A systematic literature review. The reliability of sensitive information provided by injecting drug users in a clinical setting: clinician-administered versus audio computer-assisted self-interviewing ACASI.
AIDS Care ;24 12 Darke S. Self-report among injecting drug users: a review. Abuse liability of prescription opioids compared to heroin in morphine-maintained heroin abusers.
Local complications after intravenous injection of dissolved tablets of buprenorphine. Presse Med. Medication-assisted therapies--tackling the opioid-overdose epidemic. Outcome of long-term heroin-assisted treatment offered to chronic, treatment-resistant heroin addicts in the Netherlands. Download references. We thank all the members of the PrebupIV Study Group and all the stakeholders involved, especially participating centers, their staff, and in particular the study participants.
Our thanks also to Jude Sweeney for the English revision and editing of our manuscript. Carrieri, P. Chappard, E. Choucair, M. Debrus, R. Delacroix, M. Dematteis, V. Joannard, V. Laporte, M. Mora, A. Morel, S. Morel, K. Ndiaye, F. Olivet, E. Pletschinger, D.
Rojas-Castro, P. Roux, B. Spire, M. Suzan, G. Maradan, F. Participating centers and their staff: S. Penavayre Pau , C. Labbe Lille , R. Delacroix Paris 02 , T. Ngiema Le Havre , D. Abouhari Chartres , S. Le Friec Brest , F. Crossouard Rennes , V. Meignan Laval , A. Celdran La Roche-sur-Yon , J. Kubath Bayonne , N. Fleuranceau-Rodier Limoges , L. Baptiste Niort , Y.
Lamant La Rochelle , S. Coulmain Poitiers , G. Collin Clermont-Ferrand , C. De Froment Toulouse , S. Pivi Nancy , A. Herter Metz , JL. Ferry Thionville , M. Daoud Epinal , E.
Skamba Mulhouse , R. Taugourdeau Nevers , L. Bernard Avignon , LA. Parent Toulon , E-Y. Data from a retrospective study involving five different treatment centers, examining the effects of switching patients to Suboxone, were gathered from 64 opioid-dependent patients who had undergone the medication transfer. Most patients The majority of these patients However, due to adverse events one patient only discontinued treatment with Suboxone during the 4-week study period, and five during the four month follow-up period.
Of the 26 patients in the follow-up period, Suboxone was misused intravenously once each by 4 patients and twice by 1 patient. These 5 patients all reported that injecting Suboxone was like injecting "nothing" with any euphoria, or that it was a bad experience. We recommend that a transfer from Subutex to Suboxone should be carefully discussed and planned in advance with the patients and after the transfer adverse events should be regularly monitored.
With regard of buprenorphine IV abuse, the combination product seems to have a less abuse potential than buprenorphine alone. Buprenorphine is a mu-opioid receptor partial agonist and kappa-opioid receptor antagonist. The high dose sublingual tablet formulation Subutex has proven an effective treatment for opioid dependence [ 1 ] and is in use in over 40 countries worldwide. The buprenorphine plus naloxone Suboxone combination tablet was developed with the objective of having the same sublingual effectiveness and safety profile as buprenorphine alone Subutex but with a lower intravenous IV misuse potential [ 2 ].
Naloxone, when taken sublingually, is poorly absorbed and should have little or no pharmacological effects [ 3 ]. When Suboxone is injected intravenously, naloxone is intended to precipitate withdrawal effects in opioid-dependent users, to attenuate feelings of "drug liking", and to provide a generally unpleasant experience [ 3 ]. In Finland, the most misused IV opioid during the last few years has been buprenorphine [ 4 ] mainly originating from other countries, notably France.
As a consequence of abuse, access to and monitoring of the treatment has been very strictly controlled, thus necessitating significant resources. At the initiation of this study approximately patients were receiving treatment with Subutex in Finland. When Suboxone became available under special license in Finland towards the end of , several treatment centers switched their patients rapidly from Subutex to Suboxone as a strategy to curb misuse of buprenorphine.
