NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update

Buprenorphine prescribing

The NHSGGC Substitute Prescribing Management Group has decided to change from Suboxone® (buprenorphine and naloxone) to generic single agent buprenorphine 0.4mg, 2mg and 8mg sublingual tablets across all Addiction services, including GP shared care.

 

When Suboxone is administered sublingually, the therapeutically active ingredient is buprenorphine, with naloxone being inactive. The naloxone component only becomes active if Suboxone is injected and was designed to deter abuse and diversion. However local clinical experience has shown that abuse and diversion of Suboxone was still possible usually with consumption via snorting.

 

The majority of patients in NHSGGC consume their Suboxone tablets under supervision within the pharmacy; therefore, there is no reason for them to be prescribed a combination of buprenorphine and naloxone that was designed to be dispensed unsupervised.

 

The cost of Suboxone is now significantly higher than that of generic buprenorphine, with little evidence to support a significant clinical advantage in the context of the local trends in illicit drug use and treatment accessibility. In particular, a literature review of the comparative safety of Suboxone, buprenorphine and methadone showed no definitive evidence of enhanced safety with Suboxone. This remains theoretically plausible rather than supported by any real evidence. In this context, the very large cost difference between Suboxone and generic buprenorphine cannot be justified.

 

 

What will change for the patient?

 

The generic buprenorphine tablets are dissolved in the mouth – just as before. The tablets vary in size and flavour. Suboxonetablets have a lemon and lime flavour; generic buprenorphine tablets may have a different flavour, or have no flavour at all.

 

Other Information

 

The indications, cautions, doses and pharmacokinetics profiles for both Suboxone and buprenorphine, remain the same. The side effects profile for buprenorphine tablets are less than for Suboxone. In the unlikely event that patients experience issues, please report these directly to the prescriber or drug worker and report any adverse events through the Yellow Card.

 

 

 

Published 5th May 2017