COMMENTS FROM VARIOUS COLLEAGUES REGARDING CRUSHING OF SUBUTEX:
Question: I have patients who ask me to crush their buprenorphine to shorten the supervision time. Our shared care monitoring group has discussed this and is generally in favour as we believe it will reduce diversion of buprenorphine onto the streets. However, we're a little unclear about the practicalities - what is the procedure for crushing and administering supervised buprenorphine doses? Can you show us how it's done?
Answer: Crushing is popular in Australia, for both of the reasons that you have given, indeed in some states it is mandatory for the pharmacist to crush unless the doctor writes 'do not crush' on the prescription.
However, buprenorphine (Subutex) becomes unlicensed when it has been crushed, and the patient must be warned of this. They can be reassured that they are unlikely to feel any different; data from Australia (Muhleisen P, Spence J & Nielsen S: "Crushing buprenorphine tablets" (letter) Drug and Alcohol Review Dec 2003 p471-2) suggests that there is no difference in bioavailability of the drug when doses were crushed, as evidenced by the fact that patients were encouraged to request an increased dose if they required it, and did not do so.
(The Royal College of General Practitioners (UK), Substance Misuse Management in General Practice, SMMGP) (dgs-info, 7, Mai-Juni 2006)
To crush or not to crush - buprenorphine tablet administration; Drug and Alcohol Review (2003) 22;4:471-2; Muhleisen P, Spence J, Nielsen S. Crushing buprenorphine tablets.
Crushing buprenorphine and supervised consumption. (Bob Dunkley, 2005 National Drug Treatment Conference, London, UK). Power-Point Präsentation.
2003 haben die Gesundheitsbehörden in Victoria/Australien verfügt, Subutex ausschließlich in gemörserter Form abzugeben. Ärzte werden gebeten, die Formulierung ‚Do not crush’ nicht auf die Verordnung zu schreiben (Drugs and poisons unit Newsletter May 2003
Die britische Royal Pharmaceutical Society hat 2005 Empfehlungen publiziert (The Pharmaceutical Journal, Vol 274 No 7343 p401; 2 April 2005):
The Royal Pharmaceutical Society has issued guidance for pharmacists regarding the crushing of buprenorphine sublingual tablets (Subutex) before their administration.
Im März 2007 erschien in Drug and Alcohol Review der Artikel: Buprenorphine supply by community pharmacists in Victoria, Australia: perceptions, experiences and key issues identified (Volume 26, Number 2/March 2007; DOI 10.1080/09595230601146645, Pages 143-151), der die aktuelle Lage beleuchtet. (Abstract)