Quiz in Survey’s Clothing

First generics, then Zubsolv, and now Bunavail: Reckitt Benckiser desperately wants to retain market share for its brand of buprenorphine/naloxone. Several weeks ago the company offered me $125 to complete a short survey. Who could refuse? I assumed they wanted to learn something about my prescribing habits. Not so. It turned out to be a kind of quiz to determine whether I would give the “correct” answers to questions about their product.

It seems that R-B worries that if prescribers fail to toe the line they may lose the market altogether, thus the questions aimed at prevention of diversion and abuse.

  • We learn that we should prescribe a “limited amount” of the drug at the first visit. Would anyone prescribe an unlimited amount?
  • We should “verify the patient is taking the medication as prescribed.” Perhaps we should shadow the patient in order to watch each time they take the drug.
  • We should conduct a urine drug screen and count those "pills." (I thought pharmacists counted the pills!)

We should counsel patients not only to protect their supply of the drug from theft, but tell them to store it “away from anyone for whom it has not been prescribed.” But how far away? “Stop, spouse! You can’t go in that room! That’s where I keep my Suboxone! Stay away from it.”

Apparently R-B wants us to preferentially prescribe their product with its child-proof packaging. (Zubsolv, too, comes individually wrapped.) The quiz reminds us that children can die from overdose of the drug. It seems we heard very little about such concerns before introduction of the safer wrappers. Should physicians also warn patients to keep small objects, car keys, gasoline, rat poison, sharp objects and Tylenol away from children at every encounter?

R-B wants us to complete the “Appropriate Use Checklist” (or similar “documentation”) at each encounter. Is there an app for that?

R-B tells us that “psychosocial support is considered necessary for safe and effective treatment.” Fortunately, either there is no definition for “psychosocial support” or the definition is so broad as to include almost anything. Surely we could say the same about diabetics and insulin treatment. But we do not require diabetics to undergo psychotherapy or counseling on a weekly basis for the rest of their lives. Maybe R-B wants us to believe that with sufficient psychosocial support these patients will no longer need their product. Not.

Enough nannies already. We have nanny DEA. We do not need nanny pharma, and we do not need dumbed down education disguised as a survey.

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