Doctor's against Subutex for any reason.???

Like some of you, I also asked my doc to prescribe the generic Subutex to same money and he also shot it down immediately. I thought that the naloxone was only there to prevent IV usage. I have never been an IV opiate user and never will, and I do not think my doc thinks I would do that either. It seems like he thinks that the Subutex doesn't have the ceiling effect that the Suboxone does, but this is incorrect right? I mean the ceiling effect is part of the Bupreorphine drug right? It has nothing to do with the Naloxone correct?

You are correct, the ceiling has nothing to do with naloxone. It is a property of the buprenorphine.

I have been on suboxone 3 times (currently in the third). I've noticed many suboxone doctors are general practioners who are easily influenced by R&B or the crazy (either off record or rumored) DEA threats. To them it's not worth losing their entire practice for 30 or 100 patients.

The "specialists" are harder to get in to, but generally more knowledgeable.

I had one doctor tell me he only urine tests because the government checks less frequently if it's policy. Legal or not, it's what someone scared/intimidated him with.

I nonchalantly asked my doctor about it last week when I went...but he politely told me that he only prescribes it in special circumstances, because of the abusive properties of it. I explained that I had read some pretty solid information that said that even though it CAN be abused, most people would prefer NOT to abuse it, mainly because it's not that easy to get on the street. Also, I told him from what I had gathered, that most addicts believed they would come out cheaper by just buying their "DOC" than to buy this because it costs so much on the street.

It wasn't enough to convince him..and I left with the same films that I was getting when I went in. Oh well..it was worth a shot...but for me it would've been the difference in a $5 copay and an $80 copay.
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I had an opinion once, but it kept my lips from making that kissing noise.

"You're an asset if you make me look good, otherwise, a nuisance." <-- Politicians and people in power.

I've been with my sub doc for 3 years and on sub 3.5 years. My sub doc is actually my PCP and he writes my scrips for pain. I asked him about the subutex generic about 7 or so months ago, like many, because it's significantly cheaper. My doc shot me down in a matter of seconds as well. He's normally a pretty reasonable guy and talks things out with me usually. Not this time.

RB is convincing doctors AND insurance companies that subutex is inherently dangerous, which is a bunch of HOOEY! It all boils down to money for them and them KEEPING their money.
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-As I have grown older, I've learned that pleasing everyone is impossible, but pissing everyone off is a piece of cake.

-I'm only responsible for what I say, not for what you understand.

Same thing happened to me. I asked my doctor for generic sub to save money, since I don't have insurance and have to pay cash. I have never used a needle in my life, but he didn't even consider it and said, "no, the film is better". I just left it at that. Very annoying.

I have been a suboxone patient for a lil over a year........

and Im not saying anything that hasnt been said here already, I just wanted to share what happened with MY doctor....

like hat, my doctor has always been really reasonable with me, seeming to reallly try and help his patients.

When I first went to see him, he gave me the films first, with the coupon, I had absolutely NO money ya know, coming from my "habit" for almost ten years.

A few weeks, into my treatment, I was complaining about the cost, almost $10 a strip, and Im on 24mg a day.....

So HE DID tell me all about the generic, and I was MORE than willing to give it a try.......

I think I was on the generic bupe for at least two months.

ALL OF A SUDDEN, he was SO agianst it. He had this attitude when I cam in for my refill. He said, "why did we take you off the film?"
I said becuase of the cost.

Well, he tells me all about how he "can't really write" the subutex anymore becuase of the abuse potential, and Im gonna have to "figure it out" (about the cost)
this was would have had to been in September, as best as I can determine. september, 2011

It was then, that I went ahead and got a computer, I was like Im gonna figure out one way or another to either get insurance to help me pay for this or find a program.
It was within a month of buying my laptop, and getting the internet, that I found THIS site, and found the
PATIENT ASSISTANCE PROGRAM

I was actually the FIRST one my doctor had ever put on it, he had NEVER even HEARD OF IT.
My year is up in mid october.

