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