insurance is too expensive.

The growing number of private doctors prescribing Suboxone is causing a quiet treatment revolution.

An ongoing study of buprenorphine maintenance in New York CIty has found that it is typically available based not on a patient's need but on their pocketbook, and poor people need not apply, according to Laura G. Duncan, the study's research coordinator. As for those on Medicaid, coverage of bupe, when available, usually requires jumping through a series of bureaucratic hoops. Patients sometimes need a referral from a primary care physician or specialist, which further jacks up the price.

Methadone maintenance is generally provided through Opiod Treatment Programs (OTPs), some of which also offer other services such as inpatient detox and counseling. A 2008 SAMHSA study found that 72% of OTPs without additional services used only methadone—no buprenorphine. In 2010 some 304,500 opiate users in the US got medication-based treatment from an OPS; of these only 2% were on bupe. A total of 27,500 opiate users received buprenorphine; of these 76% were prescribed the drug outside of OTPs—through private insurance.

The growing number of private doctors prescribing Suboxone is causing a quiet revolution in addiction treatment. In order to write a scrip for bupe, which is a Schedule III narcotic, doctors have to receive a waiver, which involves completing at least eight hours of training. A recent SAMHSA survey found that 53% of waivered physicians had no prior experience using methadone for maintenance; 56% were in nonaddiction specialties.

The vast majority of doctors who prescribe bupe have affluent caseloads. Those who serve poor and uninsured patients tend not to get the waiver, presumably on the assumption that their patients cannot afford the treatment, according to Duncan. “Bupe is still unusual in low-income medical settings due to economic inaccessibility, so providers there may not be as knowledgeable about it." Even those doctors who are aware of Suboxone tend not to waste time educating patients about unavailable treatments. This cycle reinforces itself.

The evolving view of addiction as a disease of the brain rather than as a moral failure has had important implications for both addicts and doctors. Only a decade ago, addiction was generally considered outside the scope of a non-addiction psychiatrist or a primary care physician; now buprenorphine is sparking more and more opiate addicts to get treatment independent of the traditional recovery routes, particularly methadone clinics. "We have the mainstreaming of addiction treatment into [general] medicine with Suboxone," Duncan says. "In primary care a patient tends to have a partnership with their doctor. No one has to know."

For people who depend on traditional recovery at methadone clinics it is a very different matter—they face the traditional stigma that attaches to addiction. The best example? The speed and frequency with which "Not in My Backyard" protests spring up at the very mention that a methadone clinic might be located in the neighborhood. This stigma may be taken for granted, and the problems it causes are predictable.

Irish researchers studying methadone treatment at OTPs this year found that "linkages between social control and institutional stigma that serve to reinforce 'addict' identities, expose undeserving customers to the public gaze, and encourage clients to be passive recipients of treatment." A federally funded study of methadone policy found that "frequent clinic visits hinder patients' full reintegration into society by restricting their ability to travel and imposing continued contact with less stable patients. Such restrictions may also deter out-of-treatment patients, who see an unending, inconvenient and stigmatized regimen." In this way, the necessity of daily visits to a methadone clinic can prevent people who are in recovery from recovering their place as functional and respected members of society: once an addict, always an addict. As a result, some opt out of methadone treatment; others opt out of society to go on treatment.

People who depend on traditional recovery at methadone clinics face traditional addiction stigma.

Another important difference between methadone and buprenorphine is their dosing requirements. People on methadone must make frequent visits to the clinic—usually daily for the first 30 to 90 days—to receive their doses in order to prevent “diversion,” the act of misusing or selling the drug. Those prescribed Suboxone, however, may get anywhere from a week’s to a month’s supply. In most states, methadone maintenance patients are allowed a month’s worth only after showing two years of compliance—clean drug tests and, often, mandatory counseling or meetings. (In Florida, it is five years.) When traveling, methadone-takers must put in a vacation request at their clinic to qualify for extra medication, or “take homes”; if they do not qualify, they have to set up courtesy dosing at a clinic near their destination. Bupe-takers merely pack the right number of pills.