My doctor says he can write a letter or something, to get me approved for another year. so everyone keep thier fingers crossed for me.....
My boss does not offer ANY kind of benefits, and becuase the big job Ive been on is ending , My hourly pay is actually going DOWN three bux an hour.
Im looking for another job, of course.....but in this economy, I dont car what THEY say, it still sucks finding a job, and my rural comunity,,,,,,,ITS TOUGH. Im just now gettin my reputation outta the gutter. everyone knew i was "all strung out on pills and H"

sorry Ikinda went off the deepend there, but I just HAD to share that. that the DOCTOR was the one that brought it up to ME, and then "couldnt do it anymore"
after only a month or so........
I mean, he HAD to have "gotten word" from somewhere , right????

Just my opinion, I really have no idea, and I dont think Im gonna ask, cuz even then, I could "sense" it was a VERY touchy subject!!!
_________________
anyone can give up,
its the easiest thing in the world to do, but to
hold it together, when everyone would understand if you fell apart
That's TRUE STRENGTH
http://almostoneyearclean.blogspot.com/

What a tragedy it is that so many health professionals are so thoroughly misinformed on the pharmaceutics that are unique to buprenorphine. Instead of researching the multitude of clinical studies done with buprenorphine, they instead lazily refer to the misinformation of an unqualified drug representative who has not the best interest of the patients at heart, or even the doctors they persuade, but rather the manufacturer of the medicine they promote. By convincing prescriber's that Suboxone is the safest, efficaciously superior, and most DEA approved form of buprenorphine the manufacturer Reckitt Benckiser monopolizes the market. As a result patients suffer, and doctors (Perhaps unknowingly) violate the Hippocratic Oath to do no harm. For if a physician has the power to improve the quality of life for a patient simply by writing a prescription, but choose not to make available for the patient the option to afford the same life-saving medication at a cost they can afford by allowing a generic, then such a violation ought to be malpractice. But that is just my reasoning.

I am fortunate enough to have discovered a physician that gladly writes my monthly supply of buprenorphine for the generic equivalent. He specializes in psychiatry and has extensive experience with various types of addictions. As well as various types of addicts. Some of whom have taken advantage of his thoughtfulness and compassion. No need to elaborate, sense most of us here already know the mentality of the addict: One can easily imagine how a doctor like that could easily be exploited. Sense qualities like kindness and hope, as well as giving the patient the benefit of the doubt are presented as weaknesses to an addict looking to get what they want. However, out of his 90-100 patients being treated with the buprenorphine alone formulation, the majority are doing just as well, if not better, than those limited to the brand name Suboxone. I say better only because the recovering addict has one less thing to worry about by knowing they'll be able to afford their bupe. I have never posted here before, or anywhere else for that matter, but this topic is very important to me so I could not resist responding. My apologies if I am just reiterating what is already known, but I hate to see people suffer. Especially when a viable treatment option emerges in which countless studies have proven successful, yet still remains out of reach for so many simply because a business wants to maximize profits through unjustly high costs of it's product.

The best thing we can do is make sure we ourselves understand how this medication really works. Knowing that Buprenorphine has such a higher binding affinity for the mu-opioid receptor system than naloxone even when administered intravenously demonstrates the absurdity of such a combination. For that reason Suboxone is no better equipped to be abuse proof than its generic and single component counter-part buprenorphine. If you struggle to pay for brand name, I suggest you inform your prescriber what the data shows. thanks for reading my contribution. Or skipping right past it Smile

Either way, good luck everyone with your bupe treatment, I hope it has been as successful for you as it has been for me! *Happy Dance*

Hi Entropy and welcome to the forum! Thanks for posting such a well-written and poignant contribution to this discussion. I agree with you fully. And you're right, we need to find a way to educate our doctors. Unfortunately, it's just not that easy. Many (most?) doctors, with their years of education more than ours (some of us), often feel we have NOTHING to offer them in the way of teaching them about suboxone. They are the MIGHTY doctors and we much HAIL THEM!!! We are the lowly addicts and stupid to boot! I'm not saying all doctors are like this, obviously they are not. However, many of them are and trying to get them to listen to US - laypersons - about the properties of a medication - well, it's easier said than done, in my opinion. But it is something that we need to shoot for.

