Have you heard of Bunavail?
This opioid addiction treatment drug can help you to get clean from opioids such as heroin, fentanyl, and oxycodone. You stick it in your mouth, on the inside of your cheek. It remains there and releases its medicine.
When the Bunavail finishes its job, it dissolves. The drug it releases into your body is buprenorphine, the same medicine found in Suboxone. Both Suboxone and Bunavail contain buprenorphine and naloxone.
Are methadone maintenance clinics a thing of the past?
In the old days, methadone was the treatment of choice when it came to medication-assisted treatment of opioid addiction. Fortunately, buprenorphine became available in the early 2000s.
Now patients have fewer concerns, especially with drug interactions, slow breathing from respiratory depression, and other serious side effects.
What if a patient physically dependent on opioids is allergic to buprenorphine? Methadone might still be an option for treatment.
Otherwise, to avoid breathing problems, buprenorphine may be a better choice. When a patient is ready to complete treatment, methadone withdrawal symptoms are worse than those with buprenorphine.
What about neonatal opioid withdrawal syndrome? Buprenorphine is probably a better choice for pregnant patients.
Some patients prefer Bunavail.
What makes Bunavail better than Suboxone for some patients? Suboxone has a reputation for having a bad aftertaste. And, you have to keep your mouth closed until all of the Suboxone dissolves.
Suboxone is a film that goes under the tongue. You cannot talk or open your mouth for any reason for at least a few minutes.
Even a few minutes of not being able to speak can seem like an eternity if you are at work or taking care of your children at home. Things get worse with the generic tablet form of Suboxone. These tablets can take 10, 20, or even 30 minutes to dissolve.
Why isn’t Bunavail more popular?
Bunavail sounds like a great idea. You press it into your cheek and get on with your day. Why isn’t everyone who takes Suboxone switching to Bunavail? If Bunavail is superior to Suboxone, it wouldn’t be the first time in history that an inferior product won over the market.
The famous example of Betamax vs. VHS videotapes comes to mind, though both of these technologies have lost out to the forward march of technology.
Bunavail is not very well known, even to doctors who give prescription drugs for opioid dependence. Yet, if you check any medication guide, you will see that it is an option along with other partial opioid agonists/antagonist drugs.
Should I ask my doctor about switching to Bunavail?
The problem is due to Bunavail not gaining traction in the market. Imagine that you get a prescription for Bunavail, and your pharmacy does not carry it. If they are willing to order it, you then find out that it is expensive, and your insurance does not cover it.
Is there a generic Bunavail? Unfortunately, there is no generic available on the market for Bunavail. There are, however, generic versions of Suboxone tablets and films.
What about ZubSolv? Is it better than Bunavail?
Another competitor to both Suboxone and Bunavail is ZubSolv. While Bunavail is uniquely different from Suboxone in that you stick it in your cheek and you can keep talking, ZubSolv works just like Suboxone.
You hold it under your tongue. Then, you wait for it to dissolve before you can open your mouth. Like Suboxone, ZubSolv is an excellent option for treating heroin addiction.
Is there any advantage to ZubSolv over Suboxone?
Even though ZubSolv is a sublingual medication, just like Suboxone, it does have some advantages. Remember how Suboxone has a bad aftertaste?
ZubSolv has a pleasant minty taste. It also dissolves very quickly. ZubSolv and Suboxone both contain buprenorphine and naloxone.
In studies, ZubSolv clocked in as taking an average of 2.9 minutes to dissolve. Otherwise, ZubSolv and Suboxone are very similar. It does come down to a matter of taste and insurance coverage.
What about Bunavail vs. ZubSolv? Which is better?
If your doctor is open to allowing you to choose your buprenorphine/naloxone brand, which would you choose? What if you had to pick between ZubSolv and Bunavail? Bunavail is excellent because you stick it in your cheek, and that’s it.
With Bunavail, you don’t have to worry about holding your tongue down inside your mouth. Keeping your mouth closed is not an issue.
Still, ZubSolv is not a bad alternative. While you do have to keep it under your tongue, it is just for a few minutes, and the taste is pleasant.
Is Bunavail the superior product?
I would imagine that patients, given the choice and the descriptions on paper, would choose Bunavail. However, realistically, it is probably going to remain the underdog, not getting as much use as you would think. If you start taking a buprenorphine medication in rehab, they are most likely going to give you Subutex, another sublingual tablet, at first.
Subutex is plain sublingual buprenorphine that doctors prescribe for initial treatment. Other uses include the treatment of pregnant patients. Patients who have had an allergic reaction to naloxone may also get Subutex.
If you go to an outpatient doctor or clinic, you will probably start with Subutex or Suboxone. Doctors don’t usually give patients choices when it comes to treating fentanyl addiction. And, they prescribe from habit and experience.
Why would ZubSolv sublingual tablets win out over Bunavail?
If Suboxone and Subutex are the brands that doctors go to first, why would you end up with ZubSolv over Bunavail at a later point in your treatment? Just like your doctor, you are likely going to follow your experience as well.
If you are accustomed to putting your treatment med under your tongue, you know how this feels, and you know it works. What if Bunavail doesn’t work as well for you as Suboxone? Are you prepared to take it home and try it out?
ZubSolv is closer to what most patients have experienced. The instructions for ZubSolv are identical to the instructions for Suboxone and Subutex.
Why would you switch to ZubSolv from Suboxone? Your insurance company may prefer ZubSolv. Or, you may have taken ZubSolv using vouchers to pay for it.
Life-saving vouchers make all the difference.
Since generic Suboxone became available, patients have had less trouble getting their medication. Not long ago, this was not the case. Imagine being a new patient seeing your Suboxone doctor for the first time.
The visit goes well, and you leave with a prescription in hand. Then, the pharmacy nightmare begins. Your pharmacy tells you that your insurance does not cover Suboxone.
The cost is outrageous. When you are ready to start treatment, and you can’t get your medication right away, you may have an increased risk of relapse and overdose.
Your only hope is to ask the doctor to apply for “prior authorization.” Insurance companies drag their feet with this process. It is a tactic to avoid paying for your medication. Fortunately, Orexo, the company that makes ZubSolv, offers a one time voucher that allows for 30 free ZubSolv tablets.
This offer has made it possible for patients to get treatment medication with a prescription right away at no cost, no questions asked. This marketing strategy is brilliant. Patients get to try out ZubSolv, and they may develop a loyalty to the brand that was there for them in desperate times when their insurance company and other drug companies were not.
For a patient in opioid withdrawal who has just come off of street oxycodone, fentanyl, or heroin, having fast access to treatment can be life-saving.
Conclusion: The winner of Bunavail vs. ZubSolv.
In these types of articles, I rarely pick a clear winner at the end. This time, I am going to side with ZubSolv as the winner. While the medication itself is not much different from other competing brands, Orexo has gone above and beyond in marketing.
They have provided placebo tablets so doctors can demonstrate the medication use and how to open the child-proof packaging. And, they have published free unbranded books to teach patients and their loved-ones about opioid addiction. Yet, of all their marketing efforts, the best is the free vouchers.
A patient can download a voucher from the ZubSolv website and use it to pay for their prescription at the pharmacy. When a new patient is ready to start treatment, fast access to medication is critical. While Bunavail is unique and has clear benefits for some patients, I believe that it will remain a niche product. However, there is nothing wrong with serving a niche.
Bunavail will appeal to some people for its unique benefits. It is always good to have more options when it comes to treating opiate dependence.