Buprenorphine shortage?

[smilingjane]

Morning all

I have had problems obtaining my Buprenorphine script over the last couple of months.

Often having to call the chemist 3 times over the 28 days of my monthly script.

This is tricky as I have MA/CFS and repeated calls and visits to pick my script up seems to dominate each month.

I have several items in each script and the easiest way to collect it/ accept delivery is one day a month.

Does anyone else have this issue?

I now have run out. Does my chemist have a duty to offer an alternative and what could that be?

I don't want anything like Oxycodone as I had problems with that before I started my Buprenorphine 2 years ago.

My chemist is calling my GP to ask what their advice is.

I am wondering what other people's experience has been?

Thanks colleagues

Jane 😊

[LotteM]

Hi Jane, the best alternative medicine is methadone., as it is also a long-lasting opioid (long half-life).

Or, you could discuss buprenorphine patches. I checked in your earlier post and you wrote you take 0.6mg (sometimes 0.8mg) in sublingual tablets daily. I’ll have to check for equivalent dosing.

Here is an opioid equivalence chart: gloshospitals.nhs.uk/health...

You current dose of 0,6 mg tablets corresponds to 50mg morphine. In a buprenorphine patch (look low in the chart at BuTrans patch) an equivaltent dose would be a 7d patch of 20mcg/h.

I hope this helps! Talk to your gp and to your pharmacist. If your pharmacist is more accessible, let her/him phone to the gp practice, as this is about medicines and pharmacists know more than gps about it.

[smilingjane in reply to LotteM]

Hi Lotte

Thank you for your response.

To keep you up to date I take a steady 0.400 mcgs twice a day.

What would that be in patches? I remember reading others find that the patches run out sometimes - did/does this happen with you?

Many thanks to you and Jools who are always so helpful.

Jane 😊

[smilingjane in reply to LotteM]

I am a little confused re the conversion chart.I cannot take Morphine, it causes migraines.

Are the patches you mentioned Morphine or Buprenorphine?

Many thanks 🙏🏼

[Joolsg in reply to smilingjane]

Lotte takes Buprenorphine patches.

[smilingjane in reply to Joolsg]

Thanks Jools. Yes Lotte has mentioned. Ive ust called the pharmacy team at the surgery, suggesting.I've always been a bit unsure as I've heard they don't last the time expected.

I have a small stash for emergencies thank the Lord or which ever higher being. (Apart from youha!) Is helping out there.

X

[Joolsg in reply to smilingjane]

Yep. The patch runs out at day 4 for most on here so they put a new patch on at day 5 and leave old patch until day 7.

[SueJohnson in reply to smilingjane]

My laugh for the day or 2nd - thank the Lord or which ever higher being. (Apart from youha!) Is helping out there. 🤣🤣🤣

[LotteM in reply to smilingjane]

Hi Jane, the morphine amount is used as a standard. Every other type of opioid on the chart is compared to 10mg of morphine. I did the calculations for you. So the morphine is only a calculation step, and has nothing to do with taking morphine in real life.

If you print the list on the link I gave you and/or write down the link and give it to your pharmacist, they can do the calculation themselves.

Your 0.4mg daily buprenorphine dose corresponds to 32 mg morphine. In turn, 32 mg morphine corresponds to 15mcg/h buprenorphine patches. They don’t list this amount on the chart, but I know it exists.

I take 5mcg/h patches. Provided I have the Teva or Mylan brand they work mostly 7d a week, thus don’t run out early. But it is good to know that patches CAN run out early.

Again, talk to your pharmacist and see if you can get patches. And if you get them, just see how they work for you. If they indeed run out early you should discuss with your pharmacist and try different brands. If the problem remains, ‘staggering’ the patches like Jools described most likely help. It does require that your doctor and pharmacist are willing to prescibe the dosing as more frequently than once a week.

[smilingjane in reply to LotteM]

Thank you so much for your detailed response. I am fully prepared now 😄

[Greenleaf360 in reply to LotteM]

It's called MME or morphine milligram equivalent and is used to compare the value of opioids. Google 'MME'. Google will return an app for the calculations.

[smilingjane in reply to Greenleaf360]

Thank you Greenleaf 😊

[Joolsg]

This is outrageous. It happened once in London and I called around every chemist within 3 miles and they simply asked for my NHS number and managed to get Buprenorphine from another supplier

Switching to Oxycontin won't help as they work differently. Methadone is the nearest equivalent.

[smilingjane in reply to Joolsg]

Thanks Jools x

[TheDoDahMan in reply to Joolsg]

I'm in the US and routinely get methadone as my RLS opioid. But it seems like in the UK such a thing is strictly "verboten". Does anyone here know why?

[smilingjane in reply to TheDoDahMan]

Hi DoAhMa Not sure I'm understanding?

Do you mean the UK are only allowed to prescribe the medicine on the packet?