WELCOME TO THE FORUM, Entropy and I hope you decide to hang around and keep posting. Smile

_________________
-As I have grown older, I've learned that pleasing everyone is impossible, but pissing everyone off is a piece of cake.

-I'm only responsible for what I say, not for what you understand.

I have talked with two Drs on this topic. My gp who was also my sub Dr for four years and than my methadone Dr who also runs his own private suboxone practice.

Ill start with my Sub/gp Dr. He is a open honest Dr who was 100% honest with me about subutext. I asked if he thought if subutext might work better for pain and would he b willing to switch me over. He said no but gave me reason and the only people he will put on subutext is of course pregnant women. And before i get into why he wouldnt, ill will state i asked him if it had anything to do with money and he laughed, he will get no more or less with suboxone vs subutext scripts. Well we started talking why he wont and simply bc hes not going to give a addict in the search of help subutext which is easier to abuse when theres a medication that is the same thing with lower abuse rates. And lets b honest subutext is much more abused than suboxone do the simple fact you can snort/inject it with less risk than doing both those things with suboxone.

Now on the other hand the Dr at my methadone clinic is more open to treatment with subutext but after all steps are taking to make suboxone work. He will not put any new patients on subutext period and you must have been in his program for at least six months with no failed drug test or failed to show da proper numbers with each pill counts. But he did state he has not seen anyone of these meds have a higher or lower sucess rate. And he willwork with a patient but only after trust has been earned and progress is made but if any patient has a set back on subutext after the switch will be given two options to leave the program fter a proper taper or could go back on suboxone and has one chance left to stay in treatment under his care.The reason he is sostrict with subutext patients
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Yes these drugs saved our life's. But does that mean we have to give the rest of our life to these drugs?

Hello Entropy and welcome.

My Dr. told me "subutex is not appropriate for the treatment of addiction" when I asked about the switch but I recently moved so there might be another few Dr.'s I can ask before too long. I have read some of this thread but not all of it, so this question could've already been asked by another member, but it seems to me, whatever company that makes the subutex generically should include naloxone if that's the big issue. I can't believe that the chemical price of naloxone is what drives RB's price up so high on suboxone, I always thought it was the fact that they're the only company that makes that particular mixture. Does anyone know if there is another reason why the generic subutex doesn't or cannot contain naloxone? (a patent or the like maybe? If so, it can't last forever can it?) Does anyone know or have an opinion as to whether or not we might be seeing a generic bupe medication including naloxone on the market anytime soon?

Heres a thread all about the 'generic' with the naloxone added, and links to the BEMA website!!!!

I cant freaking wait!!!

http://suboxforum.com/viewtopic.php?t=6699&highlight=BEMA
_________________
anyone can give up,
its the easiest thing in the world to do, but to
hold it together, when everyone would understand if you fell apart
That's TRUE STRENGTH
http://almostoneyearclean.blogspot.com/

I just posted about this on another thread.. I wont go all into it again but basically ive seen suboxone snorted and IV'ed many many times with no ill effects and that is with the tablets AND the strips.. the naloxone does nothing, it definitely doesnt stop it from being shot up so really suboxone is no better than subutex.. they both have THE SAME abuse potential.

Not tryijg to be mean... but this is why doctors won't give subutex to addicts slot of the time. Because of soo many people shooting it up. And. It's funny how much my doctor tells people that a generic tablt is coming out after March.... and that's so untrue. There is the bema biped and naloxone... but it won't be out for awhile... and is not a tablet. But. Help the cause and don't shoot Suboxone. The fillers alone are reason enough not to.... who wants a shirty high and no arm!

