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PostPosted: Wed Aug 30, 2017 7:41 pm 
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Hey there,

So I am a pharmacist and I'm not the devil lol. I try to treat ALL patients with kindness, respect, and professionalism. I apologize for those in the field who have not always been to suboxone patients... BUT my question to this forum-

Why do I have so many picky patients who want a certain color/brand/certain word on their suboxone generic tablets? I have patients who only want DARK orange, they refuse the lighter color. I have patients who ONLY want white tablets. I just want to understand. It's hard for me to keep up with who wants what brand, to stay prepared at the more popular color/brand at the moment...

I'm all ears. This creates a bit of a headache for me at times... If I could understand what makes one better than another, maybe I could find it less annoying.


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PostPosted: Wed Aug 30, 2017 9:58 pm 
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Hi Pharmacygirl3, Welcome! Happy to have a voice of the pharmaceutical world here! I think it is similar to brand loyalty.....as an example, some people feel that only Tylenol will cure their headache and will not use a store brand or think about Ibuprofen instead! As far as color, I have seen people refuse to buy baby aspirin if it was not Bayer and that orange color! It is fascinating what people get in their head! This is the only explanation that I can think off! Please, stick around! It will be nice to have an expert here!


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PostPosted: Wed Aug 30, 2017 11:15 pm 
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Thanks for posting. I have never heard of a pharmacy offering patients a choice of generic. I have about 40 patients taking generic buprenorphine or buprenorphine/naloxone. The pharmacy (I deal with about 30 different ones) gives them one option, take it or leave it. I have seen patients get switched 3 times in 4 months, I presume because that was the best wholesale price for the month.
Do you let them request a specific manufacturer and then get it?
Do you keep in stock all the different generics?
The pharmacists around here don't entertain the questions/complaints you are getting.


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PostPosted: Thu Aug 31, 2017 1:29 am 
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I too am interested in docm2 questions.
How many generic 2mg/.5 and 8/2 mg bup/nal combo manufacturers are there?
I count 8 ?
Actavis, Akorn formerly Hi tec, Amneal, EthyPharm, Kremers Urban, Lannett, SunPharm, West-Ward bot Roxanne.

I'm thinking back to prior posts on generic bup/nal preference. I don't think its about what is more 'popular', instead its what that pt feels to be most effective and efficient, for them.

Keep in mind that dissolving / absorbing sublingual bup/nal tabs takes a long time, longer than the film. It can be a cumbersome up to 15" procedure to get the tab sublingually maximally absorbed with real body reactions clearly involved like generating taste, smell, excess saliva production w no swallowing, no speaking allowed, patience... Bup is an expensive restricted med and and folks need all of it, no one wants to waste their dose. Each have different tastes which can gag some. Each generate different amounts of saliva requiring adjustment. Each have different dissolving times again requiring adjustment, including some folks have to maximize absorption by painting bup on the inside of their cheek w their tongue. Some folks need to cut up to taper down or split dose 4mg 2 X's day and smaller ones are harder to cut up, one may appear to wear off too fast, some dislike changing fillers and excipients...So switching bup/nal generics can be a big change some folks prefer not to go thru -- if given a choice.

Thanks for asking! Hopefully, you'll hear directly from members currently on generic bup/nal combo!

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PostPosted: Thu Aug 31, 2017 12:09 pm 
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May I ask you a question? As a pharmacist, are you aware of the additional confidentiality requirements, beyond HIPAA, for your patients who are addicts? In other words, are you aware of 42 CFR Part 2? Do you believe most pharmacists are aware of the regulation?

We receive a shocking amount of anecdotal evidence that pharmacists have embarrassing and loud conversations about the medication we opioid addicts are prescribed.

In reference to your question, there aren't many addicts who aren't very afraid of withdrawal and relapse. The quality and consistency of our medication is important. I don't understand how people are making the determination that their strips aren't orange enough though. I've seen people who have been concerned when their suboxone strips seem old compared to other strips. That is not something I would have ever brought up myself, and I'm now on Zubsolv tablets. Thank you for caring about your patients. We really do rely on you to help keep our addiction in check!

Amy

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PostPosted: Thu Aug 31, 2017 2:29 pm 
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Like docm2 said, as far as everyone I've spoken to at my clinic, the pharmacists around my area do not give the option of which generic they're getting. One month it'll be the orange tablets, another month it'll be the half moon white tablets etc.... the reason I know this is because they talk about it in group a lot. Some prefer this and aren't happy to see they've gotten that this time..... so I totally agree with docm2.

