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PostPosted: Thu May 04, 2017 1:08 pm 
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May 2, 2017 FDA approves Bunavail for induction. (Old news as Dr's have inducted w Bunavail for awhile).

The FDA now allows for use of Bunavail at the start of buprenorphine treatment for opioid dependence. Previously, the indication for Bunavail only covered the maintenance phase of treatment for opioid dependence.

http://bdsi.investorroom.com/2017-05-02 ... Dependence

Some believe Bunavail is far less likely to be abused, as it ultimately has less buprenorphine to abuse and a gummy matrix that would deter abuse.

The efficiency of their buccal delivery system requires only ~50% of the buprenorphine dose required with Suboxone to achieve the same plasma levels (aka a 4.2 mg Bunavail film is equal to an 8 mg Suboxone).

With Bunavail, the buprenorphine is housed in a gummy matrix, making it next to impossible to inject, snort etc, which can be done with Suboxone and Zubsolv.

Suboxone -Zubzolv- Bunavail
[1mg]..........0.7mg..................
2mg............1.4mg..................
4mg............2.9mg........2.1mg
8mg............5.7mg........4.2mg
12mg..........8.6mg........6.3mg
[16mg]......11.4mg.................
[The doses in brackets do not exist and are for comparative use only.]

Imo, from competitor aspect, given the recent expansion of Federal law to allow more patients to start buprenorphine treatment, Bunavail, wants to catch patients at the outset and then keep these patients on their product. This avoids attempting to later convert patients from Suboxone, Zubzolv or generic bup/naloxone because some/many patients understandably resist changing their bup medication. I also think the sales reps will push it's low abuse potential.

Where any of you inducted on Bunavail? Are any of you on maintenance on Bunavail?

_________________
Did well on Suboxone. Stopped May 2011.
Stopping went well -- its the staying stopped -- where the real work begins.
Coming here 'keeps recovery green'.


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PostPosted: Thu May 04, 2017 7:13 pm 
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I haven't kept up ((lately...the past year or 1 1/2 year)) with what's happening on generics and with the cap on patients and such...

I would like it if someone -- maybe even one of our 2 doctors that may find some time -- could make a running list of the current suboxone/buprenorphine medications that are available..
I think many folks get confused about Suboxone ....instead of thinking it's a name brand for a particular mixture of buprenorphine/naloxone, they think Suboxone is the ingredient that does the work...

But I think it would be handy to have a list of the products available from (Indivior/RB/Whatever their name this week)...and the others who have come out, plus any that may be coming online in the next 6-12 months.
I know Suboxone, Zubsolv, and Bunavil (and of course, subutex)..

We should have a list of the MG doses available..

Last that I checked with my insurance, the bunavil was either more expensive or about the same as Suboxone 8mg.
The only one I looked into was Subutex..
I would prefer to be able to cut my Suboxone into really small pieces..sometimes I will get 5 pieces from an 8mg Suboxone...and that's just impossible with Subutex.

I'm currently forcing myself to take really tiny piece of Suboxone ...just to prove a point to myself ...

I already know it ...but sometimes I have to show myself before I'll believe it...

But I just got my meds yesterday..I get plenty of Suboxone too..but for my own lessons, I'm going to prove to myself that I can make it on even just 8mg a day...just for the sake of doing it.
I'm prescribed 3 times that amount...and I want the extras to put back anyway...
But I want to make myself believe what I already know to be factual.

It does feel good as today has gone by to know that I've only taken 1 suboxone all day long. Granted it was in very small pieces....

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DOB: July 1, 1985
October 8, 2013

RIP little brother. Gone, but not forgotten.


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PostPosted: Fri May 05, 2017 5:11 pm 
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Most people, I suspect, are prescribed much more buprenorphine than they need. Most don't realize that; others, I fear, are sharing or diverting. I can't criticize you, Jonathan, because I realize that doctors sometimes suddenly discharge patients for bizarre reasons, or drop out of practice without warning. But I have to encourage patients to be honest with their physicians.

I'll provide a bit of clarity...

