Author Topic: Generic 2mg Bupe shortage/manufacturing problem?  (Read 3051 times)

Prun

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Re: Generic 2mg Bupe shortage/manufacturing problem?
« Reply #15 on: July 26, 2018, 12:51:26 AM »
Typing on phone so apologies for any typos

You raise a valid and interesting point OP8S that providers needs to consider, that of people who have had a very different experience of treatment, and so donít recognise it as such in its current form. If people would rather rattle than access free treatment that is really a sad state of affairs. Considering that older people are likely to suffer with more physical health issues and hence more likely to need support.
We have developed a pathway specifically for older people accessing our services, but is mainly geared towards the needs identified in this cohort eg a focus on physical health, isolation, etc. I had never considered the issue of perception of treatment being different due to past experience. I may be way off here.

OP8S

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Re: Generic 2mg Bupe shortage/manufacturing problem?
« Reply #16 on: July 26, 2018, 01:25:07 PM »

Not way off at all Prun. I often think that my area iis something of a micro-cosim when it comes to the bigger picture nationwide. Though I may possibly be wrong. Myself & my friend's first scripts for OST were given by GP's, all of them fairly low dose reducton scripts which was what we wanted because none of us liked daily collection in a small town. Many years later a GP turned up at the CDT & convinced the powers that be that MMT would possibly be of more benefit to persistent revolving door users like myself they grudgingly decided to agree. Early on the CDT clinics he & another GP prescribed at where a bit anarchic, people jumping queues, the place stinking of weed. If you missed your appointment your script would be left with a key. The GP's didn't just prescribe for OST but also treated wounds, gave antibiotics, antidepressants, benzo detox etc. It was basically a NHS surgery for users, housed in an old building with sofas, chilled music & tie-dyed curtains. It kept the nice new surgery from getting filled with junkies, provided everything we needed for healthcare & OST. People like myself said we'd give maintenance a try & many who had previously not been employed got jobs. As far as drug tests went there was very little need for testing because we would just tell the GP's what we'd been up to, there was no punitve measures for having a toot or whatever, the focus was on stopping i/v use. Harm Reduction.

After a while the number of patients grew, things became a lot less anarchic, the growing number of keys became a bit more professional. Some saw it as their job to get people off scripts, wagged fingers when you gave positive tests for opiates & there was a bit more pressure to reduce. If you were responding well to treatment & wanted to remain on OST then all you needed to say was " NO " it was still a service based on Harm Reduction.

Fast forward to Scotland's Road to Real Recovery, the service was changing premises due to lack of funding. I hadn't seen my prescribing DR in a while but was extremely busy at work & the scripts kept arriving at the pharmacy. I received a letter from a NHS Psychiatrist, the day before my birthday I attended an appointment where I was told that I had been on OST for " too long, on a vast dose "( 120) & that my MMT plus other medications prescribed for other properly diagnosed medical conditions were " going to kill me within a matter of years ". The psych refused even to shake my hand when we met, it was obvious what he thought of drug users & showed surprise when I explained that I needed these medications to continue working for my employer of 20+ years. When I tried to explain I was ushered out the office, appointment over. Thankfully it was winter & quite dark outside so others on the bus home weren't able to see the tears running down my face. Life had been good, settled & I had young children, I felt as if the rug had been pulled out from under me. I couldn't understand how I had gone from the patient on MMT who ocassionally gave permission for our GP to let big-wigs from the NHS & LA sit in on appointments to be told that treatment was now over basically. Due to the following stoppage of PRN analgesia & the stress I lost my job. It wasn't right, I knew it wasn't right & I'm not the kind of person who will give in to injustice. With support from The Alliance & latterly RELEASE I fought tooth & nail not to be treated punitively or as a second class patient, it's taken 5 years of my life to get back to the point where I'm not continually hassled by our provider & I'm fairly confident that my treatment is in my hands. I've chosen MMT as that has been one of the best decisions I've made ( according to my 81 year old mother also ). Unfortunetly a lot of people my age chose the path of least resistance & if they're being made to jump through hoops at their age, are getting treated punitively for using on top by people half their age or not attending Recovery meetings they are just going to return to where they can get what they want without the hassle. Some are still working others not, too many now gone. For people who have used drugs most of their adult lives & aren't interested in giving up the focus should be what they are used to simply Harm Reduction.
Harm Reduction is how you get people interested in treatment, after that dialogues can be opened about what they want for the future. Some may want to kick drug use, others will want to carry on. Those that do shouldn't have to be made to jump through any hoops,most just want a script , a monthly chat with their DR/key, some Naloxone & access to sterile equipment.

