Suboxone Alternative

Will buprenorphine show up in drug tests? Can nurses take Suboxone? Can I do drug court on methadone or buprenorphine? My PO says NO medication-assisted treatments.
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michelle56
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Suboxone Alternative

Post by michelle56 » Sat May 26, 2018 11:51 am

Hello, My name is Michelle. I am new here. I have lived with severe and constant pain for more than 30 years. In 2007 a doctor gave OxyContin for the first time. It was like heaven. No side effects of being high, just less pain. The negative was that over time I had to have the dose adjusted. In 2015, I learned about Butrans (Buprenorphine patch) and decided to try it. I spent several months tapering off the OxyContin (80mg QUD) and then started the Butrans at 15 micrograms. I had real relief from the medication and also turned out to be allergic to the glue. After several months I was no better so I had to make a change. I switched doctors to one in my town and thus easier to access and she agreed to prescribe Suboxone. I have been taking Suboxone for 8 months. I dislike it for two reasons. One, it liquifies upon placing it under the tongue and runs down my throat. While I can't say how much is actually absorbed it is clearly near half which then prevents me from having much relief. Because Suboxone has been less than a positive choice for me, I continue to research other options. Last week I found one. Belbuca.

Belbuca and its sister Bunavail are Buprenorphine and Buprenorphine with Naltrexone respectively. The difference is the method used to enter the system. Instead of a strip of plastic, these drugs are in a disc that sticks to the inside of the cheek using a glue-like substance. In addition, the material used dissolves within seconds. More of the medication enters the system and better pain control is achieved. I can't imagine anyone could be opposed to trying something better than the current common choice.

I shared this information with my physician and asked her prescribe it. She declined and instead of giving me a real and understandable reason, she lied to me. She claimed she looked into it. She claimed it came in a single dose of 75 mcg. and therefor it would not be effective on me. I was certain that she was wrong and went back to my research to confirm. The dose goes up to 900 mcg. So the dosing is different. It uses the micrograms like Butrans. I assumed at first that she misunderstood what she read or was told and shared the correct information along with links to confirm. Again she refused claiming my insurance won't cover it. Something no one can know unless and until it is declined. I explained that I have the option to appeal to my insurance if they decline, but by refusing to prescribe it, she was preventing me from appealing. She had no reason not to prescribe the medication in one form or the other. I told her that if she refused that I would prefer to go back to the Butrans. Again she refused. I have now spoken with her boss and her bosses boss to no avail.

To add insult to injury, she was perfectly happy yesterday to prescribe a muscle relaxant that she has never heard of and one that my insurance declined. I have every intention of appealing primarily so I can speak to them about this doctors evil. I need help to understand why someone would abuse their power so blatantly. She might as well have punched me in the face.

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Re: Suboxone Alternative

Post by jennjenn » Sat May 26, 2018 12:33 pm

Hey Michelle and welcome!

It’s my understanding that Belbuca is like the Butrans, it comes in micro doses. Bunavail is buprenorphine with naloxone and is an alternative to the suboxone strips...... basically what I’m trying to explain is Belbuca and the Butran thing is a hugely weaker dose than the strips, tablets and bunavail.

The Belbuca is more so for pain as to where the others are more for addiction. If the strips are just too much for you then Bunavail may work. I’ve taken both and I like both. Bunavail is different because it goes on the inside of your cheek with a protective gel that allows you to talk while it’s absorbing. The only negative to that is it does leave a gel type substance behind after your medication has absorbed.

The key to the strips for me personally is when I put it under my tongue, I immediately clamp down and don’t move it around. That way you’re keeping it contained while it’s melting and absorbing. There’s going to be some escape but that’s just how it works, you’re only getting about 30% of the medication sublingually anyway (I think that’s what Dr. Junig said, I hope I didn’t get that part wrong). Regardless, it’s normal to not get every single bit of the medicine, we do end up swollowing some. There’s different ways to try it, you should check out Dr. Junig’s blog on getting maximum absorption from the strips.

