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Phone: (813)-328-4120 Fax: (813)-328-4003 Email: emergencemat2021@gmail.com 5471 West Waters Avenue, Unit 300, Tampa, FL 33634
Emergence M.A.T.
OWCP Specialist
Suboxone | Zubsolv | Bunavail | Subutex

FAQ: What is the difference between Suboxone, Zubsolv, Bunavail, and Subutex, and is one superior to others?
All four products have similar action and are equal in equivalent doses. One is not superior to others. They do have some differences in how they are used, and how they taste. They also have different rebate programs, and one might turn out to be cheaper than others. Patients who have insurance may have the medications mostly covered by their insurance.

All four products

• have Buprenorphine as their main ingredient, and in equivalent doses have equal effect,

• are only approved for the treatment of opioid use disorder (formerly known as opioid dependence and opioid addiction),

• and require that the provider obtain a special certification from the Drug Enforcement Agency (DEA) to prescribe these medications.

Suboxone, Zubsolv, and Bunavail contain a combination of Buprenorphine and Naloxone.

Subutex is Buprenorphine without Naloxone.


Subutex (Buprenorphine Tablet)
Subutex (Buprenorphine) as a brand is no longer manufactured, and the name is now understood to represent the Buprenorphine mono preparation.

Subutex used to be marketed as a 2mg and an 8mg tablet. After the patent expired the manufacturer stopped making and marketing it under that brand name. The generic form of this medication is available.

If the provider writes a prescription for Subutex, then the pharmacist will dispense Buprenorphine (without Naloxone), made by one of the generic manufacturers.

Subutex (Buprenorphine) is the only product out of the above four that does not have any Naloxone.

The current recommendations restrict its prescription to specific situations.

Subutex is recommended to be used for:

• induction, that is starting someone on Buprenorphine for the first time (prescribed for the first few days),

• patients who are pregnant, (even though Buprenorphine is not yet recommended for use in pregnancy)

Subutex does not contain Naloxone … therefore it has abuse potential, and diversion potential. Patients or others who may acquire it through illicit means, may crush these tablets and inject it … after all Buprenorphine is an opioid agonist, and produces opioid like effects. Given this potential for misuse, most providers in USA will not ordinarily prescribe Subutex.

The other three formulations, Suboxone, Zubsolv, and Bunavail, have Naloxone.

The Naloxone component in these three preparations is quite significant. When Naloxone is used for reversal of opioid overdose the ER physician will typically give 0.2 mg intravenously, in incremental dose, till reversal is achieved and sustained. On the average it takes anywhere from 0.4mg to 1.2mg of IV Naloxone, that is one to three ampules of Naloxone (each ampoule being 0.4mg of Naloxone).

The combination products Suboxone, Zubsolv, and Bunavail, in their most common prescribed form, have 0.7 to 2mg of Naloxone, enough to block any immediate euphoric effect of Buprenorphine, if injected intravenously.

However, if they are taken as prescribed, then only a negligible amount of Naloxone gets absorbed and does not have any significant blocking effect


Suboxone tablets and films are now generic and significantly cheaper than Zubsolv and Bunavail.

Zubsolv, and Bunavail, have similar cost for equivalent doses. Prescription plans will generally have only one of them as their preferred drug in their formulary.

Equivalent doses

The most common forms of these medications that are available have the following amount of Buprenorphine and are considered equivalent dose.

Generic Buprenorphine 8mg/Naloxone 2mg available as a sublingual tablet.

Suboxone Buprenorphine 8mg/Naloxone 2mg available as a sublingual film.

Zubsolv Buprnorphine 5.7mg/Naloxone 1.4mg available as a sublingual tablet.

Bunavail Buprenorphine 4.2mg/0.7mg available as buccal film.


Buprenorphine + Naloxone Generic Tablet
Sometimes referred to as Suboxone generic tablet because it replaces the orange colored Suboxone tablet that used to be available till a few years back. It contains Buprenorphine and Naloxone in combination, it is now marketed as a white tablet and may come in different sizes and shapes as there are multiple generic manufacturers.

This generic tablet is available in two strengths:

• Buprenorphine 2 mg/Naloxone 0.5 mg, tablet

• Buprenorphine 8 mg/Naloxone 2 mg, tablet

The most common strength prescribed is Buprenorphine 8mg/Naloxone 2mg tablet that is placed under the tongue from where the medication is absorbed. The tablet can be cut into half with a tablet cutter, but cutting it any smaller is difficult. Some pharmacies have tiny tablets, easy to use but impossible to cut. That makes tapering on an existing prescription difficult.

This also comes as a Buprenorphine 2 mg/Naloxone 0.5 mg tablet, but is difficult to find and the cost is not exactly one fourth of the 8mg tablet, making it a poor value. Patients who have tapered their dose to 2mg/day may find it useful.

