Buprenorphine/naloxone versus methadone opioid rotation in patients with prescription opioid use disorder and chronic pain: study protocol for a randomized controlled trial

Ellerbroek, Hannah; Heuvel, Sandra A S van den; Dahan, Albert; Timmerman, Hans; Kramers, Cornelis; Schellekens, Arnt

doi:10.1186/s13722-022-00326-1

Cited by 5 publications

(1 citation statement)

References 78 publications

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“…The half-life of naloxone is approximately 1.0-1.5 hours, and the half-life of some high-potency opioids far exceeds that, making rebound toxicity of the opioids a possibility once naloxone concentrations drop [58][59][60]. Naloxone is also a component of suboxone, a combined medication that includes buprenorphine; however in this preparation, naloxone may not be absorbed into the systemic circulation in quantities sufficient to be detected on a drug screen [61,62]. Also of note is that use of naloxone to reverse a toxicity event may lead to a recurrence of toxicity symptoms later as well as new psychiatric, medical, and toxicological conditions [8,63,64].…”

Section: Plos Onementioning

confidence: 99%

Postmortem toxicology findings from the Camden Opioid Research Initiative

Kusic,

Heil,

Zajic

et al. 2023

PLoS ONE

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The United States continues to be impacted by decades of an opioid misuse epidemic, worsened by the COVID-19 pandemic and by the growing prevalence of highly potent synthetic opioids (HPSO) such as fentanyl. In instances of a toxicity event, first-response administration of reversal medications such as naloxone can be insufficient to fully counteract the effects of HPSO, particularly when there is co-occurring substance use. In an effort to characterize and study this multi-faceted problem, the Camden Opioid Research Initiative (CORI) has been formed. The CORI study has collected and analyzed post-mortem toxicology data from 42 cases of decedents who expired from opioid-related toxicity in the South New Jersey region to characterize substance use profiles. Co-occurring substance use, whether by intent or through possible contamination of the illicit opioid supply, is pervasive among deaths due to opioid toxicity, and evidence of medication-assisted treatment is scarce. Nearly all (98%) of the toxicology cases show the presence of the HPSO, fentanyl, and very few (7%) results detected evidence of medication-assisted treatment for opioid use disorder, such as buprenorphine or methadone, at the time of death. The opioid toxicity reversal drug, naloxone, was detected in 19% of cases, but 100% of cases expressed one or more stimulants, and sedatives including xylazine were detected in 48% of cases. These results showing complex substance use profiles indicate that efforts at mitigating the opioid misuse epidemic must address the complications presented by co-occurring stimulant and other substance use, and reduce barriers to and stigmas of seeking effective medication-assisted treatments.

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