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buprenorphine capsules can take between five and
ten minutes to dissolve – clearly far from ideal for
supervised consumption in a busy pharmacy or prison
setting – it’s hoped that products like this can help cut
the drop-out rates for buprenorphine treatment,
which currently stand at about 50 per cent within six
months.
‘We’re finding administering Espranor takes about
30 seconds, so it’s certainly a much quicker product
than the generic hard compressed tablet,’ says GP and
substance misuse specialist Dr Bernadette Hard, who
has been prescribing Espranor in her Cardiff-based
service since January. While her service began using it
in a criminal justice setting, they have since had some
clients move their prescriptions to community
pharmacies, she points out.
‘Our main motivation for wanting to trial this new
preparation was the challenges we faced around
diversion and misuse, and we had around 30 people
when we did the initial switch,’ she says. ‘The people
that we felt were appropriately on buprenorphine and
benefitting from it had a very positive experience with
switching – they liked the fact that it dissolved
quicker and they didn’t feel they were being
scrutinised, because if you are taking it properly but
someone feels you might not be, that can be quite
uncomfortable. Some pharmacists are really good and
respectful, others less so.’
The feedback so far has been very positive, she
says. ‘For those clients where we were always a little
bit suspicious around their motivation for wanting to
be on buprenorphine, some of them did struggle with
the switch. Some found that – where they probably
hadn’t been taking their full amount before – when
we switched them onto Espranor they had to reduce
their dose because they were finding it a little too
strong. One or two have actually said they used to
get bullied for their tablets, so they’d prefer to be on
Espranor because they have fewer people requesting
them, things like that.’
So how important is choice in substitute
prescribing generally? ‘Well, we don’t have many
options,’ she says. ‘You can try and categorise via a
patient’s history who you think is going to do better
on methadone or buprenorphine, and most of the
time we’re right about that. But not always, and some
people just gel with one product and I think it