This week I’ve been thinking about a story I heard recently that is tangentially related to addiciton, but more related to the fundamental problems of running a healthcare system in our capitalist economy.
Reckitt Benckiser is the pharmaceutical company that manufactures Suboxone, which is the brand name of buprenorphine. My practice and my patients depend on buprenoprhine, since that is by far the best method we have to treat the chemical imbalances of addiction. Suboxone comes in two forms, a tablet and a film. I personally prefer that my patients be on the films, since they are individually wrapped, and therefore easier to monitor and count. Despite that, I was surprised to learn this week that Reckitt Benckiser is “voluntarily discontinuing” the tablet form of Suboxone. In a report explaining the move, they said that
The decision to discontinue SUBOXONE Tablets was based on accumulating data demonstrating significantly lower rates of accidental pediatric exposure with SUBOXONE compared with the tablet form.
Reducing “accidental pediatric exposure” sounds like a good thing, right? Especially if it’s just a change in the form of a drug, and a change to a form that I as a physician prefer. But as I was reading discussions about the move on online communities of addiction specialists, I found this possible explanation:
Are you all following the story about RB pulling Suboxone tabs because of ‘pediatric exposures’? They hired a Denver company to look into pediatric exposurers– apparently found 4 deaths in 5 years (compared to tens of thousands of teenage deaths!). They obviously were looking for a plausible marketing campaign… they are using it as the reason to pull Suboxone tabs– which I don’t really care that much about, except that this is one more step toward eliminating generic competition. To that end, they ALSO filed an FDA citizens’ petition to have generic buprenorphine taken of the market. Question– what will be the result, when $3 buprenorphine is gone, and only $7 Suboxone is available? What will insurers do about longterm coverage?
Many of my patients rely on generic buprenorphine to stay alive. Shame on RB.
So how can we know why the tablets are being pulled? The short answer is that we can’t, not really. Is this move to films, which as I’ve mentioned is more convenient for me, just a masked plan to cut off generic competition, which would ultimately hurt my practice and my patients a great deal? If Reckitt Benckiser were to openly move to tablets as a way to cut off generics of buprenorphine, and came right out and said that, of course there would be a public outcry and a PR backlash. It’s possible that this seeming concern for children is just an underhanded way to increase profits? Of course. The simple fact of our for-profit healthcare system is that every statement or move, whatever rationale is given, might just be aimed at increasing profits. In many cases, it is the most logical motive.
While this for-profit system is certainly a foundation of America, perhaps it has less of a place in our healthcare system, where above all we need to have consistency and trust. Just something to think about as we move election season into high gear.