The emerging approach to treatment—non-specialist physician prescriptions for opiod dependence—has its own drawbacks. Many people in recovery benefit from a combination of medication and self-help or counseling in order to address the many issues related to addition. But in a recent SAMHSA study, 41% of bupe patients had attended no substance abuse or mental health counseling sessions in their first month of treatment. On this score, methadone clinics that require such attendance may have an advantage.

The disease model of addiction is widely perceived as resulting in a decrease in stigma. (It could be argued that popular culture's obsession with celebrity—and their high rates of substance abuse—has done more.) Yet the stigma persists, especially for people who live on the margins because of the color of their skin or the size of their income—those who stand in line at the nation's methadone clinics. While no less an "addict," a person who is on Suboxone can, if desired, entirely skirt the stigma by keeping their disease private, even a secret, including no public acknowledgement at a clinic or a 12-step meeting. As Tom points out, bupe is white-collar maintenance; methadone is for everybody else.

There’s nothing new in how society confers social stigma on those who live on have nots. If we truly believe addiction is a medical disease, then it seems cruel to restrict the economically disadvantaged to the treatment that is more burdensome in terms of risk, adherence and disrespect. Making Suboxone available at methadone clinics will not magically make stigma disappear, but it is likely to improve the odds of a successful recovery for people who have nowhere else to go.

From: http://www.thefix.com/content/methadone-Suboxone-stigma-maintence-treatment8555?page=all

 

[Captain.Heroin]

Pharmaceutical companies make drugs to make money... are people really surprised by this?

I for one am glad they are switching to films only. Buprenorphine is buprenorphine; less inactive ingredients, better for people like me who are micron filtering. %)

 

[drug_mentor]

^ Umm, I think you might be missing the point a little bit mate. The point is that Reckitt isn't doing this to reduce harm but to try and maintain as much monopoly of the buprenorphine market as possible, which limits generic/cheaper alternatives. This potentially stops people who would otherwise be able to afford getting on bupe from being able to and then they are stuck in the cycle of heroin addiction or have to go on methadone which they may find less effective or too much of a hassle to dose at a clinic daily.

It is pretty selfish of you to be happy just because it makes your recreational drug use a little easier or safer, but potentially blocks more affordable options for people looking to get on OMT. I know you have a history with heroin addiction and frankly I am a little surprised you don't take a more negative view of big pharma blatantly exploiting addicts...

 

[caseface99]

Damn your still on bupe huh? Been how many years now? (directed at CH)

I just finally got off of it at the end of August. Ended up doing a 30 day inpatient to pull it off, Acute withdrawal lasted 21ish days - and I still take large amounts of gabapentin for the physical PAWS symptoms. Even with the gaba i get hot flashes and a few other symptoms(however more mild/less often) and without the gaba, it feels like it's only been a few weeks since I've been off. No improvement since about day 30 either. Fuck suboxone.


The real issue here isn't whether the tablets are safe, it's whether bupe is safe in the first place - what the long term effects are. Why does a drug prescribed for seizures and Nerve pain(gabapentin) decrease my symptoms by at least 70%? Or better yet why do i need to be prescribed ANYTHING for withdrawal symptoms months later, which i wouldn't have to do had i just used strait up opiates instead of doing bupe maintenance? Seems to me like they should be asking these questions and finding real answers, and maybe throwing this out there at some point in the 8 hour lecture doctors get before prescribing this, because from my experience most Dr.s think it's no different than heroin or oxy in terms of physical uncomfortableness after the acute withdrawal phase with is a disgusting bit of misinformation. I've done heroin while in acute withdrawal from pure suboxone dependance and still felt noticeable undertones of bupe withdrawal while high on the heroin.

 

[23536]

Excellent articles, toothpastedog!

 

[Mass08]

Very interesting read. I didn't realize that methadone clinics force you to participate in NA and counseling, I respect that. I still think abstinence is the best choice!!

 

[23536]

I didn't realize that methadone clinics force you to participate in NA and counseling

I think Federal law requires them to give you counseling. As for forced NA, I think that should be unconstitutional because it can be argued that NA is a religion. The mother of all ironies was when my methadone clinic sent me to NA and NA did not allow me to speak about being on methadone. I think that is a policy of the fellowship. EDIT: Yah here it is:

NSFW:

Regarding Methadone and Other Drug Replacement Programs
This bulletin was written by the World Service Board of Trustees in 1996. It represents the views of the board at the time of writing.

