The misuse of buprenorphine and a buprenorphine-naloxone combination in Wellington, New Zealand

Robinson, Geoffrey; Dukes, Patricia; Robinson, B J; Cooke, R.; Mahoney, Graeme N.

doi:10.1016/0376-8716(93)90036-p

Cited by 88 publications

(49 citation statements)

References 20 publications

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“…In a population of opioid-dependent patients in Wellington, New Zealand, the purpose of treating withdrawal was reported by 63% of buprenorphine and buprenorphine/naloxone users. Twenty-eight percent of buprenorphine users and 22% of the users of buprenorphine or the combination tablet reported euphoria seeking [12] . Our findings are similar, though with an even stronger predominance for the appropriate purposes.…”

Section: Discussionmentioning

confidence: 99%

“…Already when buprenorphine was prescribed as an analgesic (Temgesic ), misuse was reported in several studies [9][10][11]13] , such as in New Zealand, where intravenous misuse of buprenorphine was so common in 1990 that the combination of buprenorphine and naloxone was introduced the year after [12] . More recently, the Australian study by Jenkinson et al [18] , like our study, assessed a sample of syringe exchange clients.…”

Section: Discussionmentioning

confidence: 99%

“…Early reports on misuse of the substance concerned buprenorphine registered as an opioid analgesic. Such misuse has been reported since the 1980s, for example in studies from Australia [9] , Scotland [10] , England [11] , New Zealand [12] , and in a Spanish study where the majority of a sample of heroin users had used this analgesic at some time, in most cases through intravenous administration [13] . In recent years, buprenorphine has become an established treatment for opiate dependence.…”

Section: Introductionmentioning

confidence: 99%

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Buprenorphine Misuse among Heroin and Amphetamine Users in Malmo, Sweden: Purpose of Misuse and Route of Administration

et al. 2007

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Buprenorphine misuse by injecting drug users was assessed in a survey of 350 needle exchangers, either amphetamine (57%) or heroin users (42%). 89% of heroin users and 24% of amphetamine users reported using buprenorphine at some time during the previous year. Most users reported illicit acquisition. Among illicit users, 87% of heroin users reported intake for withdrawal treatment or self-detoxification, and 11% for euphoria. Euphoria seeking was more common among amphetamine users (62%, p < 0.001). Intravenous misuse was reported by 43% of illicit users, and snorting by 29%. Sole sublingual intake was more common among heroin users than among amphetamine users (46 vs. 20%, p < 0.05), and less common among patients reporting euphoria seeking (20 vs. 46%, p < 0.05).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Buprenorphine Misuse among Heroin and Amphetamine Users in Malmo, Sweden: Purpose of Misuse and Route of Administration

et al. 2007

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“…It is not clear, however, how effective this strategy will be in reducing buprenorphine abuse. Although the reported misuse, as well as the street price, of the combination buprenorphine/naloxone tablet decreased relative to buprenorphine alone, it was still abused in some countries (Robinson et al, 1993). Therefore, the present study sought to systematically characterize the reinforcing effects of the combination, relative to buprenorphine alone.…”

mentioning

confidence: 99%

Self-Administration of Intravenous Buprenorphine and the Buprenorphine/Naloxone Combination by Recently Detoxified Heroin Abusers

