Not All Opioids Are The Same

Not All Opioids Are The Same

By Ed Coghlan.

We find ourselves in the middle of what is being called “the opioid crisis”.  And as the government has become more concerned about opioid addiction-the debate has evolved (or some might say devolved) to the addictive qualities of opioids.

BioDelivery Sciences CEO, Mark Sirgo

For some in the chronic pain world, that is not only too simplistic but also dangerous to the chronic pain patients who use opioids responsibly to manage their lives.

Let’s add one more element to the debate.

Not all opioids are the same.

That’s the point that BioDelivery Sciences CEO Mark Sirgo was emphasizing in a recent interview with the National Pain Report.

His company developed and distributes BELBUCA® (buprenorphine), a buccal film indicated for the management of pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate.

Sirgo, who is a doctor of pharmacy, has been working on the technology used in BELBUCA for over a decade.

Like many in the chronic pain industry, he’s frustrated with the federal government.

“Opioids have been used to treat pain for decades and they work-and have brought a lot of people relief,” he said. “With the government involved the pendulum swings from one side to the other and there’s very little compromise in the middle.”

And Sirgo believes his small company is in the middle-an alternative to the addiction crisis that can bring relief to chronic pain patients.

BELBUCA is a Schedule 3 opioid, which is defined to have lower abuse potential and less physical and psychological dependence  than other opioids that are all categorized by the DEA as Schedule 2. Essentially, with BELBUCA, you don’t get the same  euphoria with taking it that many Schedule 2 opioids “provide”, and Sirgo says that’s the main point.

“It’s euphoria that many people crave, and once that happens that patient can not only become a pain patient, but an addicted pain patient.”

So if this is a better mousetrap, why aren’t more people using it?

You can almost hear Sirgo sigh when asked that.

“If the payers in managed care knew this and the elected officials knew this, there would be momentum and maybe even an edict that chronic pain patients would start on a Schedule III product first, such our product,” said Sirgo. “But we are a small company and getting the word out is difficult.”

Yet they are making some progress, mostly with pain physicians.

“There’s some momentum, we are a very small company and can’t leverage the way a larger pain companies can…but we are making some headway with some managed care companies and doctor practices.”

He said as patients use it after having been on a Schedule 2 opioid like hydrocodone, they often say the “opioid fog lifts,” they have more energy, more positive approaches to life.

“We need more time and more exposure,” he added.

BELBUCA is not a pill—it’s like what he describes as “a thin film resembling a Listerine strip,” a biodegradable film that dissolves in your mouth in a few seconds. And it leads Sirgo to ask a simple question.

“Why wouldn’t a doctor put a chronic pain patient on this first before they moved to a category two opioid?”

While he may be frustrated about the slow adoption, he knows the “opioid epidemic is front and center, and it’s not going away.”

And that gives the Company time to increase its exposure and make the case that not all opioids are the same.

“No one is talking enough about solutions, like better educating healthcare providers and following patients more closely to make sure they are using the pain products responsibly,” he said. “We need to meet in the middle and find a real solution so that patients are not going to continue to suffer from having their medications reduced with no alternative to addressing their pain.”

Sirgo doesn’t proclaim that BELBUCA is the sole solution to address chronic pain.

“It is a responsible choice among opioids,” he said.

In the meantime, Sirgo is waiting for sanity to return to the discussion.

“People who are suffering are the ones we are trying to help. Washington is not helping.”