The point I was trying to make was that suboxone can be abused just like subutex.. there is absolutely no difference, doctors believe naloxone stops IV'ing but it doesnt do anything when IV'ed. Here is the link to the new generic-

http://www.bdsi.com/Other_BEMA_Products.aspx

Im not sure if its a tab or strip, I just know its supposed to be dissolved between your cheek and gum.. It will be out by the end of 2013 though. In my opinion, people shooting suboxone and snorting it are not in recovery, they are addicts still using. An addict will be an addict though and will always find away around doing things.. I remember when the time released oxys came out.. it definitely was not very long before it was found out how to break them down.
aside from RB telling doctors things about subutex, there is no reason it shouldnt be prescribed just as much as regular suboxone, Theres TONS of evidence that its no different aside from the naloxone which again DOES NOTHING to deter abuse. I dont understand how RB can get away with saying naloxone makes it less abuseable, especially when companies get sued all the time for false advertising, thats basically what RB is doing. Im glad im already prescribed subutex and dont have to worry about it for now but it just makes me so mad how so many more people would be able to afford treatment if they could be switched but because of RB lying doctors wont prescribe it. No matter what drug comes out, addicts will always find a way to abuse it if they have a chance to get high. For the most part though I do believe this med is used right and we should be able to use either form.

It's funny how my doc told me the same thing in regards to subutex. Funny they all got the same answers in regards to asking for the generic. It isn't that the doctors are misinformed. My doc acted like the "Subutex is made only for pregnant women" I KNEW that he KNEW this was a line of crap. These guys are not misinformed, lied to by R&B about naloxone being a blocker, yada yada yada. It's obvious they work together to form this "operation"

I mean my sub clinic can double or triple book appointments, accept no insurance, Rarely do drug tests. ETC. Me going to the sub doc just seems shady, i walk in with cash. B.S. with someone for like 5 minutes, pay cash, Then his nurse hands me the script thru the window with a appointment card to come back in a month. I keep hoping everytime i walk outta there that the swat team isn't going to arrest me in the parking lot.

I have no idea how this sub operation actually still up and running outside of methadone type settings. Oh because of the schedule of bupe? With all the abuse... Especially down in the oxy capital of the U.S. (florida) I knew a bunch of dealers who all had oxy xanax and subs for sale.... All the time. a good majority of people who sling blues also carry subs for sale to.

I'm going to put money on it. Subs are going to be moved to schedule 2 due to high risk of abuse/dependence. There is very little difference as to how i get my subs. Both dealers accept cash only. Both chit chat with me in person for a couple mins if i am lucky. Both send me back letting me know they will be around next time to smile and repeat the process.

In florida- the freaking state responsible for pumping oxycodone to practically all the other states. Suboxone is getting put under the same firing squad as the rest of the bad stuff. People are abusing it, dealers are getting busted having it along with other pills, some fellows are shooting it, and in we even got this one clinic that you call for "suboxone addiction" I can't be the only one seeing this. (well besides the law enforcement agency and all the other clean citizens who look at people taking this like they are junkie scum. : '(

To me, this is one ride i want to get off of. (sorry for being moody im like 6 days off of sub from 12mg a day. I have 40 sub films and now tommorow i will reinduct myself with 2-4mg) I'm completely shocked how nasty this withdraw has been. I feel like one more day i'd be in a mental ward. This is true terror and i'm glad i did this to myself to see both sides of what this medicine has to offer. And for me... It has very very very little left to offer me. Wow.... I feel like someone has forced me to stay wide awake a whole week while beating the living crap outta my arms, legs, back, shoulder blades. Anyone who says great stuff about this medicine and hasen't allready volunterly handcuffed themselves together by taking it forever. Try to not take your sub for 5 days or so. This will let you know gauge how far from normal you have really lead your brain/body. I am over this!

