Bupe Methadone / bupe supply about to run out?

[i_am_helix]

I'm on bupe again and I'm starting to get worried about supply because of the coronavirus. Supply chains everywhere will soon slow down or stop and bupe is made overseas from my knowledge.

Im thinking of going to methadone for a while because at least we make our own in Aus but even that could dry up if this goes on long enough. The pharmacies we get this shit from don't really care or can't really do anything to prepare anyway.

Any thoughts on this?

 

[sekio]

I don't think you'll have to worry, methadone and buprenorphine are made and distributed in humongous quantities, and it's not as if all commercial goods coming out of china have stopped entirely.

 

[JessFR]

I'm on bupe again and I'm starting to get worried about supply because of the coronavirus. Supply chains everywhere will soon slow down or stop and bupe is made overseas from my knowledge.

Im thinking of going to methadone for a while because at least we make our own in Aus but even that could dry up if this goes on long enough. The pharmacies we get this shit from don't really care or can't really do anything to prepare anyway.

Any thoughts on this?

I won't lie, I've had this worry too. I think it's pretty natural to worry about it if you're opioid dependant and on a substitution therapy.

However, rationally, I don't think it's worth worrying about. First off... Far as I know methadone syrup is used exclusively for opioid substitution therapy, so it doesn't seem particularly likely that there would be problems due to high demand. Bupe might be a little more likely, but even then, I don't think these are the kinds drugs most at risk. I'd expect antibiotics, antivirals, and antipyetics to be most at risk since they will be used more if a lot more people are sick.

So that's the drug itself, then you have the other 3 risks, precursors becoming harder to get, transportation problems, and individual pharmacies having their staff get sick.

In my experience there are usually a few different pharmacists who work at different times at most pharmacies, so there's some redundancy there. Drug transport it a high priority so it's probably less likely to be left undone compared to other goods. And I don't think it's too likely that precursors which are used for so many things will be allowed to become unavailable during an epidemic. Not unless things got way worse than anyone's expecting.

All that said, yeah, there are risks, things can go wrong. Which sucks, but I don't think it's especially likely.

I brought this up with my pharmacist and she a had a similar view.

But that said, none of us can forecast the future. Ultimately this is one of those decisions you gotta work out in spite of knowing you don't have nearly as much information as you'd like. And difficult though it may be, it's best to try not to worry about anything you can't control.

So yea. I get your concerns. I doubt we're alone in them. But I think our nightmare is still far from certain to come true.

 

[i_am_helix]

Yeah I agree to some degree, but i think when we are in the middle of the outbreak no one will care about us and we won't have anywhere to go but hostpitals if our pharmacists decide to close their shop, and most likely can't get on to another pharmacy immediately. And going to hospital will be a nightmare the chemists there won't care about us. Have you ever been to a hospital and tried to get dosed while you are there, it's a nightmare at the best of times, I waited 2 days once to get dosed and the hospital was half full.

Basically what I am saying is that this is very likely to happen, I have started preparing. I went up on my dose so I can squirrel some away everyday as I'm on 5 TA's a week.

Good luck everyone, speak to your pharmacies now and ask them what their plans are for when the outbreak happens.

 

[JessFR]

Yeah I agree to some degree, but i think when we are in the middle of the outbreak no one will care about us and we won't have anywhere to go but hostpitals if our pharmacists decide to close their shop, and most likely can't get on to another pharmacy immediately. And going to hospital will be a nightmare the chemists there won't care about us. Have you ever been to a hospital and tried to get dosed while you are there, it's a nightmare at the best of times, I waited 2 days once to get dosed and the hospital was half full.

Basically what I am saying is that this is very likely to happen, I have started preparing. I went up on my dose so I can squirrel some away everyday as I'm on 5 TA's a week.

Good luck everyone, speak to your pharmacies now and ask them what their plans are for when the outbreak happens.