Comer¹,

Collins²

2002

J Pharmacol Exp Ther

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Buprenorphine is a partial -opioid agonist and -opioid antagonist currently under development as a maintenance medication for heroin dependence. Because of concerns about illicit diversion of buprenorphine, a combination tablet containing buprenorphine and naloxone has been developed. The present study evaluated the reinforcing effects of intravenously administered placebo, buprenorphine alone (BUP; 2 and 8 mg), and the buprenorphine/naloxone combination (BUP/NX; 2 mg of buprenorphine plus 0.5 mg of naloxone, and 8 mg of buprenorphine plus 2 mg of naloxone) in recently detoxified heroin abusers during a 6-week inpatient study. Participants (n ϭ 6) were detoxified from heroin over approximately 1 week immediately after admission. During the next 5 weeks, the reinforcing effects of placebo, BUP, and BUP/NX were evaluated. Participants first received a dose of drug and $20 and then were given the opportunity to self-administer either the dose or $20 during choice sessions. Progressive ratio break point values were significantly higher after active drug, compared with placebo, but they did not significantly differ as a function of dose or drug. In contrast, positive subjective ratings were higher after administration of BUP compared with BUP/NX, and these ratings increased in a dose-dependent manner. BUP and the combination had few effects on performance. Relative to placebo, both BUP and BUP/NX decreased pupil diameter, but there were no significant differences in pupil diameter as a function of drug or dose. These results demonstrate that both BUP and BUP/NX served as reinforcers under these conditions and that they may have similar abuse liability in recently detoxified individuals who abuse heroin.Both phase I and II clinical trials have demonstrated that buprenorphine is effective in treating opioid dependence (Bickel and Amass, 1995;Johnson et al., 2000). Despite its clear clinical utility, several lines of evidence suggest that buprenorphine has some abuse liability. Studies using nonhuman primates showed that buprenorphine serves as a reinforcer (Negus and Woods, 1995). For example, Winger and Woods (2001) showed that rates of responding maintained by buprenorphine were higher than placebo but lower than rates of responding for the full -agonists heroin and alfentanil (Winger and Woods, 2001). Another study demonstrated that buprenorphine was less reinforcing than heroin but equivalent to methadone (Mello et al., 1988). Thus, buprenorphine is self-administered by laboratory animals, and under some conditions, is self-administered at rates comparable with full -agonists.In humans, two studies examined the reinforcing effects of buprenorphine in heroin users maintained on sublingual buprenorphine in outpatient treatment settings (Petry and Bickel, 1999;Amass et al., 2000). Petry and Bickel (1999) examined the reinforcing effects of sublingual buprenorphine. Participants who were given the opportunity to choose between sublingual buprenorphine and money almost exclusively self-administered buprenorphine...

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“…With respect to abuse potential, Maxwell [41] pointed out that while early reports of findings from animal studies suggested that buprenorphine would have minimal abuse potential, varying levels of diversion and abuse were predicted by early investigations in humans [89,90].…”

Section: Extent Of the Problem In The Us And Non-european Countriesmentioning

confidence: 99%

Buprenorphine Use and Risk of Abuse and Diversion

Soyka¹

2014

Adv Pharmacoepidem Drug Safety

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Buprenorphine in Opioid Maintenance Treatment: A Brief UpdateBuprenorphine is an established first-line medication for the treatment of opioid dependence (see APA guidelines [24] AbstractOpioid maintenance therapy with methadone or buprenorphine is a well-established first-line treatment for opioid dependence. However, risk of diversion and drug-related mortality are critical issues during maintenance therapy. These issues are discussed controversially in both the scientific and public arenas and are a matter of concern also among medical authorities. In addition to a formulation containing buprenorphine alone, a combination formulation with buprenorphine and naloxone in a 4:1 ratio is available. The combination formulation was developed with the aim to prevent intravenous use or diversion. This critical review summarizes data on the risk of abuse and diversion of buprenorphine.

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The misuse of buprenorphine and a buprenorphine-naloxone combination in Wellington, New Zealand

Cited by 88 publications

References 20 publications

Buprenorphine Misuse among Heroin and Amphetamine Users in Malmo, Sweden: Purpose of Misuse and Route of Administration

Buprenorphine Misuse among Heroin and Amphetamine Users in Malmo, Sweden: Purpose of Misuse and Route of Administration

Self-Administration of Intravenous Buprenorphine and the Buprenorphine/Naloxone Combination by Recently Detoxified Heroin Abusers

Buprenorphine Use and Risk of Abuse and Diversion

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