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Suboxone Tablets Off the Market in March

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New formulations of Suboxone, and crystal meth’s impact on the gay community were two of the topics discussed at the recent annual meeting of the New York Society of Addiction Medicine. This is the first of a two-part report on the meeting, “Addiction Medicine 2013: Emerging Problems, Current Treatment.”

Suboxone (buprenorphine and naloxone), used to treat opioid dependence, will no longer be available in tablet form starting in March, because of the risk of children becoming poisoned after swallowing the drug. The company has switched to making a film version of the medication, which is put under the tongue.

Dr. Edwin A. Salsitz, MD, Medical Director of Office-Based Opioid Therapy at Beth Israel Medical Center, explained at the recent New York Society of Addiction Medicine annual meeting that the new formulation is safer because it is difficult for children to get into the film strip packages.

The U.S. Poison Control Centers found the rates of accidental pediatric exposure with Suboxone tablets were 7.8 to 8.5 time greater than seen with Suboxone film, according to a news release by the company that makes the drug, Reckitt Benckiser Pharmaceuticals.

Other formulations of buprenorphine are being studied, Dr. Salsitz said. He described a study, published in the Journal of the American Medical Association in 2010, that found buprenorphine implants placed under the skin on the inner arm in people with opioid dependence resulted in less opioid use over 16 weeks, compared with placebo implants. The implants are not yet commercially available.

“I think this will be a useful product in terms of reducing the diversion/misuse problem with buprenorphine,” Dr. Salsitz said. “It’s very much needed.”

Buprenorphine is also available in a seven-day transdermal patch (sold under the name Butrans) for treatment of moderate to severe pain. It is not approved for opioid addiction treatment, and it is currently illegal to prescribe it off-label for this purpose, he noted. Dr. Salsitz noted the patch, like the tablets, could lead to accidental pediatric exposure.

Gay Community Sees High Rate of Crystal Meth Use

Crystal meth use is pervasive in a subset of the male gay community, according to the director of the Addiction Institute of New York. Petros Levounis, MD, says in this community, abuse of meth and other substances may help them deal with social stress and discrimination.

“Rates of substance use disorders are somewhat higher for people who identify as gay, lesbian or bisexual,” Dr. Levounis said at the recent annual meeting of the New York Society of Addiction Medicine.

He noted, however, that people who identify as not completely gay or straight have much higher rates of substance use disorders than those who are completely gay, straight or bisexual. “Maybe these people don’t have the comfort of having a stable sexual identity,” he said.

Meth is a particular danger in the gay community because it decreases inhibition and judgment, while increasing sensation-seeking and resulting in extreme sexual arousal. This leads to unsafe sex and HIV transmission, Dr. Levounis noted. “The internet  has exacerbated this problem by making both buying drugs and finding sex partners easier.”

Although meth can cause erectile dysfunction, many male meth users use erectile dysfunction medications to address this problem, he added.

Gay men who have body dysmorphic disorder, or “reverse anorexia nervosa,” in which they see themselves as smaller than they actually are, may use meth to feel better about their appearance.

The good news is that patients can recover from meth addiction, Dr. Levounis said. Because patients often experience an intense return of cravings from 45 days to six months after stopping meth use, treatment should last at least six months. Treatment can include group psychotherapy, individual counseling and family therapy.

18 Responses to this article

  1. Doug / July 21, 2014 at 7:01 pm

    I have been on suboxone for about 4 1/2 yrs. I started out on the pills 8mg, then they switched me to the strips 8-2mg 3 times a day. And I will just say the pills are better. They last a lot longer then strips to. But my doctor retired and left me hanging with nothing. So now I am having to buy them from the streets. Cause all the doctors are full with their 100 max limit.

  2. Jessa Perry / June 6, 2014 at 6:48 pm

    Hi im jessa, I have been on suboxine film for a year– my life is so much better!!!

  3. Avatar of Renee Robertson
    Renee Robertson / November 13, 2013 at 9:27 pm

    I’m a married, 47 y/o mother and middle manager for a large US-based company who requested Suboxone after feeling that I had become addicted to hydrocodone for fibromyalgia and back injuries. In addition to getting off the hydro, I thrived on Suboxone (was later switched to subutex because it’s cheaper), and found I could manage my pain with one pill per day instead of 4 – 6 hydros plus 8-10 ibuprofen. I had been nauseated all the time and had elevated liver enzymes. Since starting on sub, I’m doing wonderfully and my regular bloodwork is perfect. I am sick and tired of big pharmaceutical running our lives and assuming that everyone is abusing or selling their prescribed meds! What about alcohol? Alcohol causes more deaths, accidents and murders than any drug on the planet, and it’s readily available on every corner! Children can easily get into a parents’ liquor cabinet and die from alcohol poisoning…they can overdose on regular OTC meds in the family medicine cabinet! Good grief, is there no end to their greed? Some people have chronic pain and/or opioid dependence issues. I do not touch any other drugs or even drink, but I’m tired of the constantly shifting laws surrounding the one medication that has made my life manageable. Our lawmakers need to take control, not payouts. This is clearly a case of the tail wagging the dog. Disgusting

  4. Avatar of billy Thompson
    billy Thompson / July 31, 2013 at 8:52 pm

    Well, I’ve been on suboxone for almost two years & my life has mad a complete 360!! Now that I have some severe back problems with pain so bad that not even the 3 8mg tablets I that can kill the pain. My doc mentioned me coming off soboxone and back on pain pills. I told him that’s not an option for me, so I see a back specialists on the 14!! What to do, what to do???