Jane 😊

[TheDoDahMan in reply to smilingjane]

All I'm saying is that I follow this HU site fairly closely and can't remember hearing of a UK RLS patient who was prescribed methadone, although several mention being prescribed buprenorphine. See Jools reply, following, which is a pretty good answer to my question.

[smilingjane in reply to TheDoDahMan]

Ah yes. I see what you mean.😊

[Joolsg in reply to TheDoDahMan]

So you mean why is methadone verboten?I know a UK hospital that routinely prescribes methadone for their MS patients with RLS.

So it can be prescribed here, but most GPs aren't allowed to prescribe it. It has to be prescribed by specialists usually and not many know more than the basics of RLS.

[TheDoDahMan in reply to Joolsg]

Thanks, Jools, although your last paragraph seems to be quite true here in the US too. My methadone was originally prescribed by Dr. Buchfuhrer (in Downey,California) and he didn't even mention buprenorphine, though I see that lately he has prescribed that also.

[Joolsg in reply to TheDoDahMan]

Buprenorphine only came onto the radar around 4/5 years ago. Certainly Shumbah appears to be the very first forum.member who was prescribed it in New York.

And members on here have since been asking/pushing for it.

And that seems to have snowballed. Many specialists then started to try it and patients asked to be switched to it.

And Buprenorphine seems to be more effective.

Dr Berkowski has done a comparison with methadone and favours Buprenorphine.

But we still have such an uphill battle to educate the rest of the medical profession.

[Simkin]

Not had any problems so far.

[smilingjane in reply to Simkin]

That's good StinkinAs below; would you mind sharing the general are in which you live?

Many thanks

Jane 😊

[Simkin in reply to smilingjane]

The south of the UK.Simkin

[smilingjane in reply to Simkin]

Thank you 😊

[SueJohnson in reply to smilingjane]

My laugh for the day - or maybe my 3rd - That's good Stinkin - obviously you didn't mean it 🤣🤣🤣

[Huntingleroy]

I havent had any problems yet ...touch wood !

[smilingjane in reply to Huntingleroy]

Glad to hear that.Our of interest Huntingleroy; if in the UK do you mind me asking which area?

Jane 😊

[Huntingleroy in reply to smilingjane]

Hi , yes Im in Gloucestershire

[smilingjane in reply to Huntingleroy]

Thank you 😊

[Drls]

hello I had only been able to access the sandoz brand of buprenorohine which doesn’t work as well for me as the other brands so I have been ringing around the local pharmacies each month to get the accord brand. It takes ages and is exhausting but I have been able to get the accord brand this way. Your gp should be abke to give you a paper prescription so you can shop around . I hope this helps.

[smilingjane in reply to Drls]

Thanks for responding DrlsYes. I could do that and have the in the past. I don't have access to a car and unfortunately I suffer from ME/CFS now so pretty much housebound.

So, It's not something I have the energy for. And the idea of shuffling into old age with this monthly 'task' would break my the heart.

My chemist issue Buprenorphine in the Temgesic brand usually. Not sure if you have tried that and notice any difference? Same core ingredients.

Jane 😊

[Drls]

I fully understand Jane it is exhausting and I dont really have the energy or capacity for it either - I found that temgesic made me have withdrawal symptoms since it isn’t as long lasting - I really hope you can access the right medication - you shouldn’t be having to worry about this in your situation - its so ironic that you need to be fit and healthy to access health services / get the best treatment in the uk! Even getting a gp appointment requires maximum energy and resources - best wishes Dawn

[smilingjane in reply to Drls]

Thank you Dawn.Yes th irony is staggering

You look after yourself 😊

[4Curiousosity]

years ago I had a difficult time getting Buprenorphine, but this year I have not had any problems. I’m in California USA

[smilingjane in reply to 4Curiousosity]

Thank you for that 4 curiosity.I am pleased your sorted now.

Jane 😊

[Greenleaf360]

In America Oxycodone is approved by the FDA for treating RLS. Making it a popular choice. Oxycodone and methadone are schedul2 narcotics and stringent controlled. Buprenorphine is a schedule3 narcotic and easier to prescribe. Buprenorphine has characteristics roughly equal to methadone. Methadone is used by half of rls patients on low dose opioid therapy. 25% use buprenorphine. The dopamine agonist were recently removed from recommended list. I think we are seeing a shift away from dopamine agonist and toward gabapentin and low dose opioids.

[Sqlguy]

In the US, a chemist (pharmacist) cannot offer an alternative or change a prescription in any way without the consent of the prescribing doctor. They cannot even substitute 10 20mg pills for 20 10mg pills. I don't know what the UK law is. The list of drugs with big shortages is at a record high in the US and probably in a many parts of the world, including yours. Hopefully your doctor knows this and maybe can figure out a way around it, like giving you more pills when they are in stock.

[smilingjane in reply to Sqlguy]

Thanks for your response Sqlguy.I'm not totally certain whether pharmacists can give equivalent without GPs authority. I've a feeling they can in emergencies.

😊