As far as why some prefer one kind over another, imo it's pretty simple that it's whatever they feel is the best. Some think others are a little better than a particular one. It could be absorption reasons or just that they're afraid to switch to another brand because we're so afraid to mess with something that works well. This medication has changed our lives and taken us off rock bottom, most of us never thought we'd be so lucky and I think we just get nervous when there's any kind of change that happens in fear of getting something different that may not work as well. Even though it's the same medication, some of us worry a lot :)

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PostPosted: Thu Aug 31, 2017 5:25 pm 
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I don't have a choice of generic tablets. What the pharmacy has is what I get. Every month it seems that I get a different generic. When a patient takes only a part of a tablets, some generics are much easier to split than others. Amneal generic seem to be the most difficult for me to split. Sometimes it takes a little time to get used to different generics, as some dissolve faster than others and have a different taste. They all work.


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PostPosted: Thu Aug 31, 2017 11:41 pm 
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This is an interesting observation. One would think that people who at one time may have ingested pills or other substances of totally unknown origin and content, often via intravenous injection would not be very picky about legitimate medication from a pharmacy.

However, they also are used to taking medications with the expectation of feeling a certain way in contrast to most other people who take medications hoping not to feel anything. Also, remember that these people have had their brain reward system hijacked by a substance that literally became more important to them than practically anything else in life. It’s probably like trying to serve a meal to a foodie or food critic but many times more difficult.


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PostPosted: Fri Sep 01, 2017 12:40 pm 
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Statcoder,

I'm sure not all of them would ingest pills of unknown content, me, for example. The pills I took were all directly from the pharmacy.

I always detect a note of disdain from your posts, a separateness. In this post you use "they" and "these people". So, I assume that you are not an addict. I googled "stat coder" to try to understand what the origin of your name might be. The first entries are for an app that physicians use. Maybe you are in software or maybe you are a physician, or neither.

Mostly what I've noticed about you, statcoder, is that you don't seem to be here to be helpful. Your observations, while astute, are not tinged with any kindness. This is probably one of the least judgmental posts I've seen from you, and yet I still detect negativity. Your bearing begs the question, "Why are you here?"

I hope it's obvious why I am here. I am here to help. I don't do that perfectly or without mistakes, but that's why I'm here. Perhaps you've also noticed that I am protective of the people who come here for help. I don't allow them to be called names. I bristle if I feel they are being insulted, or even talked down to.

It's probable that you don't care what I think and that is fine. Just please be careful how you talk to us and about us. I'm certainly not the only one who picks up on the disdain.

Amy

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PostPosted: Sat Sep 02, 2017 7:38 am 
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The first thing that popped out at me was the use of 'they' and 'these people'......... and NOT speaking from experience. Are u not an addict, are u personally familiar with buprenorphine? I'm asking these questions because I've picked up on it also.

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PostPosted: Thu Sep 07, 2017 11:17 am 
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I'm back, not a troll lol. I thought I had set this up to be emailed when someone replied to my post but I guess not. I assumed no one had responded! Happy to see so many did.

You all gave me many different things to think about.

At our pharmacy, we carry westward, which is a lighter orange and recently started carrying Amneal which is a much darker orange. Amneal seems to be the favorite and we've gotten many new patients just for the simple fact that we carry them. Is it the color? Do they dissolve faster? Anyone have any ideas?

docm2 wrote:
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I'm wondering if we were visited by a troll? Hope she comes back and participates as she said she would.


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PostPosted: Thu Sep 07, 2017 11:19 am 
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I work for an independent pharmacy, if we can order if and not lose money, we will order what the patient wants.



docm2 wrote:
Thanks for posting. I have never heard of a pharmacy offering patients a choice of generic. I have about 40 patients taking generic buprenorphine or buprenorphine/naloxone. The pharmacy (I deal with about 30 different ones) gives them one option, take it or leave it. I have seen patients get switched 3 times in 4 months, I presume because that was the best wholesale price for the month.
Do you let them request a specific manufacturer and then get it?
Do you keep in stock all the different generics?
The pharmacists around here don't entertain the questions/complaints you are getting.


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PostPosted: Thu Sep 07, 2017 6:50 pm 
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Thanks for posting back that you're not a troll! I went ahead and deleted my post and will do the same with docm's if he asks me to.

It would be great if you stuck around and gave us your opinion from time to time. We have two doctors here who are experts in the field of addiction and adding a pharmacist would be great. The welcome mat is out for you.

