Buprenorphine Pharmacology Review: Update on Transmucosal and Long-acting Formulations

Coe, Marion A.; Lofwall, Michelle R.; Walsh, Sharon

doi:10.1097/adm.0000000000000457

Cited by 114 publications

(95 citation statements)

References 41 publications

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“…Buprenorphine has a high binding affinity, which contributes to its safety, but it can displace other opioids and lead to "precipitated withdrawal" if it is administered too soon after use of a full agonist. 60 Precipitated withdrawal can be avoided by waiting to administer buprenorphine until the patient develops symptoms of opioid withdrawal (a sign of low receptor occupancy)usually eight to 12 hours after heroin or short acting prescription opioids-and using a low initial dose of buprenorphine. Longer periods may be needed (up to 18-24 hours) for patients using fentanyl because of its lipophilicity.…”

Section: Buprenorphinementioning

confidence: 99%

Treatment of opioid use disorder in primary care

Buresh

Stern

Rastegar

2021

BMJ

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Opioid use disorder (OUD) is a common, treatable chronic disease that can be effectively managed in primary care settings. Untreated OUD is associated with considerable morbidity and mortality—notably, overdose, infectious complications of injecting drug use, and profoundly diminished quality of life. Withdrawal management and medication tapers are ineffective and are associated with increased rates of relapse and death. Pharmacotherapy is the evidence based mainstay of OUD treatment, and many studies support its integration into primary care settings. Evidence is strongest for the opioid agonists buprenorphine and methadone, which randomized controlled trials have shown to decrease illicit opioid use and mortality. Discontinuation of opioid agonist therapy is associated with increased rates of relapse and mortality. Less evidence is available for the opioid antagonist extended release naltrexone, with a meta-analysis of randomized controlled trials showing decreased illicit opioid use but no effect on mortality. Treating OUD in primary care settings is cost effective, improves outcomes for both OUD and other medical comorbidities, and is highly acceptable to patients. Evidence on whether behavioral interventions improve outcomes for patients receiving pharmacotherapy is mixed, with guidelines promoting voluntary engagement in psychosocial supports, including counseling. Further work is needed to promote the integration of OUD treatment into primary care and to overcome regulatory barriers to integrating methadone into primary care treatment in the US.

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Section: Buprenorphinementioning

confidence: 99%

Treatment of opioid use disorder in primary care

Buresh

Stern

Rastegar

2021

BMJ

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“…Pregnant patients with OUD in active withdrawal or seeking addiction care receive a consultation for psychiatric addiction services in the ED. Preexisting institution-specific services offer focused monitoring and intervention for this specific population to minimize the risk of neonatal abstinence syndrome and miscarriage and optimize pregnancy outcomes [ 22 ]. As such, pregnant patients will be excluded from this study.…”

Section: Methodsmentioning

confidence: 99%

Development of an Emergency Department–Based Intervention to Expand Access to Medications for Opioid Use Disorder in a Medicaid Nonexpansion Setting: Protocol for Engagement and Community Collaboration

Walter¹,

Li²,

Rodgers³

et al. 2021

JMIR Res Protoc

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Background The opioid epidemic has disproportionately impacted areas in the Appalachian region of the United States. Characterized by persistent Medicaid nonexpansion, higher poverty rates, and health care access challenges, populations residing in these areas of the United States have experienced higher opioid overdose death rates than those in other parts of the country. Jefferson County, Alabama, located in Southern Appalachia, has been especially affected, with overdose rates over 2 times greater than the statewide average (48.8 vs 19.9 overdoses per 10,000 persons). Emergency departments (EDs) have been recognized as a major health care source for persons with opioid use disorder (OUD). A program to initiate medications for OUD in the ED has been shown to be effective in treatment retention. Likewise, continued patient engagement in a recovery or treatment program after ED discharge has been shown to be efficient for long-term treatment success. Objective This protocol outlines a framework for ED-initiated medications for OUD in a resource-limited region of the United States; the study will be made possible through community partnerships with referral resources for definitive OUD care. Methods When a patient presents to the ED with symptoms of opioid withdrawal, nonfatal opioid overdose, or requesting opioid detoxification, clinicians will consider the diagnosis of OUD using the Diagnostic and Statistical Manual of Mental Disorders (fifth edition) criteria. All patients meeting the diagnostic criteria for moderate to severe OUD will be further engaged and assessed for study eligibility. Recruited subjects will be evaluated for signs and symptoms of withdrawal, treated with buprenorphine-naloxone as appropriate, and given a prescription for take-home induction along with an intranasal naloxone kit. At the time of ED discharge, a peer navigator from a local substance use coordinating center will be engaged to facilitate patient referral to a regional substance abuse coordinating center for longitudinal addiction treatment. Results This project is currently ongoing; it received funding in February 2019 and was approved by the institutional review board of the University of Alabama at Birmingham in June 2019. Data collection began on July 7, 2019, with a projected end date in February 2022. In total, 79 subjects have been enrolled to date. Results will be published in the summer of 2022. Conclusions ED recognition of OUD accompanied by buprenorphine-naloxone induction and referral for subsequent long-term treatment engagement have been shown to be components of an effective strategy for addressing the ongoing opioid crisis. Establishing community and local partnerships, particularly in resource-limited areas, is crucial for the continuity of addiction care and rehabilitation outcomes. International Registered Report Identifier (IRRID) DERR1-10.2196/18734

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“…Overall, however, the abuse potential for buprenorphine is relatively low: the drug is classified by the Food and Drug Administration (FDA) as causing only mild physical dependence. The subcutaneous form has the same mechanism as the sublingual form, however, its main advantage is that it requires administration far less often (up to only once every six months) [ 16 ].…”

Section: Reviewmentioning

confidence: 99%

Opioid Use Disorder: Treatments and Barriers

Patel

Bunachita

Agarwal

et al. 2021

Cureus

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Over the last decade, opioid use around the world has risen considerably and is projected to continue to rise at an alarming rate. As opioid use rises, so too does the number of people who suffer from opioid use disorder (OUD) and opioid overdose-related deaths. As science and medicine progresses, new medications and therapies have arisen in order to help treat patients suffering from addiction. Treatment can be split into two main domains: pharmacological and non-pharmacological. Buprenorphine and methadone, currently the most prescribed medications for patients suffering from OUD, have been shown to be extremely effective in clinical trials but have significant real-world limitations. Geographical disparities between various locations, physician stigma with prescribing these medications, and training required to prescribe medication can make access to these treatments difficult for patients. Non-pharmacological interventions have also been shown to help with limited efficacy when combined with pharmacological interventions. However, the time and resources required to implement these strategies may be a difficult barrier to overcome. In this review, we assess pharmacological interventions, non-pharmacological treatments, examine barriers to treatment for patients, and propose solutions to bypass these barriers.

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Buprenorphine Pharmacology Review: Update on Transmucosal and Long-acting Formulations

Cited by 114 publications

References 41 publications

Treatment of opioid use disorder in primary care

Treatment of opioid use disorder in primary care

Development of an Emergency Department–Based Intervention to Expand Access to Medications for Opioid Use Disorder in a Medicaid Nonexpansion Setting: Protocol for Engagement and Community Collaboration

Opioid Use Disorder: Treatments and Barriers

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