Buprenorphine dosing choices in specific populations: review of expert opinion

Maremmani, Icro; Rolland, Benjamin; Somaini, Lorenzo; Roncero, Carlos; Reimer, Jens; Wright, Nat; Littlewood, Richard; Krajči, Peter; Alho, Hannu; D'Agnone, Oscar; Simon, Nicolas

doi:10.1080/14656566.2016.1209486

Cited by 14 publications

(8 citation statements)

References 23 publications

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“…This study also did not record the patients’ comorbidities, which may substantially affect individual dosages and outcomes (10). The clinic does not provide treatment on comorbidities, as patients are usually referred to their general practitioner when health problems arise, so data were not available in a format which could have been used for this study.…”

Section: Discussionmentioning

confidence: 99%

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A Retrospective Survey of Buprenorphine Substitute Treatment With Minimal Dosage in Heroin Use Disorder

et al. 2019

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Objectives: It is widely accepted that buprenorphine maintenance treatment (BMT) with dosages above 8 mg daily is effective for patients with heroin use disorder. In this study, the authors evaluated the effectiveness of long-term BMT for heroin users in China, with dosages kept on a much smaller level.Methods: This is a retrospective observational study of 72 patients who had undergone detoxification and continued with buprenorphine maintenance between 2007 and 2016. Measurements such as self-reported relapse status, buprenorphine doses, protracted symptoms, general health condition, and self-reported side effects were included.Results: At the time of interview, 51 patients had remained abstinent at follow-up (including 13 who were opioid-free). The dosages of buprenorphine were 1.33 ± 0.88 (ranging 0.3–3.5) mg/day when maintenance treatment was initiated and 1.2 ± 0.8 (ranging 0.2–3.2) mg/day at the last follow-up. The remaining patients had either relapsed on heroin (n = 11) or switched to compulsory treatment (n=10). In general, abstinent patients had minimal protracted symptoms, especially in physical symptoms. Opioid-free abstainers were more likely to report good physical health than patients on buprenorphine. Predictors of worse outcomes (relapsed or switched to compulsory treatment) were lower education levels, younger age, and younger onset of illicit drug use.Conclusions: This study shows promising results of minimal-dosage BMT in treating heroin use disorder. We recommend further studies applying minimal-dosage BMT in China and worldwide.

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Section: Discussionmentioning

confidence: 99%

“…A sufficient dose to dissolve heroin craving is the key element to the success of opioid maintenance (9, 10). Methadone is often used in dosages around 50–100 mg daily, and buprenorphine in dosages above 8 mg/day is effective in reducing heroin craving (11).…”

Section: Introductionmentioning

confidence: 99%

A Retrospective Survey of Buprenorphine Substitute Treatment With Minimal Dosage in Heroin Use Disorder

et al. 2019

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“…The antipsychotic effectiveness of opioid agonists is highlighted in a recent review, in which it is suggested that the use of opioid agonists deserves reconsideration because of their anticraving capability and effectiveness on the psychopathological level [ 40 ]. It has also been stated that specific groups, including patients with psychiatric comorbidities, may benefit from optimized and higher doses of buprenorphine to ensure sufficient dosing [ 41 ]. It is relevant to combine antipsychotic and opioid agonist medications with psychosocial support [ 38 ], since group counselling, contingency management and long-term residential treatment have been shown to have positive effects [ 42 ].…”

Section: Discussionmentioning

confidence: 99%

Comorbid opioid use is undertreated among forensic patients with schizophrenia

Kivimies

Repo-Tiihonen

Kautiainen

et al. 2018

Subst Abuse Treat Prev Policy

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BackgroundSubstance use disorders are associated with poorer clinical outcomes in patients with schizophrenia. There is no specific treatment for amphetamine or cannabis use disorder, but methadone and buprenorphine are used as replacement therapy in the treatment of opioid dependence. Our aim was to study whether patients with schizophrenia have received opioid replacement therapy for their opioid use disorder.MethodsThe study sample consisted of 148 individuals diagnosed with schizophrenia who were in involuntary psychiatric treatment as forensic patients in Finland in 2012. The proportion of the study sample with comorbid opioid use disorder having received opioid replacement therapy prior to their forensic psychiatric treatment was compared to the available information of opioid dependent patients in general. The data were collected from forensic examination statements, patient files and other medical registers retrospectively.ResultsOf the study sample, 15.6% (23/148) had a history of opioid use disorder, of whom 8.7% (2/23) had received opioid replacement treatment (95% confidence interval (Cl): 1.1–28.0), even though opioid use disorder had been diagnosed in the treatment system. According the available information the corresponding proportion among patients with opioid use disorder and using substance use disorder services was 30.4% (565/1860, 95% Cl: 28.3–32.5). The fraction of patients receiving opioid replacement therapy was significantly lower among patients with schizophrenia (p = 0.022).ConclusionsOpioid replacement therapy was seldom used among schizophrenia patients who were later ordered to involuntary forensic psychiatric treatment. More attention should be paid to the possible use of opioids when planning treatment for patients with schizophrenia.Trial registrationOur study is not a randomized controlled trial (but a register-based study); thus the trial registration is not applicable.

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“…The toxic properties of fast-acting opiates and the therapeutic properties of slow-acting ones prove to be crucial issues in HUD patients, whether they do or do not have DD. Methadone and buprenorphine should be recognized as psychoactive medications, with useful properties in the treatment of opiate addiction, having a wider therapeutic potential when heroin addiction is combined with a psychiatric disorder [20,49,57,59,61,[63][64][65][66][67][68][69][70][71][72][73].…”

Section: Towards a Hierarchical Approach To Dual Disorder Treatmentmentioning

confidence: 99%

The Conceptual Framework of Dual Disorders and Its Flaws

Pacini¹,

Maremmani

2020

JCM

Self Cite

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When psychiatric illness and substance use disorder coexist, the clinical approach to the patient is, unsurprisingly, awkward. This fact is due to a cultural context and, more directly, to the patient’s psychiatric condition and addiction behaviors—a situation that does not favor a scientific approach. In dual disorder facilities, several types of professionals work together: counselors, social workers, psychologists, and psychiatrists. Treatment approaches vary from one service to another and even within the same service. It is crucial to provide dual disorder patients with multiple treatments, comprising hospitalization, rehabilitative and residential programs, case management, and counselling. Still, when treating dual disorder (DD) heroin use disorder (HUD) patients, it is advisable to follow a hierarchical algorithm. First, we must deal with addiction: by detoxification, whenever possible. This means starting most patients on anti-craving pharmacological maintenance, though aversion therapy may be appropriate for a few of them. Opiate antagonists may be used with heroin-addicted patients as long as those patients are only mildly ill. In contrast, agonist opioid medications, i.e., buprenorphine and methadone suit moderately and severely ill patients, respectively. Achieving control of mood instability or psychotic episodes is the next step, to be followed by a prevention strategy to counteract residual cravings and dominate mood disorders or psychotic episodes through long-term pharmacological maintenance that is focused on a double target.

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Buprenorphine dosing choices in specific populations: review of expert opinion

Cited by 14 publications

References 23 publications

A Retrospective Survey of Buprenorphine Substitute Treatment With Minimal Dosage in Heroin Use Disorder

A Retrospective Survey of Buprenorphine Substitute Treatment With Minimal Dosage in Heroin Use Disorder

Comorbid opioid use is undertreated among forensic patients with schizophrenia

The Conceptual Framework of Dual Disorders and Its Flaws

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