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07/08/2010
Relapse Associated with Shorter Treatment Course
In persons dependent on prescription opioids, tapering with buprenorphine (SUBUTEX/SUBOXONE) during a 9-month period, whether initially or after a period of substantial improvement, led to nearly universal relapse in the National Drug Abuse Clinical Trials Network Prescription Opioid Addiction Treatment Study, recently presented at the American Psychiatric Association 2010 Annual Meeting.
Buprenorphine is a semi-synthetic opioid that was approved for in-office treatment of opioid dependence by the FDA in 2002. It is used in a sublingual route of administration with a relatively rapid onset of action. The clinical effectiveness of buprenorphine is believed to result from the medications ability to decrease mu-opioid receptor availability, preventing other opioids including heroin, from binding to them. The drug prevents, or attenuates, opioid withdrawal syndrome.
In the Treatment Study, persons with a history of heroin use had worse outcomes. Dr Sean Mackey, chief of the division of Pain Management at Stanford University questioned whether heroin fundamentally alters the neurobiology such that these individuals would need higher doses of buprenorphine to prevent relapse.
“There has been virtually no research on the treatment of persons dependent on prescription opioids, in spite of the major increase in prescription opioid abuse and in the numbers of persons entering treatment for addiction to prescription opioids” said Roger D. Weiss, MD, professor of psychiatry at Harvard Medical School, Boston, and chief of the Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts.