1
|
Saunders EC, Budney AJ, Cavazos-Rehg P, Scherer E, Bell K, John D, Marsch LA. Evaluating preferences for medication formulation and treatment model among people who use opioids non-medically: A web-based cross-sectional study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 163:209383. [PMID: 38670531 PMCID: PMC11180569 DOI: 10.1016/j.josat.2024.209383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 02/19/2024] [Accepted: 04/22/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Over the past decade, treatment for opioid use disorder has expanded to include long-acting injectable and implantable formulations of medication for opioid use disorder (MOUD), and integrated treatment models systematically addressing both behavioral and physical health. Patient preference for these treatment options has been underexplored. Gathering data on OUD treatment preferences is critical to guide the development of patient-centered treatment for OUD. This cross-sectional study assessed preferences for long-acting MOUD and integrated treatment using an online survey. METHODS An online Qualtrics survey assessed preferences for MOUD formulation and integrated treatment models. The study recruited participants (n = 851) in October and November 2019 through advertisements or posts on Facebook, Google AdWords, Reddit, and Amazon Mechanical Turk (mTurk). Eligible participants scored a two or higher on the opioid pain reliever or heroin scales of the Tobacco, Alcohol Prescription Medication and other Substance Use (TAPS) Tool. Structured survey items obtained patient preference for MOUD formulation and treatment model. Using stated preference methods, the study assessed preference via comparison of preferred options for MOUD and treatment model. RESULTS In the past year, 824 (96.8 %) participants reported non-prescribed use of opioid pain relievers (mean TAPS score = 2.72, SD = 0.46) and 552 (64.9 %) reported heroin or fentanyl use (mean TAPS score = 2.73, SD = 0.51). Seventy-four percent of participants (n = 631) reported currently or previously receiving OUD treatment, with 407 (48.4 %) receiving MOUD. When asked about preferences for type of MOUD formulation, 452 (53.1 %) preferred a daily oral formulation, 115 (13.5 %) preferred an implant, 114 (13.4 %) preferred a monthly injection and 95 (11.2 %) preferred a weekly injection. Approximately 8.8 % (n = 75) would not consider MOUD regardless of formulation. The majority of participants (65.2 %, n = 555) preferred receiving treatment in a specialized substance use treatment program distinct from their medical care, compared with receiving care in an integrated model (n = 296, 34.8 %). CONCLUSIONS Though most participants expressed willingness to try long-acting MOUD formulations, the majority preferred short-acting formulations. Likewise, the majority preferred non-integrated treatment in specialty substance use settings. Reasons for these preferences provide insight on developing effective educational tools for patients and suggesting targets for intervention to develop a more acceptable treatment system.
Collapse
Affiliation(s)
- Elizabeth C Saunders
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.
| | - Alan J Budney
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
| | - Emily Scherer
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
| | - Kathleen Bell
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.
| | | | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA.
| |
Collapse
|
2
|
Brandt L, Odom GJ, Hu MC, Castro C, Balise RR. Empirically contrasting urine drug screening-based opioid use disorder treatment outcome definitions. Addiction 2024; 119:1289-1300. [PMID: 38616571 DOI: 10.1111/add.16494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 02/21/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND AND AIMS A lack of consensus on the optimal outcome measures to assess opioid use disorder (OUD) treatment efficacy and their precise definition and computation has hampered the pooling of research data for evidence synthesis and meta-analyses. This study aimed to empirically contrast multiple clinical trial definitions of treatment success by applying them to the same dataset. METHODS Data analysis used a suite of functions, developed as a software package for the R language, to operationalize 61 treatment outcome definitions based on urine drug screening (UDS) results. Outcome definitions were derived from clinical trials that are among the most influential in the OUD treatment field. Outcome functions were applied to a harmonized dataset from three large-scale National Drug Abuse Treatment Clinical Trials Network (CTN) studies, which tested various medication for OUD (MOUD) options (n = 2492). Hierarchical clustering was employed to empirically contrast outcome definitions. RESULTS The optimal number of clusters identified was three. Cluster 1, comprising eight definitions focused on detecting opioid-positive UDS, did not include missing UDS in outcome calculations, potentially resulting in inflated rates of treatment success. Cluster 2, with the highest variability, included 10 definitions characterized by strict criteria for treatment success, relying heavily on UDS results from either a brief period or a single study visit. The 43 definitions in Cluster 3 represented a diverse range of outcomes, conceptualized as measuring abstinence, use reduction and relapse. These definitions potentially offer more balanced measures of treatment success or failure, as they avoid the extreme methodologies characteristic of Clusters 1 and 2. CONCLUSIONS Clinical trials using urine drug screening (UDS) for objective substance use assessment in outcome definitions should consider (1) incorporating missing UDS data in outcome computation and (2) avoiding over-reliance on UDS data confined to a short time frame or the occurrence of a single positive urine test following a period of abstinence.
Collapse
Affiliation(s)
- Laura Brandt
- Department of Psychology, The City College of New York, New York, New York, USA
| | - Gabriel J Odom
- Department of Biostatistics, Florida International University, Miami, Florida, USA
| | - Mei-Chen Hu
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Clinton Castro
- The Information School, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Raymond R Balise
- Division of Biostatistics, Department of Public Health Sciences, The University of Miami, Miami, Florida, USA
| |
Collapse
|
3
|
Azar P, Schneiderman H, Barron H, Wong JSH, Meyer M, Newman-Azar D, Narimani M, Ignaszewski MJ, Mathew N, Mullen R, Krausz RM, Maharaj AR. Rapid induction of transdermal buprenorphine to subcutaneous extended-release buprenorphine for the treatment of opioid use disorder. Addict Sci Clin Pract 2024; 19:50. [PMID: 38886826 PMCID: PMC11184727 DOI: 10.1186/s13722-024-00479-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 05/28/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Buprenorphine is an effective and safe treatment for opioid use disorder, but the requirement for moderate opioid withdrawal symptoms to emerge prior to initiation is a significant treatment barrier. CASE PRESENTATION We report on two cases of hospitalized patients with severe, active opioid use disorder, in which we initiated treatment with transdermal buprenorphine over 48 h, followed by the administration of a single dose of sublingual buprenorphine/naloxone and then extended-release subcutaneous buprenorphine. The patients did not experience precipitated withdrawal and only had mild withdrawal symptoms. CONCLUSIONS This provides preliminary evidence for a rapid induction strategy that may improve tolerability, caregiver burden, and treatment retention as compared to previous induction strategies.
Collapse
Affiliation(s)
- Pouya Azar
- Integrated Psychiatry, Pain, and Addiction Service, Vancouver General Hospital, Flr 8-2775 Laurel St, V5Z 1M9, Vancouver, BC, Canada.
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | | | - Henry Barron
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - James S H Wong
- Integrated Psychiatry, Pain, and Addiction Service, Vancouver General Hospital, Flr 8-2775 Laurel St, V5Z 1M9, Vancouver, BC, Canada
- Addictions and Concurrent Disorders Research Group, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Maximilian Meyer
- Addictions and Concurrent Disorders Research Group, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Clinic of Adult Psychiatry, University of Basel Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Dayyon Newman-Azar
- Integrated Psychiatry, Pain, and Addiction Service, Vancouver General Hospital, Flr 8-2775 Laurel St, V5Z 1M9, Vancouver, BC, Canada
| | - Matin Narimani
- Integrated Psychiatry, Pain, and Addiction Service, Vancouver General Hospital, Flr 8-2775 Laurel St, V5Z 1M9, Vancouver, BC, Canada
- School of Biomedical Engineering, Faculty of Medicine, Faculty of Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Martha J Ignaszewski
- Integrated Psychiatry, Pain, and Addiction Service, Vancouver General Hospital, Flr 8-2775 Laurel St, V5Z 1M9, Vancouver, BC, Canada
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Substance Use Response and Facilitation Service, BC Children's Hospital, Provincial Health Services Authority, British Columbia, Canada
| | - Nickie Mathew
- Integrated Psychiatry, Pain, and Addiction Service, Vancouver General Hospital, Flr 8-2775 Laurel St, V5Z 1M9, Vancouver, BC, Canada
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- BC Mental Health & Substance Use Services, Provincial Health Services Authority, British, Columbia, Canada
| | - Rodney Mullen
- Integrated Psychiatry, Pain, and Addiction Service, Vancouver General Hospital, Flr 8-2775 Laurel St, V5Z 1M9, Vancouver, BC, Canada
- The C4 Foundation, Coronado, CA, USA
| | - Reinhard M Krausz
- Addictions and Concurrent Disorders Research Group, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anil R Maharaj
- Pharmacokinetics Modeling and Simulation Laboratory, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
4
|
Pierlorenzi C, Nunzi M, Cirulli S, Direnzo GFM, Curatella L, Liberatori S, Pascucci A, Petrone E, Ventre G, Varango C, Pulito ML, Varango A, Dandolo C, Occupati B, Marenzi R, Leonardi C. Patients' perspectives on buprenorphine subcutaneous implant: a case series. J Med Case Rep 2024; 18:202. [PMID: 38581074 PMCID: PMC10998295 DOI: 10.1186/s13256-024-04483-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 03/01/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Considering the enormous burden represented by the opioid use disorder (OUD), it is important to always consider, when implementing opioid agonist therapy (OAT), the potential impact on patient's adherence, quality of life, and detoxification. Thus, the purpose of the study is to evaluate how the introduction of a novel OAT approach influences these key factors in the management of OUD. CASE PRESENTATION This article marks the pioneering use of OAT through buprenorphine implant in Europe and delves into the experience of six patients diagnosed with OUD at a relatively young age. The patients, comprising both males and a female, are of Caucasian Italian and African Italian ancestry (case 4) and exhibit an age range from 23 to 63, with an average drug abuse history of 19 ± 12 years. All patients were on stable traditional OAT before transitioning to buprenorphine implants. Despite the heterogeneity in social and educational backgrounds, health status, and drug abuse initiation histories, the case series reveals consistent positive treatment outcomes such as detoxification, absence of withdrawal symptoms and of side effects. Notably, all patients reported experiencing a newfound sense of freedom and improved quality of life. CONCLUSIONS These results emphasise the promising impact of OAT via buprenorphine implants in enhancing the well-being and quality of life in the context of OUD.
Collapse
Affiliation(s)
| | - Marco Nunzi
- UOS Patologie da Dipendenza D9 ASL Roma 2, Rome, Italy
| | | | | | | | | | | | - Edoardo Petrone
- UOS Terapia del Dolore ASL Roma 2 Ospedale S. Eugenio, Rome, Italy
| | | | | | | | | | - Cosimo Dandolo
- Servizio Dipendenze Casalpusterlengo, ASST Lodi, Lodi, Italy
| | - Brunella Occupati
- Tossicologia Medica, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Roberta Marenzi
- ASST Papa Giovanni XXII, Ospedale Di Bergamo, Bergamo, Italy
| | | |
Collapse
|
5
|
Lancaster K, Gendera S, Treloar C, Rhodes T, Shahbazi J, Byrne M, Nielsen S, Degenhardt L, Farrell M. Tinkering with care: Implementing extended-release buprenorphine depot treatment for opioid dependence. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 126:104359. [PMID: 38382354 DOI: 10.1016/j.drugpo.2024.104359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 02/23/2024]
Abstract
We examine how extended-release buprenorphine depot (BUP-XR) is put to use and made to work in implementation practices, attending to how care practices are challenged and adapted as a long-acting technology is introduced into service in opioid agonist treatment (OAT) in Australia. Our approach is informed by ideas in science and technology studies (STS) emphasising the irreducible entanglement of care practices and technology, and in particular the concept of 'tinkering' as a practice of adaptation. To make our analysis, we draw on qualitative interview accounts (n = 19) of service providers involved in BUP-XR implementation across five sites. Our analysis considers the disruptive novelty of BUP-XR. Tinkering to make a novel technology work in practice slows down the expectation of implementation in relation to transformative innovation, despite the promise of dramatic or rapid change. Tinkering allowed for more open relations, for new care practices that departed from the routine and familiar, opening potential for how BUP-XR could be put to use and made to work in its new situation, and as its situation evolved along-with its implementation. Flexibility and openness of altering relations was, however, at times, held in tension with inflexibility and closure. This analysis identifies a concern for what is made present and what is made absent in the altered care network affected by BUP-XR, with the multiple effects of supervised daily dosing practices thrown into relief as they become absented. Tinkering to implement BUP-XR locally connects with a broader assemblage of trial and movement in the constitution of treatment. The introduction of long-acting technologies prompts new questions about embedded implementation practices, including supervised dosing, urinalysis, the time and place of psychosocial support, and how other social aspects of care might be recalibrated in drug treatment.
Collapse
Affiliation(s)
- K Lancaster
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia; Goldsmiths, University of London, UK.
| | - S Gendera
- Social Policy Research Centre, University of New South Wales, Sydney, Australia
| | - C Treloar
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - T Rhodes
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia; London School of Hygiene and Tropical Medicine, UK
| | - J Shahbazi
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - M Byrne
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - S Nielsen
- Monash Addiction Research Centre, Monash University, Melbourne, Australia
| | - L Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - M Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| |
Collapse
|
6
|
Weleff J, Anand A, Squeri M, Sieke R, Thompson NR, Barnett BS. An Analysis of Benzodiazepine Prescribing to Primary Care Patients in a Large Healthcare System from 2019-2020. J Psychoactive Drugs 2024; 56:245-256. [PMID: 36940298 DOI: 10.1080/02791072.2023.2191610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/04/2023] [Indexed: 03/22/2023]
Abstract
We sought to quantify benzodiazepine prescribing by primary care providers from 2019 to 2020 and identify correlates of prescribing. We hypothesized prescribing would increase post-COVID-19 lockdown. We conducted a retrospective cohort study of adult patients with primary care visits in 2019 or 2020 in a large Ohio healthcare system. Demographics, diagnosis codes, and receipt of benzodiazepine prescriptions were collected. Using multivariable logistic regression, we examined factors associated with benzodiazepine prescription receipt during the whole study period and post-lockdown. 455,537 adult patients had 1,643,473 visits. Benzodiazepines were prescribed in 3.2% (53,049/1,643,473) of visits. Effect sizes for positive associations with benzodiazepine prescription were largest for anxiety disorders. For negative associations, they were largest for Black patients and patients with cocaine use disorder. Benzodiazepine prescribing was positively associated with multiple groups having contraindications, though effect sizes were small. Contrary to our hypothesis, odds of receiving a prescription were 8.8% lower post-lockdown. Benzodiazepine prescribing rates in our system compared favorably to national rates. Year over year odds of receiving a prescription were slightly lower post-lockdown. Racial disparities were present and deserve further study. Strategies to reduce benzodiazepine prescribing to patients with anxiety may yield the largest reductions for benzodiazepine prescribing in primary care settings.