As Jonathan noted, it's all about the buprenorphine. Period. Other points of confusion.... people inject buprenorphine, and people inject bupe/naloxone meds. There is little difference between injecting the two meds. A person using heroin will precipitate withdrawal after injecting EITHER medication, because the buprenorphine is the cause of the withdrawal. Naloxone may have a slight effect on 'liking' scores in people who do NOT have agonists in their systems, who inject the medications. But naloxone is gone after an hour, so the impact of naloxone is a bigger issue for marketing purposes than for anything else.

Current products on the market, roughly in order of market share:

Suboxone Film, the Indivior/Reckitt/whatever medication that contains buprenorphine and naloxone, sold in doses of 2, 4, 8, or 12 mg buprenorphine;

Buprenorphine, formerly sold under the now-discontinued brand Subutex, and available as a sublingual tablet in 2 and 8 mg sizes.

Buprenorphine/naloxone generics, made by a number of generic manufacturers in dosage units of 2 or 8 mg;

Zubsolv, a menthol-flavored buprenorphine/naloxone medication sold in dosages of 1.4, 2.9, 5.7, 8.6, or 11.4 mg of buprenorphine. The 5.7 mg dose provides buprenorphine absorption equivalent to 8 mg of Suboxone film.

Bunavail, a buccal (inner cheek) patch with a cover that holds buprenorphine against the mucosa of the inner cheek, increasing absorption to about 50%. Dosages of 2.1, 4.2, or 6.3 mg of buprenorphine, with the 4.2 mg dose equal to 8 mg of Suboxone Film.


All of these preparations work in the same way. All have pros and cons, but those issues are minor compared to the biggest issue, which is insurance coverage. Yes, Bunavail may be a bit more difficult to divert. I have a hard time getting excited about that issue, since people who take even diverted buprenorphine have a very low chance of 1. getting high from agonists, and 2. dying from overdose. Diversion is a complicated topic, and too many people want to make it simple-- at the cost of overzealous prosecutions and needless deaths. From everything I see in my corner of Wisconsin, diversion is caused by lack of access to buprenorphine prescribers. Heroin is readily available; nobody with the desire to get 'high' is going to spend 10 times more to get buprenorphine! Yes, people often make misguided efforts to treat themselves with illicitly-acquired buprenorphine. They lose their motivation after a few days or weeks, and resume using heroin. But how horrible is it for society that someone addicted to heroin takes a few days off from active using? Maybe that 'vacation' from addiction provides the moment of reflection that eventually leads to REAL treatment. Maybe that vacation allows the person to look at the scars on his arms, and think that 'this has to stop'!

Or maybe the vacation from using accomplishes nothing at all. We know one thing-- that it doesn't cause death. We know after all that dying from overdose is very rare in people who have taken buprenorphine (the one exception being buprenorphine use by people naive to opioids, a rare situation).

Have a nice weekend everyone!


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PostPosted: Fri May 05, 2017 5:41 pm 
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I'm glad I have a great relationship with my current doctor, but only being a 3-month patient, a lot can happen in 3 months within a doctors office.. The office politics can cause a doctor to no longer be involved with that practice (which could happen with my doctor, as she's from Gadsden, AL but drives to Bham to see Suboxone patients in this clinic, which is run by another doctor from Bham.)..

I've often thought of asking if she had a private practice that she may work out of in case something went bad in Bham, but just havent done so. I would hope that i get some warning if she has some health problems and has to cease being my doctor...and there are other doctors in the building...but I don't know if they would be as open as she is about addiction and being so susceptible to actually listening to and having genuine concern over addiction...

So I've just plainly told her that I would like to keep some stocked-up for emergency...and she's fine with it. I'm very glad she is open to that idea, as I'm afraid finding another doctor with the same beliefs would be a struggle...

It would be great if all doctors felt the same way in regards to addiction and treatment, but sadly that just isn't the case. I just emailed a doctor who replied to me on treatment-match and told him that I felt as though he thinks he can cure the disease of addiction, and even the surgeon general of the US says addiction should be viewed much the same as diabetes is viewed...and that regretfully, I don't feel the same way in thinking any doctor can suddenly pronounce me "healed" one day from addiction. While it sounds good on paper, it just doesn't happen.