Sorry if people are tired of my whining. I really do mean to be. But being off high dose sub for this long has really done a number on me mentally physically and spiritually. I don't think it was a good idea to try this experiment. But at the same time i needed to see where prolonged continued use of this med like my doc wants me to do will lead me. My thoughts are scattered like a shotgun blast. Everything just feels wrong. I can't believe i elected to be on this as long as i have been. But it isn't to late for me. I'll be cheering you guys in the stopping sub section as much as i can. Because the day i'm in that spot. Try to return the favor! We got this!

Doctors are individuals too man. One may push Suboxone cash only style with his own in house pharmacy and what not, but another may run at a treatment facility type place and require meeting attendance, counts, uas, and really push recovery on the patients....not the medicine. I've seen both sides of that coin. So I think that some are greedy little turds and some really care about their patients. Also. Same goes for experience on Suboxone. You cant say thRough eventuLly everyone will lose their minds on it or something to that effect. I'm sorry that you had a bad experience with it. But. Others, including me and some of my personal friends, have been on it a long time and it works absolute wonders every single day. I've been off it for almost a year before too. So. This is just the way to go for me and I thank god everyday that I have Suboxone. So. One man's trash is another man's treasure.

I agree that it has a lot to do with insurance, government etc. I also asked my doc after 9 months to switch to the cheaper, my husband lost his job due to illness, therefore I lost my insurance. He said he only uses it for pregnant or nursing women, shot me down quicly but politely.

I think it also has a lot to do with people who make bad choices, not us per say but the people who get subs to sell and get their drug of choice. Kinda like shoplifters who make us all feel like criminals. When there are a few that make life hard for the rest of us. They sell their sub or make a choice to abuse it, someone ends up hurt and the doc gets blamed.

I also think it sucks because I wonder if a lot of these doctors either remember what its like or have ever had to live paycheck to paycheck because we aren't all doctors. But I mostly agree this is a drug company trick to make more money.
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"Every saint has a past, therefore every sinner has a future"

From what I have found out from calling around and just doing research, the new generic is tablets. They will be available in 8mg and 2mg forms coming in 30 tablets in a bottle. It says on one site to make sure the physician writes the script for "buprenorphine hci/naloxone hci dihydrate" to distingush that its not the brand name Suboxone tablets. My pharmacy faxed their supplier and got back a picture of the bottles that will be shipped to them. My doctor said it would be available from what they are thinking in a couple of weeks. Kinda sucks being that my appointment is Tuesday. I wish there was some way to get my appointment shoved up a couple of weeks but doc thinks Im taking 16mg a day, when I am actually taking 8mg. I cant afford 16mg right now, so I had to cut my dose in half.
On the Subutex deal, from what I have read most doctors dont prescribe it because Reckitt-Benckiser was basically threatening (in so many words) doctors with DEA beating their doors down if they wrote it instead of their brand name high cost Suboxone film. Which is why doctors will say, only preggo women. I had one doctors office tell me that the brand name was cheaper than Subutex and I couldnt help but laugh over the phone, I proceeded to tell the ignorant woman that she was wrong even though she swore up and down that I was. I told her the price difference and then she hung up on me LOL.
Im not sure why the doctors dont stick to their guns and do what THEY want to do, instead of letting a pharmaceutical company take over, I mean they should know the laws and rules. They should look at them and tell them to F off, but I guess that they might be getting a cut or something and dont want to lose that money. I aint sure myself, I mean they could do a income check or something and give it to lower income families and then pregnant women and write Subutex for others. They could write Subutex for those that their insurance wont pay for it as well. There would still be instances where they wrote Suboxone but not as often. You know how these bigger companies are, once they get a taste of greed they want to keep it. Greed is one of the world's evils and those people will pay for it in the end. What comes around.goes around.

pitbullmomma could you link me when you get the time as to what generic bupe with nalox tablet you are talking about? That is great since R&B will never get a dollar of my money again. I'd like to see pics, prices, what state are you in, what pharmacy? This is one step closer in the right direction for alot of people. If i find out a little more info on this. I will spare some mercy on detesting suboxone today.