Collapse
Affiliation(s)
- Jeremy Weleff
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Akhil Anand
- Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- EC-10 Cleveland Clinic, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, OH, USA
| | - Michael Squeri
- Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rachel Sieke
- Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nicolas R Thompson
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
- Neurological Institute, Center for Outcomes Research & Evaluation, Cleveland Clinic, Cleveland, OH, USA
| | - Brian S Barnett
- Department of Psychiatry and Psychology, Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
- EC-10 Cleveland Clinic, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, OH, USA
| |
Collapse
|
7
|
Woods RH. Dental Disorders Reported to the FDA Adverse Event Reporting System in Association with Buprenorphine: An Analysis by Ingredient Composition and Route of Administration. Curr Drug Saf 2024; 19:261-267. [PMID: 37526182 DOI: 10.2174/1574886318666230731151447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/15/2023] [Accepted: 06/21/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Prior research has suggested buprenorphine-containing medications may be associated with an increased risk of dental disorders. However, published data describing adverse dental reactions in buprenorphine users by active ingredient composition and route of administration are limited. OBJECTIVE The purpose of this study was to evaluate the influence of formulation on spontaneous reporting of dental disorders among patients treated with buprenorphine. METHODS Adverse event reports submitted to the United States Food and Drug Administration Adverse Event Reporting System (FAERS) between 2015 and 2022 were analyzed. Reporting odds ratios (ROR) and 95% confidence intervals (CI) were calculated to measure disproportionality of dental disorder reporting as classified by 39 Medical Dictionary for Regulatory Activities preferred terms. RESULTS Compared to pooled reports for all other drugs across FAERS, both buprenorphine monotherapy (ROR 3.09; 95% CI 2.61-3.66) and combination buprenorphine/naloxone (ROR 14.61; 95% CI 13.34-16.01) were associated with positive disproportionality signals. Signals of disproportionate dental disorder reporting were also detected for buprenorphine medicines administered by sublingual (ROR 20.03; 95% CI 18.04-22.24), buccal (ROR 4.46; 95% CI 3.00-6.61) and oral (ROR 7.17; 95% CI 5.03-10.22) routes, but not for other modalities. In considering active ingredient and route together, sublingual buprenorphine monotherapies (ROR 23.55; 95% CI 17.84-31.11) and sublingual buprenorphine/naloxone (ROR 19.47; 95% CI 17.39-21.80) were each associated with disproportionate reporting of dental disorders. CONCLUSION Subject to the limitations of spontaneous adverse event data, this study identified significantly disproportionate reporting of dental disorders to FAERS among patients treated with buprenorphine- containing medications, including formulations administered by sublingual, buccal and oral routes. These findings are consistent with prior data and suggest that regular oral care and proper dental hygiene be emphasized for patients undergoing therapy with orally dissolving buprenorphine.
Collapse
Affiliation(s)
- Richard H Woods
- Levin, Papantonio, Rafferty, Proctor, Buchanan, O'Brien, Barr & Mougey, P.A., Pensacola, FL 32502, United States
| |
Collapse
|
8
|
Vu PD, Bansal V, Chitneni A, Robinson CL, Viswanath O, Urits I, Kaye AD, Nguyen A, Govindaraj R, Chen GH, Hasoon J. Buprenorphine for Chronic Pain Management: a Narrative Review. Curr Pain Headache Rep 2023; 27:811-820. [PMID: 37897592 DOI: 10.1007/s11916-023-01185-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 10/30/2023]
Abstract
PURPOSE OF REVIEW The aim of this review is to educate healthcare professionals regarding buprenorphine for the use of opioid use disorder (OUD) as well as for chronic pain management. This review provides physicians and practitioners with updated information regarding the distinct characteristics and intricacies of prescribing buprenorphine. RECENT FINDINGS Buprenorphine is approved by the US Food and Drug Administration (FDA) for acute pain, chronic pain, opioid use disorder (OUD), and opioid dependence. When compared to most other opioids, buprenorphine offers superior patient tolerability, an excellent half-life, and minimal respiratory depression. Buprenorphine does have notable side effects as well as pharmacokinetic properties that require special attention, especially if patients require future surgical interventions. Many physicians are not trained to initiate or manage patients on buprenorphine. However, buprenorphine offers a potentially safer alternative for medication management for patients who require chronic opioid therapy for pain or have OUD. This review provides updated information on buprenorphine for both chronic pain and OUD.
Collapse
Affiliation(s)
- Peter D Vu
- Department of Physical Medicine and Rehabilitation, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Vishal Bansal
- Department of Physical Medicine and Rehabilitation, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Ahish Chitneni
- Department of Rehabilitation and Regenerative Medicine, New York-Presbyterian Hospital - Columbia and Cornell, New York, NY, USA
| | - Christopher L Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Omar Viswanath
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - Ivan Urits
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - Anvinh Nguyen
- Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA
| | - Ranganathan Govindaraj
- Department of Anesthesiology, Critical Care, and Pain Medicine, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Grant H Chen
- Department of Anesthesiology, Critical Care, and Pain Medicine, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
| | - Jamal Hasoon
- Department of Anesthesiology, Critical Care, and Pain Medicine, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA.
| |
Collapse
|
9
|
Scurti P, Nunzi M, Leonardi C, Pierlorenzi C, Marenzi R, Lamartora V. The experience of buprenorphine implant in patients with opioid use disorder: a series of narrative interviews. Front Psychiatry 2023; 14:1205285. [PMID: 37720906 PMCID: PMC10501400 DOI: 10.3389/fpsyt.2023.1205285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/20/2023] [Indexed: 09/19/2023] Open
Abstract
Background This study used narrative medicine (NM) to assess the point of view of patients with opioid use disorder (OUD) and the impact that addiction and a new treatment approach via buprenorphine implant had on their daily lives as compared with previous oral Opioid Agonist Therapy (OAT). Methods Five patients with OUD undergoing treatment with a buprenorphine subcutaneous implant participated voluntarily and provided their anonymity by self-describing, in response to questions prompted by the clinician, their experience with this innovative therapy. The narratives were analyzed according to standard NM methodology. Citations of patients' positive or negative experiences with traditional OAT and buprenorphine implant were classified according to five categories-patient's determination toward complete opioid abstinence, emotional impact, impact on life, smoothness of therapy, and therapy dependency-and quantified to obtain a picture of the overall therapy experience. Results The analysis revealed the extent of the burden not only of addiction but also of the traditional OAT on patients' life, including relationships with family, job management, and free time. Conversely, the therapy with buprenorphine implant revealed a significant improvement in the quality of life of the patients, who also largely reported a positive emotional outcome during this therapy, as well as a solid determination to achieve complete recovery. Conclusions This study illustrates the complex problems of living with OUD and provides insights into the added value of an innovative buprenorphine implant therapy that, due to its administration route and prolonged duration, allows patients to take an additional step toward total opioid abstinence and complete recovery of daily life.
Collapse
Affiliation(s)
| | - Marco Nunzi
- UOS Patologie da Dipendenza d9 ASL Roma 2, Roma, Italy
| | | | | | - Roberta Marenzi
- ASST Papa Giovanni XXIII, Ospedale di Bergamo, Bergamo, Italy
| | | |
Collapse
|
10
|
Maremmani I, Dematteis M, Gorzelanczyk EJ, Mugelli A, Walcher S, Torrens M. Long-Acting Buprenorphine Formulations as a New Strategy for the Treatment of Opioid Use Disorder. J Clin Med 2023; 12:5575. [PMID: 37685642 PMCID: PMC10488107 DOI: 10.3390/jcm12175575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/12/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Long-acting buprenorphine formulations have been recently marketed for the Opioid Agonist Treatment (OAT) of opioid use disorder (OUD) associated with medical, social, and psychological support. Their duration of action ranges from one week up to 6 months. The non-medical use of opioids is increasing with a parallel rise in lethal overdoses. Methadone and buprenorphine are the standard treatment for opioid dependence. Methadone Maintenance Treatment (MMT) is widely recognized as one of the most effective ways of reducing the risks of overdose, crime, and transmission of HIV (Human Immunodeficiency Virus) in people who use opioids; however, its effectiveness has been hindered by low rates of uptake and retention in treatment. Furthermore, both methadone and buprenorphine are widely diverted and misused. Thus, a crucial aspect of treating OUD is facilitating patients' access to treatment while minimizing substance-related harm and improving quality of life. The newly developed long-acting buprenorphine formulations represent a significant change in the paradigm of OUD treatment, allowing an approach individualized to patients' needs. Strengths of this individualized approach are improved adherence (lack of peaks and troughs in blood concentrations) and a reduced stigma since the patient doesn't need to attend their clinic daily or nearly daily, thus facilitating social and occupational integrations as the quality of life. However, less frequent attendance at the clinic should not affect the patient-physician relationship. Therefore, teleconsulting or digital therapeutic services should be developed in parallel. In addition, diversion and intravenous misuse of buprenorphine are unlikely due to the characteristics of these formulations. These features make this approach of interest for treating OUD in particular settings, such as subjects staying or when released from prison or those receiving long-term residential treatment for OUD in the therapeutic communities. The long-lasting formulations of buprenorphine can positively impact the OUD treatment and suggest future medical and logistic developments to maximize their personalized management and impact.
Collapse
Affiliation(s)
- Icro Maremmani
- VP Dole Research Group, G. De Lisio Institute of Behavioural Sciences, Via di Pratale 3, 56121 Pisa, Italy;
- UniCamillus, International Medical University in Rome, Via di Sant’Alessandro 8, 00131 Rome, Italy
| | - Maurice Dematteis
- Department of Pharmacology and Addiction Medicine, Grenoble-Alpes University Hospital, Grenoble Alpes University, Rue de la Chantourne, 38043 Grenoble, France;
| | - Edward J. Gorzelanczyk
- Department of Theoretical Basis of Biomedical Sciences and Medical Informatics, Nicolaus Copernicus University, Collegium Medicum, 85-067 Bydgoszcz, Poland;
- Faculty of Philosophy, Kazimierz Wielki University, 85-092 Bydgoszcz, Poland
- The Society for the Substitution Treatment of Addiction ”Medically Assisted Recovery”, 85-791 Bydgoszcz, Poland
| | - Alessandro Mugelli
- Department of Neurosciences, Psychology, Drug Research and Child Health (NeuroFarBa), University of Florence, Via della Pergola, 50121 Firenze, Italy;
| | - Stephan Walcher
- CONCEPT Center for Addiction Medicine, Kaiserstrasse 1, D-80801 Munich, Germany;
| | - Marta Torrens
- Addiction Research Group, Hospital del Mar Research Institute Barcelona, 08003 Barcelona, Spain
| |
Collapse
|
11
|
Hard B, DeSilva M. Evaluating the feasibility of prolonged-release buprenorphine formulations as an alternative to daily opioid agonist therapy regardless of prior treatment adherence: a pilot study. Pilot Feasibility Stud 2023; 9:113. [PMID: 37403145 DOI: 10.1186/s40814-023-01348-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 06/20/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Effective opioid agonist therapy (OAT) depends on good patient adherence. However, the daily, supervised administration of standard OAT represents a significant burden to patients and often drives poor adherence. Prolonged-release buprenorphine (PRB) formulations may mitigate some of this burden, enabling clinic visits to be substantially reduced. For treatment guidelines to be effective, the likely benefit of a transition to PRB therapy in different patient populations must be established. METHODS The aim was to determine the feasibility of assessing PRB as an alternative to daily OAT in two groups: those currently adhering well to daily OAT (group 1, N = 5) and those not currently showing adherence or a positive response to daily OAT (group 2, N = 10). This open-label, prospective, non-controlled pilot study was conducted at the Kaleidoscope Drug Project in South Wales, UK. Participants were assessed for history, drug use, psychosocial assessment scores, and clinical severity at baseline and after 6 months of treatment. Primary outcomes were the feasibility of assessing PRB as an alternative to daily OAT and the acceptability of PRB therapy in each group. Secondary outcomes were treatment response, on-top drug use, psychosocial measures, and assessment of clinical severity. RESULTS Participants from both groups demonstrated high levels of participation with assessment protocols at both baseline and 6-month follow-up, indicating study feasibility. PRB treatment was acceptable to the majority of participants, with all of group 1 and 70% of group 2 adhering to PRB therapy for the duration of the study and opting to persist with PRB therapy over other OAT options after study completion. All participants who remained on treatment demonstrated marked improvements in psychosocial and clinical severity assessment scores, with some returning to employment or education. On-top drug use remained absent in group 1 and was reduced in group 2. CONCLUSIONS Evaluation of transition of participants from daily OAT to PRB therapy was shown to be feasible, acceptable, and effective across both groups. A larger randomised controlled trial is warranted, particularly to assess PRB therapy in participants with a history of poor treatment engagement, as the need for therapy is greater in this group and their management is associated with higher costs of care.
Collapse
Affiliation(s)
- Bernadette Hard
- Kaleidoscope Drug Project, Resolven House, St Mellons Business Park, Fortran Rd Cardiff, Wales, CF3 0EY, UK.
| | - Mohan DeSilva
- Kaleidoscope Drug Project, Resolven House, St Mellons Business Park, Fortran Rd Cardiff, Wales, CF3 0EY, UK
| |
Collapse
|
12
|
Moses TEH, Waineo E, Levine D, Greenwald MK. Optimizing buprenorphine training during undergraduate medical education: Medical student feedback and attitudes. Am J Addict 2023; 32:376-384. [PMID: 36850044 PMCID: PMC10313763 DOI: 10.1111/ajad.13395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 02/03/2023] [Accepted: 02/08/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Strong evidence supports efficacy of medications for opioid use disorder (MOUD), but stringent prescribing policies impair access. Many physicians report discomfort prescribing MOUD due to inadequate knowledge. Most medical students believe MOUD training should occur during undergraduate medical education (UME). As legislation surrounding buprenorphine prescribing shifts, it is timely to consider how best to incorporate MOUD training into UME. METHODS At the start of 3rd year, all students (n = 290) received a survey regarding experiences working with people with OUDs, and beliefs and knowledge regarding harm reduction and treatment. During orientation, students completed an 8-h online MOUD training. Afterwards, students completed another survey, including questions about training perceptions. RESULTS One-third of students (32.8%) completed MOUD training and both surveys. Before training, 60.0% had not heard of the waiver, but 82.1% endorsed interest in prescribing buprenorphine. Despite mixed feelings about training content and delivery, 79.1% believed future classes should receive it. Most thought it should be integrated longitudinally throughout the curriculum rather than as separate online training. CONCLUSION AND SCIENTIFIC SIGNIFICANCE Medical students want more MOUD education throughout their training; however, the 8-h online training may be less-than-optimal. As this training is no longer required to prescribe buprenorphine, there is an opportunity to modify the content presented. There is an urgent need for physicians with the knowledge and willingness to treat patients with OUD. Introducing integrated training about MOUD should help future physicians feel confident in their knowledge to treat patients and comfortable applying for the waiver.
