Transition From Full Mu Opioid Agonists to Buprenorphine in Opioid Dependent Patients—A Critical Review

Soyka, Michael

doi:10.3389/fphar.2021.718811

Cited by 9 publications

(6 citation statements)

References 67 publications

(98 reference statements)

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“…The transition from higher doses of rac-methadone is possible, as was applied in our centers. Several dosing strategies have been proposed to soften withdrawal symptoms and facilitate transfer, including the use of other opioids or medications and, especially, micro-dosing techniques for buprenorphine, as reported by others, including the transition from the higher to lower dosing protocols [34].…”

Section: Discussionmentioning

confidence: 99%

Multicenter Observational/Exploratory Study Addressed to the Evaluation of the Effectiveness and Safety of Pharmacological Therapy in Opioid-Dependent Patients in Maintenance Therapy in Southern Italy

et al. 2022

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A multicenter-observational study was performed to assess the effectiveness of rac-methadone, levomethadone, and buprenorphine in opioid-dependent patients in polytherapy in Southern Italy. The primary endpoint was the reduction of urinary positivity to the substances and the maintaining doses. Patients (N = 266, age = 44.80 ± 5.65, male = 79.70%, female = 20.30%) have been recruited. At recruitment, 75% of them were on treatment with rac-methadone, levomethadone, and buprenorphine/naloxone. The patients were grouped into three clusters. The levomethadone patients of Cluster A (N patients = 211), after 180 days, showed stability in urinary methadone positivity, with a marked decrease in heroin −53 ± 4%, cannabinol’s −48 ± 2%, and cocaine −37 ± 6% positivity, with no differences between treatments. A lower QTcF value of 426 ± 8.4 ms was recorded in the levomethadone patients (delta = −19 ms) vs. rac-methadone, at significantly lower doses of levomethadone (−34%, −50.2% in males) (p < 0.05). The Cluster B data were collected from 37 patients, with a high prevalence of comorbidity infections (HIV/HCV/HPV), monitored for 21 months during COVID-19. High doses of levomethadone (58.33 ± 31.58 mg/day) were needed to stabilize those that were negative for opioids and cannabinoids, in contrast to the rac-methadone and buprenorphine/naloxone patients that showed positive toxicology. Eighteen patients of the Cluster C in double diagnosis (major depressive 38.90%, bipolar 27.78%, and schizophrenia 16.67%) were stabilized with high doses of racemate 97.5 ± 8 mg/day, 51.8 ± 5 mg/day of levomethadone (−46.8% vs. rac-methadone; −71% in men), and 2.5 ± 1 mg/day of buprenorphine/naloxone. Three patients in remission were treated with tapering doses of levomethadone. Significantly reduced QTcF values were recorded with levomethadone (delta −32 ms vs. rac-methadone) in the bipolar patients, as well as the schizophrenia patients in remission (delta −45.19 ms vs. rac-methadone). Our patients were safely stabilized. Levomethadone, compared to the racemate, contributes to reducing the illicit use, especially of opioids and cannabinoids at significantly lower doses with cardiovascular safety, which, in bipolar patients, is clinically significant.

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Section: Discussionmentioning

confidence: 99%

Multicenter Observational/Exploratory Study Addressed to the Evaluation of the Effectiveness and Safety of Pharmacological Therapy in Opioid-Dependent Patients in Maintenance Therapy in Southern Italy

et al. 2022

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“…The mainstay for the treatment of opioid use disorder has been opioid substitution therapy with either methadone or buprenorphine (sublingual film or long-acting injectable depot buprenorphine [LAIB] preparations) [1]. There are a number of indications for transitioning between these medications including patient preference, greater access to unsupervised dosing in some jurisdictions with buprenorphine and clinical concerns about safety [2,3]. Methadone is a full agonist of the mu opioid receptor while buprenorphine is a partial agonist at the mu receptor; however, buprenorphine has a very high affinity for the mu receptor and can displace other full agonist opioids from the mu receptor resulting in the phenomena commonly known as precipitated withdrawal [4,5].…”

Section: Introductionmentioning

confidence: 99%

Buprenorphine microdosing regimen using transdermal buprenorphine patches to transition from methadone to buprenorphine

Naren,

Cook,

MacCartney

et al. 2024

Drug and Alcohol Review

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IntroductionThis case series records a cohort of patients treated with transdermal buprenorphine patches as part of a buprenorphine microdose induction protocol to transition from methadone to buprenorphine in a community setting. This has historically been a difficult process to manage in community settings and this case series explored a method to gradually manage this in an outpatient setting.MethodA retrospective file audit was conducted of the electronic medical records of cohealth Innerspace patients who had undergone buprenorphine microdose induction using transdermal patches. A total of 32 patients were identified.ResultsIn this case series 23 of the 32 patients successfully transitioned from methadone to sublingual or long‐acting injectable depot buprenorphine preparations utilising the transdermal buprenorphine microdosing technique. All patients in this case series regardless of the success of the transition were retained in treatment.Discussion and ConclusionsA fixed‐dose transdermal buprenorphine patch regimen enabled 23 of 32 patients in this case series transition from methadone to buprenorphine in an outpatient setting. Given the small sample size further research is required to demonstrate the effectiveness of this technique.

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“…All 3 medications have different mechanisms of action, which are attributed to their variable receptor-binding affinities. 3,4 Methadone is a full opioid agonist, while buprenorphine is a partial μ-opioid receptor agonist and naltrexone is a μ-opioid receptor antagonist. Higher doses of methadone induce opioid tolerance with reduced effects of the injected drug.…”

mentioning

confidence: 99%

Prescribed and Diverted Methadone Toxicity in South Australia

Stephenson,

Van Den Heuvel,

Humphries

et al. 2023

Am J Forensic Med Pathol

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Methadone is one of the most common medications currently prescribed for the treatment of opioid use disorders (OUDs). While methadone maintenance programs (MMPs) have been highly successful in the management and treatment of OUDs resulting in a reduced number of fatalities, the risk of overdose/toxicity remains. The current study was undertaken to analyze trends in overdoses attributed to prescribed and diverted methadone in South Australia (SA) between 2000 and 2019. Over the 20-year period, 344 methadone-related deaths occurred in SA with a significant increase in deaths over the study period (P = 0.03). The mean age of decedents was 42.5 years with a male to female ratio of 1.8:1, with approximately 20% of decedents enrolled in a MMP at the time of death. Overall, only 5.2% of cases demonstrated methadone diversion, which was associated with methadone prescribed for chronic pain and was most likely to be diverted from a friend/housemate or a partner. However, the source of methadone in more than half of cases was unknown, so this is likely a significant underestimate of actual MMP methadone diversion and total methadone diversion.

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Transition From Full Mu Opioid Agonists to Buprenorphine in Opioid Dependent Patients—A Critical Review

Cited by 9 publications

References 67 publications

Multicenter Observational/Exploratory Study Addressed to the Evaluation of the Effectiveness and Safety of Pharmacological Therapy in Opioid-Dependent Patients in Maintenance Therapy in Southern Italy

Multicenter Observational/Exploratory Study Addressed to the Evaluation of the Effectiveness and Safety of Pharmacological Therapy in Opioid-Dependent Patients in Maintenance Therapy in Southern Italy

Buprenorphine microdosing regimen using transdermal buprenorphine patches to transition from methadone to buprenorphine

Prescribed and Diverted Methadone Toxicity in South Australia

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