Buprenorphine: A review

Sidarth Wakhlu, MD

doi:10.5055/jom.2009.0007

Authors

Sidarth Wakhlu, MD

DOI:

https://doi.org/10.5055/jom.2009.0007

Keywords:

buprenorphine, maintenance therapy, opioid addiction, opioid withdrawal

Abstract

A significant breakthrough in the treatment of opioid addiction occurred with the passage of the Data Addiction Treatment Act of 2000 (DATA 2000),1 signed into law by President Clinton, which allowed physicians for the first time in more than eight decades to prescribe opioid medications for the treatment of opioid addiction in the normal course of their practice. Two years later, on October 8, 2002, Suboxone (Buprenorphine/Naloxone) and Subutex (Buprenorphine) received FDA approval for the treatment of opioid addiction. Prior to DATA 2000, opioid maintenance treatment was available through highly regulated methadone clinics. This article discusses opioid addiction in the United States today and the principles of buprenorphine therapy.

Author Biography

Sidarth Wakhlu, MD

Psychiatry, UT Southwestern Medical Center, Dallas, Texas.

References

Drug Addiction Treatment Act of 2000, Public Law No. 106-310, Title XXXV-Waiver authority for physicians who dispense or prescribe certain narcotic drugs for maintenance treatment or detoxification treatment, 2000. Available at http://www.buprenorphine.samhsa.gov/fulllaw.html.ntrol. Accessed March 19, 2008.

Substance Abuse and Mental Health Services Administration (SAMHSA): Results from the 2006 National Survey on Drug Use and Health: National Findings, Rockville, MD: Department of Health and Human Services, SAMHSA, Office of Applied Studies. NSDUH Series H-32, DHHS Publication No. SMA 07-4293; 2007. Available at http://www.oas.samhsa.gov. Accessed June 28, 2008.

Office of National Drug Control Policy (ONDCP): Drug Policy Information Clearinghouse. Heroin Fact Sheet June 2003. Available at http://www.whitehousedrugpolicy.gov/publications/factsht/heroin/197335.pdf. Accessed July 11, 2008.

Substance Abuse and Mental Health Services Administration (SAMHSA), Office of Applied Studies: Drug Abuse Warning Network, 2005: National Estimates of Drug-Related Emergency Department Visits. DAWN Series D-29, DHHS Publication No. (SMA) 07-4256, Rockville, MD, 2007.

Booth M: Opium: A History, 1st ed. New York: St Martin’s Press, 1998.

Maxwell JC: Substance Abuse Trends in Texas. Gulf Coast Addiction Technology Transfer Center, University of Texas at Austin, 2007.

Maxwell JC: “Cheese” Heroin: Status as of October 31, 2007. Gulf Coast Addiction Technology Transfer Center, University of Texas at Austin, 2007.

Center for Substance Abuse Treatment: Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Treatment Improvement Protocol (TIP) Series 40. DHS Publication No. (SMA) 04-3939. Rockville, Md: Substance Abuse and Mental Health Services Administration; 2004. Available at http://buprenorphine.samhsa.gov/Bup%20Guidelines.pdf. Accessed July 19, 2008.

Philadelphia Camden High Intensity Drug Trafficking Area (HIDTA): Intelligence Bulletin 06-02. “Update Heroin Overdoses in Camden and Philadelphia.” April 26, 2002.

Centers for Disease Control and Prevention (CDC): National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention 2006 Disease Profile. Atlanta, GA: U.S. Department of Health and Human Services, CDC, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.

Mark TL, Woody GE, Juday T, et al.: The economic costs of heroin addiction in the United States. Drug Alcohol Depend. 2001; 61: 195-206.

Metzger DS, Navaline H, Woody GE: Drug abuse treatment as AIDS prevention. Public Health Rep. 1998; 113 (Suppl 1): 97-106.

Ball JC, Ross A: The Effectiveness of Methadone Maintenance Treatment: Patients, Programs, Services, and Outcomes. New York: Spring-Verlag, 1991.

Musto DF: Historical Perspectives. In Lowinson JH, Ruiz P, Millman RB, et al. (eds.): Substance Abuse: A Comprehensive Textbook, 3rd ed. Baltimore: Williams & Wilkins, 1997.

Lowinson JH, Payte JT, Salsitz E, et al.: Methadone Methadone. In Lowinson JH, Ruiz P, Millman RB, et al. (eds.): Substance Abuse: A Comprehensive Textbook, 3rd ed. Baltimore: Williams & Wilkins, 1997.

Hardwood HJ, Hubbard RL, Collins JJ, et al.: The costs of crime and the benefits of drug abuse treatment: A cost-benefit analysis using TOPS data. In Compulsory Treatment of Drug Abuse: Research and Clinical Practice (NIDA Research Monograph Series). Rockville, MD.