Collapse
Affiliation(s)
- Tabitha E H Moses
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Eva Waineo
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Diane Levine
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Mark K Greenwald
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan, USA
| |
Collapse
|
13
|
Swain JE, Ho SS. Brain circuits for maternal sensitivity and pain involving anterior cingulate cortex among mothers receiving buprenorphine treatment for opioid use disorder. J Neuroendocrinol 2023; 35:e13316. [PMID: 37491982 DOI: 10.1111/jne.13316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 06/09/2023] [Accepted: 06/10/2023] [Indexed: 07/27/2023]
Abstract
Opioid-induced deficits in maternal behaviors are well-characterized in rodent models. Amid the current epidemic of opioid use disorder (OUD), prevalence among pregnant women has risen sharply. Yet, the roles of buprenorphine replacement treatment for OUD (BT/OUD) in the brain functions of postpartum mothers are unclear. Using functional magnetic resonance imaging (fMRI), we have developed an evolutionarily conserved maternal behavior neurocircuit (MBN) model to study human maternal care versus defensive/aggressive behaviors critical to mother-child bonding. The anterior cingulate gyrus (ACC) is not only involved in the MBN for mother-child bonding and attachment, but also part of an opioid sensitive "pain-matrix". The literature suggests that prescription opioids produce physical and emotional "analgesic" effects by disrupting specific resting-state functional connectivity (rs-FC) of ACC to regions related to MBN. Thus, in this longitudinal study, we report findings of overlapping MBN and pain matrix circuits, for mothers with chronic exposure of BT/OUD. A total of 32 mothers were studied with 6 min rs-FC at 1 month (T1) and 4 months postpartum (T2), including seven on BT/OUD and 25 non-BT/OUD mothers as a comparison group. We analyzed rs-FC between the insula, putamen, and the dorsal anterior cingulate cortex (DACC) and rostral ACC (RACC), as the regions of interest that mediate opioid analgesia. BT/OUD mothers, as compared to non-BT/OUD mothers, showed less left insula-RACC rs-FC but greater right putamen-DACC rs-FC at T1, with these between-group differences diminished at T2. Some of these rs-FC results were correlated with the scores of postpartum parental bonding questionnaire. We found time-by-treatment interaction effects on DACC and RACC-dependent rs-FC, potentially identifying brain mechanisms for beneficial effects of BT, normalizing dysfunction of maternal brain and behavior over the first four months postpartum. This study complements recent studies to ascertain how BT/OUD affects maternal behaviors, mother-child bonding, and intersubjectivity and reveals potential MBN/pain-matrix targets for novel interventions.
Collapse
Affiliation(s)
- James E Swain
- Department of Psychiatry and Behavioral Health, Renaissance School Of Medicine at Stony Brook University, Stony Brook, New York, USA
- Department of Psychology, Program in Public Health, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA
- Department of Obstetrics, Gynecology and Reproductive Medicine, Program in Public Health, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - S Shaun Ho
- Department of Psychiatry and Behavioral Health, Renaissance School Of Medicine at Stony Brook University, Stony Brook, New York, USA
| |
Collapse
|
14
|
Torres-Terán I, Venczel M, Stieler T, Parisi L, Kloss A, Klein S. Prediction of subcutaneous drug absorption - characterization of subcutaneous interstitial fluids as a basis for developing biorelevant in vitro models. Int J Pharm 2023; 638:122906. [PMID: 37001831 DOI: 10.1016/j.ijpharm.2023.122906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/26/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023]
Abstract
Unlike orally administered drugs, the absorption profile of subcutaneously injectable drugs in humans is difficult to predict from preclinical studies. Since the subcutaneous interstitial fluid (ISF) is the first fluid interacting with the administered formulation before the respective drug is absorbed, it could critically affect bioavailability. The aim of the present study was to gain a better understanding of the similarities and differences of ISF of different species. For this purpose, ISF was isolated from subcutaneous tissues of five preclinical animal species, i.e., mice, rats, minipig, landrace pig, non-human primates, and humans, using a centrifugation method, and characterized with respect to its major constituents and physicochemical properties. The results show trends between animal species, with ISF from non-human primates differing significantly from that of the other preclinical species for most parameters analyzed and showing similarities to ISF of human origin. Although from a statistical point of view it will be necessary to further increase the existing data sets, the presented data provide valuable information for the development of biorelevant in vitro models to predict the in vivo performance of subcutaneously administered formulations, as they provide fundamental information for the design of biorelevant ISF media for both preclinical species and humans.
Collapse
|
15
|
Khodaverdi E, Hadizadeh F, Hoseini N, Eisvand F, Tayebi M, Kamali H, Oroojalian F. In-vitro and in-vivo evaluation of sustained-release buprenorphine using in-situ forming lipid-liquid crystal gels. Life Sci 2023; 314:121324. [PMID: 36574944 DOI: 10.1016/j.lfs.2022.121324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 12/15/2022] [Accepted: 12/20/2022] [Indexed: 12/25/2022]
Abstract
AIMS Sustained-release systems reduce the incidence of drug side effects and the need for frequent drug consumption, thus increasing patient compliance with treatment. In this study, we aimed to produce sustained-release buprenorphine (BP) using lipid-liquid crystal gels. MAIN METHODS The three experimental groups in this study included: group I: lipid-liquid crystal formulation 5 (F5) containing BP, group II: BP-free F5, group III: BP solution in NMP, and group IV: control (no treatment). The formulations were injected subcutaneously into the rabbits' back neck. KEY FINDINGS The results showed that the time required to reach the drug's maximum concentration (Tmax) was longer in group I than in group III. The maximum BP concentration (Cmax) and the constants of the drug removal rate and drug absorption rate (Ka) were significantly higher in group III compared to group I. The half-life (t1/2) of the drug in blood circulation was significantly longer in group I than in group III. Histopathological analysis revealed no histological abnormalities in the skin and heart in group I (BP-containing F5); however, mild hyperemia was observed in interstitial vessels in group III (BP-containing NMP). The kidney and liver tissues showed normal structure in the control group, as well as groups I and II. However, in the group receiving BP-containing NMP, significant congestion, tissue damage, necrosis, and fibrosis were observed in the kidney and liver. SIGNIFICANCE The results showed that the lipid-liquid crystal system can be used to design slow-release platforms for BP, minimizing the side effects associated with the use of its conventional forms.
Collapse
Affiliation(s)
- Elham Khodaverdi
- Targeted Drug Delivery Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Pharmaceutics, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farzin Hadizadeh
- Department of Medicinal Chemistry, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran; Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nilofarsadat Hoseini
- Targeted Drug Delivery Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Pharmaceutics, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farhad Eisvand
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohadeseh Tayebi
- Targeted Drug Delivery Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Pharmaceutics, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein Kamali
- Targeted Drug Delivery Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Pharmaceutics, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Fatemeh Oroojalian
- Department of Advanced Technologies, School of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran; Natural Products and Medicinal Plants Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran.
| |
Collapse
|
16
|
History of the discovery, development, and FDA-approval of buprenorphine medications for the treatment of opioid use disorder. DRUG AND ALCOHOL DEPENDENCE REPORTS 2023; 6:100133. [PMID: 36994370 PMCID: PMC10040330 DOI: 10.1016/j.dadr.2023.100133] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 01/12/2023]
Abstract
Buprenorphine-based medications were first approved by the United States Food and Drug Administration in 2002 for the treatment of opioid dependence, or opioid use disorder (OUD) as the condition is presently known. This regulatory milestone was the outcome of 36 years of research and development, which also led to the development and approval of several other new buprenorphine-based medications. In this short review, we first describe the discovery and early development stages of buprenorphine. Second, we review key steps that led to the development of buprenorphine as a drug product. Third, we explain the regulatory approval of several buprenorphine-based medications for the treatment of OUD. We also discuss these developments in the context of the evolution of regulations and policies that have progressively improved OUD treatment availability and efficacy, although challenges remain in removing system-level, provider-level, and local-level barriers to quality treatment, to integrating OUD treatment into routine care and other settings, to reducing disparities in access to treatment, and to optimizing person-centered outcomes.
Collapse
|
17
|
Foltin RW, Zale S, Sykes KA, Nagaraj N, Scranton RE, Comer SD. A novel long-acting formulation of oral buprenorphine/naloxone produces prolonged decreases in fentanyl self-administration by rhesus monkeys. Drug Alcohol Depend 2022; 239:109599. [PMID: 35963210 DOI: 10.1016/j.drugalcdep.2022.109599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Due to the poor oral bioavailability of buprenorphine, an oral formulation has not been thought possible. Lyndra Therapeutics is developing a once-weekly long-acting oral product containing buprenorphine. We evaluated the efficacy of this formulation in reducing intravenous (i.v.) fentanyl self-administration by three male and three female rhesus monkeys. METHODS Buprenorphine HCl and naloxone HCl were co-formulated using an 11:1 ratio of buprenorphine:naloxone in a controlled-release gastric residence formulation administered in an oral capsule (LYN-013). Naloxone was included to determine the feasibility of combining naloxone with buprenorphine in the formulation as an abuse deterrent. Complete fentanyl dose-response functions were determined during each session. The efficacy of single doses of 56/5, 112/10 and 168/15 mg buprenorphine/naloxone in reducing fentanyl self-administration was examined over 13 days. RESULTS LYN-013 significantly decreased the rate of responding for fentanyl for 3 days and significantly reduced total intake of fentanyl for 8 days. Time to maximal buprenorphine levels (Tmax) ranged between 56 and 68 h for all 3 doses. The maximal buprenorphine level (Cmax) following 168 mg was 2.3 ng/ml which was significantly greater that those observed for 56 mg (1.22 ng/ml) and 112 mg (1.35 ng/ml). Finally, the area-under-curves (AUCtau) were buprenorphine dose-dependently increased from 88 to 127-265 h*ng/ml. There were no signs of non-specific changes in behavior. CONCLUSIONS A once-weekly oral buprenorphine/naloxone formulation produced sustained suppression of fentanyl self-administration in monkeys suggesting that oral delivery of buprenorphine with this formulation could provide a new opportunity to treat opioid use disorders (OUD).
Collapse
Affiliation(s)
- Richard W Foltin
- Division on Substance Use Disorders, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Stephen Zale
- Lyndra Therapeutics, Inc., 65 Grove St, Watertown, MA 02472, USA
| | - Kristine A Sykes
- Lyndra Therapeutics, Inc., 65 Grove St, Watertown, MA 02472, USA
| | - Nayana Nagaraj
- Lyndra Therapeutics, Inc., 65 Grove St, Watertown, MA 02472, USA
| | | | - Sandra D Comer
- Division on Substance Use Disorders, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and Columbia University Irving Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
| |
Collapse
|
18
|
Zhang J, Song C, Dai J, Li L, Yang X, Chen Z. Mechanism of opioid addiction and its intervention therapy: Focusing on the reward circuitry and mu‐opioid receptor. MedComm (Beijing) 2022; 3:e148. [PMID: 35774845 PMCID: PMC9218544 DOI: 10.1002/mco2.148] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 05/03/2022] [Accepted: 05/07/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Jia‐Jia Zhang
- National Translational Science Center for Molecular Medicine & Department of Cell Biology The Fourth Military Medical University Xi'an China
| | - Chang‐Geng Song
- Department of Neurology Xijing Hospital The Fourth Military Medical University Xi'an China
| | - Ji‐Min Dai
- Department of Hepatobiliary Surgery Xijing Hospital The Fourth Military Medical University Xi'an China
| | - Ling Li
- National Translational Science Center for Molecular Medicine & Department of Cell Biology The Fourth Military Medical University Xi'an China
| | - Xiang‐Min Yang
- National Translational Science Center for Molecular Medicine & Department of Cell Biology The Fourth Military Medical University Xi'an China
| | - Zhi‐Nan Chen
- National Translational Science Center for Molecular Medicine & Department of Cell Biology The Fourth Military Medical University Xi'an China
| |
Collapse
|
19
|
Poliwoda S, Noor N, Jenkins JS, Stark CW, Steib M, Hasoon J, Varrassi G, Urits I, Viswanath O, Kaye AM, Kaye AD. Buprenorphine and its formulations: a comprehensive review. Health Psychol Res 2022; 10:37517. [PMID: 35999975 PMCID: PMC9392838 DOI: 10.52965/001c.37517] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023] Open
Abstract
Buprenorphine, a novel long-acting analgesic, was developed with the intention of two purposes: analgesia and opioid use disorder. Regarding its pharmacodynamics, it is a partial agonist at mu receptors, an inverse agonist at kappa receptors, and an antagonist at delta receptors. For the purpose of analgesia, three formulations of buprenorphine were developed: IV/IM injectable formulation (Buprenex®), transdermal patch formulation (Butrans®), and buccal film formulation (Belbuca®). Related to opioid dependence, the formulations developed were subcutaneous extended release (Sublocade®), subdermal implant (Probuphine®), and sublingual tablets (Subutex®). Lastly, in order to avoid misuse of buprenorphine for opioid dependence, two combination formulations paired with naloxone were developed: film formulation (Suboxone®) and tablet formulation (Zubsolv®). In this review, we present details of each formulation along with their similarities and differences between each other and clinical considerations.
Collapse
Affiliation(s)
| | - Nazir Noor
- Department of Anesthesiology, Mount Sinai Medical Center
| | | | - Cain W Stark
- Medical College of Wisconsin, 8701 West Watertown Plank Road, Wauwatosa, WI 53226
| | - Mattie Steib
- Louisiana State University Health Shreveport School of Medicine
| | - Jamal Hasoon
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, Beth Israel Deaconess Medical Center
| | | | - Ivan Urits
- Department of Anesthesiology, 1501 Kings Hwy, Shreveport, LA 71103, Louisiana State University Health Shreveport
| | - Omar Viswanath
- Clinical Professor of Anesthesiology, LSU Health Sciences Center School of Medicine, Creighton University School of Medicine, Innovative Pain and Wellness
| | - Adam M Kaye
- Department of Pharmacy Practice, Stockton, CA, 95211,, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific
| | - Alan D Kaye
- Department of Anesthesiology, Shreveport, LA, Louisiana State University Health Sciences Center - Shreveport
| |
Collapse
|
20
|
Swain JE, Ho SS. Reduced Child-Oriented Face Mirroring Brain Responses in Mothers With Opioid Use Disorder: An Exploratory Study. Front Psychol 2022; 12:770093. [PMID: 35185679 PMCID: PMC8854864 DOI: 10.3389/fpsyg.2021.770093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 12/29/2021] [Indexed: 02/01/2023] Open
Abstract
While the prevalence of opioid use disorder (OUD) among pregnant women has multiplied in the United States in the last decade, buprenorphine treatment (BT) for peripartum women with OUD has been administered to reduce risks of repeated cycles of craving and withdrawal. However, the maternal behavior and bonding in mothers with OUD may be altered as the underlying maternal behavior neurocircuit (MBN) is opioid sensitive. In the regulation of rodent maternal behaviors such as licking and grooming, a series of opioid-sensitive brain regions are functionally connected, including the ventral pallidum (VP). In humans, these brain regions, interact with the supplementary motor area (SMA) to regulate maternal behaviors and are functionally dysregulated by opioids. It is unclear how these brain regions respond to the emotions of their child for mothers receiving BT. In this functional magnetic resonance imaging (fMRI) pilot study in 22 mothers within the first postpartum year, including six mothers receiving BT and 16 non-OUD mothers as a comparison group (CG), we devised a child face mirroring task in fMRI settings to assess maternal responses to pictures of facial expressions of own child and an unknown child in an empathic mirroring condition (Join) and a non-mirroring observation condition (Observe). In each condition, faces of neutral, ambiguous, distressed, and joyful expressions of each child were repeatedly displayed in a random order. The response of SMA during empathic mirroring (Join) vs. non-mirroring (Observe) of own child was reduced among BT/OUD vs. CG. Within MBN, the left VP, critical for parental sensitivity, had a similar deficit. This study outlines potential mechanisms for investigating the risks of deficits in the neural responses to actual maternal sensitivity and parenting behavior in mothers with OUD, and potential targets for interventions that reduce stress and augment maternal behavior and child outcome.
Collapse
Affiliation(s)
- James E. Swain
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, United States
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
- Department of Obstetrics, Gynecology, and Reproductive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, United States
- Program in Public Health, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, United States
- Department of Psychiatry and Psychology, Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, United States
- *Correspondence: James E. Swain,
| | - S. Shaun Ho
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, United States
| |
Collapse
|
21
|
Abstract
This review summarizes current evidence related to perioperative opioid prescription fulfillment and use and discusses the role of personalized anesthesia care in mitigating opioid-related harms without compromising analgesia.
