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sublingual buprenorphine like Subutex is only indicated for take-home if the patient can not tolerate suboxone (oral buprenorphine/naloxone). If you're prescrib

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

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