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Authored by: Ed Coghlan

There are 16 comments for this article
  1. rsdno at 9:11 pm

    Ive been shot 3 times stepped on an anti personel mine once as a RN for Construction company people hear there is a FDA Guideline ,like when the FDA said “eat more meat than anything remember the Triangle their guide line ,just a guide not an order ,its what lobbyists try to get out ,different meds work for different people after 49 years with CRPS etc etc my Doctor is young and panicked she may over prescribe ,no one cares a whit if we are underprescribed though ,Im punished though I never once misused my meds ,I think its “Better dead than prescribe a med” is the new Doctors Oath ,or you hear the Nurses oath “do no harm”since we dont prescribe anyway
    When it comes to opiates or whatever worked for those of us who have suffered years ,my gosh we are now apologizing for hurting if we were so evil as to take Oxy or other opiates ,I only know what helps and doesnt

  2. Joy Collins at 2:45 pm

    I am very upset by the untrue statement regarding a high, intense euphoria, and other “addictive” and untrue issues compounded with the blurring of chronic pain and addiction. I have multiple chronic conditions and have never experienced a “HIGH” at all. We are not cookie-cutter clones of each-other and our brains neuro-receptors are each differently wired. I am allergic to Morophine, oxymorphone, and have had extreme negative reactions to anesthesia used for certain operations. Why is the CDC, and DEA, in charge of chronic pain anyway ? After the reform my adhd medication of 12 years disappeared and when it reappeared it wasn’t at all the same. I have never returned, and been harmed by both adhd and oxycodone medications before in my life. Have never filed so many formal grievances regarding the only two medically necessary medications I need to function. Truth in labeling doesn’t seem to exist anymore, substances like synthetic arsenic, cadmium, and other famous poisons should not be in any medication at all, I’ve tried 6 manufactures oxycodones, [brands included], under medicare part d providers, one of which nearly gave me an aneurism, and another pain pt a stroke after one dose. I’ve tried all adhd meds, including brands, prior approval and they are inauthentic. I faxed my senator yesterday regarding both severe medication issues, and other gov activities undisclosed which are deadly. When medically necessary medications become corrupted, and cause other chronic diseases [such as chronic heavy metal exposures], and undisclosed to patients, anything is possible. I refuse to lay down and die because of poisons covertly put in medically necessary medications. This was secretly planned and doctors and pharmacists were secretly informed, but no-one mentions this, and I dont belive doctors knew the extent of the ingredient changes.

  3. Kathy C at 10:18 am

    We really have no way to evaluate any of this anymore. Our Government Agencies that were supposed to protect us are now complicit with the Industry. They are not about to uses Science or Evidence Based determinations. The response to the so called “Opiate Epidemic” was to increase Profits for Pharma, the Insurance Industry and New Age Quacks. We are Post Science and Post Fact now. There is no way to tell if this is an effective Medication or more marketing hype.

  4. Reed at 4:03 am

    Depends on your state laws, but belbucca is w/o naloxone whereas most prescribed buprenorphine sublingual is with nalaoxone (suboxone) (subutex is without naloxone). Sublingual is absorbed under the tongue. Belbubucca through the mucal lining of the cheek. (Is very similar to sublingual, but theoretically supposed to be much more effective). Most sublingual is in Milligrams (like 8MG tablets or the equivalent film). Belbucca is in Micrograms (usually 100-900 micrograms). Again, theoretically, the high rate of delivery via the formulation would deliver more actual buprenorphine (the bioavailability), so sometimes micrograms can be more effective than milligrams because more of it is absorbed into the system. At least that’s the way I understand it.

    It works for a lot of people. And if it does, that’s great. If not, try to stick with whatever works best for you. Medicare likely won’t cover it’s because it’s new, and it is expensive. They give you a coupon that makes the first few Rx’s affordable, but after that, it will be costly. T

  5. GotNerve at 9:08 pm

    Belbuca film was denied by Medicare. Buprenorphine sublingual was ordered instead.
    What’s the difference between the two besides the composition of the medication?

