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 Post subject: Brand Name vs. Generic
PostPosted: Fri Sep 06, 2013 11:24 am 
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Long story short. Was opiate dependent for almost 9 years. Voluntarily enrolled in treatment program with Suboxone. I'm a veteran. The VA recently switched to generic buprenorphine. Doesn't work as well for me! A little research confirmed I'm not alone! I was surprised at not finding any topics on this subject. There are quite a few posts on other sites regarding the generic form. Hoping I might find someone else in the same boat. Thanks!


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PostPosted: Fri Sep 06, 2013 11:56 am 
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Hi David,

We actually have had a few posts about this here. But you're right, I can't recall very many. Maybe someone will see this and give their input, I've never tried the generic form.

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PostPosted: Sat Sep 07, 2013 8:50 pm 
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I also heard some bad reports from the generic on other sites while I was doing my research. I got name brand films and they where cheaper than the generic pills. There is a $50 coupon on the name brand web site so that helped out.


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PostPosted: Sun Sep 08, 2013 6:54 am 
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Never ever liked the film .... Always loved the tabs .... To me the generic form is better , breaks down faster in your mouth , been on 2 mgs of Suboxone for 5 yrs now .. My generic tabs are made by activis pharma , there white with a crescent moon imprint on them and I've been using them since they came out , I hear there also very , I don't know that 1st hand though , saw it on some other web site ..... Good Luck , Mike


Last edited by Painter on Tue Sep 17, 2013 8:02 am, edited 1 time in total.

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PostPosted: Sat Sep 14, 2013 12:25 pm 
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I prefer tabs over film since disposing of evidence is tricky with film wrappers. You should see what I have to go through when visiting my folks. I would also prefer generic since my insurance doesn't cover and I have to pay out of pocket. I have a bad feeling I have one of those Suboxone only Drs.

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PostPosted: Sat Sep 14, 2013 3:31 pm 
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Minnie wrote:
I prefer tabs over film since disposing of evidence is tricky with film wrappers. You should see what I have to go through when visiting my folks. I would also prefer generic since my insurance doesn't cover and I have to pay out of pocket. I have a bad feeling I have one of those Suboxone only Drs.



LOL...I can totally relate!!!! I have had to come up with some creative solutions to that myself a time or two! :lol:

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PostPosted: Sun Sep 15, 2013 3:29 pm 
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When you guys mention generic, you need to be distinct, for those who are researching the possible avenues....now we have 2 generic (pill) forms of Suboxone, and a 3rd came out the 16 of September. Then you have just regular Subutex, which doesn't have Naloxone in it,and it's normally given to pregnant women who are on suboxone, the doctors will switch them over to Subutex to keep from introducing the unborn fetus to unnecessary drugs.

And, as of January 2014, there will be a film version that's generic...but it'll be a film that you put on your cheek, not under your tongue.

So, when you guys discuss it, keep in mind you have a generic pill form from the following companies:
Amneal
Actavis
Zubsolv (september 16)

The first two came out in March..

The one coming in January is from BDSI laboratories.
So, tell us which name / company's version of Suboxone you're speaking of when you say it doesn't compare with the film version.
I too have to worry about this in a couple of months, since CVS Caremark (my insurance company on the RX side -- even though I have BC/BS of Alabama for medical)....is dropping coverage for RB Suboxone film as of January 1, 2014. So, December is the last month I'll be able to get Suboxone film on my insurance, and my doctor is willing to give me whatever version I ask for...I just want to make sure that I'm getting the same stuff, as far as the effectiveness of it. I've heard some say that the Actavis form doesn't seem like they've taken anything...and is too hard/takes too long to dissolve.

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PostPosted: Mon Sep 16, 2013 9:12 pm 
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Painter wrote:
I hear there also very snortable , I don't know that 1st hand though , saw it on some other web site ..... Good Luck , Mike


Was that comment really necessary? I mean, come on, this is a recovery site and you mention abusing the very drug that saved our lives. Others may disagree with me because there are several ways to have it go through your mucus membranes. Plugging comes to mind.....yuck! I personally believe you should take the medication as it is prescribed unless your Doctor says otherwise.

Please think before you post. This site has a lot of visitors who just might try your method now unless I delete it.

I don't mean to offend you. You are a valued member here and contribute good opinions.

