Belbuca, Suboxone, and a mini-rant about their underusage

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gtrplayer
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I am posting this in the "new medicines" forum because it seems not many people have heard of Belbuca. For those who are not aware, Belbuca is a buprenorphine only drug that is administered the same way Suboxone films are. However; the doseages are astronomically low. From the Belbuca website, the drug comes in 75micrograms (hereafter, mcgs), 150mcg, 300mcg, 450mcg, 600mcg, 700mcg, and 900mcg. Belbuca, unlike Suboxone, is FDA approved for the treatment of chronic pain requiring around the clock dosing. The only other buprenorphine drug that has FDA approval for pain is the Butrans Transdermal Patch, with dosages of 5mcg, 7.5mcg, 10mcg, and 20mcg/hour to be worn for seven days. To me, this is a setup for failure when patients are asked whether or not these drugs helped their pain. 

I was on Suboxone, 8mg/2mg films 3 times daily for pain management, and it was the best I ever felt in my life. After that doctor's office kicked me out for continuing to take my psychiatrist prescribed Klonopin, I have had to be placed back on 7.5mg hydrocodone, and the pain relief simply is not there. Prior to being put back on the hydrocodone, the dr did try Butrans, and it was a horrible experience. Maybe it was my Dr, maybe it was my high expectations of the drug due to my success with Suboxone. Regardless, it was a complete failure of a drug. 

The thing that really upsets me is that, in other countries outside of the US, buprenorphine has been an analgesic used in pain for years. As a matter of fact, Suboxone was initially developed during the "make an abuse resistant opioid" phase that pharmaceutical companies went through, and ultimately, it was deemed to be a better opiate replacement drug than it was a painkiller. However; regardless of where you look online, includine medical journals, you will not find the actual study itself. I was fortunate enough to read the articleAll while Suboxone was still in it's infancy, and Reckett-Benckiser was it's manufacturer. What happened with Suboxone is nothing new. Anyone who remembers the early days of Viagra should remember that the drug was trialed as a pulmonary hypertension drug, but was later marketed as an erectile dysfunction drug after patients reported they were obtaining erections that they previously could not achieve. So, we went somewhere along the lines of 5 or 6 years with Viagra being exclusively used, on-label, for ED. My grandmother had to take it for pulmonary hypertension, and it was an absolute Godsend for her, and may have even prolonged her life by many years. After the ED market cooled off, along comes a brand new drug, Revatio, made by Pfizer, and contained the exact same ingredients, in different strengths, as Viagra.

Pharmaceutical business is an absolute racket. Right now, there are three buprenorphine/naloxone combination products on the market that absolutely should be used in pain management for select individuals. Those drugs are Suboxone, Bunavail, and Zubsolv.  Every one of those medications listed contain buprenorphine in milligram strengths, not micrograms. I have heard some claim that these drugs are not ideal for pain management because of the naloxone. Well, the naloxone is negligible and has no effect when taken as directed and not tampered with. One other thing I do not understand is why the drugs that are approved for pain management contain 1/1000th of the strength of their naloxone containing counterparts. Do you really want to give a recovering addict more of a drug than necessary. It seems like backwards thinking to give someone with a known history of abusing narcotics a higher dose of a narcotic than you would give the legitimate chronic pain patient. Perhaps I am missing something, but I have searched all over and can find nothing that makes any sense to me regarding the disparity in dosage formulations.

One thing that I have heard is that "less is more" with buprenorphine. Well, that's BS. There is never a time where less is more. Giving a pain patient an absurdly low dose of buprenorphine and expecting them to achieve pain relief is illogical thinking. When taken by itself, as in, not mixed with benzodiazepines, Suboxone is a much safer drug than many of the pain relief drugs on the market today. The overdose deaths that I have read about that were the result of Suboxone ingestion always included at least one of the following: 1. a benzodiazepine taken by the victim that was not prescribed to him/her, and the dr did not know about the patient's bzo abuse. 2. The victim who overdosed from Suboxone was not actually prescribed Suboxone, but received it from a friend, and 3. The Suboxone patient was found to have alcohol in their system as well as Suboxone. 

With all the above being said; I still feel that simply because a patient is on a benzodiazepine should not preclude them from being on Suboxone. A patient's history should be looked at prior to prescribing Suboxone, and the dr should know whether or not the patient has been on a benzodiazepine medication long enough to be accustomed to it, and should be able to mitigate the risk of overdose from ingesting both substances. I am not saying that accidental overdeaths do not occur. In fact, when I first started taking Suboxone, I did not take my Xanax XR for three days because I felt as though I did not need it since the pain was controlled. When I did resume taking it, I only took 1 tablet per day, instead of the two I normally took. Simple common sense can save lives, people. 

I'm just frustrated as heck right now. I'm getting no relief from my current medication, and can not find a pain doctor who treats pain with Suboxone in Indiana, aside from the one I was kicked out of. Yet, online, I see many people post that they are taking Suboxone/Zubsolv/Bunavail for pain, and it just burns my backside. If anyone out there is from Indiana, and knows of a pain doctor who treats pain with Suboxone, feel free to PM me. I never, ever ask for anyone to solicit info to me, but I'm beyond desperate at this point, and completely fed up with my current pain doctor, and his inability to listen to anything I have to say. 

 

goat
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re/

https://projects.propublica.org/checkup/drugs/2017/states/indiana


 i am pretty sure you did a intenet search.   I know nothing about suboxone.  good luck brother

Njshoregurl
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That's what husband was

That's what husband was prescribed - BELBUCa for his back (he has extensive damage on back and knee)
Was in pain Med's and doc decides- OH every patient is now going to be on belbuca?!
He needs to find a doc in NJ/PA area this scares me now- for him! Wow! HE did get his mess this month and dropped the belbuca off--- but?? I told him find a dr-

gtrplayer
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Thanks, Goat.