Collapse
|
22
|
Soyka M. Transition From Full Mu Opioid Agonists to Buprenorphine in Opioid Dependent Patients-A Critical Review. Front Pharmacol 2021; 12:718811. [PMID: 34887748 PMCID: PMC8650116 DOI: 10.3389/fphar.2021.718811] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 10/05/2021] [Indexed: 12/28/2022] Open
Abstract
Methadone, a full opioid agonist at the mu-, kappa-, and delta-receptor, and buprenorphine, a partial agonist at the mu receptor, are first-line medications in opioid maintenance treatment. Transition from methadone to buprenorphine may precipitate withdrawal, and no accepted algorithm for this procedure has been developed. Current treatment strategies recommend transfer from methadone to buprenorphine predominantly in patients at low doses of methadone (30-40 mg/day). There are some reports indicating that transition from higher doses of methadone may be possible. A number of dosing strategies have been proposed to soften withdrawal symptoms and facilitate transfer including use of other opioids or medications and especially microdosing techniques for buprenorphine. The case series and studies available thus far are reviewed.
Collapse
Affiliation(s)
- Michael Soyka
- Psychiatric Hospital, University of Munich, Munich, Germany
| |
Collapse
|
23
|
Nalven T, Spillane NS, Schick MR, Weyandt LL. Diversity inclusion in United States opioid pharmacological treatment trials: A systematic review. Exp Clin Psychopharmacol 2021; 29:524-538. [PMID: 34242040 PMCID: PMC8511246 DOI: 10.1037/pha0000510] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pharmacological treatments for opioid use disorders (OUDs) may have mixed efficacy across diverse groups, i.e., sex/gender, race/ethnicity, and socioeconomic status (SES). The present systematic review aims to examine how diverse groups have been included in U.S. randomized clinical trials examining pharmacological treatments (i.e., methadone, buprenorphine, or naltrexone) for OUDs. PubMed was systematically searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The initial search yielded 567 articles. After exclusion of ineligible articles, 50 remained for the present review. Of the included articles, 14.0% (n = 7) reported both full (i.e., accounting for all participants) sex/gender and race/ethnicity information; only two of those articles also included information about any SES indicators. Moreover, only 22.0% (n = 11) reported full sex/gender information, and 42.0% (n = 21) reported full racial/ethnic information. Furthermore, only 10.0% (n = 5) reported that their lack of subgroup analyses or diverse samples was a limitation to their studies. Particularly underrepresented were American Indian/Alaska Native (AI/AN), Asian, Native Hawaiian/Other Pacific Islander (NH/OPI), and multiracial individuals. These results also varied by medication type; Black individuals were underrepresented in buprenorphine randomized controlled trials (RCTs) but were well represented in RCTs for methadone and/or naltrexone. In conclusion, it is critical that all people receive efficacious pharmacological care for OUDs given the ongoing opioid epidemic. Findings from the present review, however, support that participants from diverse or marginalized backgrounds are underrepresented in treatment trials, despite being at increased risk for disparities related to OUDs. Suggestions for future research are advanced. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Collapse
Affiliation(s)
- Tessa Nalven
- Department of Psychology, University of Rhode Island
| | | | | | | |
Collapse
|
24
|
Soyka M, Franke AG. Recent advances in the treatment of opioid use disorders–focus on long-acting buprenorphine formulations. World J Psychiatry 2021; 11:543-552. [PMID: 34631459 PMCID: PMC8474991 DOI: 10.5498/wjp.v11.i9.543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/06/2021] [Accepted: 08/04/2021] [Indexed: 02/06/2023] Open
Abstract
Oral methadone or sublingual buprenorphine are first-line medications for pharmacotherapy of opioid use disorders (OUDs). Three long-acting buprenorphine depot or implant formulations are currently available for the treatment of OUDs: (1) CAM 2038 (Buvidal) for subcutaneous weekly and monthly application; (2) RBP-6000 (Sublocade™) as a monthly depot formulation; and (3) A six-month buprenorphine implant [Probuphine™]. The pharmacology, clinical efficacy and prospects of these medications are discussed.
Collapse
Affiliation(s)
- Michael Soyka
- Psychiatric Hospital, University of Munich, München 80336, Germany
| | | |
Collapse
|
25
|
Soyka M, Groß G. Transition from methadone to subcutaneous buprenorphine depot in patients with opioid use disorder in custodial setting - a case series. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2021; 47:599-604. [PMID: 34407703 DOI: 10.1080/00952990.2021.1963757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Methadone, a full opioid agonist, and buprenorphine, a partial agonist at the opioid receptor, are established first-line medications for opioid maintenance therapy. Transition from methadone to sublingual buprenorphine may precipitate withdrawal and is usually performed only in patients on low dose of methadone (<30-40 mg). Transition from methadone to a novel subcutaneous buprenorphine depot (Buvidal) has not been previously described. OBJECTIVES To test the hypothesis that a rapid transition from methadone to buprenorphine depot after a single dose of buprenorphine 4 mg sublingual is safe and well tolerated. METHODS Retrospective chart analysis of a case series of seven opioid users under custodial setting (prison) who were switched from methadone to buprenorphine depot (initial dose 16 mg weekly subcutaneously) after an initial test dose of buprenorphine 4 mg sublingual within 48 hours. RESULTS Clinical data indicate that a rapid transition from methadone to depot buprenorphine is feasible (six patients within 48 hours, one within 4 days). All patients were successfully switched to buprenorphine depot and the transfer period was completed without dropouts or major medical problems. Further dose adjustments were performed in 4 of 7 patients. CONCLUSIONS Transition of opioid users from methadone to buprenorphine depot is feasible and safe via 4 mg buprenorphine sublingual. This procedure may facilitate induction of buprenorphine depot formulations in patients treated with methadone.
Collapse
Affiliation(s)
- Michael Soyka
- Psychiatric Hospital University of Munich, Munich, Germany
| | - Gregor Groß
- Psychiatric Department, Justizvollzugsanstalt Straubing, Straubing, Germany
| |
Collapse
|
26
|
Bartlett SR, Wong S, Yu A, Pearce M, MacIsaac J, Nouch S, Adu P, Wilton J, Samji H, Clementi E, Velasquez H, Jeong D, Binka M, Alvarez M, Wong J, Buxton J, Krajden M, Janjua NZ. The impact of current opioid agonist therapy on hepatitis C virus treatment initiation among people who use drugs from in the DAA era: A population-based study. Clin Infect Dis 2021; 74:575-583. [PMID: 34125883 DOI: 10.1093/cid/ciab546] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Evidence that opioid agonist therapy (OAT) is associated with increased odds of hepatitis C virus (HCV) treatment initiation among people who use drugs (PWUD) is emerging. The objective of this study was to determine the association between current OAT and HCV treatment initiation among PWUD in a population-level linked administrative dataset. METHODS The British Columbia (BC) Hepatitis Testers Cohort was used for this study, which includes all people tested for or diagnosed with HCV in BC, linked to medical visits, hospitalizations, laboratory, prescription drug, and mortality data from 1992 until 2019. PWUD with injecting drug use or opioid use disorder and chronic HCV infection were identified for inclusion in this study. HCV treatment initiation was the main outcome, and subdistribution proportional hazards modeling was used to assess the relationship with current OAT. RESULTS 13,803 PWUD with chronic HCV were included in this study. Among those currently on OAT at the end of the study period, 47% (2,704/5,770) had started HCV treatment, whereas 22% (1778/8033) of those not currently on OAT has started HCV treatment .. Among PWUD with chronic HCV infection, current OAT was associated with higher likelihood of HCV treatment initiation in time to event analysis (adjusted hazard ratio 1.84 [95%CI, 1.50, 2.26]). CONCLUSIONS Current OAT was associated with a higher likelihood of HCV treatment initiation. However, many PWUD with HCV currently receiving OAT have yet to receive HCV treatment. Enhanced integration between substance use care and HCV treatment is needed to improve the overall health of PWUD.
Collapse
Affiliation(s)
- Sofia R Bartlett
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Stanley Wong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Amanda Yu
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Margo Pearce
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Julia MacIsaac
- Division of Addiction Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Susan Nouch
- Department of Family and Community Practice, Vancouver Coastal Health, Vancouver, BC, Canada.,Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Prince Adu
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - James Wilton
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Hasina Samji
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Emilia Clementi
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Hector Velasquez
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Dahn Jeong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Mawuena Binka
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Maria Alvarez
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Jason Wong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jane Buxton
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
27
|
Mielau J, Vogel M, Gutwinski S, Mick I. New Approaches in Drug Dependence: Opioids. CURRENT ADDICTION REPORTS 2021; 8:298-305. [PMID: 34055568 PMCID: PMC8149259 DOI: 10.1007/s40429-021-00373-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2021] [Indexed: 11/16/2022]
Abstract
Purpose of Review This article aims to provide an overview of standard and adjunctive treatment options in opioid dependence in consideration of therapy-refractory courses. The relevance of oral opioid substitution treatment (OST) and measures of harm reduction as well as heroin-assisted therapies are discussed alongside non-pharmacological approaches. Recent Findings Currently, recommendation can be given for OST with methadone, buprenorphine, slow-release oral morphine (SROM), and levomethadone. Heroin-assisted treatment using diamorphine shall be considered as a cost-effective alternative for individuals not responding to the afore-mentioned opioid agonists in order to increase retention and reduce illicit opioid use. The modalities of application and the additional benefits of long-acting formulations of buprenorphine should be sufficiently transferred to clinicians and the eligible patients; simultaneously methods to improve planning of actions and self- management need to be refined. Regarding common primary outcomes in research on opioid treatment, evidence of the effectiveness of adjunctive psychological interventions is scarce. Summary Maintaining a harm reduction approach in the treatment of opioid addiction, a larger range of formulations is available for the prescribers. Embedding the pharmacological, ideally individualized treatment into a holistic, structure-giving concept also requires a reduction of fragmentation of ancillary services available, drug policies, and treatment philosophies on a global scale.
Collapse
Affiliation(s)
- Juliane Mielau
- Department of Psychiatry and Psychotherapy, Psychiatric Hospital of Charité at St. Hedwig Hospital, Große Hamburger Straße 5- 11, 10115 Berlin, Germany
| | - Marc Vogel
- Department of Addictive Disorders, Psychiatric University Clinic Basel, Basel, Switzerland.,Department of Addictive Disorders, Psychiatric Services Thurgau, Muensterlingen, Switzerland
| | - Stefan Gutwinski
- Department of Psychiatry and Psychotherapy, Psychiatric Hospital of Charité at St. Hedwig Hospital, Große Hamburger Straße 5- 11, 10115 Berlin, Germany
| | - Inge Mick
- Department of Psychiatry and Psychotherapy, Psychiatric Hospital of Charité at St. Hedwig Hospital, Große Hamburger Straße 5- 11, 10115 Berlin, Germany
| |
Collapse
|
28
|
Peckham AM, Kehoe LG, Gray JR, Wakeman SE. Real-world outcomes with extended-release buprenorphine (XR-BUP) in a low threshold bridge clinic: A retrospective case series. J Subst Abuse Treat 2021; 126:108316. [PMID: 34116808 DOI: 10.1016/j.jsat.2021.108316] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/27/2020] [Accepted: 01/23/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND In clinical trial settings, extended-release buprenorphine (XR-BUP) is noninferior to sublingual buprenorphine and may offer some advantages. However, real-world experiences of XR-BUP are limited and outcomes are unknown for low-threshold clinics with high-risk populations. Practical guidance is lacking on overcoming treatment challenges, such as inability for some to stabilize on sublingual (SL) BUP for seven days prior to XR-BUP and ongoing craving/withdrawal symptoms during treatment. METHODS Retrospective case series of a convenience sample of 40 serial adults with opioid use disorder (OUD) treated with XR-BUP from Massachusetts General Hospital bridge clinic from February 1, 2019, to July 31, 2019. RESULTS Patients were mostly male (67.5%), non-Hispanic white (97.5%), unstably housed (77.5%), and average age of 32.1 years old. The average SL BUP dose prior to XR-BUP was 18.6 mg (standard deviation [SD] = 5; range 8-32) for an average treatment duration of 105 days (SD = 191; range 1-810). Ten (25%) patients received SL BUP for fewer than the seven recommended days (mean = 3.7, SD = 1.4, range = 1-6). Standard induction dosing was administered to 30%, empiric high-dose XR-BUP (300 mg monthly) was administered to 25%, and 55% were treated with supplemental SL BUP ranging from 4 to24mg, daily or as needed, for varying time periods. At the end of data collection, 65% remained on XR-BUP, 30% discontinued XR-BUP, and one patient was lost to follow-up. Acute care utilization rates were similar between patients who continued XR-BUP versus discontinued at 18.5% and 16.6%, respectively (χ2 = 0.02, p-value = 0.89). Toxicology was negative for other opioids in 65% of patients throughout treatment. There were no reports of overdose, withdrawal after use of opioids, or precipitated withdrawal after subsequent XR-BUP. Patients' most cited reason for discontinuing XR-BUP was a preference for SL BUP. CONCLUSION This real-world evaluation of XR-BUP in a low-threshold clinic found that treatment was feasible, well tolerated, and outcomes were good, with most individuals choosing to continue treatment and a majority with no evidence of ongoing opioid use or precipitated withdrawal.
Collapse
Affiliation(s)
- Alyssa M Peckham
- Department of Pharmacy, Massachusetts General Hospital, 55 Fruit St, Boston, MA, United States of America; School of Pharmacy, Bouvé College of Health Sciences, Northeastern University, 360 Huntington Ave, Boston, MA, United States of America.
| | - Laura G Kehoe
- Department of Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, United States of America.
| | - Jessica R Gray
- Department of Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, United States of America.
| | - Sarah E Wakeman
- Department of Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, United States of America.
| |
Collapse
|
29
|
Johnson AR, Forster SP, White D, Terife G, Lowinger M, Teller RS, Barrett SE. Drug eluting implants in pharmaceutical development and clinical practice. Expert Opin Drug Deliv 2021; 18:577-593. [PMID: 33275066 DOI: 10.1080/17425247.2021.1856072] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction: Drug eluting implants offer patient convenience and improved compliance through less frequent dosing, eliminating repeated, painful injections and providing localized, site specific delivery with applications in contraception, ophthalmology, and oncology.Areas covered: This review provides an overview of available implant products, design approaches, biodegradable and non-biodegradable polymeric materials, and fabrication techniques with a focus on commercial applications and industrial drug product development. Developing trends in the field, including expanded availability of suitable excipients, development of novel materials, scaled down manufacturing process, and a wider understanding of the implant development process are discussed and point to opportunities for differentiated drug eluting implant products.Expert opinion: In the future, long-acting implants will be important clinical tools for prophylaxis and treatment of global health challenges, especially for infectious diseases, to reduce the cost and difficulty of treating chronic indications, and to prolong local delivery in difficult to administer parts of the body. These products will help improve patient safety, adherence, and comfort.
