Buprenorphine/naloxone as a promising therapeutic option for opioid abusing patients with chronic pain: Reduction of pain, opioid withdrawal symptoms, and abuse liability of oral oxycodone

Abstract

Aim Few studies have examined abuse of prescription opioids (PO) among individuals with chronic pain under buprenorphine/naloxone (Bup/Nx) maintenance. The current 7-week inpatient study assessed oral oxycodone self-administration by patients with chronic pain who had a history of opioid abuse. Methods Participants (N=25) were transitioned from their pre-admission prescribed opioid to Bup/Nx. All of the participants were tested under each of the sublingual Bup/Nx maintenance doses (2/0.5, 8/2 or 16/4 mg) in random order. During each maintenance period, participants could self-administer oxycodone orally (0, 10, 20, 40 or 60 mg, PO) or receive money during laboratory sessions. Drug choice (percent) was the primary dependent variable. Subjective ratings of clinical pain and withdrawal symptoms also were measured. Mann-Whitney tests compared % drug choice for each active oxycodone dose to placebo. Logistic regression analyses identified correlates of oxycodone preference, defined as 60% or greater choice of oxycodone compared to money. Results Pain was significantly reduced while participants were maintained on Bup/Nx compared to pre-admission ratings. No differences in percent drug choice were observed between the active oxycodone doses and placebo under each Bup/Nx maintenance dose. However, factors associated with oxycodone preference were: lower Bup/Nx maintenance dose, more withdrawal symptoms and more pain. Conclusions These data suggest that Bup/Nx was effective in reducing pain and supplemental oxycodone use. Importantly, adequate management of pain and withdrawal symptoms by Bup/Nx may reduce oxycodone preference in this population.

The endocannabinoid hydrolysis inhibitor SA-57: Intrinsic antinociceptive effects, augmented morphine-induced antinociception, and attenuated heroin seeking behavior in mice

“…Case reports and retrospective studies support the proposition that prescription opioid use for pain control may serve as a gateway for heroin addiction, and strategies that limit opioid abuse potential may also be of benefit for the treatment of opioid addiction (Roux et al, 2013; Conroy and Hill, 2014, Mars et al, 2014). Several studies have demonstrated that endocannabinoid hydrolytic inhibitors ameliorate precipitated and spontaneous morphine withdrawal signs in morphine-dependent mice (Ramesh et al, 2011; 2013, Gamage et al, 2015).…”

Patient-reported pathways to opioid use disorders and pain-related barriers to treatment engagement

“…Meeting patient-centered needs for pain control while also reducing risks related to misuse and abuse such as overdose or death has proven to be particularly challenging for clinicians (Kampman & Jarvis, 2015; Neumann et al, 2013). Buprenorphine/naloxone may be a reasonable approach for patients with co-occurring chronic pain and an OUD as it adequately controls pain for some individuals while simultaneously addressing addiction (Roux et al, 2013). Such an approach could help alleviate patient concerns about uncontrolled pain.…”

Sex Differences Among Opioid-Abusing Patients With Chronic Pain in a Clinical Trial

“…Prior papers from this dataset analyzed the effects of bup/nx and oxycodone on pain, opioid withdrawal symptoms, and abuse liability among enrolled participants in this study (Jones et al, 2011; Roux et al, 2013). The sample for this paper consisted of screening participants who met criteria for opioid abuse/dependence for prescription opioids with chronic pain (duration of 6 months or longer), regardless of whether they subsequently enrolled in the treatment study.…”