Patients do not have to purchase the entire prescription, they can purchase a few tablets at a time, however, discuss this with the pharmacist, as each pharmacy has its own rules.

The retail cost per 8mg tablet is anywhere between $1 to $4. Being a generic formulation there are no rebate cards. It is best to compare retail prices and download coupons for your zip code through services like:

goodrx.com

When comparing prices make a note of how many tablets, and what strength. I find that sometimes they are giving the cost of 14 tablets and sometimes 30.


Suboxone Film (Buprenorphine + Naloxone)
Suboxone contains Buprenorphine and Naloxone in combination, marketed as a film in a sealed foil pouch. Each pouch has one film. 30 patches to each pack. The most common strength prescribed is Buprenorphine 8mg/Naloxone 2mg.

The retail cost per 8mg film is anywhere between $6 to $12. It is on the formulary of some prescription plans, but might require preauthorization.

With my patients Suboxone film remains popular because, it is easy to carry, and the film can be cut to very small pieces … which makes it useful when a patient is tapering the dose.

Suboxone film is available in four strengths:

• Suboxone Buprenorphine 2 mg/Naloxone 0.5 mg, film

• Suboxone Buprenorphine 4 mg/Naloxone 1 mg, film

• Suboxone Buprenorphine 8 mg/Naloxone 2 mg, film

• Suboxone Buprenorphine 12 mg/Naloxone 3 mg, film

Suboxone 8mg film (Buprenorphine 8mg/Naloxone 2mg) is the most popular form with my patients that are tapering their dose. The 2mg film has one fourth the medication but costs almost as much as the 8mg film. The manufacturer offers a rebate for both self-pay and insured patients. You can download rebate card from Suboxone website:

Suboxone

Suboxone Medication Guide

Suboxone Prescribing Information


Zubsolv (Buprenorphine + Naloxone)
Zubsolv is marketed as a tablet that is placed under the tongue. It dissolves easily. Some patients prefer the taste over Suboxone generic tablets and films.

The most common form in use is Zubsolv 5.7 mg Buprenorphine with 1.4 mg Naloxone.

Zubsolv tablet is available in four strengths:

• Zubsolv 1.4 mg Buprenorphine with 0.36 mg Naloxone, tablet

• Zubsolv 5.7 mg Buprenorphine with 1.4 mg Naloxone, tablet

• Zubsolv 8.6 mg Buprenorphine with 2.1 mg Naloxone, tablet

• Zubsolv 11.4 mg Buprenorphine with 2.9 mg Naloxone, tablet

Zubsolv has the easiest free trial program that can give you a total of 30 tablets free, it requires printing your own coupon, and is limited to self pay patients, and is once a life time benefit. The provider does not have to fill any forms, a prescription specifically for Zubsolv is required. They have not mentioned any end date. Find the details at the Zubsolv website.

Zubsolv website:

Zubsolv

Zubsolv Medication Guide

Zubsolv Prescribing Information


Bunavail (Buprenorphine + Naloxone)
Bunavail is marketed as a film that is applied to the buccal mucosa (the inside of the cheek). Only one side is designed to stick and that is the side that has medications. The medication is absorbed through the buccal mucosa and the film then comes off lose and can be spit out. The manufacturer claims that their formulation is more efficient and more of the medication is absorbed. Bunavail 4.7mg film is equivalent to Suboxone’s 8mg film.

Patients have to learn how to use it, as it is different from other sublingual forms.

Bunavail buccal film is available in three strengths:

• Bunavail 2.1 mg Buprenorphine/0.3 mg Naloxone, film

• Bunavail 4.2 mg Buprenorphine/0.7 mg Naloxone, film

• Bunavail 6.3 mg Buprenorphine/1 mg Naloxone, film

Bunavail buccal film 4.2 mg/0.7 mg is the most commonly available strength

It is difficult to cut the film therefore trying to taper the dose on a given prescription is difficult.

The manufacturer offers a rebate for both self-pay and insured patients. You can download rebate card from the Bunavail website

Bunavail website:

Bunavail

Bunavail Dosing Guide

Bunavail Prescribing Information

Buprenorphine is a scheduled III controlled substance.

All four products have been placed under Schedule-III of the controlled substances act, making their prescription and dispensing less cumbersome than most of the opioid medications that are used for the control of pain. However, prescribing these medications requires a special waiver certificate over and above the DEA certificate and registration that is required to prescribe opioid pain medications.

Why this is called a waiver certificate?

According to current laws addiction can only be treated at approved addiction treatment facilities which are licensed by the state and federal government. By granting this certificate the DEA waives this requirement and allows certified medical providers to prescribe addiction treatment from their clinics. Certification can be obtained after doing a brief training course and acquiring competence in prescribing this medication. Each physician can to treat up-to 275 active patients. The provider does not have to be an addiction specialist, most providers are family practice doctors, general internists, psychiatrists, and pain management doctors. Dr. Seldes is certified to 275 patients.