I see that commercial in my mind of Passages Malibu...Pax Prentiss is on that commercial bragging, and his exact quote at the end is this, "I was an addict, now I'm not"....
That just tells me that he's full of it. And because "malibu" is at the end of their name, they probably charge $80,000 for a month...

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Adam Wayne P.
DOB: July 1, 1985
October 8, 2013

RIP little brother. Gone, but not forgotten.


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PostPosted: Sat May 06, 2017 12:56 am 
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Agree for sure on the complexity of diversion and its importance is real and mostly helpful. But, the non Opioid Use Disorder world sees bup abuse as a problem. And that's the world where the decision makers live and decide.

'All have pros and cons, but those issues are minor compared to the biggest issue, which is insurance coverage. Yes, Bunavail may be a bit more difficult to divert'
Exactly, which is why Bunavail's push of it's low/no abuse is against Indivior for its 'safety' profile. Remember, Indivior, maker of Suboxone, shockingly pulled both the Subutex and Suboxone tablets and launched then forced Suboxone film bc they said they tablets were unsafe around kids? Yes, and that ruse worked quite well - $1B well last year!! Make no mistake, other eyes have seen their success. The wart is the FDA states bup tablets are safe and 35 US states and a grand jury are looking at criminal charges against Indivior for 'product hoping'. Also, given Indivior's bad press against generic bup tablets, plain or w naloxone, its a wonder that generic plain bup tablets at 20% and bup/nalx at 15% still grew to 35% of the market share and are growing.

There's at least 2 forces at play here: 1) capitalism combined w greed/perhaps fraud AND 2) addiction and its mighty tentacles that wreck and destroy lives... These forces act upon all of us...

Seriously worth a read.... Oct 2016
http://www.thedailybeast.com/articles/2 ... -1-billion

Best to all tonight! P

_________________
Did well on Suboxone. Stopped May 2011.
Stopping went well -- its the staying stopped -- where the real work begins.
Coming here 'keeps recovery green'.


Last edited by Pelican on Sat May 06, 2017 1:57 am, edited 1 time in total.

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PostPosted: Sat May 06, 2017 1:21 am 
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I wonder when that lawsuit will have any effect -- if it ever does actually play out...

Knowing RB/Indivior...they will have their attorneys push the dates out as close to 2023 as they possibly can..because Sub film patent.

I've been on both, the pill and film. Haven't had anything except that prescribed..

I have taken Subutex...but that was around 2012-13 when I got a little relaxed in staying the course and told myself that I wasn't doing anything bad since it wasn't going back to addiction/ opiates..
I had a friend that I would swap film with for subutex...but I think over a period of maybe 2-3 months, we only swapped around 5-10 total...
She wanted to try the film, and I wanted to try the subutex.
I wasn't impressed...

Chances are, most Suboxone film patients who do the same thing I currently do are happy where they are with film and would likely stay if given the choice...
I like being able to cut an 8mg film into 5 pieces...
There's no way to cut a subutex, which is smaller than an advil tablet, into 5 pieces. I remember breaking a subutex and it just crumbles into powder...so it doesn't really help much to have that problem...

Getting past the stigma that RB created both in the doctor offices and on the street...Not sure what it will take..
Likely a lot of time and training medical professionals who don't know ..
And there are plenty who don't know. A few practice in the clinic where I am a patient. I don't see the same doctor as my neighbor, but she catches hell from her sub doc.
He does a blood test every time she comes in. She's nearly 60, with scoliosis and doesn't even give the impression of a dishonest person, let alone someone who would divert meds...
But he has made her bring in empty sub packs for counting...etc.
I've never had to do any of that. And I only do urine ...never done blood testing.
Never had a bad UA either...and neither has she.

I keep her informed on the actuals of Suboxone and bupe...and how it works...what it can and can't do...
She saw me when I was doing Oxy and knows how much different I am since I've been on Suboxone. She knows exactly how close to death I was...

But there are so many people out there who don't have information to go on..so they trust whatever they are told. And sometimes I think some of these doctors just go on Google for their reasoning... (like, "the FDA makes us dispense 28-day supplies"...or "the FDA says we can't RX subutex unless it's a pregnant woman"..)

_________________
Adam Wayne P.
DOB: July 1, 1985
October 8, 2013

RIP little brother. Gone, but not forgotten.


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