Optimising the benefits of unobserved dose administration for stable opioid maintenance patients: Follow-up of a randomised trial

Bell, James; Ryan, Anni; Mutch, Carolyn; Batey, Robert; Rea, Felicity

doi:10.1016/j.drugalcdep.2008.02.012

Cited by 9 publications

(2 citation statements)

References 4 publications

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“…For example, in the United States, where buprenorphine/naloxone is available by prescription from qualified physicians, reports of misuse have been limited [33–35]. In Australia [36–38] and Finland [11], where buprenorphine misuse was relatively common, the introduction of buprenorphine/naloxone has been associated with lower rates of misuse, even for patients receiving the medication without close monitoring [11,14,39,40]. The results from our quantitative approach complemented those observed in these surveys and further identified conditions under which the abuse liability of buprenorphine/naloxone was minimized (i.e.…”

Section: Discussionsupporting

confidence: 56%

Abuse liability of intravenous buprenorphine/naloxone and buprenorphine alone in buprenorphine‐maintained intravenous heroin abusers

et al. 2010

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BACKGROUND Sublingual buprenorphine is an effective maintenance treatment for opioid dependence, yet intravenous buprenorphine misuse occurs. A buprenorphine/naloxone formulation was developed to mitigate this misuse risk. This randomized, double-blind, crossover study was conducted to assess the intravenous abuse potential of buprenorphine/naloxone compared with buprenorphine in buprenorphine-maintained injection drug users (IDUs). METHODS Intravenous heroin users (n=12) lived in the hospital for 8–9 weeks and were maintained on each of 3 different sublingual buprenorphine doses (2 mg, 8 mg, 24 mg). Under each maintenance dose, participants completed laboratory sessions during which the reinforcing and subjective effects of intravenous placebo, naloxone, heroin, and low and high doses of buprenorphine and buprenorphine/naloxone were examined. Every participant received each test dose under the 3 buprenorphine maintenance dose conditions. RESULTS Intravenous buprenorphine/naloxone was self-administered less frequently than buprenorphine or heroin (P < 0.0005). Participants were most likely to self-administer drug intravenously when maintained on the lowest sublingual buprenorphine dose. Subjective ratings of “drug liking” and “desire to take the drug again” were lower for buprenorphine/naloxone than for buprenorphine or heroin (P = 0.0001). Participants reported that they would pay significantly less money for buprenorphine/naloxone than for buprenorphine or heroin (P < 0.05). Seven adverse events were reported; most were mild and transient. CONCLUSIONS These data suggest that although the buprenorphine/naloxone combination has intravenous abuse potential, it is lower than for buprenorphine alone, particularly when participants received higher maintenance dosages and lower buprenorphine/naloxone challenge doses. Buprenorphine/naloxone may be a reasonable option for managing the risk for buprenorphine misuse during opioid dependence treatment.

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Section: Discussionsupporting

confidence: 56%

Abuse liability of intravenous buprenorphine/naloxone and buprenorphine alone in buprenorphine‐maintained intravenous heroin abusers

et al. 2010

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“…However, this must be balanced against the health risks posed by unregulated use of methadone in the community both to individuals already prescribed, those not engaging with services and non drug users [ 66 - 68 ]. Previous work has suggested that taking the opposite approach, starting unsupervised and moving to supervised when concerns around appropriate use become apparent, can lead to greater attrition [ 69 ]. Disempowerment and disengagement are also potential outcomes if clients feel that they are not a part of their treatment planning [ 44 , 70 ] and, in this study, participants who felt that they had not had the aims of their treatment explained were more likely to report 'topping up' their methadone prescription.…”

Section: Discussionmentioning

confidence: 99%

The nature of methadone diversion in England: a Merseyside case study

Duffy

Baldwin

2012

Harm Reduction Journal

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BackgroundMethadone maintenance treatment (MMT) is a key element in treatment for opiate addiction; however concerns about the diversion of methadone remain. More current empirical data on methadone diversion are required. This research investigated the market for diverted methadone in Merseyside, UK, in order to provide a case study which can be transferred to other areas undertaking methadone maintenance treatment on a large scale.MethodsQuestionnaires were completed (in interview format) with 886 past year users of methadone recruited both in and out of prescribing agencies. Topic areas covered included current prescribing, obtaining and providing methadone, reasons for using illicit methadone and other drug use.ResultsLarge proportions of participants had obtained illicit methadone for use in the past year with smaller proportions doing so in the past month. Proportions of participants buying and being given methadone were similar. Exchange of methadone primarily took place between friends and associates, with 'dealers' rarely involved. Gender, age, whether participant's methadone consumption was supervised and whether the aims of their treatment had been explained to them fully, influenced the extent to which participants were involved in diverting or using diverted methadone.ConclusionMethadone diversion is widespread although drug users generally do not make use of illicit methadone regularly (every month). The degree of altruism involved in the exchange of methadone does not negate the potential role of this action in overdose or the possibility of criminal justice action against individuals. Treatment agencies need to emphasise these risks whilst ensuring that treatment aims are effectively shared with clients to ensure adherence to treatment.

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Supervised dosing with a long-acting opioid medication in the management of opioid dependence

Saulle¹,

Vecchi²,

Gowing

2017

Cochrane Database of Systematic Reviews

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Take-home medication strategies are attractive to treatment services due to lower costs, and place less restrictions on clients, but it is unknown whether they may be associated with increased risk of diversion and unsanctioned use of medication. There is uncertainty about the effects of supervised dosing compared with unsupervised medication due to the low and very low quality of the evidence for the primary outcomes of interest for this review. Data on defined secondary outcomes were similarly limited. More research comparing supervised and take-home medication strategies is needed to support decisions on the relative effectiveness of these strategies. The trials should be designed and conducted with high quality and over a longer follow-up period to support comparison of strategies at different stages of treatment. In particular, there is a need for studies assessing in more detail the risk of diversion and safety outcomes of using supervised OST to manage opioid dependence.

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Optimising the benefits of unobserved dose administration for stable opioid maintenance patients: Follow-up of a randomised trial

Cited by 9 publications

References 4 publications

Abuse liability of intravenous buprenorphine/naloxone and buprenorphine alone in buprenorphine‐maintained intravenous heroin abusers

Abuse liability of intravenous buprenorphine/naloxone and buprenorphine alone in buprenorphine‐maintained intravenous heroin abusers

The nature of methadone diversion in England: a Merseyside case study

Supervised dosing with a long-acting opioid medication in the management of opioid dependence

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