My experience was from HR to an ideology based on finances & puritanical opinoins with no evidence to back it up. It was brutal, from your doing well to " your time is up ". I imagine a lot of others of my age were treated in similar ways, bridges have been burnt & it will take a lot more than a bottle of meth to bring older users back into treatment again.

Apologies for any spelling/grammatical errors, hospital appointment yesterday, still very sore & medicated.
" The problem with the world is that the fanatics are so sure of themselves while the wiser people acknowledge doubts "      Bertrand Russell

Jackwhan

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Re: Generic 2mg Bupe shortage/manufacturing problem?
« Reply #17 on: July 27, 2018, 04:01:27 PM »
Seems no problem here, a recent adventure into our main ghetto where users are housed & I found out a few interesting facts.

Why do I rarely see people in the pharmacy/ DSP? apparently bupe is now the fashionable script offered by the DSP & is provided in a different pharmacy to meth. I wonder if they are trying to keep us seperated? MMT away from Recovery? Not that it's making 1 fig of a difference as users will swap up to 3x8mg for the price of a bag. As usual bupe is the more diverted medication, the opioid ant-agonist/blocker really has very little effect so those meant to be aiming for abstinence are just picking & choosing. A lot of my older meth head associates, completely skunnered with the last 5-6 years of treatment are just using when they feel like it & falling back on diverted subs when cash is tight or gear poor quality. Due to the bungled social experiment of the last few years they are adamant never to return to treatment.
I mentioned that after my shenanigins some staff had been replaced by more decent sorts who had heard of The OG's in an attempt to do my own outreach work, the nearest I came to a positive outcome was " I'd sooner rattle ". Seems that the local NHS, leaned heavily upon by the zero tolerance LA have really burnt bridges with us middle-aged plus users who will now carry on ducking & diving until the end. I'm begining to wonder if I've become Grandpa greenglug?
I will have to remain on meth because of other opioid analgesics prescribed, can't say I ever cared for bupe unless in emergency situations anyway.
I'm sad that so many older people have been forgottten about, they won't even be getting Naloxone kits now & are probably more likely to need them as they're using fent,brown with a lifetime of tolerance.
Apologies for goig off topic ,as usual.

Interesting.

My key told me that their first-line approach is to try to get people onto bupe, off bupe and out the door, with methadone reserved for those who are still 'chaotic'. The idea that bupe is easier to detox from is BS - having experienced both, the rattle is equally if not more severe than a meth rattle. Jumping off at 0.4mg is hellish let alone the 2mg jump that is often recomended. Key also said that at the last service he worked at it was bupe or nothing - no meth scripts at all.

I call all this bollox about bupe 'the subutex myth' - trouble is people buy into it to the detriment of those who are better-suited to methadone (and that's from someone whose personal preference is bupe).

As always, what's important is that patients get to choose the med that suits them ... and stay on it for as long as they want and need.

Something else key workers have been emphasising lately are links between bupe/methadone and various illnesses including dementia - I said I'd rather take my chances than end up back on the gear. Is there even any evidence linking these meds with dementia or is it another ploy to encourage people to come off?

As for the bupe shortage, apparently some manufacturers have upped the price for generics - the DSP staff are having to track down the cheaper suppliers and then inform local pharmacies where to buy from. I'm still getting the brand I've had for many a year.
« Last Edit: July 27, 2018, 04:10:17 PM by Jackwhan »