Not all of us come to our first NA meeting drug free. Some of us were uncertain about whether recovery was possible for us and initially came to meetings while still using.

Others came to their first meetings on drug replacement programs such as methadone and found it frightening to consider becoming abstinent.

One of the first things we heard was that NA is a program of complete abstinence and "The only requirement for membership is the desire to stop using." Some of us, upon hearing these statements, may have felt that we were not welcome at NA meetings until we were clean. But NA members reassured us that this was not the case and we were encouraged to "keep coming back." We were told that through listening to the experience, strength, and hope of other recovering addicts that we too could find freedom from active addiction if we did what they did.

Many of our members, however, have expressed concern about individuals on drug replacement programs. Questions come up regarding such individuals' membership status, ability to share at meetings, lead meetings, or become trusted servants on any level. "Are these members clean?" they ask. "Can one really be a 'member' and still be using?"

Perhaps by answering the most important question first—the issue of membership—we can establish a context by which to approach this issue. Tradition Three says that the only requirement for NA membership is a desire to stop using. There are no exceptions to this. Desire itself establishes membership; nothing else matters, not even abstinence. It is up to the individual, no one else, to determine membership. Therefore, someone who is using and who has a desire to stop using, can be a member of NA.

Members on drug replacement programs such as methadone are encouraged to attend NA meetings. But, this raises the question: "Does NA have the right to limit members participation in meetings?" We believe so. While some groups choose to allow such members to share, it is also a common practice for NA groups to encourage these members (or any other addict who is still using), to participate only by listening and by talking with members after the meeting or during the break. This is not meant to alienate or embarrass; this is meant only to preserve an atmosphere of recovery in our meetings.

Our Fifth Tradition defines our groups' purpose: to carry the message that any addict can stop using and find a new way to live. We carry that message at our recovery meetings, where those who have some experience with NA recovery can share about it, and those who need to hear about NA recovery can listen. When an individual under the influence of a drug attempts to speak on recovery in Narcotics Anonymous, it is our experience that a mixed, or confused message may be given to a newcomer (or any member, for that matter) For this reason, many groups believe it is inappropriate for these members to share at meetings of Narcotics Anonymous.

It may be argued that a group's autonomy, as described in our Fourth Tradition, allows them to decide who may share at their meetings. However, while this is true, we believe that group autonomy does not justify allowing someone who is using to lead a meeting, be a speaker, or serve as a trusted servant. Group autonomy stands only until it affects other groups or NA as a whole. We believe it affects other groups and NA as a whole when we allow members who are not clean to be a speaker, chair a meeting, or be a trusted servant for NA.

Many groups have developed guidelines to ensure that an atmosphere of recovery is
maintained in their meetings. The following points are usually included:

• Suggesting that those who have used any drug within the last twenty-four hours refrain from sharing, but encouraging them to get together with members during the break or after the meeting.
• Abiding by our fellowship's suggested clean time requirements for service positions.
• Seeking meeting leaders, chairpersons, or speakers who help further our primary purpose of carrying the message to the addict who still suffers.

We make a distinction between drugs used by drug replacement programs and other prescribed drugs because such drugs are prescribed specifically as addiction treatment. Our program approaches recovery from addiction through abstinence, cautioning against the substitution of one drug for another. That's our program; it's what we offer the addict who still suffers. However, we have absolutely no opinion on methadone maintenance or any other program aimed at treating addiction. Our only purpose in addressing drug replacement and its use by our members is to define abstinence for ourselves.

Our fellowship must be mindful of what kind of message we are carrying if a still-using addict leads a meeting, or becomes a trusted servant. We believe that under these circumstances we would not be carrying the Narcotics Anonymous message of recovery. Permissiveness in this area is not consistent with our traditions. We believe our position on this issue reinforces our recovery, protects our meetings, and supports addicts in striving for total abstinence.