  6. Steve w at 8:09 pm

    Buprenorphine 30 pills 8 mm with good rx coupon is under $50 in Walmart . Work for me

  7. MichaelL at 1:07 pm

    Sadly, the availability and cost of these dissolving buccal films, and even buprenorphine, is out of the reach of many chronic pain patients, out in fly-over country. Prior to Obamacare the people without insurance were not affording Oxycontin. Methadone was really cheap1 It treated the pain, in those who did not have cardiac reactions or uncontrollable constipation. But, I could count the number on one hand that had problems with it, in my practice! That was the choice, of so many, that had no coverage. With Obamacare, the deductibles pretty much prevent many people from getting the needed medication. Sadly, during my last year of practice, I noted that the use of benzodiazepines, in combination with pain medication might have been causing sudden death. Using NSAIDS increases cardiac disease, causing more problems with sudden cardiac death! I worry that doctors, treating people like Linda, are giving them excess NSAID-s, combining pain meds with benzodiazepines, and just generally giving them less, than cutting edge health care. Those doctors are increasing our risk to follow ill conceived guidelines. Too bad the decisions, on the care you get from your doctor, are no longer subject to the, very private, doctor/patient relationship! I guess HIPPA does not apply here?!

  8. Renee Mace at 1:00 pm

    I suffer from Central Pain Syndrome, I have the severe type meaning my pain is always high on the pain scale, so much so, that when the CDC Guidelines came into place here in WA State, I can never remember to take my prescription pain medications because I hurt all the time now. Back in 2001, after the car accident I was in, I could remember to take them because I had enough medications to treat my pain, but never have I ever gotten high or anything other than relief. Then the Feds are sent to my pain doctor of 14 years, They take away his license for prescribing pain medications. He never put any of his pain patients on pain medications until all other treatments failed, and even then he made sure that you where not abusing your medications or selling them. But still, my state just didn’t like his skills, so I lost the best pain doctor in my state. Today I see a Nurse Practitioner who has to keep lowering me on all my pain medications which has destroyed my life. Meaning no more visits with my family, no more crafting, no more helping a little a round my home, no showers except one a week if I am lucky. I have become very obese and today I have type 2 Diabetes, not from eating bad foods, but because of no movement, because any movement or sitting with my legs hanging down, gives me huge flare ups in my pain and my blood pressure rises to unhealthy readings. My Nurse Practitioner wants to put me on BELBUCA® (buprenorphine), a buccal film strips, but she says that I have to go on almost no opioids for 24 hours, then I can try the Buccal film strip. I was told by other people with Central Pain Syndrome that it is like watered down pain medications. My pain is severe and I am very scared that if I try it and it doesn’t give me enough relief, that I will no longer be able to take my regular pain medications. Please tell me that it will give me enough pain relief. I can not take morephine or codine because I am allergic to them. Most of the other medications like Lyrica gives me panic attacks and I feel suicidal on it too. The anti-seizure medications mess me up as well. With CPS, there is nothing really wrong with my legs, it’s my brain sending signals of Savage Pain. So please tell me or people like me that your medication is going to ease our pain as well as the pain medications that we are on. Well I should say the pain medications that we had that we prescribed at the right amount to let us live with controlled pain instead of the intense, severe savage pain because God Knows, we might become addicted to it, NOT!!!!!!

  9. Frustrated by Fools at 11:42 am

    Note to all in panic over the non-existent ‘opioid epidemic’. Actual chronic pain patients DO NOT GET the euphoric feeling from opioids .. on some days they get some pain relief from their more, no less. This ongoing and escalating dialogue about opioids is worse than the blind leading the blind .. it is the fools causing damage to the actual pain patients. Perhaps all without topical knowledge/experience who are doing damage to actual chronic pain patients should be given a turn with the pain to see iff their assinine views might change a bit…!

  10. Misty Morse at 9:42 am

    The new key buzz word is opioid’s. They use that word for EVERY and all opiate.
    Meanwhile many patient’s are dying due to being cut off meds or being undertreated while on meds. Dr’s have taken CDC suggestions as gospel and are lowering patient’s to unfathomable numbers. Way below state regulations. If they actually read the CDC regulations they would read that WA state level is 140 MME.
    Dr’s use the excuse of they are afraid of their license getting taken away. However, if they do what they are supposed to, then DEA said they will not mess with them.
    This supposed epidemic is nonsense and the only people getting hurt are patient’s who are not addicts , who are getting painted as addicts.
    There are always going to be people who will sell anything for money and there are always going to be people who will buy it. That is not the fault of us pain patient’s .
    We NEED our medications to function and they help patient’s do that.

