Crumbling Suboxone Film: Update

I called the Reckitt-Benckiser drug company to ask again about the crumbing films, and spoke with a very nice lady who told me essentially the same thing I heard when I called them last July:

• Yes, the company is aware the films are crumbling.
• Yes, they have fixed the problem, but there are still some films “in the pipeline” of distribution, released before it was fixed.
• The crumbling film has the same amount of active buprenorphine, so you shouldn’t feel any different taking an intact film compared to taking the crumbly one.
• You should take crumbling films back to the pharmacy so they can be replaced with films that aren’t crumbling.
• If the pharmacy gives you a hard time, call the Reckitt-Benckiser drug company at: 1-877-782-6966. If you can give them the name and phone number of your pharmacy, this company representative said she’s willing to call the pharmacy to explain the problem and guarantee the pharmacy won’t lose money by replacing the films with other films.

She was dismayed to hear that all of my patients on the films confirm that at least some of their prescriptions have been crumbling, and that a few patients did try to return them for replacements. One patient said the pharmacy wouldn’t do it, and acted in such a way that it made him feel like they thought he was trying some sort of scheme to get extra Suboxone somehow. The other said the pharmacy did replace them, but the new ones were mostly crumbling, too, so it didn’t really help.

Some patients say the crumbling film has less Suboxone in it, and they feel some withdrawal. One patient said the film, crumbling or not, was so powerful that it made him sleepy. He had changed from table to film, and was on the same dose.

What do I make of all this, you may ask?

I don’t see much benefit from the film, other than patient preference and that $45 coupon, which is nice. I do not think it’s less divertible, since I’m seeing new patients now that have used illicit, black market Suboxone, and nearly always it’s the film that they describe.

I don’t think crumbling film is acceptable, so for any patient who is on the film but wants to change back to the tablet, that’s fine with me.

Crumbing Suboxone Films

Yesterday, a busy day in my office seeing mostly Suboxone patients, I had seven patients mention that the Suboxone films were crumbly when they opened the foil package. I’ve had a patient tell me this last year, and I asked the Reckitt-Benckiser drug rep about it. She said the film should not be crumbling, and that my patients should return defective films to the pharmacy.

It’s odd that patients started mentioning this all on the same day. I wonder if the recent heat wave has anything to do with this crumbling. Maybe the 90-plus degree heat in our area has affected the films while they are being shipped. I don’t know if the drug company has done any testing on films – or tablets – to see what they do when heated.

Beginning when the Suboxone films were first introduced, I had some of my patients say that the films aren’t as strong as the tablets. Initially I wrote this off as resistance to change, but some of these patients were stable and active in counseling. Then I’ve had so many people write comments on this blog, saying the film is weaker. Now there’s this problem with crumbling. I’m not entirely comfortable with prescribing the film, and plan to talk to the drug company to see what they have to say about crumbling films.

I’ll keep you updated.