Since 2016 under the Comprehensive Addiction and Recovery Act (CARA), qualified Nurse practitioners and Physician Assistants can also apply for waiver, and prescribe the above medications.


Buprenorphine extended release depot preparations
Sublocade once a month injection
Buprenorphine is now available as a once a month injection under the brand Sublocade. This is not sold in pharmacies and is only available through a medical provider. Sublocade’s approximate cost is $1,600 per monthly dose of either strength.

Excerpt from the FDA notice:

Sublocade is a drug-device combination product that utilizes Buprenorphine and the Atrigel Delivery System in a pre-filled syringe. It is injected by a health care professional (HCP) under the skin (subcutaneously) as a solution, and the delivery system forms a solid deposit, or depot, containing Buprenorphine. After initial formation of the depot, Buprenorphine is released by the breakdown (biodegradation) of the depot. In clinical trials, Sublocade provided sustained therapeutic plasma levels of buprenorphine over the one-month dosing interval.

FDA Notice – Sublocade

Sublocade website:

Sublocade

Sublocade Fact Sheet

Sublocade Prescribing Information


Probuphine six month implant
Buprenorphine is now also available as an implant called Probuphine. It is designed to provide a constant, low-level dose of buprenorphine for six months.

Probuphine

Probuphine Medication Guide

I do not offer these extended release depot preparations.

You will have to find an approved provider through your insurance network. These long acting preparations are not sold at pharmacies, they are supplied directly to providers who have obtained the necessary approval and training to implant them.


Buprenorphine for Chronic Pain Management
Buprenorphine is an opioid agonist and is approved for the treatment of pain, however only certain formulations are approved. These formulations are very expensive, and are rarely authorized by insurance/prescription plans.

The following formulations are currently being marketed in USA.


Butrans Transdermal Film
Butrans available as 5 to 20mcg/hour dermal patches, applied to the skin. Each patch delivers medication for seven days.

Butrans website:

Butrans

Butrans Medication Guide

Retail cost of one 20mcg/hour patch is more expensive than Suboxone. Each patch is supposed to last for seven days that means a monthly cost of about $460. It requires jumping through a lot of hoops to get it covered by insurance.

A 20mcg/hr patch, according to current MME turns out to be 33.6 MME per day, that is, it is equal to 36mg of Morphine per day

Generally, it is only useful for a patient who cannot take medications by mouth. Even for those situations a fentanyl transdermal patch has lower cost.

Calculation: 20 mcg/hr Butrans transdermal patch X (4 patches/28 days) X 12.6 = 36 MME/day

Subutex (Buprenorphine) as a brand is no longer manufactured, and the name is now understood to represent the Buprenorphine mono preparation.

Subutex used to be marketed as a 2mg and an 8mg tablet. After the patent expired the manufacturer stopped making and marketing it under that brand name. The generic form of this medication is available.


Belbuca Buccal Film
Belbuca is available as 75mcg to 900mcg film applied twice a day to the mucosal surface inside the mouth. This is very similar to Bunavail, but without Naloxone.

Belbuca

Belbuca Medication Guide

Most common available form is 300mcg films at a cost of about $10 each. Amonths supply is about $600. It is not a cost effective alternative to commonly available opioid medications, and most insurances do not cover it.

According to the current MME values, which is very debatable 300mcg films twice a day gives a Morphine Milligram Equivalent value of 18 that means it will deliver an opioid equivalent of 18mg/day.

Its only advantage will be for a patient who cannot swallow pills. Even for those situations a fentanyl transdermal patch has lower cost.

Calculation: 300 mcg Belbuca buccal patch X (60 patches/30 days) X 0.03 = 18 MME/day


What is MME?
MME stands for Morphine Milligram Equivalent. It is a value used when converting one opioid to another opioid to guess as to how much should be prescribed. They do not correlate well for Buprenorphine products.

MME Conversion

In 2017 CDC removed the MME for Buprenorphine containing products that are used for treatment of addiction.


Additional information
Additional information is available at DailyMed, through US National Library of Medicine,

DailyMed

Buprenorphine

Naloxone


This page was last updated on September 29, 2020
Mark A. Seldes, MD
Dr. Seldes is a board-certified family physician, He is experienced with OWCP medical reports and performing Impairment Rating examinations. Dr. Seldes and his qualified staff, assist in obtaining compensation and medical treatment after a work-related injury.
We perform both In-person examinations and Telehealth visits for our Florida residents who are already established patients. depending on the patient's needs.

Contact Us Today!
Phone: 813-328-4120, We are Open Monday-Friday, From 8:00 AM to 5:00 PM EST. (We are Currently Accepting New Patients)

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6/16/2024 7:54:21 PM