This clinical observation provides a first look at differences between two patient subgroups, prescription opiate (PO) abusers and heroin abusers, presenting for office-based buprenorphine treatment. Medical and drug use histories, medication dose, treatment outcome, and demographic information were collected from the first 101 opiate-dependent adults entering treatment. The results indicate that PO abusers (n = 42) and heroin abusers (n = 59) differed in several demographic characteristics, drug use history, and treatment outcome. Physicians may benefit from this information by using it to tailor comprehensive treatment and medical care plans for opioid-dependent patients taking buprenorphine.
"Office-based buprenorphine maintenance has already increased treatment availability for opioid-dependent individuals and brought into treatment populations that had been unable or unwilling to attend methadone maintenance clinics, eg, prescription opioid addicts. Prescription opioid addicts seeking office-based buprenorphine are likely to present different issues than heroin addicts applying for methadone maintenance.110 Primary-care physicians who have not treated opioid dependence will also present new challenges to the field. "
[Show abstract][Hide abstract] ABSTRACT: While opioid dependence has more treatment agents available than other abused drugs, none are curative. They can, however, markedly diminish withdrawal symptoms and craving, and block opioid effects due to lapses.
The most effective withdrawal method is substituting and tapering methadone or buprenorphine, α-2 Adrenergic agents can ameliorate untreated symptoms or substitute for agonists if not available. Shortening withdrawal by precipitating it with narcotic antagonists has been studied, but the methods are plagued by safety issues or persisting symptoms. Neither the withdrawal agents nor the methods are associated with better long-term outcome, which appears mostly related to post-detoxification treatment.
Excluding those with short-term habits, the best outcome occurs with long-term maintenance on methadone or buprenorphine accompanied by appropriate psychosocial interventions. Those with strong external motivation may do well on the antagonist naltrexone. Currently, optimum duration of maintenance on either is unclear. Better agents are needed to impact the brain changes related to addiction.
Dialogues in clinical neuroscience 02/2007; 9(4):455-70.
[Show abstract][Hide abstract] ABSTRACT: Prescription opioid analgesics (POA) are widely used in the pharmacotherapeutic treatment of acute and chronic pain in North America, where nonmedical prescription opioid use (NMPOU) has become a substantial public health concern in recent years. Existing epidemiological data suggest an association between NMPOU and pain problem symptoms in different populations, including samples in substance use treatment, although the extent of these correlations has not been systematically assessed.
To systematically review and meta-analyze the prevalence of pain symptoms or problems among populations reporting NMPOU in substance use treatment.
Systematic review and meta-analyses.
A systematic review and meta-analyses were conducted for pain symptoms in substance use treatment samples reporting NMPOU within the last 30 days or at admission to treatment. Overall, 8 unique epidemiological studies were identified and included in the meta-analyses; in 7 of these samples POAs were the primary drug and/or POA dependence was reported.
The pooled prevalence of pain in all NMPOU samples in substance use treatment was 58% (95% confidence interval [CI]: 53%-64%). The pooled prevalence of pain in the studies with POAs as the primary drug and/or POA dependence was 60% (95% CI: 52%-67%), and the prevalence of pain with "any" POA abuse (n = 2 studies) was 50% (95% CI: 40%-60%). LIMITATIONS: A small number of studies were available and included in the review; these were restricted to cross-sectional datasets only. Statistical heterogeneity was found in the meta-analytical results.
Pain symptoms are disproportionately elevated in substance use treatment samples reporting NMPOU. Effective measures to prevent and treat NMPOU are urgently needed, although a substantive extent of NMPOU observed in this specific context may relate directly or indirectly to the presence of pain, e.g., either as an expression of ineffective pain care or as a consequence of previous POA-based interventions. At the same time, effective ways to treat and address ongoing pain issues in NMPOU samples need to be implemented, which may require ongoing opioid-based pharmacotherapeutic care aimed at both pain and dependence.
[Show abstract][Hide abstract] ABSTRACT: To compare the effects of a short or long taper schedule after buprenorphine stabilization on participant outcomes as measured by opioid-free urine tests at the end of each taper period.
This multi-site study sponsored by Clinical Trials Network (CTN, a branch of the US National Institute on Drug Abuse) was conducted from 2003 to 2005 to compare two taper conditions (7 days and 28 days). Data were collected at weekly clinic visits to the end of the taper periods, and at 1-month and 3-month post-taper follow-up visits.
Eleven out-patient treatment programs in 10 US cities.
Non-blinded dosing with Suboxone during the 1-month stabilization phase included 3 weeks of flexible dosing as determined appropriate by the study physicians. A fixed dose was required for the final week before beginning the taper phase.
The percentage of participants in each taper group providing urine samples free of illicit opioids at the end of the taper and at follow-up.
At the end of the taper, 44% of the 7-day taper group (n = 255) provided opioid-free urine specimens compared to 30% of the 28-day taper group (n = 261; P = 0.0007). There were no differences at the 1-month and 3-month follow-ups (7-day = 18% and 12%; 28-day = 18% and 13%, 1 month and 3 months, respectively).
For individuals terminating buprenorphine pharmacotherapy for opioid dependence, there appears to be no advantage in prolonging the duration of taper.
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