A novel approach in the detoxification of intravenous buprenorphine dependence

Abstract

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 μ-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 3rd and 7th 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 3rd and 7th 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.

Problematic Opioid Use Among Older Adults: Epidemiology, Adverse Outcomes and Treatment Considerations

“…Therefore, standard doses of buprenorphine should only be administered once patients are experiencing moderate withdrawal symptoms [ 62 ]. The risk of precipitated withdrawal can be limited through use of the transdermal formulation or micro-dosing protocols [ 63 , 64 ]. Buprenorphine is well tolerated in adults over the age of 50 years with common adverse effects including sedation, constipation, nausea/vomiting, headache, dry mouth, peripheral oedema and dizziness [ 60 , 65 ].…”

Ondansetron Does Not Reduce Withdrawal in Patients With Physical Dependence on Chronic Opioid Therapy

“…These four surveys were completed at the beginning of each study session. OOWS & SOWS have both been shown to be sensitive tools in the measurement of withdrawal scores in opioid users (Sarkar et al, 2016; Chu et al, 2009). …”

HIV infection and its psychiatric manifestations: A clinical overview

“…Although opioids are commonly prescribed to patients living with HIV/AIDS, their illicit use is also common; Lake and colleagues report that, between 2005 and 2013, the median prevalence of prescription opioid injection among HIV-positive injection drug users in Vancouver, Canada, was 24.2% (Lake 2016). Buprenorphine, a partial opioid agonist, is commonly prescribed by addiction specialists in the UK and intravenous buprenorphine misuse is on the rise (Sarkar 2016). Intravenous buprenorphine misuse can transmit HIV and lead to public health problems.…”