Buprenorphine substitution therapy

Verheul R, van den Brink W Hartgers C (1995). Prevalence of personality disorders among alcoholics and drug addicts an overview. European Addiction Research, 1, 166-77 Vignau J Brunelle E (1998). Differences between general practitioner- and addiction centre-prescribed buprenorphine substitution therapy in France. Preliminary results. European Addiction Research, 4, suppl 1, 24-8 Vocci FJ Appel NM (2007). Approaches to the development of medications for the... 

Substitution therapy with methadone or buprenorphine has been veiy successfiil in terms of harm reduction. Some opiate addicts might also benefit from naltrexone treatment. One idea is that patients should undergo rapid opiate detoxification with naltrexone under anaesthesia, which then allows fiuther naltrexone treatment to reduce the likelihood of relapse. However, the mode of action of rapid opiate detoxification is obscure. Moreover, it can be a dangerous procedure and some studies now indicate that this procedure can induce even more severe and long-lasting withdrawal symptoms as well as no improvement in relapse rates than a regular detoxification and psychosocial relapse prevention program. 

There are few empirical data on the use of substitution agents in youth with SUD. However, there is significant evidence supporting the efficacy of opiate substitution therapy for adults with opiate addiction with agents such as methadone, buprenorphine, and LAAM. While... 

Buprenorphine Partial agonist at P-opioid receptors Attenuates acute effects of morphine Oral substitution therapy for opioid-addicts Long half-life (40 h) formulated together with naloxone to avoid illicit IV injections... 

Figure 7.3 Pharmacology of opioid substitute therapy. Methadone is a relatively long-acting full agonist and buprenorphine a long-acting partial agonist and their use avoids the highs alternating with lows associated with heroin.

A common strategy for treating chronic opiate addiction iavolves the substitution of methadone which can either be provided as maintenance therapy or tapered until abstinence is achieved. Naltrexone and buprenorphine [52485-79-7] have also been used ia this manner. The a2 adrenergic agonist clonidine [4205-90-7] provides some rehef from the symptoms of opiate withdrawal, probably the result of its mimicking the inhibitory effect of opiates on the activity of locus coerukus neurons. 

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