If you’ve been taking buprenorphine in milligram doses, then going to the microgram doses like Belbuca & Butrans, it would be a big difference in dose. Hopefully someone who is definitely more familiar with the micrograms will be along soon. They’d def know more about it than me.
Jennifer

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Re: Suboxone Alternative

Post by michelle56 » Sat May 26, 2018 2:44 pm

Hello Jennifer and thank you for responding. I should have clarified more about the microgram difference. It is different. No question, but there exists a method of titrating the dose to something akin to milligrams. I have played with the Suboxone for a long time and have yet to find a way that means the majority makes through the skin. As such it is difficult to judge how much is making a difference in my pain. I am now taking four a day. I don't find much difference between four and two other than the horrible taste lasts four times longer.

When I started on Butrans, I was at 15 micrograms which was pretty right on in terms of titration from Morphine. I regret telling the doctor about the inflammation and itching that came with it. If I remember correctly, Bunavail comes in milligrams. All I wanted was the opportunity to try one or the other. In going over my records I found some disturbing comments by this doctor, who I suspect has deep prejudice against persons she deems to be drug addicts. She diagnosed me as being an Opioid addict. One would think if this were true I might have gone to a program of some sort. My previous doctors articulated and understood the difference between dependence and addiction. Something was explained to me by the Surgeon who is doing my neck surgery soon. Back when I went off the OxyContin I got very very ill and I mentioned it to the doc. He laughed and told me it was withdrawals. I argued that I was not an addict and he told me the difference. I know it is parsing words. But those words can come back to hurt you. For example, this doctor writes down the words Drug Addict and a year later when her prejudice has reared its ugly head, everyone and anyone to whom I complain now reads her file which identifies me as illegal drug user and addict. Why bother to listen to such a disgusting waste of a life? Clearly this is what they think. Additionally, this same doctor (actually an Osteopath) diagnosed me as clinically depressed, yet she never asked me about and in fact took me off of anti-depressants which I used for hot flashes. There are people in this world who are not suited to the role of caring for the infirmed. She is one of them who for no reason that I can come up with decided that I do not deserve the opportunity to try different medication.

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Re: Suboxone Alternative

Post by thisisme » Mon May 28, 2018 1:41 pm

"Why bother to listen to such a disgusting waste of a life? Clearly this is what they think."
Is that what you think? cuz from what ur writting it is.. just wanted to tell you that the people you are seeking advise from are all addicts and proud that they are winning over their addiction, so my advise is that if you want your dr to listen to you and others to support you then u have first to stop judging others, second when seeking support its important to understand that all human beings have addiction to something, some are addicted to tv, others to work, others to cigarettes, and so on... our bad luck was that we (including you) tried something called opiate or opoide and got addicted to it where you like it or not, and its always the first step to recovery is admitting that your sick.

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Re: Suboxone Alternative

Post by michelle56 » Mon May 28, 2018 2:01 pm

I am very sorry. I meant no offence to anyone. And I certainly don't judge. I can't be something I am not. I don't happen to enjoy being high. I have never enjoyed and the result is that I have never been addicted to drugs. That fact does not mean that I don't have as many or more failings as a human being. I have tried to understand what motivated the doctor I spoke of to treat me as though I cannot be trusted to
1. follow directions and 2. not misuse a medication and 3. treat me (and no doubt others) with such open hostility and malice.

I did nothing to deserve such abuse. No patient, regardless of diagnosis deserves to be treated in this manner. If I were addicted I would still expect to be treated with a modicum of respect. It certainly makes no sense to find the diagnosis without any other customary supports, such as addiction treatment, made available. I am dealing with a doctor who is prejudiced against people she deems to be addicts. I guess there is nothing else to say on that matter. I am still caused to wonder why a doctor would refuse to prescribe one brand of the same medication. That was all I wanted.

Good luck in your efforts.

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Re: Suboxone Alternative

Post by Amy-Work In Progress » Thu May 31, 2018 12:20 pm

Michelle, you're fine. Sometimes it's easy for us to take offense because we've been dealing with the stigma you're talking about for a long time now. We tend to be defensive. Sometimes it's hard not to believe what others say about addicts and us in particular.