Note: This bulletin addresses the use of methadone maintenance as a drug replacement strategy. It is not addressing the medicinal use of methadone as a pain killer. We encourage those who have concerns about the use of methadone in pain management to refer to Narcotics Anonymous pamphlet, In Times of Illness.

http://www.na.org/?ID=bulletins-bull29

 

[amanitadine]

Great articles! And screw you numbers, just reading that NSFW brought back all that language I had to suffer through as part of the 23,536 NA/AA meetings I was required to go for my early release probation. Funny thing was, methadone wasn't even on the twice weekly UA tests required. Nor was bupe. Or benzos. But PCP was, and "qualudes" was an extra option. Fucker needs updating. Gotta love the 5 panel test. Gotta love even more NOT having spooks sifting through your urine twice weekly.

I know Reckitt Benckiser makes Chore Boys too. They should get into the "love rose" industry and get that market locked down.

 

[Jabberwocky]

At captain and comments on him:
Just because you have yours shouldn't make you OK with this. I'm well past my dope days and, having gotten off cold turkey, am pretty passionate about others having the incredible value offered by things like methadone and nalox/bupe.
And there's little wrong with still being on a maintenance product IMO. I know some who'll prolly never be okay w/o theirs, not at this point in life anyways, yet with their subbies they're living "normal" lives and not dopehead lives. I hate being around anything to do with opiates, but honestly consider maintenance ppl 100% clean in practical


Re NA:
being part of the AA family means it has the 12rules- one of which is acknowledging a higher power. That is religious. Telling clients they "can make the higher power anything, even a rock" does nothing to change the religious nature (and is an offensive move IMO anyways...acknowledging religion means you're misguided, acknowledging a rock makes you retarded)

 

[Captain.Heroin]

^ Umm, I think you might be missing the point a little bit mate. The point is that Reckitt isn't doing this to reduce harm but to try and maintain as much monopoly of the buprenorphine market as possible, which limits generic/cheaper alternatives. This potentially stops people who would otherwise be able to afford getting on bupe from being able to and then they are stuck in the cycle of heroin addiction or have to go on methadone which they may find less effective or too much of a hassle to dose at a clinic daily.

It is pretty selfish of you to be happy just because it makes your recreational drug use a little easier or safer, but potentially blocks more affordable options for people looking to get on OMT. I know you have a history with heroin addiction and frankly I am a little surprised you don't take a more negative view of big pharma blatantly exploiting addicts...

There are already Subutex generics; there are not going to be any Suboxone generics based on the absurd cost of naloxone.

I think the issue is that too many doctors aren't willing to prescribe anything but Suboxone because they are ignorant, and believe Suboxone is going to not be able to be abused whereas Subutex can be. The sooner doctors realize this is not true, the sooner they can start prescribing generic Subutex for patients - especially those who cannot afford the brand name.

I get the point, I just think doctors are MUCH more to blame than R&B.

Damn your still on bupe huh? Been how many years now? (directed at CH)

3 and a half years I believe.

At captain and comments on him:
Just because you have yours shouldn't make you OK with this. I'm well past my dope days and, having gotten off cold turkey, am pretty passionate about others having the incredible value offered by things like methadone and nalox/bupe.

What's your point?

I personally believe the government should subsidize the cost of ORT if they were actually invested in winning the war on drugs. The fact is, they are not, and they would rather keep money in the hands of the government, instead of actually spending it to actually help people.

 

[Jabberwocky]

I'm very pleased to see all these comments

Excellent articles, toothpastedog!

I only do it for you ya know :D

I'll try and share more of Dr H's stuff from Heroin Helper too, although I'm way less active around that blog since work picked up (i.e. since I became employed ).

-----

On a more personal note, I've been on bupe now almost exactly a year. I still love it, although I'm not taking Tagamet daily any more for obvious reasons (I don't need boobs). Occasionally when I do take it I love the buzz. Lots of diphen, but that was always the case for me on opioids. Anyways...

My perdiciment is that I got on the sub via my mom's insurance. Since I'll be getting kicked off the 'rents insurance in the summer of '13, I have been planning on ways to deal. Honestly bupe/sub maintenance continuing would be ideal (got on it with the intention of being on it for a while, like 3-5yrs). There is a chance I'll have insurance through work, in which case I will be able to stay on it.