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PostPosted: Mon Sep 16, 2013 10:51 pm 
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Thanks for all the great advice and help. I went into treatment for alcohol not opiates. While i was going through treatment i developed severe tooth pain, found out tooth was cracked, had tooth pulled problem solved right wrong. took some tylenol for that because i was very reluctant to do vicodin. Next couple of days Developed more tooth problems, needed root canal. took tylenol problem solved right wrong. Lots of time went by and i am still in tooth pain. I finally cracked and took some vicodin. This started June 10th 2013 and lasted until later part of August, still on vicodin. Finally at this point finally found the last problem where the bone was pushing through the gum surgrey on the gum pain lasted 2 weeks still on vicodin. Finally tooth pain goes away I stop the vicodin and go into withdrawls. Tried to ween off made me take more. Trust me i was very upset I hadnt touched opiates since 2005. So now you kinda know the story. That is why I want to get off the suboxne so fast. I dont feel clean being on it. So tell me what you think. If I go off sub i certainly wont go back to vicodin. I want my freedom. I appreciate any help I can get. Sometimes I dont make good decisions. Do you really think staying on sub would help. I go and see my doctor tomorrow and ask him if i can go from 4 mg down to 2 mg. if you think I am moving to fast please reply and tell me what you think.
Right now I think I am feeling really scared. My head is telling me i screwed up now your on sub and you will never get off it. I just want to be completly off drugs and work toward being completely clean. I have a strong recovery plan in place going to a couple AA meetings everyday. I am also a disabled vet and I go to after care at the VA 4 times a week.
Rich
Hi David I am a disabled Veteran and I was put on suboxone by my Doctor. Your the first Veteran that I have met on here. I sent you a private message earlier. I was hoping we could exchange some stories. Here is a post I shared the other night


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PostPosted: Tue Sep 17, 2013 7:05 am 
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Hello there.

My insurance changed my script from the orange pills to the generic white pills (not sure what co) and I had a horrible time with the change. I didn't really make a big deal out of it at first and I took them initially, but over time, over about 10 days, the withdrawals started and it was cumulative, no matter how or when I took the medication at the same prescribed dose, I was in withdrawl and sick. I eventually had to call my doctor and he changed me from the white pills to the Suboxone Film.

My insurance company immediately jumped on me, but what saved me was that there is no generic equivalent to the film. My doctor told me that the generic companies are allowed to decrease the effective ingredient up to 20% when manufacturing a generic. I don't know if that is what happened, but I felt the change and it was not pleasant.

I must also add that I am very sensitive to medication.

Have a great day.

Theresa


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PostPosted: Tue Sep 17, 2013 8:00 am 
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Sorry rule , Mike


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PostPosted: Tue Sep 17, 2013 8:00 am 
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I do like the edit feature , let's you pull your foot out of your mouth !!


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PostPosted: Tue Sep 17, 2013 10:24 am 
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I just read this by Theresa, "My doctor told me that the generic companies are allowed to decrease the effective ingredient up to 20% when manufacturing a generic" and was stunned to see this. I did a little checking and apparently it's true. (bioavailability can be 20% lower or higher, active ingredient has to be within 7%)

The following is from wiki answers.

It is also important to note that the amount of drug which makes it into the bloodstream (bioavailability) can vary significantly for generic drugs; the bioavailability of generics is required to be within 20% of the branded drug, meaning it can be 20% lower to 20% higher. This can make a significant difference for drugs which are very dose-dependent. Also the amount of active ingredient in the generic only needs to be within 7% of the branded drug. All in all the generic might end up quite a bit less or more potent than the branded drug.

Was anybody else aware of this regarding generics?

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PostPosted: Wed Sep 18, 2013 12:56 pm 
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DailyBiPolar wrote:
Hello there.

My insurance changed my script from the orange pills to the generic white pills (not sure what co) and I had a horrible time with the change. I didn't really make a big deal out of it at first and I took them initially, but over time, over about 10 days, the withdrawals started and it was cumulative, no matter how or when I took the medication at the same prescribed dose, I was in withdrawl and sick. I eventually had to call my doctor and he changed me from the white pills to the Suboxone Film.

My insurance company immediately jumped on me, but what saved me was that there is no generic equivalent to the film. My doctor told me that the generic companies are allowed to decrease the effective ingredient up to 20% when manufacturing a generic. I don't know if that is what happened, but I felt the change and it was not pleasant.

I must also add that I am very sensitive to medication.

Have a great day.

Theresa


Hello again folks:

I wrote the above post rather quickly without any real contemplation, but as I consider my experience, and the upcoming release of the "generic" film, I want to add a few more thoughts to my original post.

First I'll add that the manufacturer of the buprenorphine generic pills that I took was actavis. As I mentioned above, when my insurance company insisted that I take this generic, I took it without a fuss to begin with. However, when I took this generic, the difference in the efficacy was apparent within a few days and even though I continued to take the medicine for over 10 days, I was in a continual state of withdrawal. Until I was able to switch back to the name brand, I was sick, very sick and in full blown withdrawal. It lasted about 2 weeks.

My doctor and I have a very open and honest relationship. After working with him for over ten years, I trust him with my life. As a rule, he always recommends that I take the name brand drugs for as long as I can because I have a significant sensitivity level to medication. He told me long ago about the 20% generic formulation allowances and he reiterated it again during this incident with the Actavis buprenorphine generic.