I'm thinking that the new generic won't be cheap right away. That's just a guess based on past experience. When Imitrex first went generic the new manufacturer charged almost as much as the name brand. This could be because only one other drug company was making it at the time. It may be different with sub because I think I heard that there are several drug companies lined up to make it. In any case, the price will drop over time. I'm just not sure if people will get price relief right away.

Amy
_________________
Done is better than perfect!

I live in KY, and links will be posted here.
There are two companies coming out with generics, Actavis and Amneal.
This is the PDF from Amneal's website.
http://www.amneal.com/headlines/archive/Amneal_BuNa_Release_Final_2-25-13.pdf
http://www.marketwatch.com/story/amneal-pharmaceuticals-receives-fda-approval-for-generic-suboxoner-2013-02-25
The second link has a small picture of the bottles and what they will look like. The new generic that is. I am trying to find a better bigger picture and I had one at some time but not sure where it went to.
My pharmacy is just called Brodhead Pharmacy its a small locally owned pharmacy. But when new things come out, you can ask them if they can be ordered and that is what I did, well the information that they came back with was that its out there but they couldnt order it at this current time. This was Thursday of last week. They did show me a picture with the generic bottles on there as well. I had a great big clear picture, I wish that I could find the durn thing.

This is how I found pictures of the bottles. You go to Google.com and type in Amneal Buprenorphine/Naloxone and hit images when you search and the first two or three pictures were just released five days ago of the new generic bottles. I hope this helps, made my curls twirl even more when I heard about all of this.
I dont care if its but 20 dollars cheaper off the bat and then it goes down in cost over a period of time, I wont be helping RB fatten their pockets anymore. That means alot, its a shame how that company is towards the doctors and the lower income patients who cant afford their huge prices.
I cant help but think how nice it will be to make one trip to the pharmacy even though its only three miles from home. Just make one trip and get it all at one time, and if I dont take it all that month throw it in the medicine cabinet and go on. This is what I have been wanting to do for some time now was get a stockpile of it incase something happens. You never know when my husband might lose his employment or my doctor might stop seeing me. Anything can happen, and having that stockpile will help so much in the case that something bad might happen.
I like to think about things like that and prepare. Its best to make sure that we are all prepared for anything. I am crazy that way, I guess.

Amen. I hope insurances of all kinds will just worry about costs and pick up the generic only. My doctor still says the film is the safer preferred treatment and will only give generic to people that can't tolerate films. So. I personally prefer the tabs and hope federal and state insurance agencies don't hold onto this whole film being safer garbage and just try to save some money lol.

Well somewhere in one of the articles that I read from Amneal or Actavis, it said that physicians should have NO CONCERN writing this alternative. I mean they have both ingredients in them that the films have. They cant give us the No Naloxone story anymore. This will mean so much for people that have been trying to get Subutex with no hope and for the ones like me who are just trying to save some money. I mean this week our finances are kinda tight because its doctor week, which means 400 dollars from his check has to come out for me, but I think maybe once the generic comes it might only be 350 and then there might not be so more the next pay check. I buy my meds every two weeks, unless I need a few to get me through. Sometimes I might take a little bit extra, it really just depends from day to day.
Like right now, I dont take the whole prescription and I think from the last two months my pharmacy said that I have like over 40 strips down there that are mine. I got 56 from both scripts, I take atleast 30 if not 45 each month. It would be nice to have those bottles of tablets at home already paid for because of the cheaper prices. I like having stockpiles of stuff, you should see my stockpile of blankets and socks. We bring those out for the winter weather, ya never know when its gonna get really cold outside and then have to pull out a extra blanket or so for the cold nights.
I used to have a toilet paper stockpile until my momma dog had puppies and yall know when them little boogers get older, you are following them around with a roll of toilet paper and a plastic bag. We did get them puppy pad trained but it took a week to do it. She had nine, they were so adorable.
Oh I am rambling again.
Anyways, good luck to everyone in their recoveries and getting the new cheaper medication.I hope yall have a good week.