  11. Reed at 7:53 am

    @Signe Topai Testing chronic pain patient’s reactions and effectiveness is absolutely the way to go for sure. I never in a million years would have thought that one formulation of Buprenorphine (and even some generics come into play) vary greatly in responsively. I always thought buprenorphine was buprenorphine. until the state made regulations against buprenorphine formulations. I went through three different formulations, until I was able to function and work. Surprisingly, it ended up being the one with probably the most naloxone in it. The problem, from what I’ve seen at State Board of Medicine meetings, is they assume the same. “Any formulation of Buprenorphine should work for all.”. It’s just not true. And half those that speak and try to sway these board members usually work for Adept pharma. It seems like only the Doctors that have a lot of experience prescribing Buprenorphine, know to try the different formulations. Everyone reacts differently to the same drug. I went through over a month of ups and downs, sleeplessness, and pain, stuck in bed for days, until I finally became normal enough to work, but it was so worth it because I would do anything to stave off having to escalate to a stronger class of rx treatment, especially in this crazy “epidemic”. Currently, Belbucca is on-lablel approved for CP, but I wish the companies that make other formulations would apply to the FDA for that status. Most of them just get approval for addiction treatment, with no regards for any effectiveness for chronic pain. For that I will give Belbucca kudos.

  12. Signe Topai at 7:09 am

    Hear, Hear! I don’t usually advocate for drug companies, however I have been prescribed this medication, allowing me to continue to work as a Physician Education Teacher with Chronic Myofascial Pain Disorder. I was lucky because I lived in California at the time were I had access to a Doctor prescribing buprenorphine. Once, I moved to a small town in Colorado, I was no longer prescribed this medication. I was horrified when several Doctor’s, holding a PHD, didn’t know what it was!
    I feel every Chronic Pain Patients should be tested first to verify what type of medication would work the best for there chronic pain. For some it may be the schedule III medications while others may need scheduled II. All that chronic pain patients want is to have the right to be giving a medication that allows them to live! To live a life were you don’t have to choice between having the physical strength of shower or cook something to eat. Normal people take theses for granted. I want a medication to ease my pain, NOT TO GIVE ME EUPHORIA. I have the right to the pursue of happiness which for me is having the ability to teach again!
    So wether it is Scheduled III or II medications. We have the right to choice !

  13. Linda at 6:11 am

    I’m happy to share with my physician. Thanks for sharing the information. I also have a question for anyone who might have education to pass along to me.

    I have been on 1 Tylenol 3+ 2 ibuprofen every sky hours for may years. I live in relentless pain anyway. The only way I can truly tell that those 3 pills are doing any good, is if I forget to write down the time of my last dose and forget taking them on time. My back, hip, leg, ankle and foot and head will remind me within 15 minutes, and I’ll remember.

    That medicine only allows me to be able to eat, or wash a few dishes, or sit down for about an hour. After that, the remainder of my 24 hours floats back and forth between torture, lesser throbbing, the bed, and the chair. Literally everything has changed for me. I can’t sleep despite my nighttime medicine of 1 gabapentin, 1 Tylenol 3, 1 50mg trazadone, 2 ibuprofen, and 1 Valium. The hurting is just way above and beyond any of that.

    I have 2 ruptured discs, a damaged hip, long-term sciatica (dead but painful leg) , ankle pain from, and this is weird, me constantly twisting my foot back and forth and all around, shaking it, just constant strain I subject it too because I can’t help it from my pain. That’s how much I hurt, and make it worse myself because I can’t get relief from this never-ending pain.