I was so hoping that they'd come out with a generic sub pill by now. On the one hand, I'd be able to better control my dose (sniffing the pills always worked best for me), although the 2mg strips are so big they're easy to control dosage (just so wasteful sublingually - I can't deal with intranasal strip use no pun intended). On the other hand, I'd be able to afford a generic sub pill under pretty much any circumstances.

Hopefully I'll be able to stay on suboxone. If I can't though, because I don't have enough work insurance or the generic sub pill doesn't come out by then (seems like it won't), I'll have to look into alternatives: MMT, Kratom maintenance and PPT maintenance. Frankly I wouldn't be so against the kratom maint, but I was planning on that after I'm done with suboxone anyways, even if it would have been five years on the bupe. I just don't think the kratom will be enough 1.5yrs into the process, and I'll more likely go for MMT or PPT.

That will have to do totally with what my living situation is and where I find myself (in some areas I would be able to make my own PPT from seed to brew, where in others MMT would be easiest). So upset about this suboxone thing, the pills not going generic on the market anytime soon... Then again, if only my doc wasn't so dumb, as most sub docs are - not all, most - cause then I could just avoid the whole problem by getting Rx'd generic subutex/bupe instead of suboone/bupe+naloxone, given that there is no practical difference in the med given my circumstances, in which case all my problems (potential problems) this summer will be solved.

Who knows what'll happen though. And the story keep changing, it took me a while to get the OP info here from the fix and opiophile and whatnot. I'm happy whenever I find not a shitty article on the fix... they don't have enough of them! not shitty articles I mean (although there are a few )

At captain and comments on him:
Just because you have yours shouldn't make you OK with this. I'm well past my dope days and, having gotten off cold turkey, am pretty passionate about others having the incredible value offered by things like methadone and nalox/bupe.
And there's little wrong with still being on a maintenance product IMO. I know some who'll prolly never be okay w/o theirs, not at this point in life anyways, yet with their subbies they're living "normal" lives and not dopehead lives. I hate being around anything to do with opiates, but honestly consider maintenance ppl 100% clean in practical


Re NA:
being part of the AA family means it has the 12rules- one of which is acknowledging a higher power. That is religious. Telling clients they "can make the higher power anything, even a rock" does nothing to change the religious nature (and is an offensive move IMO anyways...acknowledging religion means you're misguided, acknowledging a rock makes you retarded)

Well said. If you read my blog posts (yes I was a needy child) I think you'll find theres a lot we agree about, even if I am obviously still on and will almost certainly continue on, opioids... even if our perspectives, some of our values, and/or positions irl right now are vastly different... still a lot to agree with and explore vastly might not be the right adjudicative to use there

 

[Captain.Heroin]

I was so hoping that they'd come out with a generic sub pill by now.

This isn't going to happen; naloxone is really costly, see my comments above. My gut instinct is that R&B probably designed Suboxone to be something that generics couldn't compete with. Regardless, there probably will never be a generic for Suboxone.

There are generics for Subutex, and it's up to doctors and patients to educate themselves on the uselessness of naloxone while taking buprenorphine, so that people who cannot afford Suboxone can get generic Subutex.

It's really the doctors who should be blamed for being ignorant to pharmacology.

Hopefully I'll be able to stay on suboxone. If I can't though, because I don't have enough work insurance or the generic sub pill doesn't come out by then (seems like it won't), I'll have to look into alternatives: MMT, Kratom maintenance and PPT maintenance. Frankly I wouldn't be so against the kratom maint, but I was planning on that after I'm done with suboxone anyways, even if it would have been five years on the bupe. I just don't think the kratom will be enough 1.5yrs into the process, and I'll more likely go for MMT or PPT.

Generic subutex is still an alternative.

 

[Crankinit]

While the fact that they're making this move to block generics enrages me, I actually do prefer the strips to the tablets. They dissolve much faster, fit into your mouth with greater ease and even taste (slightly) better).

