A Novel Approach in the Detoxification of Intravenous Buprenorphine Dependence

By Sarkar, Sukanto; Subramaniam, Eswaran et al. | Indian Journal of Psychiatry, April-June 2016 | Go to article overview

A Novel Approach in the Detoxification of Intravenous Buprenorphine Dependence


Sarkar, Sukanto, Subramaniam, Eswaran, Konthoujam, Janet, Indian Journal of Psychiatry


Byline: Sukanto. Sarkar, Eswaran. Subramaniam, Janet. Konthoujam

Background: Opioid dependence remains a significant problem in India, and of late intravenous (IV) buprenorphine use has increased in India, especially in combination with antihistamines and benzodiazepines. Its usage has many serious consequences in the form of needle-transmitted hepatitis and HIV, which is showing an increasing trend. Buprenorphine is a partial agonist at [micro]-opioid receptors. In tablet form (and rarely as IV), it is widely used in the treatment of opioid detoxification. We assessed the safety and efficacy of transdermal patch of buprenorphine with week long duration of action in the treatment of detoxification of IV buprenorphine dependence in view of its many advantages. Materials and Methods: Six consecutive patients with International Classification of Diseases diagnosis of Opioid Dependence Syndrome (IV buprenorphine) were given a buprenorphine patch for treatment of withdrawal symptoms after receiving consent. Severity of opioid dependence was assessed by using Severity of Opioid Dependence Questionnaire on the day of presentation. Subjective and objective rating for opioid withdrawal was done by subjective opiate withdrawal scale (SOWS) and objective opiate withdrawal scale (OOWS) prepatch and postpatch 3[sup]rd and 7[sup]th day. Buprenorphine side effect checklist was applied on a daily basis. Results: The patients had a mean age of 30 years, of whom 83.3% are males. All were educated and 50% were currently employed. All of them had additional comorbid substance use as well as a comorbid psychiatric diagnosis. Each of them received a patch of varying dosage. The patch dose used initially was based on clinical considerations alone and was fairly adequate in controlling acute withdrawal symptoms. There is a significant improvement in SOWS and OOWS while comparing the baseline (prepatch) with 3[sup]rd and 7[sup]th day (postpatch) (P ≤ 0.05). None of the patients reported any side effect with the patch. Conclusion: This study shows that transdermal buprenorphine is safe, useful, and clinically effective, and a 7-day application may provide an alternative means of detoxification. However, the result of the study needs to be replicated in a larger sample in a clinical setting, and a control group receiving a conventional mode of treatment needs to be included.

Introduction

Opioid dependence remains a significant problem in India, and many users prefer intravenous (IV) buprenorphine whenever heroin is unavailable and often mix it with a benzodiazepine to provide adequate “kick.” A few users prefer it over brown sugar or dirty heroin whenever it is unavailable. The prevalence of IV buprenorphine use has shown a significant decline in recent years, but nevertheless remains a significant problem in many pockets of the country. The profile of buprenorphine use reported in literature is of an urban, college-going young male belonging to middle-socioeconomic status. They often have a history of multiple drug use and often use a cocktail of buprenorphine 0.6 mg, diazepam 10 mg, and promethazine 100 mg.[sup][1],[2],[3] Its usage has many serious negative consequences in the form of respiratory depression, needle-transmitted hepatitis, HIV, and systemic infections. Its withdrawal symptoms though less intense than heroin withdrawal has a similar clinical picture and often requires medical support.[sup][4]

Buprenorphine is a weak partial agonist at [micro]-opioid receptors. It has a high affinity for [micro]-opioid receptors, binding more tightly to these receptors than full opioid agonists.[sup][5] It also exhibits pharmacological properties that are more characteristic of an antagonist and thus, may have important implications for clinical utility.[sup][6] It has the dual effect of producing opioid responses while blocking the effects of additional opiate use and is used for the treatment of addiction and pain. …

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A Novel Approach in the Detoxification of Intravenous Buprenorphine Dependence
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