Talk:Buprenorphine

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Subutex[edit]

The first paragraph states, "It is available in a variety of formulations: Subutex, Suboxone, Zubsolv (buprenorphine HCl and naloxone HCl; typically used for opioid addiction)"

...however, Subutex does not contain naloxone, and I feel that this should be pointed out. Thus, I think Subutex deserves its own sentence; something like "Suboxone, Zubsolv (buprenorphine HCl and naloxone HCl; typically used for opioid addiction), Subutex (sublingual tablets for opioid addiction), Temgesic (sublingual tablets for moderate to severe pain), etc.". Thoughts? Psychonaut25 - 13375p34k / C0n7r1b5 04:32 AM EST, 15 October 2013 (UTC)

New changes editor wanted help[edit]

Please discuss your edits here. Thank youTeeVeeed (talk) 16:57, 24 May 2018 (UTC)

Hi TeeVeeed,
New to this and was wondering how i can provide sources to someone and they can add footnotes etc to distinguish the various types of buprenorphine available. Critical to mention long acting and their place in the treatment spectrum. Just a well meaning physician who lacks editing prowess and may need to cite more sources. Any help would be appreciated. — Preceding unsigned comment added by DrXMD (talkcontribs) 19:06, 24 May 2018 (UTC)
The long acting formulation has nearly nothing published about it. Strange.[1]
We already contain a statement from the FDA " A once a month injection has been approved in the United States and it should be available in 2018."
DrXMD do you have high quality secondary sources on the long acting formulation?
Doc James (talk · contribs · email) 05:05, 25 May 2018 (UTC)
Yeah I was able to find very little about it so far and I wonder if it is actually available everywhere? The funny thing is I know of someone who recently suffered a relapse and getting a shot /(not getting it) was what set them off and then there was a strangely brief detox and then some red-tape about getting this "shot" again (having to order it and rules about getting it) and I assumed it was vivatrol but maybe it was this? I would like to know more about it. TeeVeeed (talk) 20:55, 25 May 2018 (UTC)
Okay so I have found some info. Not suitable as references but some things are becoming clear about this. One that insurance is not covering it because it is alleged "not proven scientifically" see quote further on. Two--that there has been a little forum-spamming/trolling to promote. Three-the pharma reps gossip forum calls it worst product launch ever.http://www.cafepharma.com/boards/threads/could-sublocade-grab-record-for-worst-launch-in-history.620687/page-4 Four--additional paperwork, a month wait to be approved to use the drug-drug is ordered and shipped to dr from drug company. Also medical staff may not be comfortable with this invasive procedure. And remember the doctors authorized to administer these injections must have the special DEA waiver and up til now, no skill in depot-style painfull injections was needed for a buprenorphine waiver physician. Five. (a forum/review site quote) "declined my prior-auth for reasons of “medication lacking scientific data”. This isn’t surprising. Remember, this medication was rushed (to me, two 24-week trials with less than 900 patients is rushed) to market and those trials will turn in to real world studies." end quote Also info. (again not verified) has been posted saying that %15 of the test subjects had trouble with the injection itself.
Six--this was approved in late 2017 and six month reports are just coming in now especially considering the one month lag time to get the drug (it is a six month treatment plan??). I do not agree with those statements just noting that I had to go deep to find info about this and it is NOT VERIFIED. I was also able to see where the pharm. company has invested pretty heavy in this market including a lawsuit/patent to try and make a Buprenorphine generic film. I have questions about the dosing (inclu. How many shots? How many pellets?)-----the drug is very very weird anyhow, and this dosing schedule seems a bit arbitrary but there do seem to be some good reasons for utilizing it. I am going to have a hard time reconciling, "prevents diversion" as a strategy since from the very beginning diversion was actually PROMOTED haha as a buprenorphine benefit (pretty sure there are reliable cites for that). Drug addicts running out early--(using the daily self-dosing), abusing-- and being robbed of meds or feeling like they must sell it for cash Okay, this will be an obstacle there/prevent that. They already test people in the Buprenorphine program to make sure that they ARE using it not selling it so this injection is more like pre-insurance against that. How MUCH of the drug is being released approximately daily is a question and they are going from"300" to"100" to ?????? nothing? when it wears off? I thought that no more than a 20% drop at a time in opiates was the best way to go but no cite for that sorry this weird drug may have special powers. Or do they go back to daily dosing or proceed to vivitrol/or naloxone/something else??? Since it has barely been on the market for the six months recommended for treatment, "after-reports" are not out there. So at some point, everything wears off---(do they get the pellet removed?)-we would want to answer that, they install more pellets during the six month treatment? what happens to the old ones do they remove them-how is the pain with something like that? And going from "100" to nothing that slowly eeeeks out of your system might be bad after about five to ten days or so after the stuff is completely depleted. And I DO have good sources that say that medical professionals are "not sure" about the best way to ween someone off buprenorphine anyhow but that seems like a pretty steep cliff to drop someone off of so there must be some follow-up drug unless they want a slow-onset cold-turkey situation. I do think that there may be interest in this drug having a page on our project but I'd like to see some questions answered by reliable sources.23:29, 25 May 2018 (UTC)