OP8S

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Re: Generic 2mg Bupe shortage/manufacturing problem?
« Reply #18 on: August 01, 2018, 09:54:38 AM »
Regarding bupe/meth being associated with dementia, it does rather sound like one of those latest fashionable sentences used by keys to get their " successful outcome ". I have no evidence of this being true but have worked in quite a few dementia units & can say that I've seen people from all walks of life being diagnosed with dementia, not one of them had ever been on a OST script. Some extremely bright people, some not. There is a type of dementia linked to alcohol " Lewy Body Dementia " but unless there has been some new research done linking opioid use to dementia ( wouldn't be surprised in the USA ) my humble experience led me to believe that as life expectancy increases, hearts fixed, lungs fixed, drugs to keep organs working etc. that something has to give sometime. Apart from certain illnesses most of us can be kept going but there's no cure for loosing your marbles. In this country Dr's are quite terrified of " not doing there upmost to keep people alive " in case of legal action, so if it's the family's wish people are left in a coma like state with expensive medications & care until the end then that's what they get.
Everyone I worked with said that they'd be taking care of their own last few breaths, I hope I'm able to do so. If not my son has agreed to deliver a fatal blow with a lump hammer when I get to that stage, almost a bit too enthusiastically.
As you say as well, I'd rather live to a ripe old age on a script than spend a year or two scurrying about on the streets before dying of hypothermia, overdose, BBVs or a blade, the usuals.
" The problem with the world is that the fanatics are so sure of themselves while the wiser people acknowledge doubts "      Bertrand Russell

Prun

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Re: Generic 2mg Bupe shortage/manufacturing problem?
« Reply #19 on: August 02, 2018, 07:30:38 PM »
To my knowledge there is no evidence of buprenorphine causing dementia. Where the worker may be getting confused is the tolerability of buprenorphine in people already suffering with dementia. This from a recent study published in Clinical Interventions in Aging 2018:

Active buprenorphine had significantly higher risk of discontinuation compared with placebo in people with advanced dementia and depression, mainly due to psychiatric and neurological adverse events. Daytime activity dropped significantly during the first week of treatment. Concomitant use of antidepressants further reduced the tolerability of buprenorphine.

So not causal, but may not be the most suitable pain relief for someone with dementia. A very different thing.

sapphire

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Re: Generic 2mg Bupe shortage/manufacturing problem?
« Reply #20 on: August 03, 2018, 03:27:06 PM »
I am aware of evidence that benzos can add to your likelihood of getting dementia, but not any strong evidence of bupe/methadone.

The myths surrounding methadone and buprenorphine cause me acid reflux! DSP's will try to tell you that bupe is 'better' and that less people use whilst on it, but in my experience they are actually more likely to jot take their meds/sell or swap them and go use.

This whole thing that bupe patients are somehow more likely to 'recover' (whatever that means) than mmt patients is just crap.

If methadone patients were actually dosed optimally, and not chained to the chemist/DSP, and we had a system more like America/Canada, perhaps we would see many more hapoy/productive/employed methadone patients.

The patients who are perpetually under medicated are set up to fail, so how the heck can the government expect 'success' out of this program?!

It really does not give 2 hoots about mmt patients as long as they can prescribe us just enough so they Dan say they're keeping crime down.

The whole thing is rotten from the inside out.

simon

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Re: Generic 2mg Bupe shortage/manufacturing problem?
« Reply #21 on: August 03, 2018, 07:32:04 PM »
I am aware of evidence that benzos can add to your likelihood of getting dementia, but not any strong evidence of bupe/methadone.

The myths surrounding methadone and buprenorphine cause me acid reflux! DSP's will try to tell you that bupe is 'better' and that less people use whilst on it, but in my experience they are actually more likely to jot take their meds/sell or swap them and go use.

This whole thing that bupe patients are somehow more likely to 'recover' (whatever that means) than mmt patients is just crap.

If methadone patients were actually dosed optimally, and not chained to the chemist/DSP, and we had a system more like America/Canada, perhaps we would see many more hapoy/productive/employed methadone patients.

The patients who are perpetually under medicated are set up to fail, so how the heck can the government expect 'success' out of this program?!

It really does not give 2 hoots about mmt patients as long as they can prescribe us just enough so they Dan say they're keeping crime down.

The whole thing is rotten from the inside out.
I think that is a superb post, still loads of myths about Buprenorphine from the marketing of it. In practice I see more people do well on MMT and also more reduce off when they've been on MMT.

sapphire

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Re: Generic 2mg Bupe shortage/manufacturing problem?
« Reply #22 on: August 04, 2018, 11:44:09 AM »
Yes, IMO and IME, optimally prescribed methadone is much more successful than bupe.
Most of the people I've encountered on bupe sell it and still use.