If you're planning on conserving your takeaways it's definitely better that you're on bupe. In a lot of Australia takeaways are given diluted. It's not sterile and not intended for longer term preservation. There might be ways to extend that but it's a lot easier if you're on bupe. Not to mention that you can get a lot more takeaways in bupe than methadone.

On the other hand I strongly suspect bupe is a more involved manufacturing process.

But back to the point, by all means conserve, you gotta do what you gotta do to feel secure. But I still don't think this outcome is by any means certain.

As for switching from one pharmacy from to another, the rules regarding opioid substitution and how easy it would be to do that vary from state to state and I only know the QLD rules. I've been on methadone in NSW but I never cared about the rules then cause I was still using then.

 

[i_am_helix]

So I just rang directline and they have no plans for when shit hits the fan and they have about 1000 people calling them per day trying to find somewhere to get dosed. They told me to just call a hospital when my pharmacy is closed. I asked them ok then which hospital doses methadone or buep and she said she can't tell me, I would have to call around. I asked them have they planed for when this happens: "no" (with attitude like fuck you why should we prepare it's your fault you are a junky) So basically they have not prepared at all, and don't actually care. This virus is going to close down a lot of pharmacies.

 

[i_am_helix]

If you're planning on conserving your takeaways it's definitely better that you're on bupe. In a lot of Australia takeaways are given diluted. It's not sterile and not intended for longer term preservation. There might be ways to extend that but it's a lot easier if you're on bupe. Not to mention that you can get a lot more takeaways in bupe than methadone.

On the other hand I strongly suspect bupe is a more involved manufacturing process.

But back to the point, by all means conserve, you gotta do what you gotta do to feel secure. But I still don't think this outcome is by any means certain.

As for switching from one pharmacy from to another, the rules regarding opioid substitution and how easy it would be to do that vary from state to state and I only know the QLD rules. I've been on methadone in NSW but I never cared about the rules then cause I was still using then.

Yeah it's not hard to switch in NSW or VIC, you just ask your dr to change the script. True about the takeaways, I don't think they would go bad though it's just a bit of cordial isn't it? I only get 5 TA's a week at the moment anyway because I'm on Subutex and government guidelines state that should be the max, and DR's are scared of getting sued and won't go over the guidance.

Might be a good time to swap to subxone and get 2 weeks of TA at a time and up my dose even more lol.

Good luck everyone. Hopefully your pharmacies stay open and stocked.

 

[JessFR]

So I just rang directline and they have no plans for when shit hits the fan and they have about 1000 people calling them per day trying to find somewhere to get dosed. They told me to just call a hospital when my pharmacy is closed. I asked them ok then which hospital doses methadone or buep and she said she can't tell me, I would have to call around. I asked them have they planed for when this happens: "no" (with attitude like fuck you why should we prepare it's your fault you are a junky) So basically they have not prepared at all, and don't actually care. This virus is going to close down a lot of pharmacies.

I would suggest talking to your doctor rather than directline. That's what I intend to do, not that I'm expecting much. He's a good doctor but...he's a doctor.

What makes you so sure that lots of pharmacies will close down? I'm certainly not saying it's impossible, just wondering what's got you so sure

Yeah it's not hard to switch in NSW or VIC, you just ask your dr to change the script. True about the takeaways, I don't think they would go bad though it's just a bit of cordial isn't it? I only get 5 TA's a week at the moment anyway because I'm on Subutex and government guidelines state that should be the max, and DR's are scared of getting sued and won't go over the guidance.

Might be a good time to swap to subxone and get 2 weeks of TA at a time and up my dose even more lol.

Good luck everyone. Hopefully your pharmacies stay open and stocked.

To my knowledge nowhere in Australia dilutes methadone with cordial anymore. I know they used too, ages ago, well before my time. And I certainly can't speak for everywhere in the country. But I've never seen methadone diluted with anything but regular water. At least not in the past 5 years or so when I've been on it at various times in NSW and QLD.

I wouldn't have thought that would cause stability problems either, but it is specified in some of the opioid treatment program guidelines not to provide diluted takeaways for beyond 10 days specifically because of stability concerns. An abundance of caution perhaps, but that's what caused me to mention it.

