I'm a pharmacist wanting to understand this issue

The pharmacist eyes you suspiciously, and suddenly you wished you had shaved earlier this morning... your second-grade teacher is in line behind you, talking to your girlfriends mother... as the pharmacist yells for all to hear, 'I'm sick of YOU PEOPLE-- and I'm not filling this for you anymore!' Or your doctor, after increasing your pain meds for years, suddenly treats you like a criminal...
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Jess1208
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Re: I'm a pharmacist wanting to understand this issue

Post by Jess1208 » Wed Sep 12, 2018 11:39 am

Kinda on this subject, my last Suboxone Film refill (the 4mg-films), with every film I have taken thus far, the markings were only on 1/2 of the film. It is very obvious that the markings end right down the middle and the other side has absolutely no markings. Like I got the end side of the production before the films were cut into their sizes and packaged to go. I'm not worried about the potency, or if half of my films have no medicine on them, or anything like that. It is just very odd to me because my suboxone brand film refills have always been so consistent for the past 4 years that Ive been on it.

I imagine they make these in one huge baking sheet type pan (LOL) and like pour the solution in and get it to dry, then cut them up evenly into the strips that we receive (even tho they have claimed that the potency/dose is not evenly distributed throughout each film), Im not sure how else they would mass produce these films. This is just what I assumed. Its just weird that all my films only had markings on one side of the film and the other half of the film was completely blank. Like I got the strips from the very end lol

Has anyone else had this? Or received films with no markings at all? Mine usually have "N4" written in white. (since I get the 4mg-films.)

Im going to try to attach a photo so u can see what I mean. Hope the pic is ok. Im not worried about it. (I am currently on 3mg a day right now). Its just weird!

PS I am also glad to have a Pharmacist on here. My Pharmacists at my local Kroger are always so incredibly kind and respectful to me, regardless of what medication I am picking up. I guess I got lucky to have a great Pharmacy. I appreciate them so much!

Jess
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Dee19
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Re: I'm a pharmacist wanting to understand this issue

Post by Dee19 » Sat Sep 15, 2018 10:02 am

My husband was first given Zubsolve, they have a coupon for 15 free mint flavored pills. When he was given a prescription, our insurance wouldn't cover the Zubsolve. He was given a generic Suboxone. He said the strips work much better than the Zubsolve.

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Amy-Work In Progress
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Re: I'm a pharmacist wanting to understand this issue

Post by Amy-Work In Progress » Sun Sep 16, 2018 11:45 am

Dee, it may be true that people prefer the strips to Zubsolv, but one thing I can tell you is that Zubsolv tastes SO MUCH BETTER than the strips!

Jess, when I looked at the picture of you strips I immediately thought that you got the strips on the edge and that the printing just didn't go to the edge.

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Re: I'm a pharmacist wanting to understand this issue

Post by jennjenn » Mon Sep 17, 2018 9:31 am

I got the strips for 6 years straight and I never had one look like that Jess. Ever. I had a lot of differences over the years, sometimes they’d be so brittle that an edge would fall off before I could get it out of the package. Sometimes they’d look so fresh that you’d swear they just come off the assembly line lol. One time I even got a few that weren’t cut right and had an extra 2mg folded over the back of the strip. I swear to you I’m telling the truth. Never happened to me since but it did happen. Regardless of all those differences, I never had any of them work any less than normal, so it obviously never affected the strength of the medicine.
Jennifer

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Re: I'm a pharmacist wanting to understand this issue

Post by GodsChild777 » Thu May 16, 2019 5:56 pm

I came across this forum and had to stop to post. I have been on suboxone for a few years now, I am a few months away from my last taper.I was prescribed opiates for a injury for over 4 years and was tired of how they made me feel wanted to be off them. Shortly after stopping I was switch to suboxone once we realized my body was dependent on the opiates. I went through horrible withdrawal it was the scariest most uncomfortable out of body/mind experience imaginable. I’ve always gotten the same suboxone generic tablet for a long time. However there has recently been a few occasions recently this past year that I’ve pick up my script being a different brand , that did differ in color/size or taste. There is a difference by far on how they work for someone that’s body is adjusted to something they normally take. The past 2 generics I tried both gave me different problems. The first one hardly helping making me feel as though I was withdrawing again and that is very scary. Especially when you have daily priority’s to take care of and you feel extremely unwell. We are on this medication to help us not feel sick and live a normal life. It gets worrisome when you known something your taking isn’t allowing you to feel up to par. The second medication is as a lighter color orange tablet that worked fine except it gave my the most horrific headaches imaginable. The smallest sound and light hurt even as much as smells hurt. Crazy I know. These things are not made up in our heads. There are all types of medications that can cause different effects/reactions when switched to something other then what your use to. Different fillers and such. It has nothing to do with anything else. Just the fact that nobody wants to feel icky. I’m not saying this is how anyone else feels but speaking for my self. Life before opiates When you are able to just wake up and feel normal and go on with your day. Well that’s pretty much what life is for me on suboxone at this time after opiates. It allows to be to wake up to feel as close to normal as possible. So when that is changed by something like different brand that don’t allow you to feel normal. Thats a big deal. That’s where all the different request for certain brands of the generic suboxone come from. I know for me I just want exactly what I know works well enough for me to feel normal so I can live life the best I can day by day. God bless you all.

