by SuboxDoc on November 21, 2011
There are ongoing efforts to eliminate the cap on treating people for opioid dependence with buprenorphine or Suboxone. I don’t know what the odds of success are, but the efforts would benefit from public demand. If you have had difficulty finding a doctor with room under the cap, write a letter or email that explains just how important the issue is to you, and send it to the address(es) below.
The change requires an Act of Congress, or perhaps an executive order from someone high-placed in the Dept of Health and Human Services. Consider sending a ‘cc’ to your elected representatives in the Senate or House of Representatives. I am not excited about using NAABT.org, since they tend to be patsies for Reckitt-Benckiser (I’ve asked to have a link to this blog, or to our 6000-member forum on their web page, but they won’t– but they link to an R-B – supported forum instead– draw your own conclusions). But this issue is too important even for my own righteous anger to get in the way!
Send comments to the following e-mail or mailing address:
NAABT, Inc.
P.O. Box 333
Farmington, CT 06034
Email address:
MakeContact@naabt.org
Permanent link to this post (215 words, estimated 52 secs reading time)
by SuboxDoc on November 12, 2011
A Reader Writes:
Message:
The State of XXXXXX prescription price list noted Target Pharmacy as the cheapest for Suboxone at $6.99/Suboxone pill, 8mg-2mg, qty. 30. So I started getting my prescriptions filled at Target.
Well, needless to say they raised their prices twice since then and I am now paying $8.158333/Suboxone pill, 8mg-2mg, qty. 30, Nov. 12, 2011.
My question: How can they be alowed to jack their prices up so fast and so high in a short period of time? What can I do? It’s like they pulled a bait and switch on me.
Please write back Dr. Junig
My Reply:
I sympathize with you. The best thing you can do is have an educated and educatable doctor– someone who has enough humility to recognize when he/she is wrong, and adjust accordingly. Somebody who recognizes that as physicians, we are constantly sorting through new data, responding clinically to phenomena according to science. Most importantly, someone who recognizes that in medicine, as in all fields, people make assumptions about things with partial data, and sometimes later learn that their assumptions were wrong.
I realize that is difficult in the current era when people with addictions are considered ‘manipulative’ for simply raising appropriate questions. The truth is also competing with the marketing and persuasion tactics by Reckitt-Benckiser– a company that has found a way to influence policy-makers in government and addiction societies. I am generally a fan of corporate greed, as I believe that the marketplace is the best stage for ideas to rise or fall (mixing several metaphors, I know!) But I am appalled by the extent of involvement of Reckitt-Benckiser, the British corporation that makes Suboxone, with physician societies– the groups that are supposed to be advocating for policies that save lives that are being lost to addiction.
by SuboxDoc on November 9, 2011
A recent message from a reader:
What would be the ideal care-plan for the pt taking 24mg/dayof Subutex who is going in for c section? I would like to show the response tomy OB, so if there is any way, please be specific as to any tapering or substituting of another low-dose narcotic before surgery, the best med for pain control in recovery and while still in hospital, up to discharge and the best PO med course for home. I would be so appreciative and you’d really help ease my fears.
Thank you 
My Answer:
I receive this question often, and I am confident in my ability to provide education about the issue. I have to point out that I can’t act as your doctor and give medical advice — but I’ll share my experienceafter having a number of patients on buprenorphine (i.e. Suboxone) go through a wide range of surgeries.
You can share with your doctor that I’m Board Certified in Anesthesiology, and I worked in Ors and pain clinics for ten years before leaving the field for psychiatry residency. Your doctor is more likely to believe me, knowing I have experience in that area.
I will send you a couple references about this topic, and I’ll also send my ‘Users Guide to Suboxone’. The articles provide support for the treatment I’m about to describe.
Did I mention that anyone reading this MUST use the information only to spark a discussion with his/her own doctor? Do NOT use this information on your own; doing so would be quite dangerous—not to mention illegal.
This is a preview of
Suboxone, Pregnancy, C-Section, and Surgery
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by SuboxDoc on November 2, 2011
I owe it to readers to make it clear that I do not endorse any product sold for the expressed purpose of reducing opioid withdrawal. I have PPC ads on the site, but I have no control over the ads that run in them. I am not saying that the products that often appear in ads do NOT work– only that I have not prescribed or advised people to use them, and know of no peer-reviewed studies showing them to be effective or ineffective.
As always, caveat emptor.
Permanent link to this post (110 words, estimated 26 secs reading time)
by SuboxDoc on October 27, 2011
As I give my last post more thought…. I wonder if there is ANY clinical difference between $uboxone at $7 per dose, vs. generic buprenorphine at $2.33 per dose? Researchers out there– can anyone send me a reference?
Read my last post for details– but the essence is that naloxone is destroyed when Suboxone is taken properly (orally, sublingually), and has no action whatsoever– on that issue there is scientifc agreement (although there is a great deal of ignorance among prescribers about this fact). The ONLY think naloxone does, is to supposedly serve as a deterrent to IV injection of buprenorphine.
Sounds good, but… we know that people divert Suboxone intravenously, naloxone and all. Buprenorphine binds opioid receptors very tightly- so tightly that the naloxone doesn’t effectively compete with buprenorphine.
The State of WI requires Medicaid patients to take expensive Suboxone Film, whereas in other cases they require prescribing the generic. What is the argument for requiring the film? RB would argue (now that the tablet has lost the luster of being on-patent) that the film is harder to ‘divert’– i.e. to inject. But frankly, the intravenous diversion of buprenorphine is a tiny issue compared to things like heroin addiction and a budget crisis. Most of the diversion of buprenorphine, either Suboxone or generic, is not injected, but rather taken orally to ward off withdrawal– and the film makes no difference in that case.
Insurers, likewise, are wasting millions of dollars (literally) by paying for Suboxone— sometimes exclusively(!) Have the bean counters fallen asleep on this issue?
This is a preview of
$uboxone Clinically Identical to Buprenorphine??
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Read the full post (361 words, estimated 1:27 mins reading time)
