Preference for buprenorphine/naloxone and buprenorphine among patients receiving buprenorphine maintenance therapy in France: A prospective, multicenter study

Daulouède, Jean-Pierre; Caer, Yves; Galland, Pascal; Villéger, Pierre; Brunelle, Emmanuel; Bachellier, Jérôme; Piquet, Jean-Michel; Harbonnier, Jean; Leglise, Yves; Courty, Pascal

doi:10.1016/j.jsat.2009.07.002

Cited by 19 publications

(12 citation statements)

References 16 publications

(19 reference statements)

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“…[23] In yet another study, 54% of opioid dependent subjects preferred the tablet size, taste, and sublingual dissociation time of bup/nal as compared to buprenorphine. [24] Collectively, these studies suggest that adding naloxone to buprenorphine may have pharmacologically transformed buprenorphine to be distinctly different from buprenorphine as a mono drug.…”

Section: Bup/nal Versus Buprenorphine Alonementioning

confidence: 99%

Buprenorphine–Naloxone Therapy in Pain Management

Chen

Mao

2014

Anesthesiology

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Buprenorphine-naloxone (bup/nal in 4:1 ratio; Suboxone®, Reckitt Benckiser Pharmaceuticals Incorporation, Richmond, VA) is approved by the Food and Drug Administration for outpatient office-based addiction treatment. In the past few years, bup/nal has been increasingly prescribed off-label for chronic pain management. The current data suggests that bup/nal may provide pain relief in chronic pain patients with opioid dependence or addiction. However, the unique pharmacological profile of bup/nal confers it to be a weak analgesic that is unlikely to provide adequate pain relief for patients without opioid dependence or addiction. Possible mechanisms of pain relief by bup/nal therapy in opioid-dependent chronic pain patients may include reversal of opioid-induced hyperalgesia as well as improvement in opioid tolerance and addiction. Additional studies are needed to assess the implication of bup/nal therapy in clinical anesthesia and perioperative pain management.

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Section: Bup/nal Versus Buprenorphine Alonementioning

confidence: 99%

Buprenorphine–Naloxone Therapy in Pain Management

Chen

Mao

2014

Anesthesiology

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“…Not enough is known about patients’ desires and strategies to self-treat their opioid dependence and treatment preferences about buprenorphine/naloxone are not well understood (Daulouede et al, 2010). This study elaborates on the self-treatment for chronic illness strategies described by Morden, Jinks, & Ong, et al, (2012); the authors advocate for a more holistic understanding of self-treatment since patients use information to calculate their personal risk of harm in order to self-treat.…”

Section: Introductionmentioning

confidence: 99%

Self-Management of Buprenorphine/Naloxone Among Online Discussion Board Users

Brown

Altice

2014

Substance Use & Misuse

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Background Buprenorphine/naloxone is an effective medication used to treat opioid dependence. Patients in treatment and those using it illegally without prescriptions have discussed using buprenorphine/naloxone anonymously on Internet discussion boards. Their beliefs about self-treatment and efforts to self-treat are not well known. Objectives To identify facilitators of self-treatment by online buprenorphine/naloxone users. Methods A qualitative, retrospective study of discussion board postings from September 2010 to November 2012 analyzed 121 threads from 13 discussion boards using grounded theory. Results Facilitators of self-management themes that emerged included: (1) a ready supply of buprenorphine/naloxone from a variety of sources; (2) distrust of buprenorphine prescribers and pharmaceutical companies; (3) the declaration that buprenorphine/naloxone is a “bad-tasting” medicine; (4) the desire to adopt a different delivery method other than sublingually; and (5) a desire to become completely “substance-free.” The sublingual film formulation appears to be an important facilitator in self-treatment because it can more easily be apportioned to extend the medication because of limited supply, cost, or to taper. Conclusions/Importance The findings indicate a range of self-management activities ranging from altering the amount taken to modifying the physical medication composition or changing the administration route; some of these behaviors constitute problematic extra-medical use. Contributors to discussion boards seem to trust each other more than they trust pharmacists and prescribing physicians. The shared knowledge and behaviors of this understudied online community are important to healthcare providers because of the previously unknown precautions and risks taken to self-treat.

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“…Data from another trial, however, showed that patients whose therapy was switched in a similar manner preferred the tablet taste, size and sublingual dissolution time of buprenorphine/ naloxone compared with buprenorphine alone. [27] The most frequently reported side-effect in this study was constipation, which continued throughout the trial and is linked to the mechanism of action of buprenorphine, and occurs with other opioids. [28] Other adverse effects included cramps, sweating, insomnia and nausea, which are indicative of opiate withdrawal.…”

Section: Discussionmentioning

confidence: 72%

Therapeutic Switch to Buprenorphine/Naloxone from Buprenorphine Alone

Montesano

Zaccone

Battaglia

et al. 2010

Clinical Drug Investigation

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Pharmacological therapy has an important place in the management of opioid dependence. Methadone has been the mainstay of therapy but has a number of limitations. Buprenorphine monotherapy is another option, but misuse and diversion can have negative consequences. The opioid receptor antagonist, naloxone, has been added to buprenorphine to create a combination product with a reduced potential for misuse and diversion. This study evaluated the use of buprenorphine/naloxone for 24 weeks as a pharmacological management of opioid-dependent patients after therapeutic switch from buprenorphine alone. Patients (n = 43) received sublingual tablets of buprenorphine/naloxone. The buprenorphine dose was 2-24 mg (mean 16). Patients saw a physician, including an interview using a structured data sheet, and had counselling each week. Assessments were performed at week 2 (period 1), week 6 (period 2), week 16 (period 3) and week 24 (period 4). Laboratory immunoenzymatic testing was performed weekly to detect drugs in the urine. The management of withdrawal symptoms was rated as 'satisfactory' by 67% of patients during period 1 and 91% during period 4. The majority of patients was highly satisfied with therapy and considered that buprenorphine/naloxone provided good control of cravings. Two patients dropped out of therapy, but all others continued to receive buprenorphine throughout the study. Approximately 50% of patients stated that they disliked the sensory properties (taste, colour, odour and feel) of buprenorphine/naloxone. Adverse effects were as would be expected on the basis of the mechanism of action of buprenorphine (i.e. opioid-induced constipation) and for patients undergoing drug withdrawal. Only 2% of patients attempted the intravenous misuse of buprenorphine/naloxone, none of whom experienced any gratifying effects. Opioid-dependent patients maintained on buprenorphine monotherapy can be safely switched to a sublingual buprenorphine/naloxone tablet without any loss of treatment effectiveness. Buprenorphine/naloxone can be administered in an outpatient or primary care setting, and effectively controls cravings and withdrawal symptoms. Patient satisfaction was high, making retention in treatment more likely.

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Preference for buprenorphine/naloxone and buprenorphine among patients receiving buprenorphine maintenance therapy in France: A prospective, multicenter study

Cited by 19 publications

References 16 publications

Buprenorphine–Naloxone Therapy in Pain Management

Buprenorphine–Naloxone Therapy in Pain Management

Self-Management of Buprenorphine/Naloxone Among Online Discussion Board Users

Therapeutic Switch to Buprenorphine/Naloxone from Buprenorphine Alone

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