The Subjective, Reinforcing, and Analgesic Effects of Oxycodone in Patients with Chronic, Non-Malignant Pain who are Maintained on Sublingual Buprenorphine/Naloxone

Abstract

Some sources suggest that significant misuse of opioid drugs exists among patients with chronic pain. However, the risk factors and motivation behind their abuse may differ from those of other opioid abusers. This study sought to examine the abuse liability of oxycodone among patients with chronic, non-malignant pain who met the DSM-IV criteria for opioid abuse. Eighteen opioid-dependent patients with chronic pain lived on an in-patient unit of the New York State Psychiatric Institute during the 7-week study. Participants were given oral oxycodone (0, 10, 20, 40, and 60 mg/70 kg) while maintained on various doses of sublingual buprenorphine/naloxone (Bup/Nx; 2/0.5, 8/2, and 16/4 mg/day). Doses of both medications were administered under double-blind conditions. Oxycodone produced an overall positive, but less robust, subjective profile than previously reported in recreational opioid users without pain. Furthermore, unlike our findings in recreational opioid users and more similar to effects in non-drug-abusing individuals, oxycodone failed to serve as a reinforcer. As for the maintenance drug, Bup/Nx produced a dose-related reduction in some of the effects of acutely administered oxycodone. These data suggest that sublingual Bup/Nx has the potential as an analgesic medication and further research should investigate its use in treating patients with chronic pain who abuse opioids.

Sex Differences Among Opioid-Abusing Patients With Chronic Pain in a Clinical Trial

“…Prior papers from this dataset analyzed the effects of bup/nx and oxycodone on pain, opioid withdrawal symptoms, and abuse liability among enrolled participants in this study (Jones et al, 2011; Roux et al, 2013). The sample for this paper consisted of screening participants who met criteria for opioid abuse/dependence for prescription opioids with chronic pain (duration of 6 months or longer), regardless of whether they subsequently enrolled in the treatment study.…”

A review of human drug self-administration procedures

“…The temporal relation between response and reinforcer is important because increasing the delay proportionally decreases the value of the reinforcer (Catania, 1979). Despite these limitations, choice procedures have been used in abuse liability assessments of: prescription opioids (tramadol; Babalonis et al ., 2013; oxycodone, Jones et al ., 2011), marijuana (Cooper et al ., 2012), alcohol (Barrett et al ., 2006), D-amphetamine (Vansickel et al ., 2010), and cocaine (Stoops et al ., 2010). …”

Chronic Pain and DepressionAmong Primary Care Patients Treated with Buprenorphine

“…17 While buprenorphine has analgesic properties, it is not typically initiated, dosed, or directed toward pain relief in opioid-dependent persons. [21][22][23][24] Persistent pain is associated with negative substance use outcomes in persons receiving buprenorphine for opioid detoxification 25 or as maintenance treatment. 12 Unrelieved chronic pain contributes to early buprenorphine treatment termination.…”