  5. Avatar of Ashley Smith
    Ashley Smith / June 4, 2013 at 12:17 pm

    Yes you will have suboxone withdraw bad! If you go cold turkey. Some say it’s worse and last longer than withdraw from perscription drugs. I’ve been on films almost 3 years now n I’m scared shitless to get off. They will taper u down to get you off but still scary to think bout if I wasn’t on suboxone and something triggered me I’d be right back on the street!

  6. Avatar of brianna
    brianna / June 4, 2013 at 9:53 am

    I have been on the films for 2 years, the pills are rarely seen in ky. i have to say suboxone has saved my life, i have been on them for 6 years now. im ready to get off the. they have done the job it was supposed to do. i am just scared of withdraw i have been told you will go through withdraw does anyone know anything about that? i have never went without, i guess its just the fear idk..

  7. Avatar of krirsten
    krirsten / May 19, 2013 at 3:10 pm

    my question is why would you need to be on the medication for over 2 yeras? It is supposed to transition you through withdrawals and a short while to decrease cravings.. not for people to remain on for the rest of their lives!!

    • Gary T / July 29, 2014 at 4:33 pm

      Addicts/people all have different needs. There is no one size fits all approach to addiction treatment or medicine. Dose and length of time on the medication depends on the individual, what they were using, how much and for how long. In general, the longer an addict was using the longer they’ll be on medication. Some actually recommend that addicts remain on the medication for about as long as they were using for (or half as long).

      For some addicts, they will indeed remain on Buprenorphine or MMT for a significant length of time. This is what maintenance is for. It isn’t always to “transition an addict through withdrawals”; it replaces the addicts drug of choice and suppresses withdrawal for as long as it is taken. Because it is itself an opioid, it has it’s own similar withdrawal syndrome. The idea is that it has a longer duration of action, and when taken consistently at the lowest dose necessary, produces less + side effects (e.g. euphoria), while also blocking the positive subjective effects of other opioids. Therefore, the addict can work to stabilize and improve their life situation without having to seek out or spend exorbitant amounts of money on illicit drugs (and all that entails). If they did attemp to use, it wouldn’t feel like it usually does.

      Eventually, granted the patient is stable enough, a slow taper will ensue. This should mitigate the withdrawal syndrome: the hope being that A. it will be less severe and B. the patient will be better suited to handle it without relapse. However, if a patient has attempted to taper on mutliple occassions and ends up relapsing, it might be better for them to stay on maintenance indefinitely.

  8. Avatar of Sara
    Sara / May 9, 2013 at 5:18 pm

    I just started taking the suboxone tablets and its May… I thought they said they were taking them off the market? I was a needle user for a long time and the strips are much easier to shoot then the pills anyways! I get the generic pills and they are really hard, not soft like the name brands so I imagine they would be harder to shoot.

  9. Avatar of Jay
    Jay / April 19, 2013 at 4:44 am

    Ive been on the generic subutek for a while now, much cheaper and just as effective. I heard from a fellow patient that the Doctor showed him a DEA letter that starting in May of this year, you can only be on for 2 years? Anyone else heard of this? Maybe its time to get the advocacy gloves back out!?

  10. Avatar of BJ
    BJ / March 15, 2013 at 7:45 am

    As a suboxone user, I can tell.everyone that the tablets are more expensive to buy from.the pharmacy than the strips.. as for the flavoring, it is orange and not cherry and even after being on them for almost 2 years, I still gag a little when taking them..it is not a “fun fruity ” flavor. I am on the strips, my doctor knew over a year ago that they were going to be taking the tablets off the market and refused to prescribe them to any of his patients. However I have recently seen a round tablet(the ones being taken off the market are shaped like an octogon)..I have taken both forms and subutex(form without a blocker) ..and the films dissolve faster than any other form, I have never had one “slip around”, actually as long as you don’t eat, drink or smoke like you’re supposed to, the film usually sticks in one place while dissolving.. I’ve never had one dissolve after being opened, but if its is really humid or hot, they will get tacky and are hard to handle. In my area, all of the users that aren’t using them for the right reasons or in the right method are very upset bc in this area, they prefer the tablets because they snort them and say that’s what they prefer to inject.. I was never a snorter or shooter, just a very serious horse back riding injury and a quack doctor that preferred throwing pills at me instead of actually helping, once she tried putting me on oxycotin, I knew I had to take the matter into my own hands. To the lady above with the problems with your boyfriend, I wish you the best of luck, I’ve been in your shoes and its somewhere I wouldn’t wish on my worst enemy.. luckily mine decided that me and our kids were worth it(or maybe sleeping on the street and having everyone in his family refuse to give him money or a place to stay unless he was sober).. I hope he comes around, suboxone saved my life and I finally feel “normal”