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Re: I'm a pharmacist wanting to understand this issue

Post by jennjenn » Fri May 17, 2019 6:43 am

Thank you Godschild! I 100% agree with everything you just said!
Jennifer

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Re: I'm a pharmacist wanting to understand this issue

Post by pugmommy » Sun May 19, 2019 10:14 pm

Some people absorb medications differently, excipients can have a different delivery. I for one can only use suboxone brand, no other absorbs for me at all except for now the company launched its own generic version, sandoz, which is the same formulation so I can finally save money with generic. My pharmacy had no problem ordering this for me, it came in the next day.
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Re: I'm a pharmacist wanting to understand this issue

Post by allanwmd1 » Tue Oct 08, 2019 8:43 pm

Great question. The answer is simple. First, by FDA regulation, generic Suboxone may have up to 20% less buorenorphine. Many patients don’t know this, but sure can feel the difference. They may attribute the difference to many things, but it usually is less buprenorphine. Because they don’t feel well on the genetics, of course they will be very picky although may not know why.
Certainly, since Suboxone must be held in the mouth for awhile, taste preference would be an issue as it would be for anyone. When our mind can’t understand something, it rushed to explain the “ thing” within its current knowledge base leading to errors in understanding. It’s hard to resist this, especially when a patient treatment is the issue. I like the notion, “ more will be revealed”

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Re: I'm a pharmacist wanting to understand this issue

Post by jennjenn » Sat Oct 12, 2019 7:40 am

So you’re saying that the generics don’t have as much buprenorphine in it as the name brand suboxone? I don’t think that is legal is it? I take generic now but used to take the strips for years and years, I didn’t notice any difference when I switched....... and I worry a lot. I know some ppl do have issues with certain generics but I don’t think it’s from less medication. Anyone else wanna chime in on your thoughts?
Jennifer

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Amy-Work In Progress
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Re: I'm a pharmacist wanting to understand this issue

Post by Amy-Work In Progress » Sun Oct 13, 2019 9:37 am

allanwmd1 wrote:
Tue Oct 08, 2019 8:43 pm
Great question. The answer is simple. First, by FDA regulation, generic Suboxone may have up to 20% less buorenorphine. Many patients don’t know this, but sure can feel the difference. They may attribute the difference to many things, but it usually is less buprenorphine. Because they don’t feel well on the genetics, of course they will be very picky although may not know why.
Certainly, since Suboxone must be held in the mouth for awhile, taste preference would be an issue as it would be for anyone. When our mind can’t understand something, it rushed to explain the “ thing” within its current knowledge base leading to errors in understanding. It’s hard to resist this, especially when a patient treatment is the issue. I like the notion, “ more will be revealed”
This statement is so true!! And it affects so many "things" in our lives. This is why someone can be on buprenorphine for 3 years with no problems, they start to feel (insert symptom here), and it must be the fault of the buprenorphine. Our side effects section is filled with this phenomenon.

Welcome to the forum, allanwmd1!

Amy
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Re: I'm a pharmacist wanting to understand this issue

Post by Jess1208 » Tue Oct 29, 2019 10:43 am

I always have issues when I get put on the Dr. Reddy generics. I was on brand-name Suboxone for almost 5 years. My daily dose has been 4mg/day for the majority of my time on this medication. Sometimes the pharmacy would give me generic and I would ALWAYS feel like I need a dose increase when on the generics. I KNOW I am not imagining this. I suffer from a chronic pain illness and need to be able to rely on this medication to keep me level. I know everyone has their own opinions, and mine is that at 4mg/day, I AM under the ceiling level. At least MY personal ceiling level. So when I get generics I feel like I am really taking 2mg/day and I feel very unstable.

My suboxone nurse and doctor agreed to start writing for SUBOXONE DISPENSE AS WRITTEN. Unfortunately my physical abilities are extremely limited (due to pain and pain triggers) so my husband picked up my most recent refill. He gets home and I see that it was filled as generic. Im already worrying that I might run out of my script early. I never feel this way with the suboxone name-brand films. The Pharmacist obviously didn't read the entire prescription. and I didn't say anything because of the stigma I may get for bringing it back and complaining.