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PostPosted: Thu Sep 07, 2017 10:17 pm 
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I'm glad you came back, I agree with you Rule, go ahead and remove my troll post.
We will be interested in your perspective Pharmacygirl. Many don't realize the increasingly vital role that pharmacists are expected to play in the health care world. No longer does, 'I'm the doctor, dispense what I tell you', will fly.
I hear the pharmacists frustrations when they get caught between an insurance prior authorization and an impatient patient.
Again, I hope you continue to post. There are some other questions through out the thread you started.


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PostPosted: Fri Sep 08, 2017 12:55 am 
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I would love it, Pharmacy gal, if you were able to answer my question about 42 CFR Part 2 and confidentiality. Please! :D

Amy

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PostPosted: Thu Sep 21, 2017 3:22 pm 
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Pharmacygirl13,

I missed this and want to correct mischaracterizations.
Statcoder wrote:
One would think that people who at one time may have ingested pills or other substances of totally unknown origin and content, often via intravenous injection would not be very picky about legitimate medication from a pharmacy.
No its the opposite. Active recovery on bup -- IS being very picky. Its called being healthy w the powerful desire to stay well and not go back to wreckage and destruction. When we got/get on bup, we were/are finally on a med that saves -- not destroys, so ya some have concerns when their bup med is changed and can be worried and picky when their new better life is threatened.
Statcoder wrote:
However, they also are used to taking medications with the expectation of feeling a certain way...
Yes, this is definitely true in active addiction.

Statcoder wrote:
...in contrast to most other people who take medications hoping not to feel anything.
This is incorrect bc for many other people (non addicts), they do want to feel their meds and not feeling their meds is a huge problem of medication adherence, formerly called compliance. Studies show patient records report "Dr, I stopped my high blood pressure med, osteoporosis med, antibiotic med, thyroid med etc. bc I couldn't FEEL it was doing anything so I don't need it". Folks do expect to feel meds and when they don't its a big part of the problem of patients stopping their meds too soon. Electronic record adherence/compliance programs are being sold to comb thru electronic patient records to earlier identify and catch which patients are not feeling their meds or have side effects, cost issues etc. and stop them too early.

Statcoder wrote:
Also, remember that these people have had their brain reward system hijacked by a substance that literally became more important to them than practically anything else in life.
This is definitely true in active addiction leading to wreckage and destruction from bad behavior.

Statcoder wrote:
It’s probably like trying to serve a meal to a foodie or food critic but many times more difficult.
Statcoder seems to incorrectly imply that when on bup, folks are still hijacked w the same active addiction bad behavior issues. When on bup, behavior improvement can be immediate and dramatic. In time, with time, over time, real delightful life change can occur like new jobs, promotions, marriage, parenthood and gaining family/friends trust and confidence back. Nice!!

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PostPosted: Wed Oct 18, 2017 9:17 pm 
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I didn’t read all of these replies but the reason I’m now switching is because the Actavis football shaped pills give me horrendous diarrhea and constant gas. The gas is like sulfuric burps of the worst kind and CONSTANT. They smell really yucky which is super embarrassing. And then I also experience horrible flatulance. Ok so embarrassing to admit yes... but that’s my reason. Noticed it was an issue as soon as I had to switch to a Walgreens pharmacy who prescribes this particular generic. Yuck!


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PostPosted: Fri Oct 20, 2017 5:59 pm 
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Jane, wow! That sounds awful! When you were on the brand causing your problems did you try spitting the saliva out after the pill dissolved instead of swallowing it? If you ever have this problem with a buprenorphine product that is what I would suggest. Buprenorphine is only absorbed in the mouth or other mucous membranes, not in the stomach, so there's no reason to swallow the saliva with the dissolved pill in it. I hope this helps if there is a future problem!

Amy

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PostPosted: Fri Oct 20, 2017 9:55 pm 
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Hi, I just wanted to thank, Amy-work in progress, for immediately defending us. Yes, we are people of all ages trying very hard to fight a demon that is trying to take our lives and yes, we have to be careful who comes into our home and what their intentions are. We are very protective of each other and our safe haven here.

It seems your intentions are good and truthful, so you may sit and have a cup of tea or coffee. We hope you are a constant visitor and are willing to help us if we need you. Know that we don't just let anyone into our home. However upon reading all the posts in this thread, I see that you may be helpful to us and for that, we thank you.

I am 2 weeks shy of being 75 years old. I have been on Suboxone 7 years and I thank God everyday for it. I am also a mama bear protecting her cubs here. Please don't mess with my babies. That's all I ask. Thank you & welcome.

Love & hugs,
Queenie


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