Preference for brand-name buprenorphine is related to severity of addiction among outpatients in opioid maintenance treatment

Abstract

As a form of opioid maintenance treatment, high-dose buprenorphine is increasingly being used in the United States. On the French market since 1996, it is the most commonly prescribed and frequently employed opioid maintenance treatment. For unknown reasons, the brand-name form is used far more often than the generic form (76-24%). The objective was to show that the patients' levels of addiction were differentiated according to the form of buprenorphine currently being used and to their previous experience of a different form. An observational study in 9 sites throughout France used self-assessment questionnaires filled out in retail pharmacies by all patients to whom their prescribed buprenorphine treatment was being delivered. The 151 canvassed pharmacies solicited 879 patients, of whom 724 completed the questionnaires. Participants were statistically similar to non-participants. The patients using the brand-name form subsequent to experience with the generic form exhibited a more elevated addiction severity index and a higher dosage than brand-name form users with no experience of a different form. Compared to generic users, their doses were higher, their was addiction more severe, and their alcohol consumption was more excessive; they were also more likely to make daily use of psychotropic substances. However, the level of misuse or illicit consumption was similar between these groups. Preferring the brand-name buprenorphine form to the generic form is associated with a higher level of severe addiction, a more frequent need for daily psychotropics, and excessive drinking; but the study was unable to show a causal link.

Experiences and Preferences of Opioid-Use-Disorder Patients Who Switched from Brand to Generic Buprenorphine/Naloxone Films: A Case Series

“…However, past studies (Binder et al) have associated the preference for the brand-name formulation over a generic with higher levels of addiction; that being the case, the brand-to-generic switch described herein may present a risk of relapse to patients with comparatively higher levels of dependency. 7 None of the patients in this case series were able to receive the formulation they preferred; not one of them switched back to Suboxone films, and none were able to receive the generic version they identified as working the best for them. Contrarily, before this mandated brand-to-generic switch, a single Subutex-maintained (SL tablet) patient expressed a preference for the Suboxone film and was able to switch from the SL tablet to the film with no apparent resistance from the provider or insurance carrier, which switch resulted in the increased satisfaction and adherence of the patient.…”

“…5 Although these generic versions were certified to be bioequivalent to Suboxone, a potential exists for unexpected effects associated with the sudden switch from the brand-name version to 1 or both of the generic ones, in a given individual, which effects may become apparent only after the clinical use of said generics in and by the general population. Patients experiencing withdrawal symptoms when switched from the brand to the genetic formulations of buprenorphine (film and/or tablet) has been reported; [7][8][9][10] however, this is the first study to individually describe 1) the brand-to-generic switch of buprenorphine/naloxone SL films (Suboxone to 1 or both of the generic formulations manufactured by Sandoz and Alvogen, 2) all the Suboxone-maintained OUD patients from a single MAT clinic, and 3) patients' individual experiences and preferences as documented in their medical records by their providers. This study is particularly important as it elucidated the providers' approaches to successfully restabilizing patients who were not able to go back to their previous brand-name formulation.…”

“…Higher dosages than those prescribed when using generic buprenorphine have been previously reported in patients who had not previously used brand-name buprenorphine. 7 Some patients in our study had their daily doses augmented by 2 mg. Patients taking the generic formulation and who received the increase, took the additional, small dose in the afternoon; by all reports, the patients felt better with the added dose.…”

“…High Addiction Severity Index scores and the use of higher-than-normally-prescribed daily doses have been associated with a patient preference for the Suboxone brandname formulation over the generic buprenorphine tablets. 7 Additionally, a recent short report, although inconclusive, indicated that some patients experienced withdrawal symptoms when abruptly switched from Suboxone to the generic versions of the films. 8 Most of the reports that have described the brand-to-generic switch (between films and tablets) have relied strictly on inconclusive clinical observations; a study focusing on the clinical manifestations in maintenance-phase patients who have been abruptly switched from brand-name Suboxone to generic versions of the film is, to our knowledge, lacking.…”