Collapse
Affiliation(s)
- Ashley R Johnson
- Pharmaceutical Sciences, Merck & Co., Inc., Merck & Co., Inc., Rahway, NJ, USA
| | - Seth P Forster
- Pharmaceutical Sciences, Merck & Co., Inc., Merck & Co., Inc., Rahway, NJ, USA
| | | | - Graciela Terife
- Pharmaceutical Sciences, Merck & Co., Inc., Merck & Co., Inc., Rahway, NJ, USA
| | - Michael Lowinger
- Pharmaceutical Sciences, Merck & Co., Inc., Merck & Co., Inc., Rahway, NJ, USA
| | | | - Stephanie E Barrett
- Pharmaceutical Sciences, Merck & Co., Inc., Merck & Co., Inc., Rahway, NJ, USA
| |
Collapse
|
30
|
Chappuy M, Meroueh F, Trojak B, Bachellier J, Bendimerad P, Kosim M, Hjelmström P, Nubukpo P, Brousse G, Rolland B. Factors of Interest in Extended-Release Buprenorphine: Comparisons Between Incarcerated and Non-Incarcerated Patients with Opioid Use Disorder. Patient Prefer Adherence 2021; 15:1259-1267. [PMID: 34163143 PMCID: PMC8214559 DOI: 10.2147/ppa.s311674] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/22/2021] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Extended-release buprenorphine (XR-BUP) covers a range of formulations of buprenorphine-based treatments for opioid use disorder (OUD) that release the medication over a period of one week, one month, or six months. OUD is particularly prevalent among incarcerated populations, and previous findings have shown that incarcerated subjects were not less interested in XR-BUP than non-incarcerated subjects. However, no study has ever investigated whether the factors of interest in XR-BUP were similar in incarcerated and non-incarcerated populations. PATIENTS AND METHODS We carried out post-hoc analyses using data from the "AMBRE" survey, which was conducted among 366 individuals with OUD, that were recruited in 68 French addiction settings, including six prison medical centers. The reasons for interest in XR-BUP were compared between incarcerated and non-incarcerated interviewees, using logistic regressions models, which provided raw and adjusted odds ratios (aORs) and 95% confidence intervals (95% CI). Adjustment variables were gender, age category, level of education, and type of current medication for OUD, respectively. RESULTS Data from 317 participants (ie, 221 non-incarcerated, and 96 incarcerated individuals) were included in the analyses. Adjusted comparisons found that "no longer taking a daily treatment" (aOR= 2.91; 95% CI= 1.21-6.98) and "having a more discreet medication" (aOR= 1.76; 95% CI= 1.01-3.10) were reasons that appealed more to incarcerated participants than to non-incarcerated ones. On the other hand, the potential reduction of withdrawal symptoms (aOR= 0.54; 95% CI= 0.29-0.99) or the risk of misuse (aOR= 0.56; 95% CI= 0.34-0.94) associated with XR-BUP treatment were considered more important by non-incarcerated individuals than by incarcerated ones. CONCLUSION Incarcerated interviewees were interested in XR-BUP for different reasons than those outside prison. In particular, incarcerated patients were more interested in practicability and discretion features, and less in improving recovery or reducing misuse than non-incarcerated patients.
Collapse
Affiliation(s)
- Mathieu Chappuy
- Service Universitaire d’Addictologie de Lyon (SUAL), CH Le Vinatier, Bron, 69500, France
- Service d’Addictologie, Groupement Hospitalier Centre, Hospices Civils de Lyon, Lyon, France
- CSAPA, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France
| | | | - Benoit Trojak
- Service Hospitalo-Universitaire d’Addictologie, CHU de Dijon, Dijon, France
- INSERM U1093, UFR Staps, Université de Bourgogne Franche Comté, Dijon, France
| | - Jérôme Bachellier
- Service Universitaire d’Addictologie de Tours, CHU Bretonneau, Tours, France
| | - Patrick Bendimerad
- Service d’Addictologie, Groupe Hospitalier de La Rochelle-Ré-Aunis, La Rochelle, France
| | - Margaux Kosim
- Consultations de Médecine-Alcoologie PASS, Groupe Hospitalier Pitié Salpêtrière, Paris, France
- Camurus SAS, Paris, France
| | | | - Philippe Nubukpo
- Service d’Addictologie, Centre Hospitalier Esquirol, Limoges, France
- INSERM UMR 1094, Université de Limoges, Limoges, France
| | - Georges Brousse
- Service de Psychiatrie B et d’Addictologie, CHU de Clermont-Ferrand, Clermont-Ferrand, France
- Équipe d’Accueil 7280, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Benjamin Rolland
- Service Universitaire d’Addictologie de Lyon (SUAL), CH Le Vinatier, Bron, 69500, France
- Service d’Addictologie, Groupement Hospitalier Centre, Hospices Civils de Lyon, Lyon, France
- INSERM U1028, CNRS UMR 5292, CRNL, Université de Lyon, UCBL1, Bron, France
- Correspondence: Benjamin Rolland Service Universitaire d’Addictologie, CH Le Vinatier, Pôle MOPHA, 95 Bd Pinel, Bron, 69500, FranceTel +33 437 915 555Fax +33 437 915 556 Email
| |
Collapse
|
31
|
Volkow ND, Blanco C. The changing opioid crisis: development, challenges and opportunities. Mol Psychiatry 2021; 26:218-233. [PMID: 32020048 PMCID: PMC7398847 DOI: 10.1038/s41380-020-0661-4] [Citation(s) in RCA: 168] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 01/02/2020] [Accepted: 01/23/2020] [Indexed: 12/16/2022]
Abstract
The current opioid epidemic is one of the most severe public health crisis in US history. Responding to it has been difficult due to its rapidly changing nature and the severity of its associated outcomes. This review examines the origin and evolution of the crisis, the pharmacological properties of opioids, the neurobiology of opioid use and opioid use disorder (OUD), medications for opioid use disorder (MOUD), and existing and promising approaches to prevention. The results of the review indicate that the opioid epidemic is a complex, evolving phenomenon that involves neurobiological vulnerabilities and social determinants of health. Successfully addressing the epidemic will require advances in basic science, development of more acceptable and effective treatments, and implementation of public health approaches, including prevention. The advances achieved in addressing the current crisis should also serve to advance the science and treatment of other substance use disorders.
Collapse
Affiliation(s)
| | - Carlos Blanco
- National Institute on Drug Abuse, Bethesda, MD, 20892, USA.
| |
Collapse
|
32
|
Chan B, Gean E, Arkhipova-Jenkins I, Gilbert J, Hilgart J, Fiordalisi C, Hubbard K, Brandt I, Stoeger E, Paynter R, Korthuis PT, Guise JM. Retention Strategies for Medications for Opioid Use Disorder in Adults: A Rapid Evidence Review. J Addict Med 2021; 15:74-84. [PMID: 32956162 PMCID: PMC7864607 DOI: 10.1097/adm.0000000000000739] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 08/02/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Although medications for opioid use disorder (MOUD) save lives, treatment retention remains challenging. Identification of interventions to improve MOUD retention is of interest to policymakers and researchers. On behalf of the Agency for Healthcare Research and Quality, we conducted a rapid evidence review on interventions to improve MOUD retention. METHODS We searched MEDLINE and the Cochrane Library from February 2009 through August 2019 for systematic reviews and randomized trials of care settings, services, logistical support, contingency management, health information technology (IT), extended-release (XR) formulations, and psychosocial interventions that assessed retention at least 3 months. RESULTS Two systematic reviews and 39 primary studies were included; most did not focus on retention as the primary outcome. Initiating MOUD in soon-to-be-released incarcerated people improved retention following release. Contingency management may improve retention using antagonist but not agonist MOUD. Retention with interventions integrating medical, psychiatric, social services, or IT did not differ from in-person treatment-as-usual approaches. Retention was comparable with XR- compared to daily buprenorphine formulations and conflicting with XR-naltrexone monthly injection compared to daily buprenorphine. Most psychosocial interventions did not improve retention. DISCUSSION Consistent but sparse evidence supports criminal justice prerelease MOUD initiation, and contingency management interventions for antagonist MOUD. Integrating MOUD with medical, psychiatric, social services, delivering through IT, or administering via XR-MOUD formulations did not worsen retention. Fewer than half of the studies we identified focused on retention as a primary outcome. Studies used different measures of retention, making it difficult to compare effectiveness. Additional inquiry into the causes of low retention would inform future interventions.Registration: PROSPERO: CRD42019134739.
Collapse
Affiliation(s)
- Brian Chan
- Section of Addiction Medicine, Oregon Health and Science University, Portland, OR (BC, PTK); Central City Concern, Portland, OR (BC); Scientific Resource Center of the Agency for Healthcare Research and Quality Evidence-based Practice Centers Program, Portland, OR (EG, IAJ, JG, JH, CF, KH, IB, ES, RP, JMG)
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Osborne V, Davies M, Roy D, Tescione F, Shakir SAW. Systematic benefit-risk assessment for buprenorphine implant: a semiquantitative method to support risk management. BMJ Evid Based Med 2020; 25:199-205. [PMID: 32094200 PMCID: PMC7691701 DOI: 10.1136/bmjebm-2019-111295] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Prior to approval in the European Union, a systematic benefit-risk assessment was required to compare buprenorphine implant to sublingual buprenorphine as part of the license application to the European Medicines Agency. OBJECTIVE The Benefit-Risk Action Team framework was used to describe the overall benefit-risk of buprenorphine implant in comparison to sublingual buprenorphine. STUDY SELECTION/METHODS A value tree of key benefits and risks related to the implant formulation of buprenorphine was constructed. Risk differences (RD) or reporting ORs (ROR) and corresponding 95% CIs were calculated for each outcome, along with the number needed to treat and number needed to harm. Swing weighting was assigned to outcomes and the weighted net clinical benefit (wNCB) was calculated. FINDINGS Key benefits assessed: reduced risk of illicit opioid use (RD=0.09, 95% CI 0.01 to 0.17), reduced risk of misuse and diversion (ROR=0.13, 95% CI 0.02 to 0.94), improved compliance and convenience (RD=0.20) and quality of life measures (RD=0.03). Key risks assessed: clinically significant implant breakage (RD=0.01, 95% CI 0.00 to 0.01), migration/missing implant (RD=0.01, 95% CI 0.00 to 0.02), infection at insertion/removal site (RD=0.08, 95% CI 0.03 to 0.12) and implant-related allergic reaction (RD=0.07, 95% CI 0.03 to 0.11). The wNCB for buprenorphine implant was 4.96, which suggests a favourable benefit-risk profile. CONCLUSIONS The benefit-risk profile of buprenorphine implant is considered favourable in comparison to sublingual buprenorphine, based on this semiquantitative analysis using available data. Further data from real-world use on benefits and risks should be used for ongoing monitoring of the benefit-risk profile of buprenorphine implants in the postmarketing setting.
Collapse
Affiliation(s)
- Vicki Osborne
- Drug Safety Research Unit, Southampton, UK
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Miranda Davies
- Drug Safety Research Unit, Southampton, UK
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | - Debabrata Roy
- Drug Safety Research Unit, Southampton, UK
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| | | | - Saad A W Shakir
- Drug Safety Research Unit, Southampton, UK
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
| |
Collapse
|
34
|
Soyka M. Novel Long-Acting Buprenorphine Medications for Opioid Dependence: Current Update. PHARMACOPSYCHIATRY 2020; 54:18-22. [PMID: 33212514 DOI: 10.1055/a-1298-4508] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Opioid maintenance treatment with oral methadone or sublingual buprenorphine is the first-line treatment in opioid dependence. Three novel long-acting buprenorphine formulations have been approved or will be available soon: for subcutaneous weekly and monthly application, the depot formulations CAM 2038 (Buvidal®), the monthly depot formulation RBP-6000 (Sublocade™), and a 6-month buprenorphine implant (Probuphine™). Clinical data available so far on the efficacy of these 3 medications are given, and possible clinical implications are discussed.
Collapse
|
35
|
Larance B, Degenhardt L, Grebely J, Nielsen S, Bruno R, Dietze P, Lancaster K, Larney S, Santo T, Shanahan M, Memedovic S, Ali R, Farrell M. Perceptions of extended-release buprenorphine injections for opioid use disorder among people who regularly use opioids in Australia. Addiction 2020; 115:1295-1305. [PMID: 31860767 PMCID: PMC7292758 DOI: 10.1111/add.14941] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 10/11/2019] [Accepted: 12/16/2019] [Indexed: 12/19/2022]
Abstract
AIMS To examine perceptions of extended-release (XR) buprenorphine injections among people who regularly use opioids in Australia. DESIGN Cross-sectional survey prior to implementation. XR-buprenorphine was registered in Australia in November 2018. SETTING Sydney, Melbourne and Hobart. Participants A total of 402 people who regularly use opioids interviewed December 2017 to March 2018. MEASUREMENTS Primary outcome concerned the proportion of participants who believed XR-buprenorphine would be a good treatment option for them, preferred weekly versus monthly injections and perceived advantages/disadvantages of XR-buprenorphine. Independent variables concerned the demographic characteristics and features of current opioid agonist treatment (OAT; medication-type, dose, prescriber/dosing setting, unsupervised doses, out-of-pocket expenses and travel distance). FINDINGS Sixty-eight per cent [95% confidence interval (CI) = 63-73%] believed XR-buprenorphine was a good treatment option for them. They were more likely to report being younger [26-35 versus > 55 years; odds ratio (OR) = 3.16, 95% CI = 1.12-8.89; P = 0.029], being female (OR = 1.67, 95% CI = 1.04-2.69; P = 0.034), < 10 years school education (OR = 1.87, 95% CI = 1.12-3.12; P = 0.016) and past-month heroin (OR = 1.81, 95% CI = 1.15-2.85; P = 0.006) and methamphetamine use (OR = 1.90, 95% CI = 1.20-3.01; P = 0.006). Fifty-four per cent reported no preference for weekly versus monthly injections, 7% preferred weekly and 39% preferred monthly. Among OAT recipients (n = 255), believing XR-buprenorphine was a good treatment option was associated with shorter treatment episodes (1-2 versus ≥ 2 years; OR = 3.93, 95% CI = 1.26-12.22; P = 0.018), fewer unsupervised doses (≤ 8 doses past-month versus no take-aways; OR = 0.50; 95% CI = 0.27-0.93; P = 0.028) and longer travel distance (≥ 5 versus < 5 km; OR = 2.10, 95% CI = 1.20-3.65; P = 0.009). Sixty-nine per cent reported 'no problems or concerns' with potential differences in availability, flexibility and location of XR-buprenorphine. CONCLUSIONS Among regular opioid users in Australia, perceptions of extended-release buprenorphine as a good treatment option are associated with being female, recent illicit drug use and factors relating to the (in)convenience of current opioid agonist treatment.