You are dependent on your medication and it seems to me that you're not addicted from what you describe. I don't know one addict who doesn't use up opioid medication faster than they're supposed to. I certainly ran short every single month.

Yes, that doctor's attitude is terrible! It's ironic that some of the same doctors who freely gave out big prescriptions are now judgmental toward the addicts they helped create.

Please understand that this forum is mostly about addiction, so that is our frame of reference. You have gotten your first dose of the ugliness that is so often hurled our way. Your doctor is ignorant. If I were in your shoes I would be looking for another doctor. I know of a practice that just opened up here in Denver that takes patients like you. They assess your pain and if you are addicted or not and work to find solutions for their patients. Whether that be hypnotherapy, physical therapy, or buprenorphine for addiction. They are very new, but I think that this is the type of practice that we need and will have more of in the future.

Frankly, I wouldn't let anyone treat me like I am "less than" just because I am addicted to opioids. I would probably write them a letter explaining why they are incorrect and terminate their services (after finding a new doctor who had a much better attitude.) I tend to be an advocate for myself and for other opioid addicts when I encounter stigma.

You are fortunate that you didn't have the genetic combination that makes you susceptible to opioid addiction. I think that there is sometimes an unconscious thought in people who aren't addicts that they are somehow better than addicts. This attitude is fairly ingrained in our society because addicts were considered immoral for so long. I think that you probably unconsciously believe this to be the case, because I think I was the same way before I became addicted in my thirties. I was never a drinker, and I didn't try anything harder than a joint twice in my life. I thought I was in the clear. And then my mother died and opioids knocked me on my ass. And some addicts come here thinking that they are "better" addicts, as if there is such a thing! Lol. My attitude is there but for the grace of God go I.

You are welcome here, and sorry if we came off at all defensive. I don't pretend to know all about Butrans or Belbuca, but I do know that micro doses of buprenorphine seems to help better with pain. Let us know how your appeal goes!

Amy
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Re: Suboxone Alternative

Post by michelle56 » Thu May 31, 2018 1:47 pm

Dear Amy and everyone,

Thank you so much for your kind words. Believe me, I have plenty of failings that plague my life. I am a Social Worker and have worked with many addicts over the years. My mother is an alcoholic which is why I never used it or illegal drugs. My G-D daughter has been dealing with addiction to Heroin for years. She is clean now, but she is a constant worry.

I have gone back to my doctor of 30 years. I had to ask him to take me back and I have thanked G-D ten times over since I got his two word note "OK Michelle." He will give me options so maybe I will get to try the Belbuca. Before I found Belbuca and Bunavail, I was prepared to ask to go back on OxyContin and I may still ask. It really had not occurred to me that a physician would not see the wisdom in choosing an opioid over constant pain. I am 61 years old. It seems me that managed addiction or dependence is a valid option and one that should be considered. I will have the surgery soon and maybe I will be without pain. It is a dream I pray for all the time.

Though I can move on now, I am going to pursue the doctor and her boss for what they did. I don't recall if I mentioned this, but after refusing to prescribe the Belbuca, she refilled the Suboxone for 13 days. I have never heard of such a thing and she did it purely to cause me to panic. Because of opioids needing refills monthly, I got used to calling my doctor a week or so before refill time and if it happened towards weeks end I would panic on Friday's as I have had plenty of weekends out of medication and no way to get it. It is a terrible feeling and I have no doubt that the doctor did it specifically to cause me to panic. It that is not evidence of bigotry and retaliation, I don't know what would be. I understood this woman to be very damaged. She shared with me her very private situation. As an aside, I should have realized that her boundaries are not well set. Nevertheless, she is my eldest daughters age so I offered her my shoulder. As you can imagine, her sudden refusal to provide a prescription was a very strange and disturbing turn. Anyway, if we all don't demand to be treated with respect we will never get it. I can do something that might help others with addiction or dependence. Either diagnosis leads to the same feelings of fear, self-loathing and tolerance of truly despicable treatment.

