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PostPosted: Fri Dec 13, 2013 8:22 am 
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Hello,

I have been on suboxone for 10 months now with this doc. I asked him the first appt about subutex because of it's cost in comparison to suboxone films. He told me he could not prescribe them. I didn't sweat it but the last few months I have been unable to afford the cost of my scripts. I have no insurance and been forced to take less than presribed to afford it.

So a few months back as I was waiting in the office I heard the receptionist calling in a script for subutex with the doc standing over her shoulder. As she was talking, he said to her " with this one you have to tell them that it's for pain. Do not forget to say its for taken for pain.." then when she hung up the phone the doc again said that with subutex that he writes them to be taken for pain even tho it's an opiate maintenance patient.

I've been getting my case together to approach my doc about being on subutex instead of strips. Today I asked if I could be on subutex because it's so expensive otherwise and I have no insurance. I told him I had done lots of research on the subject and hoped he would be up for it. He told me again he could not presribe it to me. He said it could only be prescribed for pain. So I pushed a little more and said it'd help out so much with costs, and he said he wished he could but he could lost his license.

I am positive he's prescribing it to others, and I believe prescribing it to opioid maintenance patients just like me.

I want on it also because I don't like having naloxone in my body and know I'd feel better without it.

What should I do?
Call him out on overhearing the phone call?


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PostPosted: Fri Dec 13, 2013 9:33 am 
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well for me, im kinda in the same boat. Been on sub 3 years now an tried to have my dr switch me. The loug and the short pf it is this..find a new doc, or learn to live with it..i found myself wasting so much time tic off that i could not convice ANY dr in my area that subutex would be better for me..i pay out of pocket also. And yes it would be much cheaper. But good luck finding a dr that hasnt been brainwashed by R B reps...
Sorry but thats how i see it today....raz


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PostPosted: Fri Dec 13, 2013 3:42 pm 
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Your Dr's logic makes zero sense but he's obviously frightful of losing his waiver/license which likely wouldn't happen but he's likely also not going to waiver even if you present him with the legalities of the situation. A Dr can't be forced to prescribe any medication is the long and short of it, in this case knowing it is the same drug plus a bit of scam in the one you are taking, I'd be upset too.

I'm guessing the people he feels comfortable RXing Subutex to are people who were indeed using medication prescribed for chronic pain, real, Imagined or scammed so he/she feels like there is a paper trail of a 'legit' pain condition.

Oddly, though, in this case Subutex is indicated only for the treatment of opioid dependence, and NOT chronic pain, so he's using it off-label for chronic pain. Perhaps, also he's making a big deal about calling it in 'for pain' as an off label use so it doesn't effect his 30 or 100 patient cap, I'm not sure but something's off. Chances are in your case he won't waiver unfortunately, you can keep presenting him with info or ask/call around for a more educated prescriber with a waiver.

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PostPosted: Sat Dec 14, 2013 2:06 am 
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My doctor made up fake excuses just like the OP the first two times I asked him for generic subutex and like others was completely pissed off for awhile because of how much money was wasted on brand name suboxone and then I asked him a 3rd time (this time I presented my case to the nurse first and she wrote down in my chart that I wanted to take subutex and the positives I listed about price difference and the fact that I believe I get side effects from suboxone) and he came in took a glance at what she wrote and then said "ok so you want to try the generic subutex?" and I said "yeah" and he just said "ok" as if it was not a big deal at all and like I had never asked in the past it was really weird. Ive been in treatment for 3.5 years and on subutex all but the first 8 months. Im worried about my future in treatment though, the price is a huge plus compared to suboxone but the real reason Im so grateful to have it is all my headache/stomach ache side effects that I got from suboxone ceased when i switched to subutex and it seems like barely any drs are willing to rx it. My dr is an older guy and Im fairly young so if I was gonna stay on maintenance indefinitely I will eventually have to be forwarded to another dr at some point and Im worried they won't give a crap what my past Dr. was ok with Rxing and will tell me I can't have subutex.


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PostPosted: Sat Dec 14, 2013 2:39 pm 
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what is the difference btw suboxen and subutex? I thought suboxen was better and that was the reason more patients were on it. from reading your posts, im getting that subutex is better and has less side effects. I suffer from severe migraines due to neck injuries, that's how I got on pain meds to begin w/. i am suppose to start on suboxen this wed. my dr is well aware of my headaches, as i get botox injections every 3mths for migraines. was i suppose to tell her subutex would be better for me?


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PostPosted: Sat Dec 14, 2013 5:46 pm 
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The only difference between the two is suboxone has naloxone added to it and subutex is just plain buprenorphine. Naloxone causes side effects in some people (I get headaches and stomach aches mostly) and also suboxone is more expensive then generic subutex, I don't know how much generic suboxone pills cost but I don't think they are as low as subutex yet, I pay roughly 2.50$ per 8mg pill for roxanne generic subutex so thats another plus to having subutex vs suboxone.


