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Why not add it using a user event (beforeLoad)?

var itemSL = form.getSublist({id:'item'});

itemSL.addButton({
    id: 'custpage_create_item',
    label: 'Search For Item',
    functionName: 'createItem',
});

OK @NElliott so you have done this before? I was hoping it could be added like you're example.

Yup that is actual code I wrote only about 2 weeks ago

OK thanks @NElliott works like a charm! I was initially afraid adding a button in that area wasn't natively supported.