Much love, my friends,

Michelle

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Re: Suboxone Alternative

Post by raudy1975 » Thu May 31, 2018 4:29 pm

Michelle,

You should watch this youtube video called the "Other side of opiods". It is about Pain patients that truly need opiods and are not able to get them and are stigmatized as addicts when they legit need the meds for their chronic pain. its a good watch.


https://www.youtube.com/watch?v=FzY2tIU83II


Hope this will help . You are in a tough situation because of the "Opiate epidemic" You truly are in pain but are lumped together with the epidemic and probably having a hell of time getting relief.

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Re: Suboxone Alternative

Post by Amy-Work In Progress » Thu May 31, 2018 5:00 pm

That is really good news, Michelle! I am glad you are back with a good doctor who will work with you! I hope you will stick around and tell us how you do with your complaint and your treatment.

Amy
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Re: Suboxone Alternative

Post by rule62 » Fri Jun 01, 2018 10:43 am

Thank you razor for posting that very informative video. I feel so sorry for those who have been abandoned by our government. Just read how many people have gotten onto Suboxone for pain only because they couldn't get the right medication. They get stigmatized as an addict and are not one. I too would choose the stigma if I had chronic pain like them.

The pendulum has swung too far the other way. Let's hope it levels out in the near future.
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Re: Suboxone Alternative

Post by coryguy52 » Wed Jul 04, 2018 7:04 am

I can certainly understand about how Drs. can do more harm than good when dealing with patients that they deem as addicts. On the other end of that spectrum, my issue is the dispensing of the generic Subutex. I've been in a Suboxone/Subutex program for some years now. I'm on a fixed income and the films were proving to be quite expensive compared to the generic Subutex. So when I asked to be changed over to the generic medicine they handed me this line of BS that it was more dangerous than the films. OK, I'm no doctor, but, I'm no fool either. They prescribe Subutex to pregnant women, but it's too dangerous for a healthy male? Why is it that with any other malady in the world if there is a generic drug available, it's not a problem for the Drs. to prescribe it? But, to treat addiction, there is a generic equivalent but they will flat out lie in order not to write for it. Keep in mind I've been on this drug for 3 years without ever having a hot urine, always keeping my account up to date, and just being a perfect patient. My sobriety is that important to me. So, after many meetings with the head Dr. they finally OK'd me to take the generic Subutex. But, then every 4 or 5 months will go by and some clerk in the office will send down a question as to why am I on generic Subutex. Then, another meeting blah blah blah!! Please explain to me why this is!! Is it a money issue? Do Drs. get some kind of kickback for prescribing the films?? Why should I pay close to $10 per film (When I'm in the donut hole) when the generics are like $3? Enlighten Me Please!!

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Re: Suboxone Alternative

Post by Amy-Work In Progress » Wed Jul 04, 2018 10:35 am

It can be confusing to try to figure out what is on the market, because it seems like new alternatives crop up all the time.

I think what you're referring to as the generic is a buprenorphine mono product which was once the brand name subutex. Apparently, Indivior, which is now the maker of suboxone discontinued the brand "subutex", but people still refer to the buprenorphine mono product by that name. By buprenorphine mono product I mean buprenorphine without naloxone. This is prescribed to pregnant women because it is the opinion of doctors that pregnant women should be on the least amount of drugs as possible.

However, the conventional wisdom is that the buprenorphine mono product is dangerous because the medical world is convinced that naloxone prevents addicts from IVing the buprenorphine. This is simply not true! We know that people are shooting up buprenorphine because the amount of naloxone in suboxone is not enough to cause precipitated withdrawal. So, it's an exercise in futility to have added naloxone to buprenorphine in the first place. But Reckitt Benckiser convinced everyone that Suboxone was SO much safer than buprenorphine alone. I believe they did this to corner the market on buprenorphine as addiction medicine.

There are now other formulations of buprenorphine/naloxone with brand names like Zubsolv and Bunavail. The cost of these vary, with some insurance companies (United Healthcare) requiring a specific name brand (Zubsolv) for their clients. There is currently no transparency required when an insurance company makes some deal with a specific name brand, like the example above.

