Thank you so much for your help and advise!!
Mr. Fly1234:
First, I'd like to congratulate you on tapering down your Suboxone (buprenorphine/naloxone) maintenance dose. From other patients' experiences, decreasing the dose and discontinuing buprenorphine are not easy tasks for many.
Under federal law, DATA 2000 or Drug Addiction Treatment Act of 2000, only qualified physicians can prescribe and treat opioid addiction with controlled narcotics medications, such as buprenorphine products (Suboxone, Subutex or generic alternatives).
It is extremely important for you to work closely with your addiction recovery physician on Suboxone taper. Medicines, like buprenorphine, can help patient eliminate withdrawal, decrease craving, and prevent relapse. However, a successful long-term treatment plan needs to include extensive behavior therapy.
Relapse is likely to occur, but slow taper of the maintenance dosage can ensure a higher chance of treatment success. Per Center for Substance Abuse Treatment or CSAT, the length of time for buprenorphine maintenance therapy may be indefinite for most patients and is highly individualized.
Manufacture prescription drug label states that Suboxone, either sublingual tablets or film, should not be "cut, crush, break, chew or swallow ". Thus, it is a great idea for you to seek assistance from specialty compounding pharmacies with dosage customization.
I was able to find a compounding pharmacy in CA that works closely with local physicians in Suboxone taper. The pharmacy is Koshland Pharm, based in San Francisco, and is led by Peter Koshland, Pharm.D. There may be others specialty pharmacies but I will need to research more.
FYI: FDA recently approved another generic alternative to Suboxone, called Zubsolv. Zubsolv sublingual tablet is smaller in size and may taste better with the new menthol flavor. You may want to consult your specialist to see if it is an alternative to Suboxone for you. Zubsolv dosages are formulated as buprenorphine/naloxone 1.4 mg /0.36 mg and 5.7 mg/1.4 mg.
For additional information on Suboxone and other resources, please go to:
1. Subutex and Suboxone Questions and Answers – FDA Postmarket Drug Safety Information
http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm191523.htm
2. Buprenorphine: SAMHSA – Substance Abuse & Mental Health Services Administration
http://buprenorphine.samhsa.gov/about.html
3. Physician and Treatment program locator: SAMHSA – Substance Abuse & Mental Health Services Administration
http://buprenorphine.samhsa.gov/bwns_locator/aboutphysician.htm
4. Zubsolv
http://www.fda.gov/downloads/Drugs/DrugSafety/UCM362203.pdf
5. Additional Resources - SAMHSA – Substance Abuse & Mental Health Services Administration
http://buprenorphine.samhsa.gov/otherlinks.html
Good luck and please also refer to MedHelp’s Addiction Forum and our addiction experts for more information and support:
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2. J T Junig, MD PhD
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3. Julia M Aharonov, DO
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