Buprenorphine Implants for Treatment of Opioid Dependence

Abstract

EPENDENCE ON OPIOIDS, IN THE form of heroin or prescription pain medications, is a significant health concern. 1-3 Methadone maintenance treatment for opioid dependence reduces morbidity, mortality, and the spread of infectious diseases 4 but is restricted to licensed specialty clinics in the United States, requires frequent clinic visits, and has a risk of mortality with overdose. 5 These issues have led to increased use of buprenorphine, and numerous studies support the efficacy of sublingually administered buprenorphine. 6 In the United States, buprenorphine can be prescribed in office-based physician practice. 7 Because it is a partial agonist, buprenorphine has less risk of overdose than methadone. 8 However, there are concerns about diversion and nonmedical use of sublingual buprenorphine, even when a buprenorphine-naloxone combination (designed to reduce misuse) is used. 9-11 Poor treatment adherence, resulting in craving and withdrawal symptoms that increase the likelihood of relapse, is also a concern with sublingual buprenorphine. 12

Commentary on Rosenthalet al. (2013): Buprenorphine implant-new hopes, old questions

“…Having said this, again as a clinician I am hardly surprised that an active OST implant would generally perform better than placebo, as already reported in the previous trial by the same group [9]. The real question of clinical importance is: how does BI compare with sublingual BNX, the currently available and widely used preparation [10]?…”

Opiate addiction - current trends and treatment options

“…33 A subdermal implant that can deliver the drug for a period of six months is in development. 34 The bioavailability of buprenorphine after taken sublingually is approximately 50%. 34 Peak plasma levels are reached within 1-3 hours and the elimination half-life at steady state is approximately 37 hours, allowing for once daily, and in some instances every other day, dosing.…”

“…34 The bioavailability of buprenorphine after taken sublingually is approximately 50%. 34 Peak plasma levels are reached within 1-3 hours and the elimination half-life at steady state is approximately 37 hours, allowing for once daily, and in some instances every other day, dosing. It is bound to globulin fragments and is distributed to various tissues with an apparent volume of distribution during steady state of 3.7 L/kg.…”

Suboxone Misuse Along the Opiate Maintenance Treatment Pathway

“…24 The study used a randomized, placebocontrolled design at 18 sites in the United States over 6 months and included 163 participants (age range, 18-65 years) divided into two groups: those who received a placebo (n = 55) and those who received a buprenorphine implant (n = 108). Over a 16-week period, the implant group had significantly more opioidnegative urine tests (median = 41%) than the placebo group (median = 21%).…”