http://suboxonetalkzone.com/double-standard-for-buprenorphine-at-pharmacies/
People knowledgeable about buprenorphine and Suboxone know that Suboxone and buprenorphine are virtually the same medication. People who inject both drugs in studies will give higher average ‘liking scores’ for buprenorphine, but there is considerable overlap between the two medications. Patients in my practice who admit to injecting Suboxone or buprenorphine (to make it last longer) before they could find a certified doctor claim that they found no difference between the two medications. I’ve described other reasons why adding naloxone to buprenorphine is more of a marketing ploy than a deterrent to diversion. For example, naloxone lasts about an hour in the bloodstream, whereas buprenorphine lasts for days, and the high-affinity binding of buprenorphine is not significantly impacted by the comparatively-weaker drug, naloxone.
The standard narrative, that holds that Suboxone is ‘safer’ than buprenorphine, relies on false assumptions. Many people who should know better believe that naloxone provides some measure of safety in people who don’t inject the medication— that the naloxone ‘blocks euphoria’ or that the naloxone ‘provides the ceiling effect.’ This is, off course, hogwash (do they use that term outside of the Midwest?).
The importance of naloxone is so low that the standard of care in pregnant women is to prescribe ONLY buprenorphine based on the argument that it makes no sense to expose a fetus to an extra medication (naloxone), when that medication doesn’t do anything. The natural question is ‘why expose ANYONE to an extra medication, when that medication doesn’t do anything?’
Opioid dependence is a potentially-fatal condition. People trying to rebuild their lives, after active addiction, frequently begin from a position of unemployment and poverty— and no health insurance. If lucky enough to find a physician who prescribes Suboxone or buprenorphine, their access is severely impacted by the cost of the medication. If their doctor prescribes Suboxone film, they will pay over $500 per month out of pocket. If their doctor instead prescribes buprenorphine, the cost drops to $135—saving almost 75%. But if that patient lives in remote Michigan and wanders into Snyder Drugs, the cost for the same amount of buprenorphine is over $450. I assume that Snyder Drugs has access to US Mail, UPS, FedEx, and all the other delivery methods available in Wisconsin (i.e. they do not rely on bobsleds). We often hear of criminal charges against people who gouge prices for generators during storms. Given that the current epidemic of opioid dependence has killed for more people than the typical hurricane, is it reasonable for a drugstore to mark up life-saving medications by 200%?
It gets worse. Snyder Drugs has a policy that forbids filling prescriptions for men for buprenorphine, but allows filling of the same prescriptions for women—pregnant or not—based on their conviction that men are more likely to divert buprenorphine than women. Men prescribed buprenorphine must drive hours to find a pharmacy that will fill their legal, legitimate prescription; several hours to avoid gouging altogether…
All Things Chronic 