OP8S

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Re: Generic 2mg Bupe shortage/manufacturing problem?
« Reply #23 on: August 05, 2018, 11:01:15 AM »
Yes, they're like smarties here, I think that's why a lot of my friends have given two fingers to their scripts? All you get is hassle from the DSP, especially if you're older, ( " why would anyone your age be using heroin? you old buggers must be supplying young un's! " Not the case.)  appointments, meetings, u/s, wagging of fingers, threats of reduction etc. I'm assuming a lot of younger folks are being given bupe so it's a bit of a pick & mix without the hassle of treatment.
" The problem with the world is that the fanatics are so sure of themselves while the wiser people acknowledge doubts "      Bertrand Russell

sapphire

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Re: Generic 2mg Bupe shortage/manufacturing problem?
« Reply #24 on: August 06, 2018, 02:39:56 PM »
Did you see the BBC news piece about drug related deaths last night? They're going up and part of that seems to be attributed to cuts in funding for drug services. In response to this, people are dropping out of treatment and going back to illicit use.

Disgusting really, as we all predicted this back in 2010 when that stupid Tory paper 'Freedom from total dependence' (or something like that lol) came out.
If many people could see that cuts in spending would result in people going back to illicit use, and the rate of DRD's massively increasing (to record levels), why did the Tories continue with it?!

It's scary to think that they actually really might value life that little. I'm sure it would be a totally different story if little Peregrine or Jocasta suddenly came down with a nasty case of heroin addiction!!

OP8S

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Re: Generic 2mg Bupe shortage/manufacturing problem?
« Reply #25 on: August 06, 2018, 04:44:22 PM »
I read it this morning. Sad & rather disheartening.
" The problem with the world is that the fanatics are so sure of themselves while the wiser people acknowledge doubts "      Bertrand Russell

simon

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Re: Generic 2mg Bupe shortage/manufacturing problem?
« Reply #26 on: August 06, 2018, 08:15:46 PM »
Conservative policy is always, bit of state help and then you're on your own.

sapphire

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Re: Generic 2mg Bupe shortage/manufacturing problem?
« Reply #27 on: August 07, 2018, 05:05:40 PM »
Sad, isn't it. As under Labour after about 1999 things actually did startto get a bit better. All went right back downhill at a rate of knots as soon as the Tories took over in 2010.

The actual machinations of treatment/recovery etc should not keep getting upset in a negative manner which ever way the political wind blows.

OP8S

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Re: Generic 2mg Bupe shortage/manufacturing problem?
« Reply #28 on: August 16, 2018, 11:40:20 AM »
Doesn't matter what Government is in you still get treated with anti-biotics to stop an infection. It's all about carving up the NHS, first they came for the junkies & nobody cared. I'd imagine the next patient group to be put out to tender will cause a bit of an outcry whether it's the cream cake lovers or our O.A.P.s but nobody gives a shit about drug users because the majority think that we're getting high on their taxes.
Being forced to reduce, having to bargain over pain relief & the general stress of it all lost me my career. Since then I've taken on several different jobs with less pay & benefits. Was I one of the people who fell through the cracks, maybe I should just be thankful that after 5+ years of hassle I've managed to keep 3/4 of my script & I've not overdosed like so many of my friends.
I'm not thankful at all, it's been a nightmare.
" The problem with the world is that the fanatics are so sure of themselves while the wiser people acknowledge doubts "      Bertrand Russell

simon

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Re: Generic 2mg Bupe shortage/manufacturing problem?
« Reply #29 on: August 17, 2018, 07:40:22 PM »
Doesn't matter what Government is in you still get treated with anti-biotics to stop an infection. It's all about carving up the NHS, first they came for the junkies & nobody cared. I'd imagine the next patient group to be put out to tender will cause a bit of an outcry whether it's the cream cake lovers or our O.A.P.s but nobody gives a shit about drug users because the majority think that we're getting high on their taxes.
Being forced to reduce, having to bargain over pain relief & the general stress of it all lost me my career. Since then I've taken on several different jobs with less pay & benefits. Was I one of the people who fell through the cracks, maybe I should just be thankful that after 5+ years of hassle I've managed to keep 3/4 of my script & I've not overdosed like so many of my friends.
I'm not thankful at all, it's been a nightmare.
Be more NHS rationing and more council cuts, sure as eggs are eggs.