 

[Jabberwocky]

T

Generic subutex is still an alternative.

one that should have supplanted methadone by now IMO. When i was going through my absurdly-intense cold turkey, i was able to score a couple of palliatives during the week or two the w/d's were still getting worse (due to the methadone cessation- i c.turkey'd off oxy+methadone+temazepam+valium, all in high dosages except the valium). I had a single 8mg bupe or sub pill and maybe 5 or 10 methadone, in total, acquired or given during the 1st couple weeks, and honestly that single bupe pill was heads and shoulders above the methadone, i mean worlds better, i was able to use the bupe in QUARTERS coming from 90mg methadone+150+oxy and still notice it had effect!!)

Bupe is still recreational tho, is it not? To some degree, even if in opiate-naive individuals?(or, maybe, in cessated individuals who're very close to clean?) "Block"-pills that're psychoactively/physically inert are the wave of the future, quicker we get the pills that can be taken to make (opiates; nicotine; whatever) completely, 100.0% subjectiely pointless for hte user to take, we'll have significantly altered the landscape of addiction.

 

[Jabberwocky]

Yea, sub/bupe is very recreational for some people - especially those who have a very small habit but can't find any opioids, so the bupe gets them not sick and a little high assuming they haven't developed too much of a tolerance. Then again, for some, even people who like opioids, bupe just makes them sick, even at really low dosages - and obviously for these people it's not recreational. Frankly, I got high from bupe for a really long time - it became my drug of choice for a lot of reasons - and it's only been recently after being on it on a daily basis for almost a year where I won't get high from it unless I take tagamet or something, which I still do once in a while, or skip a day or two to get myself into the early early stages of w/d so I'll feel it. Sad.

Yea, subutex is still an option, I just doubt it is with my current doc. I want to avoid switching docs atm, so I'm just going to ride this out. Until the spring at least then I'll have to make a move one way or the other...

And yea, imo bupe>>>>>methadone, although like I said I might have to eventually look into the latter. Probably would try kratom and ppt before that, but one never knows...

 

[Jabberwocky]

when i said bupe>methadone i meant for tapering/maintenance means; i know i enjoyed methadone about as much as my oxy tbh (recreational potential being an absurd quality in taper/maintenance products).
not trying to derail too much but do ppl ever do naloxone-only therapy? I mean, let's say theoretically you could esterify naloxone like we do to extend release of hormones (testosterone), making therapy w/ such product result in ZERO subjective response to opioids? Seems some level of naloxone would provide full blocking from all but the strongest synthetic carfents and whatnot..Or am I missing something here?..
If a product was safe and w/o abuse/recreational potential (ie a compound with such benefits, not a 'preparation' as they are always beaten w/o exception), then mass-availability is much more realistic (in this cultural climate); the result on opiate dependence could be HUGE. I know many many users who'd LOVE access to shit like suboxone, and have wanted to get it for ages, but are still just run of the mill oxy heads. I've also seen how strong the films are as taper/maintenance for others, and while i know the bupe is useful there or even on its own, a straight-up antagonist like naloxone is a better path to pursue IMO.

 

[23536]

not trying to derail too much but do ppl ever do naloxone-only therapy? I mean, let's say theoretically you could esterify naloxone like we do to extend release of hormones (testosterone), making therapy w/ such product result in ZERO subjective response to opioids? Seems some level of naloxone would provide full blocking from all but the strongest synthetic carfents and whatnot..Or am I missing something here?..

There is depot naltrexone. http://www.vivitrol.com/ Very scary stuff from what I've heard. It's not an ester; the time release mechanism is mechanical, not chemical. It lasts a month. Some people on Bluelight have literally asked how to rip the pellets out of their arms because it causes them massive unpleasantness (one of the side effects of naltrexone is deep dysphoria if I'm not mistaken).

Not that naltrexone is totally undesirable; I read somewhere that it shortens the post-coital refractory period for men--just like opiate withdrawal sometimes results in hypersexuality.

Buprenorphine has higher affinity than naloxone or naltrexone though. I theorize that Vivitrol would do little to prevent buprenorphine from working. Indeed, how does a doctor or paramedic deal with a buprenorphine overdose?

 

[Captain.Heroin]

Bupe is still recreational tho, is it not?

Yeah, it sure is. Ever hear of this movie?

http://en.wikipedia.org/wiki/Reindeerspotting

 

[Jabberwocky]

LOL never noticed that before!! thanks for the suggestion Capt'n