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PostPosted: Mon Aug 15, 2016 6:12 am 
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Having an issue with dosage I was on soboxone for over a year then switched to zubsolv 2 5.7mg tabs a day.. Told that would be equal to my suboxone dose at 16mgs 2x daily.. Been taking it for the 4th day and still feeling withdrawals like i need a increase in dosage. (Haven't taken anything over what I've been told to). Also scared to say anything to my doctor.. But I don't want to feel like this either.. Is asking for 3 5.7mgs daily too much? I am also still in limbo with insurance so paying out of pocket for all meds with a discount card zubsolv is cheaper than suboxone films and generic suboxone tablets did me no good. Please help! Feeling hopeless.. :(

Too clarify my dosage.. Daily suboxone taken 8mg twice daily=16mg total
Daily zubsolv taken 5.7 mg twice daily=11.4mg


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PostPosted: Mon Aug 15, 2016 11:03 pm 
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On AVERAGE, people absorb about a quarter of a dose of Suboxone, about a third of a dose of Zubsolv, and about half of a dose of Bunavail. The different 'base dosages' stem from the difference in average absorption. On average, a person taking 8 mg of Suboxone film, 5.7 mg of Zubsolv, or 4.3 mg of Bunavail will all have the same blood level of buprenorphine.

But every person taking buprenorphine will have unique characteristics that favor, maybe very slightly, one brand over the other-- either from differences in anatomy or amount of saliva, or differences in technique. For example I'm certain people absorb more buprenorphine when they hold a strip of Suboxone between the tongue and buccal mucosa, similar to how Bunavail increases absorption by holding buprenorphine up and out of the flow of saliva.

All of that said, I'm convinced that most patients take far more buprenorphine than necessary to stay above the ceiling threshold. People have very strong reactions to med changes with buprenorphine, which come (in my opinion) from the fear of withdrawal that lives in anyone who has been addicted to opioids. I've had literally hundreds of patients change buprenorphine products over the years, and most people initially resent the change and experience all sorts of symptoms... but when it is eventually clear that their insurance isn't going to budge, they adjust to the new med, and often end up liking it more than the one before.

There was an article in 'The Fix' a few weeks ago by a pharmacist, writing about his thoughts about buprenorphine. He had a lot of advice for doctors, leaving me with the desire to write back and tell him about all the problems we've heard about pharmacists... but I digress... he also wrote that patients who really favored a form of buprenorphine should be viewed as at higher risk for diversion, and that doctors should basically just tell patients to shut up, and take what is given to them. I found that attitude very annoying. According to him, addicts are a class of patient that doesn't deserve a choice--- even with a medication that comes with very different tastes, that is placed in the mouth for up to 30 minutes (or more) every single morning of the patient's life! So I try to provide what patients prefer, with one exception: More and more doctors have a 'thing' about buprenorphine, convinced that every patient taking that medication is injecting it. The idea is ridiculous for 95% of patients, but I cannot deny that there are a few idiots out there injecting buprenorphine. I'm not likely to prescribe the drug to someone who has injected it in the past, or if I have any doubt that the person is taking it appropriately.

Back to your case-- I don't know you at all, but because you say generics 'did you no good' and now Zubsolv isn't satisfying you, my gut tells me you are looking for something in the medication that isn't there-- that is more likely coming from perceptions alone. Sometimes choice is a good thing-- but MORE choice isn't always better. Back when we had one option, everyone was happy with it. If you woke up in a world that had nothing but generic buprenorphine/naloxone, and by law no doctor could give more than 8 mg per day, you would find a way to make it work. Heck, in the 1990's, addicts in France were thrilled to treat their opioid addictions using vials of Temgesic, a dilute formulation of buprenorphine dissolved in water! Some people know how to just force themselves to be satisfied with whatever they have. I think that skill serves them well-- and probably saves them money too.


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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

  • Board Certified Psychiatrist
  • Asst Clinical Professor, Medical College of Wisconsin

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