Preliminary data are available from an open label study involving the switching of patients from low-dose Subutex to Suboxone in Australia indicating a need for a dose increase [ 5 ]. In contrast, the relative bioavailability of different buprenorphine formulations under chronic dosing conditions has also been studied, and it is possible that the buprenorphine in Suboxone has a slightly higher sublingual bioavailability than the buprenorphine in Subutex [ 6 ].
However, detailed effects of switching therapy from Subutex to Suboxone have not been fully investigated. The study objectives were threefold: i to examine the potential effect of a switch on the total dose of buprenorphine, ii to follow whether the switch to Suboxone deters IV misuse, and iii to follow whether switching from Subutex to Suboxone results in withdrawal symptoms or other significant adverse reactions.
The study was retrospective, involving data collection from 64 opioid-dependent patients who had undergone a switch from Subutex to Suboxone. Data were collected from five treatment sites in Finland using structured data collection forms. The five treatment centers were randomly chosen from 20 treatment centers that were using Subutex and had more than 10 patients in buprenorphine treatment.
All buprenorphine patients, except four patients with low doses of buprenorphine pregnant women , in these centers were included in the study. Data were collected for three days during the week of the medication switch and at 1, 2, 3, and 4 weeks following the transfer. The data collection was repeated four months post transfer follow-up period. The data gathered from patient records prior to the switch Subutex dose, drug misuse and frequency of clinic visits is considered as baseline data.
Patient data were collected by the treating physician in each treatment site. Data protection was ensured throughout in accordance with the regulations of the National Public Health Institute.
The National Public Health Institute funded the study. The treating physicians at these selected clinics collected data about eligible patients who had undergone a "forced transfer" from Subutex to Suboxone. Data were collected from patient archives of the respective study sites and stored with codes to protect the personal details of the study patients.
Physicians recorded the Subutex dose at the day of the transfer, and the Suboxone doses used during the four weeks following the switch. Data four months after the study period were also collected.
Drug misuse measures were recorded as follows: 1 Drug misuse history at the time of entering the clinic; 2 any relevant medical history; 3 signs of buprenorphine misuse before the switch from Subutex to Suboxone and at weeks 1—4 following the switch as evidenced by the presence of fresh needle marks or patients volunteering the information ; 4 signs of misuse of other opioids urine tests and patient reports ; and 5 current misuse of any non-opioid drugs urine tests and patient reports.
Length of non-opioid drug use was also recorded. Adverse events considered being associated with the switch from Subutex to Suboxone on the day of the switch, days 2 and 3, and weeks 1 to 4 following the switch were recorded.
Adverse events four months after the study period were also collected. The MedDRA coding was followed. J Addict Dis 28 : — Neuroscience 75 : 1 — 4. J Epidemiol Community Health 51 : — Ohtani M Kotaki H Sawada Y Iga T Comparative analysis of buprenorphine- and norbuprenorphine-induced analgesic effects based on pharmacokinetic-pharmacodynamic modeling.
Eur J Pharmacol : R17 — R Eur J Pharmacol : 45 — Parfitt T Designer drug Subutex takes its toll in Tbilisi. Lancet : — Mol Pharmacol 45 : — Naunyn Schmiedebergs Arch Pharmacol : — Pharmacol Biochem Behav 49 : — Psychopharmacology Berl : — J Pharmacol Exp Ther : 11 — Med J Aust : 54 — Tzschentke TM Reassessment of buprenorphine in conditioned place preference: temporal and pharmacological considerations.
Psychopharmacology Berl : 58 — Addict Biol 12 : — Villiger JW Binding of buprenorphine to opiate receptors. Regulation by guanyl nucleotides and metal ions. Neuropharmacology 23 : — Mol Pharmacol 56 : — Yassen A Olofsen E Dahan A Danhof M Pharmacokinetic-pharmacodynamic modeling of the antinociceptive effect of buprenorphine and fentanyl in rats: role of receptor equilibration kinetics. Clin Pharmacokinet 46 : — Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide.
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Volume Article Contents Abstract. Materials and method. Interest Statement. Corinne Canestrelli , Corinne Canestrelli. Oxford Academic. Nicolas Marie. Florence Noble. Address for correspondence: F.
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