I know, it is shocking. A 20% difference in the formulation/bioavailability of generics. It is amazing that the industry has been able to keep this "dirty little secret' as far under wraps as it has. Lets be frank here, most doctors and pharmacists in my experience will swear to you that there is no difference between the generics and the name brand drugs. My own sensitivity has proven otherwise over and over again - and the 20% factor is without question, the reason why I have efficacy issues with generics.

I am quite concerned about the upcoming release of the generic buprenorphine film in January. The film is what saved me this last time from having to take the generic - once the film is available in generic, I may be forced to take the generic by my insurance company. It is unfortunate that this is allowed to happen, but those of us who are dependent upon insurance to pay for our medicine, we are held hostage and helpless by the FDA and the pharmaceutical and insurance industries lobby.

So, I really don't know what I will do in January when Zubsolv hits the market. I have great insurance, but they have recently changed the rules when it comes to generic vs. brand name drugs. My insurance (Caremark/CVS) mandates that you try the generic form of a drug once it becomes available and if you refuse, they charge you the difference between the cost of the name brand and the generic. In my case, it is medically necessary for me to have the name brands, the generics just don't work as well for me. Since they recently changed the rule, I have not had to fight this fight but I do expect that if I refuse the generic Zubsolve in January, I will need significant backup re: documentation and justification from my doctor to get the brand name and avoid the generic. Even with my doctor in my corner, it may not even make a difference. The insurance companies have all the power because they pay the bills.

Dr. Junig's discusses Zubsolv in his latest blog post on Talk Zone. He mentions that the manufacturer of Zubsolv is publicly marketing the generic (with 20% less buprenorphin) as a anti-diversion alternative. They are publicly acknowledging the 20% reduction in the active ingredient, but they are saying that it will induce the same blood levels and will be as effective as the brand name at full strength. I don't understand how that is possible, unless they have a secret recipe that magically increases blood levels. Further, I don't understand how it would be an anti-diversion alternative, unless they are suggesting that those who wish to use buprenorphine on the down low will stay away from the lower dose film. I just don't get it. I will suggest however that FDA guidelines for labeling will require them to indicate the precise amount of buprenorphin on the Zubsolv packaging and it is because they must publish the actual amount of buprenorphin that is in each film, that they have no choice but to find a clever marketing strategy to get people to buy it. I am speculating here - but one does wonder why they would openly discuss the discrepancy in dosage, when the 20% factor has been the unknown the "dirty little secret" of the industry for so long.

Here's what Dr. J had to say about this in his latest post:

" Zubsolv was recently approved as a menthol alternative to Suboxone Film. I’m not buying company stock; the ‘advantage’ to Zubsolv is a greater dosing efficiency, so that 5.7 mg oral dissolving tabs create the same blood levels as 8 mg of Suboxone film, something the manufacturer suggests may reduce diversion. But for patients who have a say in their prescribed buprenorphine product, which do you think they would favor—- a tablet with 5.7 mg of buprenorphine that is promised to act like it had 8 mg…. or a tablet of 12 mg of buprenorphine that is promised to act like it had 8 mg? The scientific and marketing people should have a discussion with the docs in the trenches.

If you missed my point…. How many of your zubsolv patients, after reading that they are taking 20% less buprenorphine, are NOT going to complain about needing their dose raised? Then again, they have some cool slogans (like Evolv, Resolv, ZUBSOLV) and their own version of ‘Here to Help’, called RISE. Maybe that will make the difference!"

If I am reading this right, Dr. J is not in favor of the marketing tool being used for this generic. If I read his post right, he mentions that Zubsolv's "will be just as effective" marketing strategy is not going to work, and once Zubsolv's patients find out that the actual dose is 20% less, that patients will be asking for an increase in dose.

I am confused by these statements made by Dr. J. Patients have a right to know what is in the drug's they are taking right? Will there be a placebo effect, probably, but is Dr. J suggesting that Zubsolv should perpetuate the the "dirty little secret" and keep the actual formulation under wraps? Well, I'm going to speculate here again and suggest that because the Zubsolv will be in a film, and FDA labeling requirements mandate that the "actual" dose be listed on the film packaging - that the Zubsolv manufacturing and marketing people had no choice but to come up with a strategy to justify the reduction in dose. I may be all wrong here, but it does make one wonder.

Anyway, I am very concerned about the January release of Zubsolv for all the reasons stated earlier. I can't afford to pay the difference between the name brand and the generic and there is no guarantee that a statement from my physician is going to make any difference in whether or not they allow me to get the brand name.