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PostPosted: Tue Dec 17, 2013 11:07 am 
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Buprecision wrote:
The only difference between the two is suboxone has naloxone added to it and subutex is just plain buprenorphine. Naloxone causes side effects in some people (I get headaches and stomach aches mostly) and also suboxone is more expensive then generic subutex, I don't know how much generic suboxone pills cost but I don't think they are as low as subutex yet, I pay roughly 2.50$ per 8mg pill for roxanne generic subutex so thats another plus to having subutex vs suboxone.


now i am even more confused. sounds to me like subutex is better, doesn't cause head and stomach aches, and is less expensive. i don't understand why more people are on suboxen then? i wish i would have known this sooner, my appt is tmrw morning


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PostPosted: Tue Dec 17, 2013 11:37 am 
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snowwhite wrote:
now i am even more confused. sounds to me like subutex is better, doesn't cause head and stomach aches, and is less expensive. i don't understand why more people are on suboxen then? i wish i would have known this sooner, my appt is tmrw morning


Hi Snow White.

Let me see if I can help and try to explain why one is prescribed more often than the other.

In my own personal opinion, I'm not certain one is more beneficial than the other and I have been on both Suboxone and Subutex. I noticed no difference in the two myself. I know others have, but for me personally it made absolutely no difference how I felt on either one.

Most all doctors will prescribe Suboxone over Subutex because of one simple reason...most everyone that comes to them seeking this drug is an addict, and needs help with withdrawals and cravings from their drug of choice. And the idea of getting on Suboxone in the first place is usually because the addict wants to stop all other drugs. As was previously explained by Buprecision, the only difference between both drugs is the addition of Naloxone to the Suboxone. Subutex is pure Buprenorphine, the active ingredient in both of them.

The idea of adding the Naloxone to the Suboxone is to prevent addicts from abusing the drug by IV or snorting methods. It is believed the pure Subutex can be abused and the doctors certainly don't want that happening so the Suboxone is almost always prescribed over the Subutex. Now some will say that Suboxone can also be abused and that may be true in some cases I guess.

There are some addicts that are sensetive to the Naloxone that is in the Suboxone. They may have symptoms such as stomach issues, headaches, and an overall achy feeling along with other symptoms sometimes. In some cases the doctor may decide to switch the patients to the Subutex which has none of the Naloxone added to it. It's usually advisable for pregnant women to be on the Subutex also.

Many sub doctors will absolutely refuse to give their patients Subutex. I wouldn't worry about it if I were you Snow White. I'm quite sure you will do fine on either Suboxone or Subutex. Your doctor should know what's best for you at the time of your visit. Keep us informed how it's going.

Hope this helps and I wish you the very best!

Karen xoxo


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PostPosted: Wed Dec 18, 2013 1:52 am 
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I have to beg y'all to read my blog! Here is one post: http://www.suboxonetalkzone.com/wasting ... -suboxone/

There many others, though, that point out why the primary role of naloxone was to turn a cheap generic medication, buprenorphine, into a patented expensive medication, Suboxone.

Note that Subutex is no longer manufactured. Instead, there is 'generic buprenorphine tabs'. I've searched for evidence that buprenorphine is more 'divertable' than bupe/naloxone, and have found very little science behind the claim. One study looked at people injecting the two drugs; when they injected just one or the other, they couldn't tell the difference... but when directly compared, the 'liking scores' for bupe/naloxone were slightly lower than for bupe alone when both were injected, one after the other.

Remember that naloxone is a very short-acting drug (it gets confused with naltrexone, which has a long half-life). When injected, naloxone is gone after 30 minutes or so-- so at most, naloxone's deterrent effect amounts to a few minutes of slightly reduced effects from injected buprenorphine.

BUT... politicians always get the science wrong. Some states have laws regulating whether buprenorphine can be used (or so I've heard from emails from readers-- I have not verified those claims).

To the original poster, consider printing out a few of my posts, including the one I listed above. When the doc says I'm just some idiot, show him the NYT article from a couple weeks ago--- it doesn't prove I know anything, but it shows that I'm at least a well-known idiot!


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PostPosted: Sun Dec 22, 2013 4:55 pm 
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I requested to be put on the Suboxone strips after a couple of years on generic subutex. Which is just as well, because the information was relayed to me that once again the Drug enforcement Agency
Prefers subutex to be prescribed only to pregnant woman.

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PostPosted: Sun Dec 22, 2013 7:12 pm 
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After seeing this, I'll go X2 on your other issue regarding the DEA and time limits on buprenorphine. The DEA as an agency doesn't prefer or not prefer one drug over another. Perhaps your prescriber has bought into that line of thinking and practices that way personally. Both Subutex and Suboxone as well as generic versions of both are CIII and can be utilized for office-based addiction treatment by DATA 2000 waivered physicians.

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