Effect of buprenorphine on psychomotor functions in patients on buprenorphine maintenance

Ankush Singhal, MBBS, MD, MRCPsych; B.M. Tripathi, MBBS, MD, MRCPsych; Hem Raj Pal, MBBS, MD; Renuka Jena, PhD; Raka Jain, MSc, PhD, Cchem, FRSC

doi:10.5055/jom.2008.0007

Authors

Ankush Singhal, MBBS, MD, MRCPsych
B.M. Tripathi, MBBS, MD, MRCPsych
Hem Raj Pal, MBBS, MD
Renuka Jena, PhD
Raka Jain, MSc, PhD, Cchem, FRSC

DOI:

https://doi.org/10.5055/jom.2008.0007

Keywords:

buprenorphine, psychomotor effects, maintenance treatment, opioid dependence

Abstract

Objective: Patients on buprenorphine maintenance for opioid dependence often abuse its additional doses over and above the maintenance dose. Being a psychoactive agent, it may affect psychomotor performance with all its consequences, for example, effect on quality of life. This study was conducted to assess the effects of its additional doses on psychomotor performance in patients who are maintained on it.
Design and Setting: This was an interventional study, carried out in an in-patient setting in a tertiary care national drug dependence treatment center.
Participants: It included 19 subjects maintained on buprenorphine, 4 mg/d (s/L) for at least a month.
Intervention: Maintenance dose was followed by three administrations of buprenorphine, 2 mg, at two hourly intervals (cumulative dose design).
Main Outcome Measures: Subjects were assessed on digit symbol substitution test, trail making, digit span, and delayed recall, after each administration and the next morning.
Results: Performance of subjects on Digit Symbol Substitution Test (χ2 = 52.98, p < 0.000) and Trail Making Test-A (χ2 = 26.29, p < 0.000) and B (χ2 = 42.08, p < 0.000) improved significantly with each assessment while other tests were unaffected.
Conclusions: Improvement in psychomotor performance (which could be true effect of drug itself or a result of other factors, eg, inadequate maintenance dose or practice effect) though contrasting with some of the earlier findings, does have significant clinical implications regarding the long-term use of buprenorphine. It would be worthwhile repeating this type of study in a placebo controlled design to further verify the results.

Author Biographies

Ankush Singhal, MBBS, MD, MRCPsych

Specialty Registrar, Mental Health Unit, Lister Hospital, Stevenage, Hertfordshire, United Kingdom.

B.M. Tripathi, MBBS, MD, MRCPsych

Professor, National Drug Dependence Treatment Centre, AIIMS, New Delhi, India.

Hem Raj Pal, MBBS, MD

Consultant Psychiatrist (Substance Misuse), North East Essex Drug and Alcohol Service (NEEDAS), Colchester, Essex, United Kingdom.

Renuka Jena, PhD

Highly Specialist Psychologist, East London and City Mental Health NHS Trust, London, United Kingdom.

Raka Jain, MSc, PhD, Cchem, FRSC

Professor, National Drug Dependence Treatment Centre, AIIMS, New Delhi, India.

References

Singhal A, Tripathi BM, Pal HR, et al.: Subjective effects of additional doses of buprenorphine in patients on buprenorphine maintenance. Addict Behav. 2007; 32: 320-331.

Preston KL, Bigelow GE, Liebson IA: Burenorphine and naloxone alone and in combination in opioid-dependent humans. Psychopharmacol. (Berl) 1988; 94: 484-490.

Strain EC, Preston KL, Liebson IA, et al.: Acute effects of buprenorphine, hydromorphone and naloxone in methadonemaintained volunteers. J Pharmacol Exp Ther. 1992; 261: 985-993.

Walsh SL, June HL, Schuh KJ, et al.: Effects of buprenorphine and methadone in methadone maintained subjects. Psychopharmacol. (Berl) 1995; 119: 268-276.

Giacomuzzi SM, Ertl M, Vigl A, et al.: Driving capacity of patients treated with methadone and slow-release oral morphine. Addiction. 2005; 100: 1027.

Strain EC, Walsh SL, Preston KL, et al.: The effects of buprenorphine in buprenorphine maintained volunteers. Psychopharmacol. (Berl) 1997; 129: 329-338.

Wechsler D: Manual: Wechsler Adult Intelligence Scale– Revised (WAIS-R). New York: Psychological Corporation, 1981.

Reitan RM, Wolfson D: The Halstead-Reitan neuropsychological test battery: Theory and Clinical Interpretation. Tucson, AZ: Neuropsychology Press, 1993.

Lezak MD: Neuropsychological Assessment. Oxford: Oxford University Press, 1995.