Collapse
Affiliation(s)
- Briony Larance
- School of PsychologyUniversity of WollongongWollongongNSWAustralia,National Drug and Alcohol Research CentreUNSW SydneySydneyNSWAustralia
| | - Louisa Degenhardt
- National Drug and Alcohol Research CentreUNSW SydneySydneyNSWAustralia
| | | | - Suzanne Nielsen
- National Drug and Alcohol Research CentreUNSW SydneySydneyNSWAustralia,Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - Raimondo Bruno
- National Drug and Alcohol Research CentreUNSW SydneySydneyNSWAustralia,School of MedicineUniversity of TasmaniaHobartTasmaniaAustralia
| | | | - Kari Lancaster
- Centre for Social Research in HealthUNSW SydneySydneyNSWAustralia
| | - Sarah Larney
- National Drug and Alcohol Research CentreUNSW SydneySydneyNSWAustralia
| | - Thomas Santo
- National Drug and Alcohol Research CentreUNSW SydneySydneyNSWAustralia
| | - Marian Shanahan
- National Drug and Alcohol Research CentreUNSW SydneySydneyNSWAustralia
| | - Sonja Memedovic
- National Drug and Alcohol Research CentreUNSW SydneySydneyNSWAustralia
| | - Robert Ali
- National Drug and Alcohol Research CentreUNSW SydneySydneyNSWAustralia,Faculty of Health and Medical SciencesUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Michael Farrell
- National Drug and Alcohol Research CentreUNSW SydneySydneyNSWAustralia
| |
Collapse
|
36
|
Srivastava AB, Mariani JJ, Levin FR. New directions in the treatment of opioid withdrawal. Lancet 2020; 395:1938-1948. [PMID: 32563380 PMCID: PMC7385662 DOI: 10.1016/s0140-6736(20)30852-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 03/10/2020] [Accepted: 04/06/2020] [Indexed: 12/16/2022]
Abstract
The treatment of opioid withdrawal is an important area of clinical concern when treating patients with chronic, non-cancer pain, patients with active opioid use disorder, and patients receiving medication for opioid use disorder. Current standards of care for medically supervised withdrawal include treatment with μ-opioid receptor agonists, (eg, methadone), partial agonists (eg, buprenorphine), and α2-adrenergic receptor agonists (eg, clonidine and lofexidine). Newer agents likewise exploit these pharmacological mechanisms, including tramadol (μ-opioid receptor agonism) and tizanidine (α2 agonism). Areas for future research include managing withdrawal in the context of stabilising patients with opioid use disorder to extended-release naltrexone, transitioning patients with opioid use disorder from methadone to buprenorphine, and tapering opioids in patients with chronic, non-cancer pain.
Collapse
Affiliation(s)
- A Benjamin Srivastava
- Division on Substance Use Disorders, Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY, USA.
| | - John J Mariani
- Division on Substance Use Disorders, Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY, USA
| | - Frances R Levin
- Division on Substance Use Disorders, Department of Psychiatry, Columbia University Irving Medical Center, New York State Psychiatric Institute, New York, NY, USA
| |
Collapse
|
37
|
Fairbairn N, Ross J, Trew M, Meador K, Turnbull J, MacDonald S, Oviedo-Joekes E, Le Foll B, Goyer MÈ, Perreault M, Sutherland C. Injectable opioid agonist treatment for opioid use disorder: a national clinical guideline. CMAJ 2020; 191:E1049-E1056. [PMID: 31548191 DOI: 10.1503/cmaj.190344] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Nadia Fairbairn
- Department of Medicine (Fairbairn, Sutherland), University of British Columbia; British Columbia Centre on Substance Use (Fairbairn, Ross, Sutherland), Vancouver, BC; Department of Psychiatry, Faculty of Medicine (Trew), University of Calgary; Alberta Health Services (Trew), Calgary, Alta.; Inner City Health and Wellness Program and Addiction Recovery and Community Health (Meador), Royal Alexandra Hospital, Edmonton, Alta.; Ottawa Inner City Health (Turnbull), Ottawa, Ont.; Providence Crosstown Clinic (MacDonald); School of Population and Public Health (Oviedo-Joekes), University of British Columbia; Centre for Health Evaluation & Outcome Sciences (Oviedo-Joekes), Providence Health Care, Vancouver, BC; Translational Addiction Research Laboratory (Le Foll), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health; Departments of Family and Community Medicine, Pharmacology and Toxicology, Psychiatry (Le Foll), Institute of Medical Science, University of Toronto, Toronto, Ont.; Département de médicine de famille et de médicine d'urgence (Goyer), Faculté de médicine, Université de Montréal; Centre de recherche et d'aide pour narcomanes (Goyer), Centre intégré universitaire de santé et de services sociaux du Centre-Sudde-I'Île-de-Montréal; Department of Psychiatry (Perreault), McGill University; Douglas Mental Health Institute (Perreault), Montréal, Que.; PHS Community Services Society (Sutherland), Vancouver, BC
| | - Josey Ross
- Department of Medicine (Fairbairn, Sutherland), University of British Columbia; British Columbia Centre on Substance Use (Fairbairn, Ross, Sutherland), Vancouver, BC; Department of Psychiatry, Faculty of Medicine (Trew), University of Calgary; Alberta Health Services (Trew), Calgary, Alta.; Inner City Health and Wellness Program and Addiction Recovery and Community Health (Meador), Royal Alexandra Hospital, Edmonton, Alta.; Ottawa Inner City Health (Turnbull), Ottawa, Ont.; Providence Crosstown Clinic (MacDonald); School of Population and Public Health (Oviedo-Joekes), University of British Columbia; Centre for Health Evaluation & Outcome Sciences (Oviedo-Joekes), Providence Health Care, Vancouver, BC; Translational Addiction Research Laboratory (Le Foll), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health; Departments of Family and Community Medicine, Pharmacology and Toxicology, Psychiatry (Le Foll), Institute of Medical Science, University of Toronto, Toronto, Ont.; Département de médicine de famille et de médicine d'urgence (Goyer), Faculté de médicine, Université de Montréal; Centre de recherche et d'aide pour narcomanes (Goyer), Centre intégré universitaire de santé et de services sociaux du Centre-Sudde-I'Île-de-Montréal; Department of Psychiatry (Perreault), McGill University; Douglas Mental Health Institute (Perreault), Montréal, Que.; PHS Community Services Society (Sutherland), Vancouver, BC
| | - Michael Trew
- Department of Medicine (Fairbairn, Sutherland), University of British Columbia; British Columbia Centre on Substance Use (Fairbairn, Ross, Sutherland), Vancouver, BC; Department of Psychiatry, Faculty of Medicine (Trew), University of Calgary; Alberta Health Services (Trew), Calgary, Alta.; Inner City Health and Wellness Program and Addiction Recovery and Community Health (Meador), Royal Alexandra Hospital, Edmonton, Alta.; Ottawa Inner City Health (Turnbull), Ottawa, Ont.; Providence Crosstown Clinic (MacDonald); School of Population and Public Health (Oviedo-Joekes), University of British Columbia; Centre for Health Evaluation & Outcome Sciences (Oviedo-Joekes), Providence Health Care, Vancouver, BC; Translational Addiction Research Laboratory (Le Foll), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health; Departments of Family and Community Medicine, Pharmacology and Toxicology, Psychiatry (Le Foll), Institute of Medical Science, University of Toronto, Toronto, Ont.; Département de médicine de famille et de médicine d'urgence (Goyer), Faculté de médicine, Université de Montréal; Centre de recherche et d'aide pour narcomanes (Goyer), Centre intégré universitaire de santé et de services sociaux du Centre-Sudde-I'Île-de-Montréal; Department of Psychiatry (Perreault), McGill University; Douglas Mental Health Institute (Perreault), Montréal, Que.; PHS Community Services Society (Sutherland), Vancouver, BC
| | - Karine Meador
- Department of Medicine (Fairbairn, Sutherland), University of British Columbia; British Columbia Centre on Substance Use (Fairbairn, Ross, Sutherland), Vancouver, BC; Department of Psychiatry, Faculty of Medicine (Trew), University of Calgary; Alberta Health Services (Trew), Calgary, Alta.; Inner City Health and Wellness Program and Addiction Recovery and Community Health (Meador), Royal Alexandra Hospital, Edmonton, Alta.; Ottawa Inner City Health (Turnbull), Ottawa, Ont.; Providence Crosstown Clinic (MacDonald); School of Population and Public Health (Oviedo-Joekes), University of British Columbia; Centre for Health Evaluation & Outcome Sciences (Oviedo-Joekes), Providence Health Care, Vancouver, BC; Translational Addiction Research Laboratory (Le Foll), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health; Departments of Family and Community Medicine, Pharmacology and Toxicology, Psychiatry (Le Foll), Institute of Medical Science, University of Toronto, Toronto, Ont.; Département de médicine de famille et de médicine d'urgence (Goyer), Faculté de médicine, Université de Montréal; Centre de recherche et d'aide pour narcomanes (Goyer), Centre intégré universitaire de santé et de services sociaux du Centre-Sudde-I'Île-de-Montréal; Department of Psychiatry (Perreault), McGill University; Douglas Mental Health Institute (Perreault), Montréal, Que.; PHS Community Services Society (Sutherland), Vancouver, BC
| | - Jeff Turnbull
- Department of Medicine (Fairbairn, Sutherland), University of British Columbia; British Columbia Centre on Substance Use (Fairbairn, Ross, Sutherland), Vancouver, BC; Department of Psychiatry, Faculty of Medicine (Trew), University of Calgary; Alberta Health Services (Trew), Calgary, Alta.; Inner City Health and Wellness Program and Addiction Recovery and Community Health (Meador), Royal Alexandra Hospital, Edmonton, Alta.; Ottawa Inner City Health (Turnbull), Ottawa, Ont.; Providence Crosstown Clinic (MacDonald); School of Population and Public Health (Oviedo-Joekes), University of British Columbia; Centre for Health Evaluation & Outcome Sciences (Oviedo-Joekes), Providence Health Care, Vancouver, BC; Translational Addiction Research Laboratory (Le Foll), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health; Departments of Family and Community Medicine, Pharmacology and Toxicology, Psychiatry (Le Foll), Institute of Medical Science, University of Toronto, Toronto, Ont.; Département de médicine de famille et de médicine d'urgence (Goyer), Faculté de médicine, Université de Montréal; Centre de recherche et d'aide pour narcomanes (Goyer), Centre intégré universitaire de santé et de services sociaux du Centre-Sudde-I'Île-de-Montréal; Department of Psychiatry (Perreault), McGill University; Douglas Mental Health Institute (Perreault), Montréal, Que.; PHS Community Services Society (Sutherland), Vancouver, BC
| | - Scott MacDonald
- Department of Medicine (Fairbairn, Sutherland), University of British Columbia; British Columbia Centre on Substance Use (Fairbairn, Ross, Sutherland), Vancouver, BC; Department of Psychiatry, Faculty of Medicine (Trew), University of Calgary; Alberta Health Services (Trew), Calgary, Alta.; Inner City Health and Wellness Program and Addiction Recovery and Community Health (Meador), Royal Alexandra Hospital, Edmonton, Alta.; Ottawa Inner City Health (Turnbull), Ottawa, Ont.; Providence Crosstown Clinic (MacDonald); School of Population and Public Health (Oviedo-Joekes), University of British Columbia; Centre for Health Evaluation & Outcome Sciences (Oviedo-Joekes), Providence Health Care, Vancouver, BC; Translational Addiction Research Laboratory (Le Foll), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health; Departments of Family and Community Medicine, Pharmacology and Toxicology, Psychiatry (Le Foll), Institute of Medical Science, University of Toronto, Toronto, Ont.; Département de médicine de famille et de médicine d'urgence (Goyer), Faculté de médicine, Université de Montréal; Centre de recherche et d'aide pour narcomanes (Goyer), Centre intégré universitaire de santé et de services sociaux du Centre-Sudde-I'Île-de-Montréal; Department of Psychiatry (Perreault), McGill University; Douglas Mental Health Institute (Perreault), Montréal, Que.; PHS Community Services Society (Sutherland), Vancouver, BC
| | - Eugenia Oviedo-Joekes
- Department of Medicine (Fairbairn, Sutherland), University of British Columbia; British Columbia Centre on Substance Use (Fairbairn, Ross, Sutherland), Vancouver, BC; Department of Psychiatry, Faculty of Medicine (Trew), University of Calgary; Alberta Health Services (Trew), Calgary, Alta.; Inner City Health and Wellness Program and Addiction Recovery and Community Health (Meador), Royal Alexandra Hospital, Edmonton, Alta.; Ottawa Inner City Health (Turnbull), Ottawa, Ont.; Providence Crosstown Clinic (MacDonald); School of Population and Public Health (Oviedo-Joekes), University of British Columbia; Centre for Health Evaluation & Outcome Sciences (Oviedo-Joekes), Providence Health Care, Vancouver, BC; Translational Addiction Research Laboratory (Le Foll), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health; Departments of Family and Community Medicine, Pharmacology and Toxicology, Psychiatry (Le Foll), Institute of Medical Science, University of Toronto, Toronto, Ont.; Département de médicine de famille et de médicine d'urgence (Goyer), Faculté de médicine, Université de Montréal; Centre de recherche et d'aide pour narcomanes (Goyer), Centre intégré universitaire de santé et de services sociaux du Centre-Sudde-I'Île-de-Montréal; Department of Psychiatry (Perreault), McGill University; Douglas Mental Health Institute (Perreault), Montréal, Que.; PHS Community Services Society (Sutherland), Vancouver, BC
| | - Bernard Le Foll
- Department of Medicine (Fairbairn, Sutherland), University of British Columbia; British Columbia Centre on Substance Use (Fairbairn, Ross, Sutherland), Vancouver, BC; Department of Psychiatry, Faculty of Medicine (Trew), University of Calgary; Alberta Health Services (Trew), Calgary, Alta.; Inner City Health and Wellness Program and Addiction Recovery and Community Health (Meador), Royal Alexandra Hospital, Edmonton, Alta.; Ottawa Inner City Health (Turnbull), Ottawa, Ont.; Providence Crosstown Clinic (MacDonald); School of Population and Public Health (Oviedo-Joekes), University of British Columbia; Centre for Health Evaluation & Outcome Sciences (Oviedo-Joekes), Providence Health Care, Vancouver, BC; Translational Addiction Research Laboratory (Le Foll), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health; Departments of Family and Community Medicine, Pharmacology and Toxicology, Psychiatry (Le Foll), Institute of Medical Science, University of Toronto, Toronto, Ont.; Département de médicine de famille et de médicine d'urgence (Goyer), Faculté de médicine, Université de Montréal; Centre de recherche et d'aide pour narcomanes (Goyer), Centre intégré universitaire de santé et de services sociaux du Centre-Sudde-I'Île-de-Montréal; Department of Psychiatry (Perreault), McGill University; Douglas Mental Health Institute (Perreault), Montréal, Que.; PHS Community Services Society (Sutherland), Vancouver, BC
| | - Marie-Ève Goyer
- Department of Medicine (Fairbairn, Sutherland), University of British Columbia; British Columbia Centre on Substance Use (Fairbairn, Ross, Sutherland), Vancouver, BC; Department of Psychiatry, Faculty of Medicine (Trew), University of Calgary; Alberta Health Services (Trew), Calgary, Alta.; Inner City Health and Wellness Program and Addiction Recovery and Community Health (Meador), Royal Alexandra Hospital, Edmonton, Alta.; Ottawa Inner City Health (Turnbull), Ottawa, Ont.; Providence Crosstown Clinic (MacDonald); School of Population and Public Health (Oviedo-Joekes), University of British Columbia; Centre for Health Evaluation & Outcome Sciences (Oviedo-Joekes), Providence Health Care, Vancouver, BC; Translational Addiction Research Laboratory (Le Foll), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health; Departments of Family and Community Medicine, Pharmacology and Toxicology, Psychiatry (Le Foll), Institute of Medical Science, University of Toronto, Toronto, Ont.; Département de médicine de famille et de médicine d'urgence (Goyer), Faculté de médicine, Université de Montréal; Centre de recherche et d'aide pour narcomanes (Goyer), Centre intégré universitaire de santé et de services sociaux du Centre-Sudde-I'Île-de-Montréal; Department of Psychiatry (Perreault), McGill University; Douglas Mental Health Institute (Perreault), Montréal, Que.; PHS Community Services Society (Sutherland), Vancouver, BC
| | - Michel Perreault
