4 ms·

I disagree that this is not novel. It's an immediately dissolvable buprenorphine. I discussed this in my top level comment, but subutex has been abused because

I disagree that this is not novel. It's an immediately dissolvable buprenorphine. I discussed this in my top level comment, but subutex has been abused because it does take some time to dissolve, so patients will sometimes take it out of their mouth when the healthcare provider is not looking in order to inject later. This version avoids that to some extent, which is novel enough to be patentable.

girvo 8y ago
Eh. Bupe isn’t that abusable, so you very quickly get a couple weeks of take-home doses. So if you’re going to IV it, this new patent makes zero difference.
- epmaybe 8y ago
  sublingual buprenorphine like Subutex is only indicated for take-home if the patient can not tolerate suboxone (oral buprenorphine/naloxone). If you're prescribing subutex take-home just because, you're not following the preferred prescribing practices. Suboxone and subutex are not used the same way, as I described in my top level comment in this thread. Subutex is for patients that are not clinically stable, so they get daily doses from their treatment center and are watched as they take the medicine. You could argue that the providers should watch them until they have dissolved it, and thus this patent is over-engineering a solution, but that's not what you argued. Suboxone is for patients that are clinically stable, compliant, and/or are unable to make frequent visits to their treatment center, so they are able to take-home their medication and take it as prescribed. These are patients that you as the healthcare provider are relatively certain wouldn't abuse it. And yes, while buprenorphine isn't as abusable as most other medications, and is far more forgiving than methadone, it's not perfect, and there is still some liability for abuse, especially with subutex. So while I agree that this patent makes very little difference (again, check my longer comment), it's not all that bad of an idea, hence why Purdue likely patented it.
  - girvo 8y ago
    Which is why I said "bupe" instead of naming either formulation. Suboxone is just as IV-abusable as Subutex itself. It makes little difference in practice. (I'm on Subutex, but that's because I'm on 0.8mg daily -- down from 32mg originally. I've never abused mine, because I really don't see the point, but I've seen enough people who have). Subutex is barely prescribed at all in Australia, where I'm from, but it makes effectively zero difference in IV usage -- the naltrexone does nothing compared to how strongly bupe itself binds to your receptors.
    - epmaybe 8y ago
      Sure, they're both IV abusable, but my point was that for the patients that are still addicted to opioids the more immediate dissolve of the patented formulation would make it more preferable to subutex for providers, simply because they know that a patient couldn't take the tablet out of their mouth since it would have dissolved immediately. It's those patients we're trying to get back on track with something better, not the patients we know are able to manage on take-home regimens. > the naltrexone does nothing compared to how strongly bupe itself binds to your receptors. What? First of all, it's naloxone rather than naltrexone that is found in suboxone. Subutex doesn't have either of them. And secondly, it's very, VERY well known that naloxone/naltrexone have far more binding affinity to the mu-opioid receptor (the type that we think causes euphoria/analgesia) compared to any sort of opioid we have on the market (maybe not sufentanyl, but even that I'm fairly certain is weaker affinity). That's exactly why we can use Narcan effectively to combat opioid overdose.
      - girvo 8y ago
        > What? First of all, it's naloxone rather than naltrexone that is found in suboxone. Subutex doesn't have either of them. I always get them mixed up, but it really isn't changing my point. And yes, no kidding, you brought up Suboxone as well as Subutex which is why I'm discussing it! I'd really prefer if you read my comments with a little more charity. Anyway, it doesn't appear as if you're listening to my point here, and that's okay :) Have a good day
- tmp-20150107 8y ago
  You'd be surprised. It's definitely being sold on as an opiate to addicts in UK prisons, both from being smuggled in (small, easily concealed, innocuous looking pills) and diversion from maintenance scripts (although I would have thought in a prison environment they would simply stand over you and wait until you swallow, or force you to drink a glass of water, since unlike someone on a treatment program voluntarily there are no issues about personal liberty etc. From what I've heard, the 8mg tablets are crushed into powder, divided into eighths and sold as 1mg doses for snorting (maybe injecting, but works in prison are pretty dodgy...) Interestingly, although the treatment center I'm with offers both Methadone and Subutex/Suboxone I was never actually given the choice between the two, or informed of the pros and cons of either. I asked, and basically I was put on Methadone treatment because I happened to mention it in one of my admission interviews. No idea if this is policy driven due to pricing or something else? Actually, I suspect it may just be a lack of training due to low funding levels, poor compensation for staff which leads to high turnover and lower quality. Thanks, NHS.

