Opioid dependence: rationale for and efficacy of existing and new treatments.
ABSTRACT Opioid dependence is a chronic and relapsing medical disorder with a well-established neurobiological basis. Opioid agonist treatments, such as methadone and the recently approved buprenorphine, stabilize opioid receptors and the intracellular processes that lead to opioid withdrawal and craving. Both methadone and buprenorphine have been proven effective for the treatment of opioid dependence and can contribute to a decreased risk of human immunodeficiency virus (HIV) transmission. In addition, a buprenorphine/naloxone combination appears to have a decreased potential for abuse or diversion, compared with that associated with methadone. Largely because of these properties, recent legislation now affords an unprecedented opportunity for general physicians to offer opioid agonist treatment through their offices. This review focuses on the neurobiological basis of opioid dependence, the rationale for methadone and buprenorphine treatments, and issues in prescribing these medications to patients with HIV infection.
SourceAvailable from: Géraldine PoisnelJournal of Pharmacological Sciences 01/2009; 110(1):36-46. DOI:10.1254/jphs.08249FP · 2.11 Impact Factor
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ABSTRACT: Zubsolv® is a new sublingual formulation of buprenorphine/naloxone that is indicated for the maintenance treatment of opioid dependence in the USA. The effectiveness and tolerability of buprenorphine/naloxone in this indication is well established. Relative to other sublingual formulations of buprenorphine/naloxone, Zubsolv® dissolves more rapidly, has greater bioavailability, tastes better, and may be preferred by many patients.Drugs & Therapy Perspectives 11/2013; 29(11). DOI:10.1007/s40267-013-0079-z
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ABSTRACT: Respiratory depression has been attributed to buprenorphine (BUP) misuse or combination with benzodiazepines. BUP/naloxone (NLX) has been marketed as maintenance treatment, aiming at preventing opiate addicts from self-injecting crushed pills. However, to date, BUP/NLX benefits in comparison to BUP alone remain debated. We investigated the plethysmography effects of BUP/NLX in comparison to BUP/solvent administered by intravenous route in naive and BUP-tolerant Sprague Dawley rats, and in combination with diazepam (DZP) or its solvent. In naive rats, BUP/NLX in comparison to BUP significantly increased respiratory frequency (f, P < 0.05) without altering minute volume (VE). In combination to DZP, BUP/NLX significantly increased expiratory time (P < 0.01) and decreased f (P < 0.01), tidal volume (VT, P < 0.001), and VE (P < 0.001) while BUP only decreased VT(P < 0.5). In BUP-tolerant rats, no significant differences in respiratory effects were observed between BUP/NLX and BUP. In contrast, in combination to DZP, BUP/NLX did not significantly alter the plethysmography parameters, while BUP increased inspiratory time (P < 0.001) and decreased f (P < 0.01) and VE (P < 0.001). In conclusion, differences in respiratory effects between BUP/NLX and BUP are only significant in combination with DZP, with increased depression in naive rats but reduced depression in in BUP-tolerant rats. However, BUP/NLX benefits in humans remain to be determined.Toxicology Letters 07/2014; 228(2):75-84. DOI:10.1016/j.toxlet.2014.04.009 · 3.36 Impact Factor