Abstract
BackgroundOpioid use disorder is one of the most prevalent addiction problems worldwide. Buprenorphine is used as a medication to treat this disorder, but in countries where buprenorphine is unavailable in combination with naloxone, diversion can be a problem if the medication is given outside a hospital setting.ObjectiveThe objective of this research is to evaluate the effect of a single, high dose of buprenorphine on craving in opioid-dependent patients over 5 days of abstinence from use of other opioids. The primary goal was to determine the safety and efficacy of buprenorphine during withdrawal in a hospital setting.MethodsNinety men who used opium, heroin, or prescribed opioids and met DSM-5 criteria for opioid use disorder (severe form) were randomized to three groups (n = 30 per group) to receive a single, sublingual dose of buprenorphine (32, 64, or 96 mg). The study was conducted in an inpatient psychiatric ward, with appropriate precautions and monitoring of respiratory and cardiovascular measures. Buprenorphine was administered when the patients were in moderate opiate withdrawal, as indicated by the presence of four to five symptoms. A structured clinical interview was conducted, and urine toxicology testing was performed at baseline. Self-reports of craving were obtained at baseline and on each of the 5 days after buprenorphine administration.FindingsCraving decreased from baseline in each of the three groups (p < 0.0001), with a significant interaction between group and time (p < 0.038), indicating that groups with higher doses of buprenorphine had greater reduction.ConclusionsA single, high dose of buprenorphine can reduce craving during opioid withdrawal; additional studies with follow-up are warranted to evaluate safety.
Highlights
Buprenorphine is well absorbed after sublingual administration [4, 9, 10], and its partial agonist action at mu-opioid receptors contributes to a safer profile of buprenorphine over methadone, with minimal respiratory depressant effects [14,15,16,17,18,19,20,21,22,23,24,25,26]
Craving is an essential feature of substance use disorders, as evidenced by its recent addition to the diagnostic criteria for these disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5; American Psychiatric Association) [3, 17, 20, 21], and it persists after detoxification to promote relapse [3, 17, 21, 22]
Buprenorphine was administered in a hospital setting to reduce the possibility of diversion of the medication, which is much more likely if the formulation does not include naloxone, which is included in some formulations for this purpose (e.g., Suboxone®)
Summary
Buprenorphine is well absorbed after sublingual administration [4, 9, 10], and its partial agonist action at mu-opioid receptors contributes to a safer profile of buprenorphine over methadone, with minimal respiratory depressant effects [14,15,16,17,18,19,20,21,22,23,24,25,26]. Buprenorphine was administered in a hospital setting to reduce the possibility of diversion of the medication, which is much more likely if the formulation does not include naloxone, which is included in some formulations for this purpose (e.g., Suboxone®). Such combined formulations are not available in Iran
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