Hey bro, after you read this, lets unpublish it so that it doesn't "bump" a thread nobody cares about. I'm only leaving it published now so you will see this.

Propublica is actually the site I used when my family Dr said, "Find a Dr, and I'll refer you." Never knew it was the patient's job, but, what do I know.

The problem I found with that site is that it appeared, to me anyhow, to list only Medicare related expenses, and nothing in regards to Medicaid, or even private health insurance. Being as how I'm practically broke at the moment, I'm not going to be going to a Dr who doesn't accept ANY insurance, and proceeds to bill $350 for the first visit, followed by $200 every subsequent visit. 

I realize that this drug, per FDA's approval, is truly only intended for a niche market. That being said, I find it ironic that our politicians B and moan about our "opioid crisis", go out of their way to inact laws restricting opioids for everyone except those with terminal illness, or cancer pain- yet they know how safe this drug, when used by itself and absent from someone intentionally misusing it in some form, or taking benzodiazepines they aren't prescribed nor have familiarity with, truly is. Someone looking to abuse an opioid surely isn't going to choose Suboxone, or any buprenorphine products for that matter, simply because what those users are attempting to get just will not happen. For an opioid naive individual? Perhaps. Yet, unlike Norco, the seemingly new "go to" pain medication handed out by all pain management doctors regardless of the pain, cause of pain, or severity of the pain; after a certain amount of mg's, there's no real reason to take more. They aren't going to feel more effect after X dose, regardless of how much they take. Now, they may die, but Darwinism tends to get it's victims for the betterment of most of us.

gtrplayer
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No idea on the triplicate post

Sorry, Goat, and fellow Pharmer members and guests. I did not mean for this to post in triplicate. Only thing I can figure is that, while my wifi was skipping for whatever reason, this became the result. Unfortunately, if I were to delete any one of the two extra posts, the original message would also be deleted. I want to leave the original response to Goat up to make sure he sees that I was not ignoring him- I simply glossed over it and missed the link he gave at the time. The post(s), all three of them, will be unpublished once he gets the chance to see my acknowledgment of his post. For some reason, I have been trouble unpublishing my own post from my smartphone (dosen't it sound pretensions when someone says smartphone versus cell phone?) Either way, the triple post is my fault and I apologize to the Pharmer family. 

Before I hit send, anyone want to place a friendly bet as to whether this posts once, or three times???

Let's find out together... 

Rocker Dan
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cant get my drug

Dear gtrplayer it seems like this unreal movement to alter what helps us is still in full swing some places.I went through all kinds of minor changes but now am back to semmi normal as far as my medication goes.I was put back on a smaller yet decent ammount of Diaezapam after my doctor said I was driving him crazy so I now live with the changes.But I  feel for you and others who after so many years are forced to choose between pain meds and Benzos!I AlsoI  lerned self control and never run out of my medicnes early anylonger.So we live and lern,I sure wish you the best in your search for a happy medium,Peace,RD

gtrplayer
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I appreciate the reply

Thanks, RockerDan, for sharing your story and posting encouragement. My major problem stems from the fact my primary dr wants me to be seen by a "specialist" for everything. I can agree that the pain specialist is needed, and wouldn't ask him to treat my pain. However; the last time I had an appointment with him, he told me to find a dr who prescribes Suboxone for pain, and he would then refer me to that dr. Well, believe it or not, doctors offices do not tell you over the phone if they do or don't prescrobe a certain med. I could have told my family dr that before he even finished suggesting me trying to find one. 

Now, to make matters worse, the psychiatrist he sent me to for medication maintenance (prescribe my Klonopin on a monthly basis) tells me she can't rx any klonopin to patients on narcotics due to a law that went into effect January 1, 2017. My problem with this is, it's not true. I have read the mind numbingly boring letter sent to physicians advising them on coadministraton of benzodiazepines and opioids. Not one time did it say "you may not rx nerve meds if a patient is on opioids", or vice versa. What is DID say, was that they urge doctors to more carefully weight risk vs benefit to rx'ing both class of drugs to the same patient, on a case by case basis. To make matters partially worse, she saw that I had been treated for adult onset ADD caused by a traumatic brain injury from a crash, and read where I had 3 car accidents since being off ADD treatment, which were totally my fault. Not texting and dribing type of not paying attention, but just "thought distraction." So now I am on Vyvanse, which works great, and always has. However, I can barely write my signature on receipts, or even write with a pen in general, because I shake too bad. The ADD meds work to keep me focused, but also causes the anxiety to get worse. 

And while I typically do not share my emotions on this page, I can not help but be 100 percent honest when I state that I am feeling absolutely overwhelmed, frustrated, disillusioned, and disheartened. I hate what I am about to say, because I don't want people responding with "pity" posts. What I say next I say just in order to remain 100% honest with anyone who may value what I write. That being said, I truly feel like these misinterpretations of guidelines are a way to cause some of us to commit suicide, and reduce the number of patients that need these medications. I can tell you, without my klonopin, I am usually so on edge I stay by myself and barely venture out. Yet, if I choose to continue the Klonopin, and discontinue the pain meds, the pain alone will cause suicidal idiation.

IMPORTANT NOTE: I do not advocate suicide, nor do I support it as a justifiable solution to a temporary problem. I urge anyone with suicidal thoughts to seek treatment, or an evaluation at the very least. However, what do you do when you are confronted with a permanent problem, to which solutions exist, but can not receive the treatment? In all honesty, I'm kind of done caring anymore. It seems so stupid to try to seek treatment when all you run into are locked doors.