Abstract
Objectives: It is widely accepted that buprenorphine maintenance treatment (BMT) with dosages above 8 mg daily is effective for patients with heroin use disorder. In this study, the authors evaluated the effectiveness of long-term BMT for heroin users in China, with dosages kept on a much smaller level.Methods: This is a retrospective observational study of 72 patients who had undergone detoxification and continued with buprenorphine maintenance between 2007 and 2016. Measurements such as self-reported relapse status, buprenorphine doses, protracted symptoms, general health condition, and self-reported side effects were included.Results: At the time of interview, 51 patients had remained abstinent at follow-up (including 13 who were opioid-free). The dosages of buprenorphine were 1.33 ± 0.88 (ranging 0.3–3.5) mg/day when maintenance treatment was initiated and 1.2 ± 0.8 (ranging 0.2–3.2) mg/day at the last follow-up. The remaining patients had either relapsed on heroin (n = 11) or switched to compulsory treatment (n=10). In general, abstinent patients had minimal protracted symptoms, especially in physical symptoms. Opioid-free abstainers were more likely to report good physical health than patients on buprenorphine. Predictors of worse outcomes (relapsed or switched to compulsory treatment) were lower education levels, younger age, and younger onset of illicit drug use.Conclusions: This study shows promising results of minimal-dosage BMT in treating heroin use disorder. We recommend further studies applying minimal-dosage BMT in China and worldwide.
Highlights
Heroin use disorder is a chronic, relapsing disorder characterized by a compulsion to seek and take opioids
Discontinuation of heroin use causes a negative emotional state, which implies key motivational elements to relapse, such as chronic irritability, emotional pain, malaise, dysphoria, Buprenorphine Maintenance With Minimal Dosage and loss of motivation for natural rewards that drives drug seeking through negative reinforcement mechanisms [1]
Opioid maintenance treatment is increasingly recognized as an effective management strategy in the treatment of heroin use disorders [2]
Summary
Heroin use disorder is a chronic, relapsing disorder characterized by a compulsion to seek and take opioids. A variety of opiate agonists, such as methadone [3], buprenorphine [5], and diamorphine [6], are considered effective as maintenance medication when used under close supervision. Unlike full agonists such as methadone and diamorphine, buprenorphine is regarded as a partial agonist of mu-opioid receptors. Buprenorphine manifests antagonistic features when it is used with agonists like morphine [8] It may prevent illicit drug use during maintenance and reduce the possibility of buprenorphine misuse
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