  11. Avatar of Nanette Wollfarth CMA
    Nanette Wollfarth CMA / March 4, 2013 at 3:16 am

    and what about children drinking alcoholic beverages by mistake also ?
    Should the breweries invent alcohol implants for that too?
    This is just another fanciful trick by Reckitt Benckiser to make a few more billion %%% off their product.
    IN this case Generic drugs save lives and $$$$$

  12. Avatar of Carlos
    Carlos / March 2, 2013 at 4:30 pm

    This is the strangest reason to take a tablet medication of the market. I am all for child safety. I would think that it would be less of an accident if they take the Chery flavor off the medication, so it be less appealing for children. That is what I think they might be saying. A more medicine tasting tablet would seem to be less appealing.

    Patients have preference. I know many patients that prefer the tablets rather than the film. I have know patients who claim that when they open the aluminum folder, cut a smaller piece of the film and place back on the folder. The rest of the film seems to dissolve itself inside the folder. I do not know if this is possible, but I have had at least 3 patients inform me of this problem.
    It is all too possible that patients prefer some form over other tablet vs. film. Some patients have complained with difficulties keeping the film under the tongue. As it appears that the film slips around under the tongue very easily for them. Fearing that they are not getting the full effect.

    Another thing I find strangest is that if the tablet is suppose to be kept under the tongue. I would think that children would try to chew it but even if the child sucks on the tablet. Obviously if the child eats the whole bottle I can see the problem. But we heard so much about the safety of the combination Buprenorphin Naltrexon that I am having a hard time understanding all of this later news (I guess I will get use to it).

    Patients like options, and I suppose patients should still be given a choice between tablets or film. Some patients outright do not have children and the pharmaceutical companies or whomever is making this decision have ask the patients what they want. Are we so stigmatizing, discriminating and outright bigots that we have forgotten that the patients is the reason for our assistance.

    I think this issue needs to be reevaluated. We surely do not want to loose any patients from treatment. The expense of treatment is high enough without having patients stop treatment over. I think that this issue needs to be studied. What I am reading is possibly influence and biases by (conformational biases) the reason for which we do research. Medicine, but psychiatry in particular “suffers” from this cognitive limitation that all humans have. I think that we are creating a problem where none may exist right now, and the claims maybe created from anecdotal information.

    The whole article and the claims seem to be conjectures and intuitions rather than hard data. I do not want to cliché, but I wonder if this is an issue of profit vs. service. In my graduate school Dr. Mark Goldstein from the Gainesville VA Hospital impress upon me that a good part of treatment was that it should be attractive. The more attractive the more likely you will be more effective and patient would be higher motivated. If some patients find the tablet more attractive than film,. and there will no longer be tablets available I wonder if patients are less likely to stay and complete treatment.

    Just some thoughts, nothing scientifically based.

  13. Avatar of Roxana Maldonado
    Roxana Maldonado / March 1, 2013 at 4:40 pm

    My significant other has an opiate dependence, he shoots heroin. He has been prescribed suboxine…he shoots them up also, he says its easier to shoot up the strips and prefers them to the tablets for that reason. Sometimes a medication helps and sometimes it makes a problem worse and easier to hide and get.

  14. Stewart B. Leavitt, MA, PhD / March 1, 2013 at 12:34 pm

    Generic versions of the buprenorphine/naloxone tablet have been approved and are coming to market, which will be much less expensive. Also, it would be good to know what law makes it “illegal” to Rx the buprenorphine transdermal patch off-label for addiction treatment.

  15. Avatar of gigi castro
    gigi castro / March 26, 2013 at 11:51 pm

    i hate the films,they don’t work,i rely on the tablets,they have saved my life..children shouldn’t even be around suboxone tablets.this is ridiculous.you can’t just take the tablets off the shelves like this!!!

  16. Avatar of David Smith
    David Smith / April 7, 2013 at 1:33 pm

    Only controlled substances FDA indicated for opioid dependence can be prescribed for maintenance/withdrawal treatment. The buprenorphine patches (Butrans) are only FDA indicated for pain. That is the reason it is illegal to prescribe Butran patches for withdrawal.

  17. Avatar of Miggy
    Miggy / January 7, 2014 at 8:27 pm

    I thought i was gonna withdrawl bad from subs took for 3 year but i rventually whinned my self of to just taking about a lil small pebbles i would break a quarter piece to lil tiny pebbles to eventually it was meerly taking a very very very smal piece of a pebble so tiny but it took 3 years to get me to that very small amout i withdrawl barly any no throwin up no bones aching perrty much nuthun i only felt anxious and couldent sleep but i took zanax 4 3 day straight wich made me relax at nite and pass out after the 3 days i stopped takin the zannax and it was a lil bit unconfterble 4 about a week but it was nuthin i did it IM SURE ALL U CAN TOO

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