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NBER Book Chapters. 07/2011;
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ABSTRACT: Aims. Opioid-dependent outpatients may be more likely to present for pharmacological treatment if less than daily dosing can be arranged. These studies compared opioid withdrawal symptoms during 24-, 72-, and 120-hour buprenorphine dosing regimens and evaluated participants' preferences for these different dosing regimens. Participants. Thirty-three opioid-dependent participants received daily sublingual maintenance doses of 4 mg/70 kg ( n = 14) or 8 mg/70 kg ( n = 19) of liquid buprenorphine. Methods. In Study I participants received, in a random order, three dosing regimens for five repetitions of each: daily maintenance doses every 24 hours (4 or 8 mg/70 kg), triple the daily maintenance dose every 72 hours (12 or 24 mg/70 kg) and quintuple the daily maintenance dose every 120 hours (20 or 40 mg/70 kg). Doses were administered under double-blind procedures, and placebos were administered on the interposed days during the latter two regimens. Subjective and observer ratings of opioid withdrawal symptoms were assessed daily prior to receipt of each dose. In Study II, a new group of participants received each of the three dosing regimens under open-dosing procedures and then chose between the different dosing regimens. Findings. Opioid withdrawal symptoms increased significantly during the every-fifth-day dosing regimen in both the blind- and open-dosing studies. In the choice phase of Study II, only one participant (7%) chose quintuple-every-fifth-day dosing over all other dosing options. Conclusions. These results suggest that the maximum duration of action of buprenorphine is less than 5 days when five times the daily maintenance dose is provided.
Addiction 05/2001; 96(6):823 - 834. · 4.31 Impact Factor
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ABSTRACT: Aims. To compare opioid withdrawal symptoms during 24-, 48-, 72- and 96-hour buprenorphine dosing regimens and to evaluate subjects' preferences for these different dosing schedules. Subjects. Fourteen opioid-dependent subjects participated in this study. They received daily sublingual maintenance doses of 4 mg/70 kg (n = 4) or 8 mg/70 kg (n = 10) of buprenorphine. Intervention. In the first study subjects received, in a random order, four dosing regimens for five repetitions of each: daily maintenance doses every 24 hours (4 or 8 mg/70 kg), double the daily maintenance dose every 48 hours (8 or 16 mg/70 kg), triple the daily maintenance dose every 72 hours (12 or 24 mg/70 kg), and quadruple the daily maintenance dose every 96 hours (16 or 32 mg/70 kg). Measures of subjective and observer opioid withdrawal symptoms were assessed prior to receipt of each dose. In a second study, subjects chose between the different dosing regimens. Findings. Some withdrawal ratings increased during the less frequent dosing schedules in the first study. In the second study, 46% of subjects preferred the quadruple-every-fourth-day dosing regimen over every other option, and only 14% preferred to be dosed daily. Conclusions. These results suggest that some opioid-dependent outpatients are willing and able to endure the withdrawal symptoms associated with less than daily dosing, and a twice-weekly dosing regimen may be possible.
Addiction 06/2000; 95(7):1069 - 1077. · 4.31 Impact Factor
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ABSTRACT: Aims. To investigate whether heroin addicts demonstrate shortened time horizons and decreased sensitivity to future consequences of their behavior compared to non-drug users . Design Setting and Participants. Thirty-four heroin addicts enrolled in a buprenorphine treatment clinic and 59 non-drug-using controls completed a personality questionnaire and two laboratory tasks . Measurements. The Stanford Time Perception Inventory (STPI) personality questionnaire assessed orientation to the future, and the Future Time Perspective (FTP) task elicited predictions of the timing and ordering of future events. The Bechara card task measured preferences for decks of cards that range in magnitude and probability of delayed and immediate rewards and punishers . Findings. Heroin addicts scored significantly lower than controls on the STPI scale indicative of future orientation. In the FTP, heroin addicts were less likely to predict events far into the future and less likely to systematically organize events in the future. In the card task, heroin addicts were less likely to win money than controls. They were more likely to play from a deck that contained greater immediate gains but that resulted in large, delayed punishers and overall net losses. They also made fewer selections from a deck that provided an overall net gain via relatively low immediate rewards and frequent small punishments . Conclusions. Shortened time horizons and decreased sensitivity to delayed consequences may explain drug abusers' persistent use of drugs, despite the long-term negative consequences associated with drug use.