- Department of Medicine (Fairbairn, Sutherland), University of British Columbia; British Columbia Centre on Substance Use (Fairbairn, Ross, Sutherland), Vancouver, BC; Department of Psychiatry, Faculty of Medicine (Trew), University of Calgary; Alberta Health Services (Trew), Calgary, Alta.; Inner City Health and Wellness Program and Addiction Recovery and Community Health (Meador), Royal Alexandra Hospital, Edmonton, Alta.; Ottawa Inner City Health (Turnbull), Ottawa, Ont.; Providence Crosstown Clinic (MacDonald); School of Population and Public Health (Oviedo-Joekes), University of British Columbia; Centre for Health Evaluation & Outcome Sciences (Oviedo-Joekes), Providence Health Care, Vancouver, BC; Translational Addiction Research Laboratory (Le Foll), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health; Departments of Family and Community Medicine, Pharmacology and Toxicology, Psychiatry (Le Foll), Institute of Medical Science, University of Toronto, Toronto, Ont.; Département de médicine de famille et de médicine d'urgence (Goyer), Faculté de médicine, Université de Montréal; Centre de recherche et d'aide pour narcomanes (Goyer), Centre intégré universitaire de santé et de services sociaux du Centre-Sudde-I'Île-de-Montréal; Department of Psychiatry (Perreault), McGill University; Douglas Mental Health Institute (Perreault), Montréal, Que.; PHS Community Services Society (Sutherland), Vancouver, BC
| | - Christy Sutherland
- Department of Medicine (Fairbairn, Sutherland), University of British Columbia; British Columbia Centre on Substance Use (Fairbairn, Ross, Sutherland), Vancouver, BC; Department of Psychiatry, Faculty of Medicine (Trew), University of Calgary; Alberta Health Services (Trew), Calgary, Alta.; Inner City Health and Wellness Program and Addiction Recovery and Community Health (Meador), Royal Alexandra Hospital, Edmonton, Alta.; Ottawa Inner City Health (Turnbull), Ottawa, Ont.; Providence Crosstown Clinic (MacDonald); School of Population and Public Health (Oviedo-Joekes), University of British Columbia; Centre for Health Evaluation & Outcome Sciences (Oviedo-Joekes), Providence Health Care, Vancouver, BC; Translational Addiction Research Laboratory (Le Foll), Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health; Departments of Family and Community Medicine, Pharmacology and Toxicology, Psychiatry (Le Foll), Institute of Medical Science, University of Toronto, Toronto, Ont.; Département de médicine de famille et de médicine d'urgence (Goyer), Faculté de médicine, Université de Montréal; Centre de recherche et d'aide pour narcomanes (Goyer), Centre intégré universitaire de santé et de services sociaux du Centre-Sudde-I'Île-de-Montréal; Department of Psychiatry (Perreault), McGill University; Douglas Mental Health Institute (Perreault), Montréal, Que.; PHS Community Services Society (Sutherland), Vancouver, BC
| |
Collapse
|
38
|
Chappuy M, Trojak B, Nubukpo P, Bachellier J, Bendimerad P, Brousse G, Rolland B. [Prolonged-release buprenorphine formulations: Perspectives for clinical practice]. Therapie 2020:S0040-5957(20)30098-6. [PMID: 32493637 DOI: 10.1016/j.therap.2020.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/06/2020] [Indexed: 12/22/2022]
Abstract
Buprenorphine and methadone are the two main opioids agonist treatments approved for opioid use disorder. Buprenorphine is a partial agonist of the mu-opioid receptors, which has been merely available through sublingual form until now. In practice, the use of buprenorphine is smoother than that of methadone, and it induces reduced risks of overdose. However, sublingual buprenorphine also exposes to risks (e.g., withdrawal, misuse) and constraints (e.g., daily intake). Three new galenic formulations of prolonged-release buprenorphine (PRB) are being commercialized and should allow some improvements in patients' comfort and safety. This narrative review aims to describe the main technical features and efficacy and safety data of these PRBs, as well as patients' and professionals' expectancies and concerns, using data of the scientific literature and the regulatory texts. PRBs consist of one subcutaneous implant and two subcutaneous injection depots. Sixmo®/Probuphine® is a six-month-long implant which needs to be surgically placed and removed and is approved for subjects previously treated with a maximum daily dose of 8mg of sublingual buprenorphine, and can be used only for two successive periods of six months before the subject needs to be switched back to sublingual form. Sublocade® is a one-month-long depot formulation that is indicated in switch from sublingual buprenorphine, and which proposes only two dose schemes, i.e., 100 and 300mg monthly. Buvidal®/Brixadi® is a one-week- or one-month-long depot formulation with multiple dosages, which can be used in initiation or in switched from sublingual formulations. While opioid users report some concerns with a risk of coercive use of long-acting forms of buprenorphine, both users and professionals deem that these new specialties could be particularly appreciated in stabilized patients bothered with the daily intake of the treatments, or specific situations at risk of treatment dropout (e.g., following hospital discharge or prison release).
Collapse
Affiliation(s)
- Mathieu Chappuy
- Service universitaire d'addictologie de Lyon (SUAL), centre hospitalier Le Vinatier, 95, boulevard Pinel, 69678 Bron, France; Service d'addictologie, groupement hospitalier centre, hospices civils de Lyon, 69003 Lyon, France; Centre de soins, d'accompagnement et de prévention en addictologie, groupement hospitalier nord, hospices civils de Lyon, 69004 Lyon, France.
| | - Benoit Trojak
- Service hospitalo-universitaire d'addictologie, CHU de Dijon, 21079 Dijon, France; Inserm U1093 cognition, action et plasticité sensorimotrice, UFR staps, université de Bourgogne Franche Comté, 21078 Dijon, France
| | - Philippe Nubukpo
- Service universitaire d'addictologie, centre hospitalier Esquirol, 87000 Limoges, France; Inserm UMR 1094 neuroépidémiologie tropicale, université de Limoges, 87000 Limoges, France
| | - Jérôme Bachellier
- Service universitaire d'addictologie de Tours, CHU Bretonneau, 37000 Tours, France
| | - Patrick Bendimerad
- Service d'addictologie, groupe hospitalier de La Rochelle-Ré-Aunis, 17000 La Rochelle, France; Service de psychiatrie, groupe hospitalier de La Rochelle-Ré-Aunis, 17000 La Rochelle, France
| | - Georges Brousse
- Service de psychiatrie B et d'addictologie, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France; Équipe d'accueil 7280, unité de formation et de recherche de médecine, université Clermont Auvergne, Clermont-Ferrand, France
| | - Benjamin Rolland
- Service universitaire d'addictologie de Lyon (SUAL), centre hospitalier Le Vinatier, 95, boulevard Pinel, 69678 Bron, France; Service d'addictologie, groupement hospitalier centre, hospices civils de Lyon, 69003 Lyon, France; Inserm, Inserm U1028, CNRS UMR 5292, CRNL, UCBL1, université de Lyon, 69500 Bron, France
| |
Collapse
|
39
|
Chappuy M, Trojak B, Nubukpo P, Bachellier J, Bendimerad P, Brousse G, Rolland B. Prolonged-release buprenorphine formulations: Perspectives for clinical practice. Therapie 2020; 75:397-406. [PMID: 32499082 DOI: 10.1016/j.therap.2020.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/20/2020] [Accepted: 05/14/2020] [Indexed: 12/31/2022]
Abstract
Buprenorphine and methadone are the two main opioid agonist treatments approved for opioid use disorder. Buprenorphine is a partial agonist of the mu opioid receptors, which has been merely available through sublingual form until now. In practice, the use of buprenorphine is smoother than that of methadone, and it induces reduced risks of overdose. However, sublingual buprenorphine also exposes to risks (e.g., withdrawal, misuse) and constraints (e.g., daily intake). Three new galenic formulations of prolonged-release buprenorphine (PRB) are being commercialized and should allow some improvements in patients' comfort and safety. This narrative review aims to describe the main technical features and efficacy and safety data of these PRBs, as well as patients' and professionals' expectancies and concerns, using data of the scientific literature and the regulatory texts. PRBs consist of one subcutaneous implant and two subcutaneous injection depots. Sixmo®/Probuphine® is a six-month-long implant which needs to be surgically placed and removed and is approved for subjects previously treated with a maximum daily dose of 8mg of sublingual buprenorphine, and can be used only for two successive periods of six months before the subject needs to be switched back to sublingual form. Sublocade® is a one-month-long depot formulation that is indicated in switch from sublingual buprenorphine, and which proposes only two dose schemes, i.e., 100 and 300mg monthly. Buvidal®/Brixadi® is a one-week- or one-month-long depot formulation with multiple dosages, which can be used in initiation or in switched from sublingual formulations. While opioid users report some concerns with a risk of coercive use of long-acting forms of buprenorphine, both users and professionals deem that these new specialties could be particularly appreciated in stabilized patients bothered with the daily intake of the treatments, or specific situations at risk of treatment dropout (e.g., following hospital discharge or prison release).
Collapse
Affiliation(s)
- Mathieu Chappuy
- Service universitaire d'addictologie de Lyon (SUAL), centre hospitalier Le Vinatier, 69500 Bron, France; Service d'addictologie, groupement hospitalier centre, Hospices Civils de Lyon, 69003 Lyon, France; Centre de soins, d'accompagnement et de prévention en addictologie, groupement hospitalier nord, Hospices Civils de Lyon, 69004 Lyon, France.
| | - Benoit Trojak
- Service hospitalo-universitaire d'addictologie, CHU de Dijon, 21079 Dijon, France; INSERM U1093 cognition, action et plasticité sensorimotrice, UFR staps, université de Bourgogne Franche-Comté, 21078 Dijon, France
| | - Philippe Nubukpo
- Service universitaire d'addictologie, centre hospitalier Esquirol, 87000 Limoges, France; INSERM UMR 1094 neuroépidémiologie tropicale, université de Limoges, 87000 Limoges, France
| | - Jérôme Bachellier
- Service universitaire d'addictologie de Tours, CHU Bretonneau, 37000 Tours, France
| | - Patrick Bendimerad
- Service d'addictologie, groupe hospitalier de La Rochelle-Ré-Aunis, 17000 La Rochelle, France; Service de psychiatrie, groupe hospitalier de La Rochelle-Ré-Aunis, 17000 La Rochelle, France
| | - Georges Brousse
- Service de psychiatrie B et d'addictologie, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France; Équipe d'accueil 7280, unité de formation et de recherche de médecine, université Clermont Auvergne, Clermont-Ferrand, France
| | - Benjamin Rolland
- Service universitaire d'addictologie de Lyon (SUAL), centre hospitalier Le Vinatier, 69500 Bron, France; Service d'addictologie, groupement hospitalier centre, Hospices Civils de Lyon, 69003 Lyon, France; Université de Lyon, UCBL1, INSERM, INSERM U1028, CNRS UMR 5292, CRNL, 69500 Bron, France
| |
Collapse
|
40
|
Biondi BE, Zheng X, Frank CA, Petrakis I, Springer SA. A Literature Review Examining Primary Outcomes of Medication Treatment Studies for Opioid Use Disorder: What Outcome Should Be Used to Measure Opioid Treatment Success? Am J Addict 2020; 29:249-267. [PMID: 32346932 DOI: 10.1111/ajad.13051] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Medications for opioid use disorder (MOUD) reduce opioid use and overdose; however, MOUD clinical trials have used varying primary outcomes to document treatment success. We conducted a literature review to assess and critically examine the methodologies used in MOUD treatment studies. METHODS Published studies in English that examined MOUD (buprenorphine, methadone, or extended-release naltrexone) were included (N = 20). The methods and frequencies of measuring primary opioid outcomes, including urine drug tests (UDTs) and self-report of opioid use were compared among studies. RESULTS A total of 20 studies fit the inclusion criteria. Each study assessed opioid use; only 12 had opioid use as a primary outcome. Other primary outcomes included retention in treatment (N = 6), and two had other primary outcomes (death and opioid withdrawal symptoms). Opioid use was assessed through both self-report and UDTs in 15 studies. Two studies did not use UDTs. Differences were found in the methods used for how opioid use, retention in treatment, self-report of opioid use, and UDTs were measured. DISCUSSION AND CONCLUSIONS The different primary outcomes used and operational definitions in each study make comparisons between studies difficult. The use of both self-report and UDTs for opioid use has several advantages, and if possible, researchers should use both measures. SCIENTIFIC SIGNIFICANCE This is the first review critically examining outcome measures from MOUD treatment studies. Creating a standard for opioid treatment outcomes in MOUD studies will allow for generalizable results that can inform both researchers and clinicians to better care for those with OUD. (Am J Addict 2020;00:00-00).
Collapse
Affiliation(s)
- Breanne E Biondi
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, Connecticut
| | | | - Cynthia A Frank
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, Connecticut
| | - Ismene Petrakis
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.,Veterans Administration Connecticut Healthcare Services, West Haven, Connecticut
| | - Sandra A Springer
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, Connecticut.,Veterans Administration Connecticut Healthcare Services, West Haven, Connecticut.,Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, Connecticut
| |
Collapse
|
41
|
Abstract
: Buprenorphine is an effective treatment for opioid use disorder. As a high-affinity, partial agonist for the mu-opioid receptor, buprenorphine suppresses opioid withdrawal and craving, reduces illicit opioid use, and blocks exogenous opioid effects including respiratory depression. Other pharmacologic benefits of buprenorphine are its superior safety profile compared with full opioid agonists and its long half-life that allows daily or less-than-daily dosing. New and innovative buprenorphine formulations, with pharmacokinetic profiles that differ from the original tablet formulation, continue to be developed. These include higher bioavailability transmucosal tablets and films and also 6-month implantable and monthly injectable products. This growing array of available formulations allows more choices for patients and increased opportunity for clinicians to individualize treatment; thus, it is important for buprenorphine prescribers to understand these differences.
Collapse
|
42
|
Kazemi Z, Taghizadeh SM, Keshavarz ST, Lahootifard F. Effect of composition on mechanical and physicochemical properties of mucoadhesive buccal films containing buprenorphine hydrochloride: From design of experiments to optimal formulation. J Drug Deliv Sci Technol 2020. [DOI: 10.1016/j.jddst.2020.101578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
43
|
Substance Use Disorder Assessment, Diagnosis, and Management for Patients Hospitalized With Severe Infections Due to Injection Drug Use. J Addict Med 2020; 13:69-74. [PMID: 30252689 DOI: 10.1097/adm.0000000000000454] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Persons with injection drug use (IDU) have high healthcare utilization. Consequently, healthcare providers have opportunities to identify and treat underlying substance use disorders (SUD) that drive these hospitalizations. The study purpose was to characterize current SUD evaluation and treatment practices by primary and consulting services during hospitalization for severe infections related to IDU. METHODS This study is a retrospective chart review of inpatient admissions to an academic medical center. The 2 inclusion criteria were documentation of IDU in clinical notes and the presence of an infection likely related to IDU. Demographic and clinical data were extracted from electronic medical records. RESULTS A total of 108 inpatient admissions met inclusion criteria and were included in the study. The most common infections related to IDU were endocarditis (n = 65, 60.2%) and osteomyelitis (n = 27, 25.0%). The primary team explicitly documented substance use in the H&P and progress notes in 103 (95.4%) hospitalizations and in 84 (77.8%) at discharge. Opioid use disorder was coded by International Classification of Diseases, Ninth Revision in 62 (57.4%). The most frequent intervention was screening, brief intervention, and referral to treatment in 99 (91.7%) episodes. The vast majority of patients did not have specific plans or recommendations for SUD treatment upon discharge. CONCLUSIONS Though more than half of the patients in this study had opioid use disorder, pharmacotherapy for opioid use disorder was typically not provided, and screening, brief intervention, and referral to treatment (SBIRT) was the most common intervention. There are significant gaps in the clinical assessment, diagnosis, and management of SUD in persons hospitalized with life-threatening complications of IDU, leaving many opportunities to improve care for this complex patient population.
