Abstract
There is a plethora of research indicating the successful treatment of opioid dependence with either buprenorphine alone or in combination with naloxone (Suboxone®). However, we encourage caution in long-term maintenance with these drugs, albeit, lack of any other FDA approved opioid maintenance compound to date. Our concern has been supported by severe withdrawal (even with tapering of the dosage of for example Suboxone® which is 40 times more potent than morphine) from low dose of buprenorphine (alone or with naloxone). In addition our findings of a long-term flat affect in chronic Suboxone® patients amongst other unwanted side effects including diversion and suicide attempts provides impetus to reconsider long-term utilization. However, it seems prudent to embrace genetic testing to reveal reward circuitry gene polymorphisms especially those related to dopaminergic pathways as well as opioid receptor(s) as a way of improving treatment outcomes. Understanding the interaction of reward circuitry involvement in buprenorphine effects and respective genotypes provide a novel framework to augment a patient's clinical experience and benefits during opioid replacement therapy.
Highlights
The main purpose of this commentary is to point out that while the United States government Food and Drug Administration (FDA) has approved the utilization of buprenorphine alone or in combination with Naloxone (Suboxone®), to treat acute pain and as an a opioid maintenance modality, our laboratory has cautioned against its long-term use to treat opioid addicted patients
This cautionary note is further enlightened by recent genetic information showing that outcome with buprenorphine alone and in combination with naloxone depends in-part on certain reward gene polymorphisms including genes that regulate both opiate and dopamine receptors
While it is well established that dopamine deficiency or a hypodopaminergic trait/state leads to aberrant substance seeking behaviors (RDS) and intact mu opiate receptors are important for maintaining “dopamine homeostasis”, we have suspected that opioiddopaminergic interaction must be involved in buprenorphine response
Summary
The main purpose of this commentary is to point out that while the United States government Food and Drug Administration (FDA) has approved the utilization of buprenorphine alone or in combination with Naloxone (Suboxone®), to treat acute pain and as an a opioid maintenance modality, our laboratory has cautioned against its long-term use to treat opioid addicted patients. This cautionary note is further enlightened by recent genetic information showing that outcome with buprenorphine alone and in combination with naloxone depends in-part on certain reward gene polymorphisms including genes that regulate both opiate and dopamine receptors.
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