The logical remedy here is for the doctor to prescribe me a higher dose of the generic so that it will be equivalent to dose of the name brand. I am so uncomfortable with this thought... the goal here is to take the minimum amount necessary to achieve relief right? I know, I know, I'll be getting the same amount of buprenorphin, but on paper it will look like I am taking more than I really am. It is unfortunate that we must play these little games with our life saving medications. If we want to get the most benefits from our medication, I don't think we have any other choice.

Thanks for listening. Have a great day.

Theresa


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PostPosted: Wed Mar 05, 2014 10:00 pm 
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Let me start by saying, I have been on buprenorphine (generic white round table with 54 411 on one side and nothing on the other, made by Roxanne.) 8mg tablet twice a day for over 4yrs (60 tablets a month cost $199 - $299). I have never diverted, no dirty UA's, nothing. I have seen my doctor's visit cost go from $75 to $175 in 4yrs. I just had an appointment on March 3rd 2014 and he said, and I quote "The DEA is cracking down on buprenorphine....blah blah blah, crossing borders, mumbled a few more words and said "Anyways, I have to write you for suboxone, it's 3 x expensive so I will taper you down to 49." I didn't think anything of it and said okay. Also about a year ago he started writing them for pain, because I deliver office furniture and sometimes have problems with my knees. Not sure if that matters any. So I go to the pharmacy to get my script of 49 suboxone that now costs $347 for just 49 of them (Ouch, sucks to not have insurance). These suboxone are the 8mg/2mg are manufactured by Amneal. (Round orange pill with AN 415 on the front nothing on the back.) So I get home take one 8mg pill, wait 2hrs later and nothing but a bad headache, diarrhea, upset stomach. So I let all that pass, thinking my body had to get adjusted to the suboxone. Today (3-5-14) I took one this morning and felt okay to go to work but usually I would take one of the generic buprenorphine and it would last all day, this morning when I took the suboxone, I started feeling like crap around lunch time. I just got off work a few hours ago and took 3/4 of one, because I'm tapering down because of cost, and my knees hurt, my hands are clammy, yawning, watering eyes. So I'm hoping I can talk to my doctor and get switched back to generic. I just don't understand, something that has been working fine for so long and cost less, has to be changed. Let me know if anyone else has gone through this or if you have any feedback, thanks.


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PostPosted: Wed Mar 05, 2014 10:58 pm 
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there is no generic film that I'm aware of...is there a new one out that I haven't heard of? zubsolv, far as I know, isn't a film. the only film version I know about is Suboxone, the Reckitt version.

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PostPosted: Thu Mar 06, 2014 2:54 am 
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the Amneal tablet you are describing is also generic form of Suboxone. Reckitt Benckiser, the company that makes Suboxone, only makes it in the film form now, since it discontinued the tablets due to what they cited as safety( pediatric)and diversion concerns. if I'm wrong here, someone can correct me, but as far as I know they're is only one form of brand name Suboxone and that's the films.

however, the pill you describe taking all these years has been plain buprenorphine without naloxone, used to be called subutex, and also made by Reckitt Benckiser, but is now only available in generic,which is far less expensive in most places than any formulation of Suboxone, branded or generic that contains naloxone. I have read by Dr. junig, and from several other sources that the DEA doesn't get involved in what meds drs rx to patients and isn't cracking down at all on drs prescribing plain buprenorphine. many doctors are uncomfortable prescribing this form of bupe without naloxone to patients other than pregnant women, or people with known allergies or problems with naloxone, because diversion/ or iv abuse is supposedly worse with plain bupe, so they blame their own rules/preferences on the DEA, so that their patients. Dont get upset with them. Unless your Dr is breaking the law, I doubt the DEA would even get involved in what form of bupe he is prescribing to his patients .not sure, other than that why your doctor would switch your medication after all that time. I would certainly report the bad side effects of the new med to your doctor, some people report getting headaches from naloxone. if he won't switch you back to the no naloxone tablets, you could try, after allowing the pill to dissolve/ absorb for appropriate amount of time, instead of swallowing your saliva, spit it out so that you won't be swallowing the naloxone which isn't absorbed well thru the membranes in the mouth anyway. that could help with the upset stomach as well. I hope your doc will be understanding about the financial and side effect aspects of the change for you, and will switch you back, but just in case I hope those suggestions will help you.
for cost concerns that could've meant the difference in my receiving treatment or not, my doctor changed me from brand name films to 8mg tabs of plain bupe, which is set to save me almost six hundred dollars a month! I wish more doctors would consider the financial aspects of this expensive treatment for their uninsured patients. I realize how incredibly lucky I am to have a doc who's willing to prescribe it to me. I showed my doctor some of the info that Dr. Junig has at suboxonetalkzone. com about plain buprenorphine vs. Suboxone, and that may have helped me so maybe you could print off some of those to show your doctor.


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