Collapse
|
44
|
Vincent KM, Ryan M, Palmer E, Rosales JL, Lippmann S, El-Mallakh RS. Interventional psychiatry. Postgrad Med 2020; 132:573-574. [PMID: 32053020 DOI: 10.1080/00325481.2020.1727671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Kathy M Vincent
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine , Louisville, KY, USA
| | - Maureen Ryan
- Psychiatry, Robley Rex VA Medical Center , Louisville, KY, USA
| | - Emma Palmer
- James L. Winkle College of Pharmacy, University of Cincinnati , Cincinnati, OH, USA
| | - Jeramie L Rosales
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine , Louisville, KY, USA
| | - Steven Lippmann
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine , Louisville, KY, USA
| | - Rif S El-Mallakh
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine , Louisville, KY, USA
| |
Collapse
|
45
|
Huhn AS, Hobelmann JG, Strickland JC, Oyler GA, Bergeria CL, Umbricht A, Dunn KE. Differences in Availability and Use of Medications for Opioid Use Disorder in Residential Treatment Settings in the United States. JAMA Netw Open 2020; 3:e1920843. [PMID: 32031650 PMCID: PMC8188643 DOI: 10.1001/jamanetworkopen.2019.20843] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
IMPORTANCE While many individuals with opioid use disorder seek treatment at residential facilities to initiate long-term recovery, the availability and use of medications for opioid use disorder (MOUDs) in these facilities is unclear. OBJECTIVE To examine differences in MOUD availability and use in residential facilities as a function of Medicaid policy, facility-level factors associated with MOUD availability, and admissions-level factors associated with MOUD use. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used deidentified facility-level and admissions-level data from 2863 residential treatment facilities and 232 414 admissions in the United States in 2017. Facility-level data were extracted from the 2017 National Survey of Substance Abuse Treatment Services, and admissions-level data were extracted from the 2017 Treatment Episode Data Set-Admissions. Statistical analyses were conducted from June to November 2019. EXPOSURES Admissions for opioid use disorder at residential treatment facilities in the United States that identified opioids as the patient's primary drug of choice. MAIN OUTCOMES AND MEASURES Availability and use of 3 MOUDs (ie, extended-release naltrexone, buprenorphine, and methadone). RESULTS Of 232 414 admissions, 205 612 (88.5%) contained complete demographic data (166 213 [80.8%] aged 25-54 years; 136 854 [66.6%] men; 151 867 [73.9%] white). Among all admissions, MOUDs were used in only 34 058 of 192 336 (17.7%) in states that expanded Medicaid and 775 of 40 078 (1.9%) in states that did not expand Medicaid (P < .001). A relatively low percentage of the 2863 residential treatment facilities in this study offered extended-release naltrexone (854 [29.8%]), buprenorphine (953 [33.3%]), or methadone (60 [2.1%]). Compared with residential facilities that offered at least 1 MOUD, those that offered no MOUDs had lower odds of also offering psychiatric medications (odds ratio [OR], 0.06; 95% CI, 0.05-0.08; Wald χ21 = 542.09; P < .001), being licensed by a state or hospital authority (OR, 0.39; 95% CI, 0.27-0.57; Wald χ21 = 24.28; P < .001), or being accredited by a health organization (OR, 0.28; 95% CI, 0.23-0.33; Wald χ21 = 180.91; P < .001). Residential facilities that did not offer any MOUDs had higher odds of accepting cash-only payments than those that offered at least 1 MOUD (OR, 4.80; 95% CI, 3.47-6.64; Wald χ21 = 89.65; P < .001). CONCLUSIONS AND RELEVANCE In this cross-sectional study of residential addiction treatment facilities in the United States, MOUD availability and use were sparse. Public health and policy efforts to improve access to and use of MOUDs in residential treatment facilities could improve treatment outcomes for individuals with opioid use disorder who are initiating recovery.
Collapse
Affiliation(s)
- Andrew S Huhn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Ashley Addiction Treatment, Havre de Grace, Maryland
| | - J Gregory Hobelmann
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Ashley Addiction Treatment, Havre de Grace, Maryland
| | - Justin C Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - George A Oyler
- Ashley Addiction Treatment, Havre de Grace, Maryland
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Cecilia L Bergeria
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Annie Umbricht
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kelly E Dunn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
46
|
Dong R, Wang H, Li D, Lang L, Gray F, Liu Y, Laffont CM, Young M, Jiang J, Liu Z, Learned SM. Pharmacokinetics of Sublingual Buprenorphine Tablets Following Single and Multiple Doses in Chinese Participants With and Without Opioid Use Disorder. Drugs R D 2020; 19:255-265. [PMID: 31197606 PMCID: PMC6738359 DOI: 10.1007/s40268-019-0277-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Two phase I studies assessed the pharmacokinetics of buprenorphine, its metabolite norbuprenorphine, and naloxone following administration of buprenorphine/naloxone sublingual tablets in Chinese participants. Methods In the first phase I, open-label, single ascending-dose (SAD) study, 82 opioid-naïve volunteers received a single buprenorphine/naloxone dose ranging from 2 mg/0.5 mg to 24 mg/6 mg while under naltrexone block. In a second phase I, open-label, multiple ascending-dose (MAD) study, 27 patients with opioid dependence in withdrawal received buprenorphine/naloxone doses of either 16 mg/4 mg or 24 mg/6 mg for 9 consecutive days. Serial blood samples were collected after a single dose (SAD study) and at steady-state (MAD study). Pharmacokinetic parameters were calculated using non-compartmental analysis. Safety assessments included adverse events monitoring and laboratory tests. Results The pharmacokinetic profiles of buprenorphine and naloxone were consistent between single- and multiple-dose studies. Peak plasma concentrations (Cmax) were reached early for buprenorphine (0.75–1.0 h) and naloxone (0.5 h), supporting rapid absorption. In the SAD study, increases in plasma exposures to buprenorphine and naloxone were less than dose proportional, in line with previous observations in Western populations. Buprenorphine-to-naloxone ratios for Cmax and area under the curve (AUC) were constant over the dose range investigated and also consistent with Western populations data. Steady state was reached within 7 days of daily dosing, with slight accumulation over repeated doses. No serious adverse events were observed. Conclusions The present data suggest that buprenorphine/naloxone pharmacokinetic profiles in Chinese participants are consistent, overall, with those in Western populations, supporting no differences in dosing. Clinical Trial Registration The protocols were registered on the official website of the China Food and Drug Administration (CFDA): http://www.chinadrugtrials.org.cn/; Registration numbers CTR20132963 (RB-CN-10-0012), CTR20140153 (RB-CN-10-0015). Electronic supplementary material The online version of this article (10.1007/s40268-019-0277-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Ruihua Dong
- Department of Clinical Pharmacology, 307 Hospital of PLA, Beijing, 100071, China
| | - Hongyun Wang
- Clinical Pharmacology Center, Peking Union Medical College Hospital & Beijing Key Laboratory of Clinical PK and PD Investigation for Innovative Drugs, Beijing, 100730, China
| | - Dandan Li
- Department of Clinical Pharmacology, 307 Hospital of PLA, Beijing, 100071, China
| | - Liwei Lang
- Clinical Pharmacology Center, Peking Union Medical College Hospital & Beijing Key Laboratory of Clinical PK and PD Investigation for Innovative Drugs, Beijing, 100730, China
| | - Frank Gray
- Indivior PLC, 215 Bath Road, Slough, England, SL1 4AA, UK
| | - Yongzhen Liu
- Indivior PLC, 215 Bath Road, Slough, England, SL1 4AA, UK.
| | | | - Malcolm Young
- Indivior PLC, 215 Bath Road, Slough, England, SL1 4AA, UK
| | - Ji Jiang
- Clinical Pharmacology Center, Peking Union Medical College Hospital & Beijing Key Laboratory of Clinical PK and PD Investigation for Innovative Drugs, Beijing, 100730, China
| | - Zeyuan Liu
- Department of Clinical Pharmacology, 307 Hospital of PLA, Beijing, 100071, China
| | | |
Collapse
|
47
|
Saunders EC, Moore SK, Walsh O, Metcalf SA, Budney AJ, Scherer E, Marsch LA. Perceptions and preferences for long-acting injectable and implantable medications in comparison to short-acting medications for opioid use disorders. J Subst Abuse Treat 2020; 111:54-66. [PMID: 32076361 DOI: 10.1016/j.jsat.2020.01.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Aim Treatment for opioid use disorders has recently evolved to include long-acting injectable and implantable formulations of medications for opioid use disorder (MOUD). Incorporating patient preferences into treatment for substance use disorders is associated with increased motivation and treatment satisfaction. This study sought to assess treatment preferences for long-acting injectable and implantable MOUD as compared to short-acting formulations among individuals with OUD. Methods We conducted qualitative, semi-structured telephone interviews with forty adults recruited from across the United States through Craigslist advertisements and flyers posted in treatment programs. Eligible participants scored a two or greater on the heroin or opioid pain reliever sections of the Tobacco, Alcohol, Prescription Medications, and Other Substances (TAPS) Tool, indicative of a past-year OUD. Interviews were transcribed, coded, and thematically analyzed. Results Twenty-four participants (60%) currently or previously had been prescribed MOUD. Sixteen participants (40%) expressed general opposition to MOUD, citing concerns that MOUD is purely financial gain for pharmaceutical companies and/or a "band aid" solution replacing one drug with another, rather than a path to abstinence. Some participants expressed personal preference for long-acting injectable (n = 16/40: 40%) and implantable formulations (n = 12/40: 30%) over short-acting formulations. About half of the participants were not willing to use injectables (n = 19/40: 48%) or implantables (n = 22/40: 55%), preferring short-acting formulations. Mixed evaluations of long- and short-acting MOUD focused on considerations of medication-related beliefs (privacy, concern over an embedded foreign body), the medication-related burden (convenience, provision of structure and support, medication administration, potential side effects), and medication-taking practices (potential for non-prescribed use, control over dosage, and duration of treatment). Conclusions Though many participants personally prefer short-acting to long-acting MOUD, some were open to including long-acting formulations in the range of options for those with OUD. Participants felt long-acting formulations may reduce medication-related burden and the risk of diversion. Conversely, participants expressed concern about invasive administration and loss of control over their treatment. Results suggest support for expanded access to a variety of formulations of MOUD. The use of shared decision making may also help patients select the formulation best aligned with their experiences, values, and treatment goals.
Collapse
Affiliation(s)
- Elizabeth C Saunders
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | - Sarah K Moore
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire, USA
| | - Olivia Walsh
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire, USA
| | - Stephen A Metcalf
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire, USA
| | - Alan J Budney
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire, USA
| | - Emily Scherer
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire, USA
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire, USA
| |
Collapse
|
48
|
Abstract
Opioid use disorder (OUD) is a chronic relapsing disorder that, whilst initially driven by activation of brain reward neurocircuits, increasingly engages anti-reward neurocircuits that drive adverse emotional states and relapse. However, successful recovery is possible with appropriate treatment, although with a persisting propensity to relapse. The individual and public health burdens of OUD are immense; 26.8 million people were estimated to be living with OUD globally in 2016, with >100,000 opioid overdose deaths annually, including >47,000 in the USA in 2017. Well-conducted trials have demonstrated that long-term opioid agonist therapy with methadone and buprenorphine have great efficacy for OUD treatment and can save lives. New forms of the opioid receptor antagonist naltrexone are also being studied. Some frequently used approaches have less scientifically robust evidence but are nevertheless considered important, including community preventive strategies, harm reduction interventions to reduce adverse sequelae from ongoing use and mutual aid groups. Other commonly used approaches, such as detoxification alone, lack scientific evidence. Delivery of effective prevention and treatment responses is often complicated by coexisting comorbidities and inadequate support, as well as by conflicting public and political opinions. Science has a crucial role to play in informing public attitudes and developing fuller evidence to understand OUD and its associated harms, as well as in obtaining the evidence today that will improve the prevention and treatment interventions of tomorrow.
Collapse
|
49
|
Fanucchi L, Springer SA, Korthuis PT. Medications for Treatment of Opioid Use Disorder among Persons Living with HIV. Curr HIV/AIDS Rep 2020; 16:1-6. [PMID: 30684117 DOI: 10.1007/s11904-019-00436-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Recent HIV outbreaks have occurred as a result of the current US opioid epidemic. Providing medications for opioid use disorder (MOUD) with methadone, buprenorphine, and extended-release naltrexone is essential to achieving optimal HIV treatment outcomes including viral suppression and retention in treatment. This review describes the pharmacology of MOUD with specific attention to interactions with antiretroviral therapy, and to the effect of MOUD on HIV treatment outcomes. RECENT FINDINGS Methadone and buprenorphine both improve HIV viral suppression, adherence to antiretroviral therapy, and overall mortality for persons with opioid use disorder (OUD). Extended-release naltrexone has been most extensively studied in persons with HIV leaving incarcerated settings, and improves HIV viral suppression in that context. Strategies that integrate MOUD and HIV treatment are crucial to optimize viral suppression. The differing pharmacokinetic and delivery characteristics of these MOUD offer diverse options. Given the chronic and relapsing nature of both HIV and OUD, long-term approaches are required.
Collapse
Affiliation(s)
- Laura Fanucchi
- Division of Infectious Disease, University of Kentucky College of Medicine, 740 South Limestone, K512, Lexington, KY, 40536, USA. .,Center on Drug and Alcohol Research, University of Kentucky College of Medicine, Lexington, KY, USA.
| | - Sandra A Springer
- Department of Internal Medicine, Section of Infectious Disease, Yale School of Medicine, New Haven, CT, USA.,Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA
| | - P Todd Korthuis
- Section of Addiction Medicine, Oregon Health & Science University, Portland, OR, USA
| |
Collapse
|
50
|
McAdam M, Brar R, Young S. Initiation of injectable opioid agonist treatment in hospital: A case report. Drug Alcohol Rev 2019; 39:138-141. [PMID: 31814186 DOI: 10.1111/dar.13020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 11/20/2019] [Accepted: 11/20/2019] [Indexed: 11/29/2022]
Abstract
Uncontrolled opioid withdrawal and pain often drive inpatients with opioid use disorder to leave hospital against medical advice, resulting in suboptimal medical and addiction treatment. When oral opioid agonist treatments such as methadone and buprenorphine/naloxone fail for management of craving and withdrawal, injectable opioid agonist treatment may serve to retain patients in care and link them to addiction services. We describe the case of a 47-year-old man with a severe, active opioid use disorder and daily use of illicitly manufactured fentanyl, who was re-admitted to hospital for post-operative management after leaving against medical advice due to uncontrolled opioid withdrawal. Intravenous hydromorphone was used to retain him in care, allowing for completion of his antibiotics and enrolment in ongoing community injectable opioid agonist treatment.
Collapse
Affiliation(s)
- Matthew McAdam
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Rupinder Brar
- British Columbia Centre on Substance Use, Vancouver, Canada.,Department of Family Medicine, University of British Columbia, Vancouver, Canada
| | - Samantha Young
- British Columbia Centre on Substance Use, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, Canada
| |
Collapse
|