Now there are generics of suboxone on the market. Reckitt Benckiser, the original manufacturer of suboxone, tried to prevent these generics from being made when their patent expired, but failed. So there are now a few generics of the original suboxone pill (which came before they started manufacturing the film). So the generics are available, but they contain both buprenorphine and naloxone. From what I understand, the generics are not much less expensive than suboxone. Over time, the price should come down, but for now the generics aren't much of a deal cost-wise.

Within the last couple of weeks a pharmaceutical company came out with a generic for the suboxone film. So those are now available too. Initial reports are that the generic films are not quite as "strong" as the original films.

Those are the newest updates that I know of. Your doctor should be able to prescribe a generic because there are generics available that have the combination of buprenorphine and naloxone, that the medical community is convinced is safer than buprenorphine alone.

Way too complicated!! If anyone knows of any updates that I didn't include, please feel free to share it.

Amy
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Re: Suboxone Alternative

Post by jennjenn » Wed Jul 04, 2018 1:22 pm

It doesn’t make a lot of sense to me either. I don’t see plain buprenorphine any different than buprenorphine with naloxone..... if someone made me take one I wouldn’t know any difference in taking a generic tablet that also has naloxone. I know there’s ppl that have reactions to naloxone and for that type of thing I get it, but other than that, it just all seems the same to me personally.

It is disappointing thinking that if I changed from the films to generic that I’d at least save a couple dollars each tablet but nope, didn’t happen for me. All I accomplished was wasting my breath asking my doctor to write me for generic because I didn’t save a dime really. Honestly, if these companies want to make generics then how about reflecting that in their price?? I’m clueless about it though, it could be the pharmacy that’s sticking it to me but whoever is doing it, my end results are the same...... I didn’t save any money by switching over to generic. Now we all know that in other medications, generics save us money so why is it different with buprenorphine??
Jennifer

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Re: Suboxone Alternative

Post by coryguy52 » Thu Jul 05, 2018 4:19 am

Exactly Jennifer!! Being that I'm on Medicare I do save a significant amount of money with the generic Buprenorphine. Like a total of $7 per pill. That's almost $200 per month savings. Which to me being on a fixed income is a lot of money. Thanks for your input!!

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Re: Suboxone Alternative

Post by Amy-Work In Progress » Thu Jul 05, 2018 12:53 pm

"Now we all know that in other medications, generics save us money so why is it different with buprenorphine??"

This reminds me of the epipen scandal. It went from costing $50 to many times that amount. It seems that good ol' capitalism is to blame! The pharmaceutical company can charge what the market will bear. The terrible thing with this example is that people with severe allergies have no choice whether to purchase the epipens at a high price or not. It's a life or death situation.

Well, is buprenorphine any different? Not really! We are also in a struggle for our lives! So, we will continue to pay high out-of-pocket prices for our meds. They have us by the balls.

One thing I will say is what I noticed about the available generic form of imitrex. When the generic by Dr. Reddy came out in 2008, the generic was almost as expensive as the brand name. This is how it starts out as a brand new generic. Over time, the price does drop and more companies start making a generic version. I hope that the buprenorphine generics will decrease in price as well!

Amy
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Re: Suboxone Alternative

Post by docm2 » Thu Jul 05, 2018 3:36 pm

However, the conventional wisdom is that the buprenorphine mono product is dangerous because the medical world is convinced that naloxone prevents addicts from IVing the buprenorphine. This is simply not true! We know that people are shooting up buprenorphine because the amount of naloxone in suboxone is not enough to cause precipitated withdrawal.
This might be of modest interest. Injecting the monoproduct is dangerous due to one of the fillers Amogen. The lesions created reminded me of Krokodil.
https://janaburson.wordpress.com/2017/0 ... the-cross/

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Re: Suboxone Alternative

Post by razor55 » Thu Jul 05, 2018 3:53 pm

I will have to say that when I was informed of the new Dr Reddy Gen film that i waould save out of pocket money vs RB brand film from my Walmart Phar. A differrence of close to 100 dollars. I do use the RB discount card. Without the card my savings would be close to 300 dollars ! So there are savings out there. It all depends on Where you shop and How you do it. Razor 60

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