Patient Preference and Adherence (Jan 2022)
Experiences and Preferences of Opioid-Use-Disorder Patients Who Switched from Brand to Generic Buprenorphine/Naloxone Films: A Case Series
Abstract
Erica Cedeño,1 Ambar Cruz,1 Joaris Cortés,2 Kyle Melin,1 Luis Roman,3 Angel Gonzalez,3 Jorge Duconge,4 Darlene Santiago4 1Department of Pharmacy Practice, School of Pharmacy, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico; 2Department of Chemistry, Rio Piedras Campus, University of Puerto Rico, San Juan, Puerto Rico; 3SANOS Corporation, Caguas, Puerto Rico; 4Department of Pharmaceutical Sciences, School of Pharmacy, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto RicoCorrespondence: Darlene SantiagoDepartment of Pharmaceutical Sciences, School of Pharmacy, University of Puerto Rico, Medical Sciences Campus, PO Box 365067, San Juan, 00936-5067, Puerto RicoTel +1 787-758-2525 ext. 5313Email [email protected]: Differences in the suppression of withdrawal symptoms have been observed in opioid-use-disorder (OUD) patients who were switched from Suboxone (the brand name of buprenorphine/naloxone sublingual films) to either 1 of 2 generic versions. These descriptive observations evidence the need to further assess the use of these generics and its impact on the adherence to and outcomes of OUD treatments. The objective of this case series was to describe patient and provider experiences, perceptions, and preferences when said patients were abruptly switched from Suboxone to one of the generic versions manufactured by Sandoz or Alvogen.Patients and Methods: A retrospective chart review of 24 Suboxone-maintained OUD patients from a single clinic who were forced to switch to a generic was performed to collect withdrawal and craving symptoms that occurred after the switch, as well as toxicology results and changes in dose (documented by the provider).Results: The medical records of 9 (37.5%) of the 24 patients showed that they were suffering from withdrawal symptoms and/or cravings, had had their doses adjusted, and/or had had a positive urine toxicology screen. All 9 subjects communicated a preference for the brand formulation over that of either of the generic versions; few expressed a preference for one generic formulation over the other. None of patients were able to switch back to the brand formulation, nor were any of them able to choose the generic that worked best for them. Insomnia, muscle pain, and gooseflesh skin were the most common withdrawal symptoms reported by the patients using the generics. Better outcomes were observed in patients who received a buprenorphine dose increase (2 mg) to suppress the withdrawal symptoms experienced while using the generics.Conclusion: Our study serves as a reference to prescribers regarding approaches (eg, a small dose adjustment) that may potentially encourage OUD treatment adherence and even improve outcomes in patients who appear to be decompensating after the brand-to-generic switch.Keywords: buprenorphine, buprenorphine generics, opioid-use disorder, withdrawal symptoms, relapse, cravings, brand-to-generic switch, Suboxone