girvo 8y ago

Eh. Bupe isn’t that abusable, so you very quickly get a couple weeks of take-home doses. So if you’re going to IV it, this new patent makes zero difference.

epmaybe 8y ago
sublingual buprenorphine like Subutex is only indicated for take-home if the patient can not tolerate suboxone (oral buprenorphine/naloxone). If you're prescribing subutex take-home just because, you're not following the preferred prescribing practices. Suboxone and subutex are not used the same way, as I described in my top level comment in this thread. Subutex is for patients that are not clinically stable, so they get daily doses from their treatment center and are watched as they take the medicine. You could argue that the providers should watch them until they have dissolved it, and thus this patent is over-engineering a solution, but that's not what you argued. Suboxone is for patients that are clinically stable, compliant, and/or are unable to make frequent visits to their treatment center, so they are able to take-home their medication and take it as prescribed. These are patients that you as the healthcare provider are relatively certain wouldn't abuse it. And yes, while buprenorphine isn't as abusable as most other medications, and is far more forgiving than methadone, it's not perfect, and there is still some liability for abuse, especially with subutex. So while I agree that this patent makes very little difference (again, check my longer comment), it's not all that bad of an idea, hence why Purdue likely patented it.
- girvo 8y ago
  Which is why I said "bupe" instead of naming either formulation. Suboxone is just as IV-abusable as Subutex itself. It makes little difference in practice. (I'm on Subutex, but that's because I'm on 0.8mg daily -- down from 32mg originally. I've never abused mine, because I really don't see the point, but I've seen enough people who have). Subutex is barely prescribed at all in Australia, where I'm from, but it makes effectively zero difference in IV usage -- the naltrexone does nothing compared to how strongly bupe itself binds to your receptors.
  - epmaybe 8y ago
    Sure, they're both IV abusable, but my point was that for the patients that are still addicted to opioids the more immediate dissolve of the patented formulation would make it more preferable to subutex for providers, simply because they know that a patient couldn't take the tablet out of their mouth since it would have dissolved immediately. It's those patients we're trying to get back on track with something better, not the patients we know are able to manage on take-home regimens. > the naltrexone does nothing compared to how strongly bupe itself binds to your receptors. What? First of all, it's naloxone rather than naltrexone that is found in suboxone. Subutex doesn't have either of them. And secondly, it's very, VERY well known that naloxone/naltrexone have far more binding affinity to the mu-opioid receptor (the type that we think causes euphoria/analgesia) compared to any sort of opioid we have on the market (maybe not sufentanyl, but even that I'm fairly certain is weaker affinity). That's exactly why we can use Narcan effectively to combat opioid overdose.
    - girvo 8y ago
      > What? First of all, it's naloxone rather than naltrexone that is found in suboxone. Subutex doesn't have either of them. I always get them mixed up, but it really isn't changing my point. And yes, no kidding, you brought up Suboxone as well as Subutex which is why I'm discussing it! I'd really prefer if you read my comments with a little more charity. Anyway, it doesn't appear as if you're listening to my point here, and that's okay :) Have a good day
tmp-20150107 8y ago
You'd be surprised. It's definitely being sold on as an opiate to addicts in UK prisons, both from being smuggled in (small, easily concealed, innocuous looking pills) and diversion from maintenance scripts (although I would have thought in a prison environment they would simply stand over you and wait until you swallow, or force you to drink a glass of water, since unlike someone on a treatment program voluntarily there are no issues about personal liberty etc. From what I've heard, the 8mg tablets are crushed into powder, divided into eighths and sold as 1mg doses for snorting (maybe injecting, but works in prison are pretty dodgy...) Interestingly, although the treatment center I'm with offers both Methadone and Subutex/Suboxone I was never actually given the choice between the two, or informed of the pros and cons of either. I asked, and basically I was put on Methadone treatment because I happened to mention it in one of my admission interviews. No idea if this is policy driven due to pricing or something else? Actually, I suspect it may just be a lack of training due to low funding levels, poor compensation for staff which leads to high turnover and lower quality. Thanks, NHS.