Pershad D: Construction and Standardization of Clinical Test of Memory in Simple Hindi. Agra, India: National Psychological Corporation, 1977: 124.

Jain R: Analytical methods. In Jain R (ed.): Detection of Drugs of Abuse in Body Fluids–A Manual for Laboratory Personnel. New Delhi: Drug Dependence Treatment Centre, AIIMS, 1998.

Anderson G, Thomson AB, Jensen NH, et al.: Cerebral dysfunction after prolonged use of opioids. Ugeskr Laeger. 1993; 155: 3459-3462. Review.

Zacny JP, Conley K, Galinkin J: Comparing the subjective psychomotor and physical effects of intravenous buprenorphine and morphine in healthy volunteers. J Pharmacol Exp Ther. 1997; 282: 1187-1197.

Jones HE, Bigelow GE, Preston KL: Assessment of opioid partial agonist activity with a 3 choice hydromorphone dose discrimination procedure. J Pharmacol Exp Ther. 1999; 289: 1350-1361.

Preston KL, Bigelow GE, Bickel WK, et al.: Drug discrimination in human post addicts: Agonist-antagonist opioids. J Pharmacol Exp Ther. 1989; 250: 184-196.

Preston KL, Bigelow GE: Drug discrimination assessment of agonist-antagonist opiates in humans. A three-choice salinehydromorphone- butorphenol procedure. J Pharmacol Exp Ther. 1994; 271: 48-60.

Preston KL, Bigelow GE: Effects of agonist and antagonist opiates in humans trained in a hydromorphone–Not hydromorphone discrimination. J Pharmacol Exp Ther. 2000; 295: 114-124.

Strain EC, Stoller K, Walsh SL, et al.: Effects of buprenorphine versus buprenorphine/naloxone tablets in non-dependent opioid abusers. Psychopharmacol. (Berl) 2000; 148: 374-383.

Walsh SL, Preston KL, Stitzer ML, et al.: Clinical pharmacology of buprenorphine: Ceiling effects at high doses. Clin Pharmacol Ther. 1994; 55: 569-580.

Weinhold LL, Preston KL, Farre M, et al.: Buprenorphine alone and in combination with naloxone in nondependent humans. Drug Alcohol Depend. 1992; 30: 263-274.

Zacny JP: A review of the effects of opiates on psychomotor and cognitive functioning in humans. Exp Clin Psychopharm. 1995; 3: 432-466.

Hanks GW, O’Neill WM, Simson P, et al.: The cognitive and psychomotor effects of opioid analgesics-II. A randomized controlled trial of single doses of morphine, lorazepam and placebo in healthy subjects. Eur J Clin Pharmacol. 1995; 48: 455-460.

O’Neill WM, Hanks GW, Simpson P, et al.: The cognitive and psychomotor effects of morphine in healthy subjects: A randomized controlled trial of repeated (four) oral doses of dextropropoxyphene, morphine, lorazepam and placebo. Pain. 2000; 85: 209-215.

Haythornwaite JA, Menefee LA, Qurtrano Piacentini AL, et al.: Outcome of chronic opioid therapy for non-cancer pain. J Pain Symptom Manage. 1998; 15: 185-194.

Jamison RN, Schein JR, Vallow S, et al.: Neuropsychological effects of long-term opioid use in chronic pain patients. J Pain Symptom Manage. 2003; 26: 913-921.

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

Ling W, Charuvastra C, Collins JF, et al.: Buprenorphine maintenance treatment of opiate dependence: A multicenter, randomized clinical trial. Addiction. 1998; 93: 475-486.

Mohan D, Ray R: Community Based Treatment for Heroin Dependence in an Urban Slum of Delhi (India). Report submitted to WHO, SEARO, New Delhi, India, 1997.

O’Neill WM: The cognitive and psychomotor effects of opioid drugs in cancer pain management. Cancer Surveys. 1994; 21: 67-84.

Sjogren P, Olsen AK, Thomson AB, et al.: Neuropsychological performance in cancer patients. The role of oral opioids, pain and performance status. Pain. 2000; 86: 237-245.

Sjogren P, Thomsen AB, Olsen AK: Impaired neuropsychological performance in chronic non malignant pain patients receiving long term oral opioid therapy. J Pain Symp Manage. 2000; 9: 100-108.

Bruera E, Macmillan K, Hansen J, et al.: The cognitive effects of administration of narcotic analgesics in patients with cancer pain. Pain. 1989; 39: 13-16.

Sjogren P: Psychomotor and cognitive functioning in cancer patients. Acta Anaesthesiol Scand. 1997; 41: 159-161.