    I also have benign intercranial hypertension and the more my body hurts the more my head hurts “because I stay in such a state ” all the time. Like wound-up or somehow physically working all the time (which I don’t, I’m disabled)

    I’ve read and tried my best to understand “pain medicine”, but I must say, I just can’t comprehend what I read. I don’t understand the differences between this schedule and that schedule and what’s more potent and what’s not. I can’t even figure out exactly what tylenol 3 is with my 2 ibuprofen compared to other opiates.

    I don’t know what to say to my doctor either, because one thing I did read was that tylenol 3 wasn’t for long term. She tried to switch me to Tramadol once but even I knew better than that. I took it before and literally nothing happened, zero relief.

    I just know my pain is BAD. My current meds aren’t working. I’m torturing myself to death. I can’t see my granddaughter because I will not scare her. I’ve hired others to do everything for me because of this pain.

    Any ideas or advice for me would be so very much appreciated.

  14. nana at 5:57 am

    The true chronic pain patients I know of (and am one ) don’t get “that euphoria” and maybe that is the BIG MISUNDERSTANDING that invites non-stop talk of an “opioid crisis”.

    We get “some” pain relief. That is all. Pain relief enough to live at least a mostly or partly a normal life- whatever that is.

    The studies I have seen show nothing of consequence.
    There was, for example, a story of how Oregon gives out enough opioids yearly to seniors that if quantified they could give one prescription to each Oregon resident.
    How many residents are in Oregon? 4.029 million. Between 2011 and 2014 prescription opioid overdoses have gone down more than 2% according to their own website. So why this buzz now?
    What opioids are they citing? Tylenol 3? Vicodin? Oxycodone? Percocet? Lidocaine patches?
    How many in a prescription to a chronic pain patient?
    How many to a resident?

    And how many in the prescription (of what) to “each resident?” 6? 10? 60? 1?

    It seems this opioid crisis is made up of vague references, unverified/specified hospitalizations (are they for pain? Overdose? Cancer? End of life? Death with dignity?)

    Come on all of you who are involved in this disruption of decent humane relevant treatment for verifiable pain patients, start using verifiable information in your reports. Give names of drugs, conditions of patients and other pertinent information that can be researched logically to check accuracy of these wild statements/studies calling for an end to humane treatment.

    You are right, Mr Coghlan. There is no one answer and Washington is not helping. They are slinging unverifiable, mathematically incorrect and unsupportable half baked data aimed at this new form of PC.

    It is the new political buzzword for the media to perpetuate with the many soundbites they are fond of. It is the new political way to climb up and up in politics. It is leaving documented, verified chronic/acute pain patients in mental turmoil and stress- and stress ups the pain quota.

    We don’t want euphoria. We want some relief from the daily pain we live in. We want to participate in life again. It is too hard to do when you are living with daily debilitating pain and everywhere you look you are vilified and afraid to fill legitimate prescriptions.

  15. Armin Groesch at 5:45 am

    Good to hear about the new drug,BELBUCA, it sounds like a viable
    alternative to hydrocodone.Too bad they can’t come up with something
    like that for fetanyl and oxycontin,which are the main drugs being abused
    as well as manufactured in china and sold on our streets illicitly.As usual the
    patients who need the meds the most, are punished by a government who has
    always disregarded the rights of those least able to help themselves.

  16. Reed at 3:31 am

    I agree, even buprenorphine is not created equal formulations are much different and the bioavailability is very different. When the state of Va lost it’s mind, my Dr. tried to put me on Belbucca, from Subutex. It didn’t work. The microgram to to milligram ration was very different and it was supposed to, in theory deliver a much higher bioavailability. It did not for me. Plus it cost 10 times that of subtex. Another instance, after that he tried Zubsolv. A bit better, but still severly under-medicated and ended up out of work for another two weeks, before being put on Suboxone. (the equivalent of Subutex, but +Naloxone), and does cause reactions. The Biovavailibility makes a huge difference. At a va Board meeting several Dr.s discussed and basically admitted Subutex was great fror chronic pain, but due do bioavailability issues, drugs like zubsolv & bunavail, and even belbucca were ineffective at bio-avallible delivery when it came to treatment of most pain patients.

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