Per "observation" recommendation[edit]

The source says "Buprenorphine alone is preferred for the initial (i.e., induction) phase of treatment, administered under the supervision of the prescribing physician in the office setting.202203 Following induction, buprenorphine in fixed combination with naloxone is preferred for maintenance treatment when use includes unsupervised administration.202 214Administration of buprenorphine without naloxone in an unsupervised setting should be limited to patients who cannot tolerate naloxone"

For unsupervised use the combination with naloxone is recommended. Doc James (talk · contribs · email) 21:24, 24 May 2018 (UTC)

Right but the way we have in article is confusing and a misrepresentation. The thing is that what they are talking about is the 1st time that the drug is used it is under observation (induction). The way that we have it makes it look like all use is supervised? I'll try to reword and keep the monitored use for induction.TeeVeeed (talk) 00:19, 25 May 2018 (UTC)
Okay so I reworded so it does not look like we are saying that all buprenorphine without naloxone use is supervised. Also added precipitated withdrawal to next paragraph. The induction period/supervised is for two reasons, one to avoid precipitated withdrawal by looking for physical signs of withdrawal and surveying about last opiate use, AND to determine that the drug is effective in relieving physical withdrawal symptoms. There could prob. be a rewrite or section added for induction practices since readers may be interested in that.TeeVeeed (talk) 00:39, 25 May 2018 (UTC)
The induction phase is a number of days not the first dose. When the person is switched to unsupervised dosing it is recommended they be given buprenorphine/naloxone not buprenorphine.
That is why there is this sentence "Administration of buprenorphine without naloxone in an unsupervised setting should be limited to patients who cannot tolerate naloxone"
Doc James (talk · contribs · email) 04:49, 25 May 2018 (UTC)
The source defines induction as "Induction Sublingual Initially, buprenorphine 8 mg on day 1 and 16 mg on day 2. From day 3 onward, administer buprenorphine in fixed combination with naloxone at the same buprenorphine dose as on day 2." Doc James (talk · contribs · email) 04:57, 25 May 2018 (UTC)

How about "For opioid addiction it is typically only recommended for the first to days of treatment under direct observation of a health care provider. For longer term treatment of addiction a combination formulation of buprenorphine/naloxone is recommended to prevent misuse by injection." Doc James (talk · contribs · email) 04:59, 25 May 2018 (UTC)

sorry about removing this thread in this diff. didn't mean to Jytdog (talk) 06:00, 25 May 2018 (UTC)
Basically what they do is try to perscribe the naloxone version for patients that are taking the drug unsupervised. That part about "a few days" for the induction phase observation is not acurate in almost all cases. Also, the drugs.com does say something about precipited withdrawl. "To avoid precipitating withdrawal, give the first dose when objective and clear signs of opiate withdrawal are evident.202 214" I would like to add something about that but I'd like to use another source besides the drugs.com one to replace what you say is not a valid source ( A patient is assed prior to first drug administration to avoid precipitated withdrawal.https://www.naabt.org/faq_answers.cfm?ID=70.) I can probably find prescribing info. about the office visit observation induction phase that verifies that only ONE office visit is the norm so I'd like to do that using a different source. I'll post that source here before changing because I'm not sure what would be acceptable.TeeVeeed (talk) 12:30, 25 May 2018 (UTC)
So I would propose that we avoid using terms that mention 3 days, one day,... and use "medically supervised office visit"? I like this source https://www.samhsa.gov/medication-assisted-treatment/treatment/buprenorphine Is this acceptable? Here is what they say about "induction" and I would like to use simalar words. "The Induction Phase is the medically monitored startup of buprenorphine treatment performed in a qualified physician’s office or certified OTP using approved buprenorphine products. The medication is administered when a person with an opioid dependency has abstained from using opioids for 12 to 24 hours and is in the early stages of opioid withdrawal. It is important to note that buprenorphine can bring on acute withdrawal for patents who are not in the early stages of withdrawal and who have other opioids in their bloodstream.". Maybe a link to COWS score? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2774236/ . Also it should be mentioned about the physician waiver needed to prescribe this drug for opiate dependence. I would like to use the SAMHSA site as a source for that also if it is an acceptable source? TeeVeeed (talk) 13:32, 25 May 2018 (UTC)
Some of this only applies to the US such as the physician waiver. That could go in the body but would need to state that it is US specific.
In some places a pharmacist observing the person taking the treatment is perfectly suitable (what is done most of the time in Canada). This bit "qualified physician’s office or certified OTP" is US specific.
Agree that a person should have not used opioids for some time / be in early withdrawal before starting. Added this.
The problem with that source is it does not clearly separate when it is talking about buprenorphine versus when it is talking about buprenorphine/naloxone. Doc James (talk · contribs · email) 18:32, 29 May 2018 (UTC)