From now on, I will have to make sure to check the films before I even pay for the script. I have never had an issue with my med or my dose until this started happening every so often.


On another note, My suboxone doctor will no longer be doing MAT program, he is going to be working the inpatient side of the hospital only, and all the other suboxone doctors at the place I go are literally forcing everybody to lower their dose and pressuring everyone to get off. Our suboxone nurse even felt the need to give us a heads-up...

Most of the people in my group have been on suboxone for as long as me, if not longer, and we are all freaking out. I had the best doctor out of all the ones there. all the other ones are real assholes and always pressure their patients to get off. I am not ready to get off. I am in SEVERE pain every single day, and I just cannot do this right now. I am trying to get my pain under control BEFORE I completely get off. but it sounds like I may not have a choice.

Jess
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Re: I'm a pharmacist wanting to understand this issue

Post by Amy-Work In Progress » Wed Oct 30, 2019 10:42 am

Are there any other buprenorphine doctors in your area, Jess?

It sucks that your doctor is going to stop offering outpatient services!

Amy
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Re: I'm a pharmacist wanting to understand this issue

Post by jennjenn » Sat Nov 02, 2019 8:52 am

Jess I’m so sorry to hear this! Feeling pressured to lower is stressful. I’ve also had many ppl talk to me about that fear for themselves but especially those of us who have been in MAT for long term, it seems we worry even more that something will change. Some ppl can lower gradually and then taper off but not everyone can or should. What I hate is when ppl aren’t treated like the individual case that they are. Just because Jane will be fine dropping her dose at a specific time doesn’t mean John will be even though they’re at the same date in their treatment. We’re individuals and not everyone is the same. I know I fuss about this a lot but it’s true and some doctors do things like that instead of treating each person with different needs and circumstances.

If this starts to happen Jess, I guess I’d be looking for another doctor that will listen. I know sometimes there’s not a lot of choices for this type of treatment but if you’re lucky enough to have more doctors in your area then it may be time to look around. I wouldn’t until something for sure happens but it may end up being a choice you have to make.
Jennifer

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Re: I'm a pharmacist wanting to understand this issue

Post by Jess1208 » Sun Nov 03, 2019 12:13 pm

Thanks for the replies Amy and Jenn, even though I feel so good in my recovery, it still scares the shit out of me to think about being forced to lower or even come off completely before I feel confident in doing so, simply because of my severe pain and all the ways THAT affects my life. Every single aspect of my life revolves around my pain and how I am forced to live my life. As you can probably guess, that is why I started using in the first place, I was self medicating because my entire life pain is all I have known and no doctors or meds helped me and after experimenting one time I thought I had found the perfect way to relieve that pain. Pain has ALWAYS been my #1 trigger. Anyone who has to live with chronic or excuciating pain on a DAILY basis knows how hard it is and how desperate you can get when the pain is so bad you literally wish you were dead! Luckily now I have a reason to live, a “purpose”, my sweet rabbit who is my entire world, my other half. He means absolutely everything to me. I am getting on better health insurance next year and I really hope I can go back to my pain management doctor who was doing procedures for me and even discussed surgery. The past couple years I have had to be on crappy insurance and I had to stop seeing the only doctor who has ever helped me or even given me options in the past 20+ years I’ve been living in constant pain. Sometimes I wonder if I would feel better if I was back on methadone maintenance instead of Suboxone, since suboxone has never helped me with my pain, but then I remember how the methadone clinics were and how inconvenient it was to take a 2hr round trip every morning at 5am just to get your daily dose. I just don’t like when my medication is messed with. Even on my “good days” I still feel like absolute crap. So I really rely on my suboxone to stay level. If one thing falls apart (or gets changed like it is now with the genetics not working well) then EVERYTHING gets “messed up”. Every little thing matters, every medication, they all have to work together to ensure I am able to live a somewhat productive life, always being in so much pain. Life goes on, bills need to be paid, I can’t afford to feel any worse than I already do on a daily basis. Waking up every day feeling like you’re withdrawing is such a horrible feeling and it takes a good 5 hours for that feeling to go away every single day. Ever since I was forced to go back on the generics I have not been sleeping AT ALL. Which just makes my pain worse as well. It’s like once one thing in my life isn’t working right, NOTHING is. I’ve also been feeling really depressed again too. Like a domino effect.
Jess
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Re: I'm a pharmacist wanting to understand this issue

Post by jacksh » Mon Mar 16, 2020 8:18 pm

I can tell you why I am picky. I have an allergic reaction to citric acid which seem to be in all the orange colored films or tablets. My first prescription was for a generic brand that only cost $10 copay. My mouth broke out so bad I could hardly talk. Since then I have been very careful about what I get. I take subutex and it's white and no problem.

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