Metzger DS, Woody GE, McAllen AT, et al.: HIV seroconversion among in and out of treatment intravenous drug users: An 18-month prospective follow-up. AIDS 9(6); 1993: 1049-1056.

Johnson RE, Jaffe JH, Fudala PJ: A controlled trial of buprenorphine treatment for opiate dependence. JAMA 1992; 267: 2750-2755

National Institutes of Health (NIH): Effective medical treatment of opiate addiction. NIH Consensus Statement 1997b; 15(6): 1-38. Available at consensus.nih.gov/cons/108/108_statement. Accessed August 1, 2008.

Jaffe JH, O’Keeffe C: From morphine clinics to buprenorphine: Regulating opioid agonist treatment of addiction in the United States. Drug Alcohol Depend. 2003; 70: S3-S11.

Gutstein HB, Akil H: Opioid Analgesics. In Hardman JG, Limbird LE (eds.): Goodman & Gilman’s The Pharmacological Basis of Therapeutics, 10th ed. New York, NY: McGraw-Hill, 2001.

Boas RA, Villiger JW: Clinical actions of fentanyl and buprenorphine. The significance of receptor binding. Br J Anaesth. 1985; 57: 192-196.

McCance-Katz E: Office-based buprenorphine treatment for opioid-dependent patients. Harv Rev Psychiatry. 2004; 12(6): 321-338.

Walsh SL, Eissenberg T: The clinical pharmacology of buprenorphine: Extrapolating from the laboratory to the clinic. Drug Alcohol Depend. 2003; 70: S13-S27.

Kakko J, Svanborg KD, Kreek MJ, et al.: 1-year retention and social function after buprenorphine-assisted relapse prevention treatment for heroin dependence in Sweden: A randomized, placebo-controlled trial. Lancet. 2003; 361: 662-668.

Auriacombe M, Fatseas M, Dubernet J, et al.: French field experience with buprenorphine. Am J Addict. 2004; 13; S17-S28.

Bruce RD, Dvoryak S, Syall L, et al.: HIV treatment access and scale-up for delivery for IDU in Ukraine with opiate substitution therapy with buprenorphine–Programme description and policy implications. Int J Drug Policy. 2007; 18(4): 326-328.

Razani N, Mohraz M, Kheirandish P, et al.: HIV risk behavior among injection drug users in Tehran, Iran. Addiction. 2007; 102: 1472-1482.

Ahmadi J, Bahrami N: Buprenorphine treatment of opiumdependent outpatients seeking treatment in Iran. J Substance Abuse Treat. 2002; 23(4): 415-417.

Substance Abuse and Mental Health Services Administration: Buprenorphine physician locator. Available at http://buprenorphine.samhsa.gov/. Accessed August 1, 2008.

Huang P, Kehner GB, Cowan A, et al.: Comparison of pharmacological activities of buprenorphine and norbuprenorphine: Norbuprenorphine is a potent opioid agonist. J Pharmacol Exp Ther. 2001; 297(2): 688-695.

Vadivelu N, Hines RL: Buprenorphine: A unique opioid with clinical applications. J Opioid Manag. 2007; 3(1): 49-58.

Malinhoff HL, Barkin RL, Wilson G: Sublingual buprenorphine is effective in the treatment of chronic pain syndrome. Am J Ther. 2005; 12(5): 379-384.

Johnson RE, Fudala PJ, Payne R: Buprenorphine: Considerations for pain management. J Pain Symptom Manage. 2005; 29(3): 297-326.

Evans HC, Easthope SE: Transdermal buprenorphine. Drugs. 2003; 63(19): 1999-2010; discussion 2011-2012.

Sitti R: Transdermal buprenorphine in the treatment of chronic pain. Expert Rev Neurother. 2005; 5(3): 315-323.

Sorge J, Sitti R: Transdermal buprenorphine in the treatment of chronic pain: Results of a phase III, multicenter, randomized, double-blind, placebo-controlled study. Clin Ther. 2004; 26(11): 1808-1820.

Radbruch L, Vielvoye-Kerkmeer A: Buprenorphine TDS: The clinical development rationale and results. Int J Clin Pract Suppl. 2003; 133:15-18; discussion 23-24.

Likar R, Kayser H, Sitti R: Long-term management of chronic pain with transdermal buprenorphine: A multicenter, openlabel, follow-up study in patients from three short-term trials. Clin Ther. 2006; 28(6): 943-952.

Pergolizzi J, Boger RH, Budd K, et al.: Opioids and the management of chronic severe pain in the elderly: Consensus statement of an International Expert Panel with focus on the six clinically most often used World Health Organization step III opioids (buprenorphine, fentanyl, hydromorphone, methadone, morphine, oxycodone). Pain Pract 2008; 8(4): 287-313. Epub May 23, 2008.