Man I'm worried too, but I'm also keenly aware that I have anxiety problems and so I'm trying to stay as objective as I can about this. There are certainly risks and reasons for concern, but I haven't seen any reason yet to think there will be widespread closures of pharmacies. Reason for concern yes, reason for certainty no.

I think it's super easy for your mind to run away with you in worry. Especially with something like this. I can't speak for you but I know it happens to me.

Personally I get 4 methadone takeaways at a time.. But I'm also unlucky and if it did happen it'd be bound to happen at the worst time possible.

 

[sekio]

Pharmacies are not going to close, if anything the panic buying going on right now will pose more of a problem than the disease will!

Remember that the seasonal flu kills something like 10,000 to 60.000 a year and hospitalizes even more. The medical system can handle the coronavirus.

 

[JessFR]

Pharmacies are not going to close, if anything the panic buying going on right now will pose more of a problem than the disease will!

Remember that the seasonal flu kills something like 10,000 to 60.000 a year and hospitalizes even more. The medical system can handle the coronavirus.

Even if Coronavirus barely killed anyone. It might not matter. What matters is how people respond to it.

I mean think about it. What if someone comes in with the Coronavirus to a methadone or bupe dispensing pharmacy. They later discover he's infected and the entire staff has to be isolated. That could briefly shut down a pharmacy.

What about the people who deliver it?
What about the doctor that prescribes it?

What about the people who make it. Or the people who make the precursors (probably large Chinese chemical wholesalers)

There's all sorts of ways the supply could be disrupted. Now hey, I'm far from convinced that methadone or subuxone will suddenly become unavailable, it might not happen at all, or only for a small number of unlucky people for a brief period of time.

But it's not a stupid thing to have concerns about.

Also, you're right that the flu does kill a lot of people. And you're right that people frequently forget that. And you're right that people are going crazy and taking this beyond any sensible reaction. But it's also true that hospitals and many other systems often run at about capacity or close to capacity all the time. Their ability to handle even a fairly modest increase in demand can be limited.

 

[ComfortablyNumb95]

Even if Coronavirus barely killed anyone. It might not matter. What matters is how people respond to it.

I mean think about it. What if someone comes in with the Coronavirus to a methadone or bupe dispensing pharmacy. They later discover he's infected and the entire staff has to be isolated. That could briefly shut down a pharmacy.

What about the people who deliver it?
What about the doctor that prescribes it?

What about the people who make it. Or the people who make the precursors (probably large Chinese chemical wholesalers)

There's all sorts of ways the supply could be disrupted. Now hey, I'm far from convinced that methadone or subuxone will suddenly become unavailable, it might not happen at all, or only for a small number of unlucky people for a brief period of time.

But it's not a stupid thing to have concerns about.

Also, you're right that the flu does kill a lot of people. And you're right that people frequently forget that. And you're right that people are going crazy and taking this beyond any sensible reaction. But it's also true that hospitals and many other systems often run at about capacity or close to capacity all the time. Their ability to handle even a fairly modest increase in demand can be limited.

i'm in italy and they're already closing methadone clinics in some cities. some people are gonna have it really bad for a few months at least. so glad i just got off opiods. my ex-dealer even told me there might be an heroin drought. yikes

 

[sekio]

Judging from the past several pandemics (SARS in 2003, MERS, H1N1, H5N1) - none of those epidemics caused major problems in the supply of drugs that I remember (and they effected China just the same!). I'm not saying it's a non-issue, I'm just pointing out that pandemics have happened before and nothing went too wrong in the long term.

Methadone is made in such humongous quantity and by many different companies, some based in the US. The DEA quota for methadone production in the year 2020 was 22,278 kilograms or almost 23 metric tons of methadone produced in ONE year. That's over 111 million 200 mg doses. That's enough to provide for the care of more than 300,000 people, not counting everything stockpiled from the previous year. The pharmacies I know of buy methadone concentrate in either 1L bottles (=10,000mg/bottle @ 10mg/ml) or 10L bottles = (100,000 mg/bottle). I think things are going to be OK.

