Practical Consideration for the Clinical Use of Buprenorphine

Abstract

Buprenorphine is a new and attractive medication option for many opioid-addicted adults and their physicians. Before initiating buprenorphine treatment, providers must be aware of such critical factors as how the medication works, its efficacy and safety profile, how it is used in opioid withdrawal as well as maintenance treatment, and how patients can best be selected, educated about buprenorphine, and monitored throughout treatment. This article reviews these important issues as well as requirements for physician and staff training and needs for additional research on this unique medication.

Patient Perspectives on Buprenorphine/Naloxone: A Qualitative Study of Retention During the Starting Treatment with Agonist Replacement Therapies (START) Study

“…As some of the participants may not have been at an acceptable level of opioid withdrawal when presenting for induction, the first dose of buprenorphine/naloxone may have precipitated withdrawal symptoms. Due to the pharmacologic properties of buprenorphine (partial agonist), compared to methadone (full agonist), opioids already taken may be displaced from the mu receptors, thus precipitating withdrawal (Jones 2004). Better outcomes may be achieved if patient induction on to buprenorphine/naloxone occurs only after having clear evidence of the signs and symptoms of opioid withdrawal (e.g., minimum score of 5 on the Clinical Opiate Withdrawal Scale [COWS]).…”

Effects of d-Amphetamine and Buprenorphine Combinations on Speedball (Cocaine+Heroin) Self-Administration by Rhesus Monkeys

“…This medication combination was chosen because d-amphetamine alone selectively reduced cocaine self-administration by nonhuman primates in three behavioral procedures (Negus, 2003;Negus and Mello, 2003a, b), and buprenorphine alone selectively reduced both cocaine and opioid self-administration in both clinical and preclinical studies (Mello et al, 1989;Mello and Negus, 1998;Montoya et al, 2004; for a review, see Bickel and Amass, 1995;Jones, 2004;Mello, 2005). Food-maintained responding during d-amphetamine + high-dose buprenorphine treatment was not significantly different from food-maintained responding during saline control treatment.…”

“…It is well established that buprenorphine reduces heroin self-administration in inpatient clinical studies (Mello and Mendelson, 1980;Mello et al, 1982) and opioid abuse in outpatient clinical trials (Johnson et al, 1992;Strain et al, 1994; for a review, see Bickel and Amass, 1995;Fudala and Johnson, 1995;Jones, 2004). Buprenorphine was approved by the FDA as a treatment for opioid abuse in 2002, and also reduced both opioid and cocaine use in outpatient studies of persons dependent on both cocaine and opioids (Kosten et al, 1989;Gastfriend et al, 1993;Schottenfeld et al, 1993;Montoya et al, 2004).…”

Uses of Diverted Methadone and Buprenorphine by Opioid‐Addicted Individuals in Baltimore, Maryland

“…(20,21,22,24) Buprenorphine is primarily utilized in the U.S. as Suboxone®, a combination tablet which includes naloxone, an opioid antagonist, to discourage its injection. (9,26) Understanding methadone and buprenorphine diversion and its association with public health problems, as well as its connection with the drug abuse treatment process, is of considerable importance given the recent expansion of buprenorphine treatment in the U.S. and the sharp rise in methadone-related overdose deaths in the past few years. (27,28) Although there has been some recent epidemiological research concerning methadone diversion, (29) there has been limited ethnographic research since the work of Hunt and colleagues (30) more than two decades ago.…”