Suboxone Film: Is it Ethical to Cut?

[elilbitz]

I am an addictions nurse working with the new Suboxone Film. It comes in only 2mg or 8mg strengths. The administrators of the hospital are requesting the nurses cut the 8mg flim strips into half to make 4mg doses. Apparently this is more cost effective than giving 2 of the 2mg strips as both the 2mg and 8mg strips cost the same amount of money. Therefore half of an 8mg strip costs 1/4 of the price of two 2mg strips.

BUT is this safe and ethical? Would this practice be a threat to our licenses?

There are no score marks on the films and there is no information about cutting at the Suboxone website. Even if it is ethical, there is the issue of time and accuracy in cutting the film, as well as handling the film. We are to cut them with just any old pair of scissors available too. Once the film is cut, we are to put the remainder back in the med cart for later use as needed. If it is not needed by the end of the med pass, it is to be disposed of. I have not yet done this. Much to the dismay of the administrators, I continue to use the 2mg film strips for the 2, 4 and 6mg dosings. I refuse to do this if it is a threat to my license. If it is not, I believe I still have issue with it and will seek to offer better ways of handling the situation.

Anyone have any experience with this? Or does anyone know where I can find the information to support whether I should cut them or not?

Thanks in advance

~E

[oldladyRN]

There are so many things wrong with this situation.

What does your pharmacist have to say about cutting and saving? My guess is that their hair would either turn gray or turn loose.

Think about it this way - do you snap a Lortab in half and place the other half in the drawer to be used during that shift? No. Regardless of whether you use a manual system (med cart) or an electronic system (pyxis, suremed, omnicell), you WASTE the unused portion. Of course, this is what you do if it IS okay to half a tablet, as when the tablet is scored.

Personally, I would not use an altered portion of the film that I found in the drawer.

I checked the manufacturer's website (suboxone.com) and didn't find any useful information either way regarding cutting/not cutting. However, I would be inclined to err on the side of caution and assume that the medications are NOT equally dispersed across the film, and that cutting the film may cause either an overdose or an underdose of the medication.

Because this is a Schedule III controlled substance, your pharmacist (along with written facility policies and procedures) should be your guide on proper administration of 4 mg and 6 mg doses when the medication is only available in 2 mg and 8 mg films.

Speaking from a State surveyor's standpoint, you are doing the right thing and I would continue to refuse to cut the strip. I would faint dead away (not really) if I opened a med cart and found little pieces of suboxone film lying all over the place.

Get it in writing. If they won't put it in writing, follow the pharmacist's recommendations combined with your nursing judgment, which seems pretty sound thus far.

oldladyRN

[elilbitz]

Thanks for your reply ~ I was never alerted that anyone responded.

For the record, the facility has no pharmacist. It is a small addictions hospital that is run by an addictions doctor who also takes on that role of pharmacist...and is also accountable for saving money...and I believe it was his idea to cut the strips! I've since left the position. I sure hope they've changed this 'policy'