Addiction 04/1998; 93(5):729 - 738. · 4.31 Impact Factor
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ABSTRACT: Polydrug abuse is common among substance abusers, but few empirical or theoretical methods accurately characterize this phenomenon. This chapter describes a simulation paradigm that was developed to apply a behavioral economic analysis to understanding polydrug abuse. Heroin abusers 'purchased' drugs as the price of drugs or income varied. In Experiment 1, heroin price rose while prices of other drugs and income remained constant. Heroin purchases significantly decreased as heroin prices increased. As price of heroin rose, valium and cocaine purchases increased and cross-price elasticity coefficients indicated these drugs substituted for heroin. In Experiment 2, prices of both heroin and valium increased separately to determine symmetry of the substitution effect. While valium substituted for heroin, heroin purchases were independent of valium prices. Marijuana and alcohol purchases were independent of valium price, but both these drugs were weak substitutes for heroin. In Experiment 3, income rose while prices remained constant. At some changes in income, demand for heroin and cocaine was income elastic, with purchases rising in greater proportion than income. Marijuana, alcohol, and valium purchases did not vary significantly as a function of income. Choices in this simulation were reliable both between and within subjects. Moreover, drug choices in the simulation were correlated with drug use as determined by urinanalysis testing. These results are discussed in terms of the utility of a behavioral economics approach for characterizing polydrug abuse.
03/1998;
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ABSTRACT: This paper applies behavioral economic concepts to address two behaviors frequently exhibited by the drug dependent: (a) spending a considerable amount of time, effort, and money to obtain and use drugs (often to the exclusion of other potential reinforcers), and (b) "loss of control" or the inability to follow through on plans to cut down or stop drug use. The first of these behaviors is examined in the context of two economic principles: (a) drug use covaries with drug availability and (b) drug use is affected by the availability of alternative nondrug activities or events. A review of drug abuse research (including basic, epidemiology, life history, and treatment research) demonstrates the relevance of these two principles to the phenomenon of drug dependence. The second of these behaviors ("loss of control") is conceptualized as resulting from the discounting of delayed rewards. Research demonstrating the discounting of delayed rewards in drug-abusing populations is reviewed. Behavioral-economic principles suggest drug-abuse treatment efforts should (a) use methods that decrease drug availability, (b) increase the availability of nondrug activities or events that may substitute for drug use, and (c) use treatment methods that will increase the extent to which delayed events control behavior in substance abusers.
Behavior Therapy.
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ABSTRACT: The relative efficacy of quintuple and sextuple buprenorphine dosing in abating withdrawal symptoms for 120 h was compared in opioid-dependent outpatients. Fourteen subjects received buprenorphine in a double-blind, placebo-controlled, cross-over design. Daily sublingual maintenance doses were 4 mg/70 kg (n=4) and 8 mg/70 kg (n=10). After a stabilization period of daily maintenance administration, subjects received quintuple (5× daily maintenance dose) and sextuple (6× daily maintenance dose) doses every 120 h. Measures of opioid agonist and withdrawal effects were assessed daily. Subjective ratings of withdrawal were significantly greater than baseline ratings beyond 96-h post dosing under both regimens. There was no evidence, however, that those subjective ratings of withdrawal differed between the two regimens. Thus, these data suggest that sextuple buprenorphine dosing, administered every 5 days, does not abate opioid-withdrawal beyond 96 hours.
Drug and Alcohol Dependence.
