11 Buprenorphine for Opioid Dependence

Abstract

As a treatment agent for opioid dependence, buprenorphine is a nearly ideal medication at our current stage of medication development. Unlike methadone, buprenorphine dosage can be rapidly adjusted with minimal potential for inducing severe consequences. In addition to its intrinsic safety, buprenorphine's relatively low abuse liability in the combination product (i.e., with naloxone as Suboxone ® ) makes it even more acceptable in regulatory quarters as well as to prescribing physicians. The approval of buprenorphine as a pharmacotherapy for opioid dependence returns to physicians the ability to treat their opioid-dependent patients with an effective opioid-based treatment for the first time in nearly 100 years. Buprenorphine is an opioid, however, and potential for misuse remains, even in combination with naloxone. Whether buprenorphine will be increasingly accepted as a treatment for opioid-dependent patients depends on clinicians recognizing the advantages of its uniquely useful properties while still heeding the need to manage their patients' therapy with reasonable vigilance. Keywordsbuprenorphine; heroin addiction; opioid dependence; pharmacotherapy; Suboxone ® Buprenorphine is a recent addition to the armamentarium for the treatment of opioid dependence, following legislation authorizing office-based prescribing in 2000 and subsequent approval in 2002 by the US FDA. As the buprenorphine-naloxone combination or in the monotherapy form, the medication boasts a unique pharmacological profile characterized by high levels of safety and a ceiling effect on respiratory suppression [1]. Thus, buprenorphine-based pharmacotherapy is well suited for use in clinical settings, with patients requiring less stringent oversight than is required for methadone maintenance [2][3][4]. Most importantly, buprenorphine is the first opioid-based medication in nearly a century to become available to clinicians in the USA for treatment of opioid dependence in the general practice setting. Buprenorphine offers physicians an acutely needed clinical tool, but