And pharmacies? if they have to close one it will not be permanent and the staff will be replaced. There are such things as on-call pharmacists. Worst case, you can get methadone dispensed at a hospital pharmacy.

I'm just a practical guy, I don't see the sense in getting too worked up over something like this.

 

[i_am_helix]

Just a update on this from Australia, so far we have seen a few pharmacies have issues here and there but for the most part they are open and people are able to switch temporarily to another pharmacies. We seem to be stable in case count here though now. I'm worried what would have happened in places like Spain and Italy where case count was high per million. Any stories out there?

 

[i_am_helix]

i'm in italy and they're already closing methadone clinics in some cities. some people are gonna have it really bad for a few months at least. so glad i just got off opiods. my ex-dealer even told me there might be an heroin drought. yikes

That sucks man I'm sure it would have got much worse as that post date was ages before the peak. This is exactly why I started this thread I expected it would happen all over, we have been lucky in Aus but I don't know for how much longer. Some of these pharmacies have no business and can't afford to stay open for much longer. This can't be sustained for much longer here in Aus I think here even if the supply chain stays intact there is going to be no where left to go get dosed at eventually.

I'm not sure how much longer mine will be open for...

 

[JessFR]

Just a update on this from Australia, so far we have seen a few pharmacies have issues here and there but for the most part they are open and people are able to switch temporarily to another pharmacies. We seem to be stable in case count here though now. I'm worried what would have happened in places like Spain and Italy where case count was high per million. Any stories out there?

Hey again, I am much more confident now than I was at the start of this thread. Especially as far as Australia's position.

I've encountered no problems and have it on good authority that pharmacies are taking steps to prepare for possible disruption.

I'm glad you bumped the thread though because I too am very interested in this subject from a broader worldwide perspective.

Australia is fortunate in that it already had pharmacy dosing set up rather than exclusively going through dedicated clinics. Among various other enviable advantages.

 

[Branggen]

Wouldnt it be kind of a good thing if methadone clinics shut down while heroin couldn't get in, everyone would be clean lol

 

[JessFR]

That sucks man I'm sure it would have got much worse as that post date was ages before the peak. This is exactly why I started this thread I expected it would happen all over, we have been lucky in Aus but I don't know for how much longer. Some of these pharmacies have no business and can't afford to stay open for much longer. This can't be sustained for much longer here in Aus I think here even if the supply chain stays intact there is going to be no where left to go get dosed at eventually.

I'm not sure how much longer mine will be open for...

Australia has done an excellent job suppressing the outbreak. And I see a lot of reason for optimism.

Our cases are going down, not up.

The main thing is keeping the pharmacies open.

 

[JessFR]

Wouldnt it be kind of a good thing if methadone clinics shut down while heroin couldn't get in, everyone would be clean lol

No, it would not.

Opioids are not just gonna vanish. All you'll have is piles of junkies ready to do anything to get well stressing the medical and legal system all at once.

 

[JessFR]

Some of these pharmacies have no business and can't afford to stay open for much longer. This can't be sustained for much longer here in Aus I think here even if the supply chain stays intact there is going to be no where left to go get dosed at eventually.

I'm not sure how much longer mine will be open for...

I don't think there's any realistic chance of pharmacies closing en masse.

I have a relative who's a pharmacist. And it's my understanding that they've never been busier than right now.

Which makes sense, pharmacies sell stuff like vitamins, immune boosting crap. And a lot of people are now buying that shit like crazy.

It depends on location, but I don't see how pharmacies will close in large numbers in Australia.

 

[Branggen]

If like 90% of the supply dried up I think a lot of people would be clean after a month and be thankful for it, would be a painful month for many though no doubt

The cost would be so high and they would run out so quickly no matter what you were willing to do I think you would be out of luck

I dont think its gonna happen, but if it did I do think it would clean people up