Methadone buprenorphine

In October 2002, the FDA approved two new medications for treating opiate addiction, both developed by Reckitt Benckiser Pharmaceuticals. The new drugs, Subutex (buprenorphine hydrochloride) and Suboxone tablets (buprenorphine hydrochloride and naloxone hydrochloride) contain buprenorphine, a partial opioid agonist. Like methadone, buprenorphine binds to the brain s opioid receptors, but produces significantly reduced pleasurable effects than heroin. 

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... 

The important difference in the cocaine-abusing opioid patient scenario is that there is also the dose of methadone, buprenorphine or alternative to consider, and there seems little doubt in practice and from study results that at least some individuals will refrain from other drug use better if their opioid is increased (Faggiano et al. 2004). 

What are the key differences between buprenorphine and methadone Buprenorphine differs from methadone in the following ways ... 

When a patient collects his or her first instalment of methadone/buprenorphine an appropriate information leaflet should be supplied, giving advice on how to use the product, special warnings, precautions and drug instructions. 

The intensity of symptoms depends both on the drug and on its mode of administration, the dosage that the individual has been using, and the time from abrupt discontinuance. Full agonist opioids used IV, which include heroin, cause the most severe withdrawal symptoms. Management involves administration of oral methadone , buprenorphine, or clonidine, with gradual dose tapering. 

Opioid Treatment Program Substance Abuse and Mental Health Services Administration (SAMHSA) certified program, usually comprising a facility, staff, administration, patients, and services that engages in supervised assessment and treatment, using methadone, buprenorphine, L-a-acetylmethadol (LAAM), or naltrexone, of individuals who are addicted to opioids. 

Prevention of craving behavior and withdrawal symptoms of opioids by permanently aaing opioid (e.g., methadone, buprenorphine)... 

Drugs employed have sedative or hypnotic properties with a rapid onset and induce memory loss during the period when the drug is active. The most-prevalent drugs detected, apart from alcohol, are the benzodiazepines and h5 notics (zolpidem and zopiclone). A wide range of other drugs, such as GHB, ketamine, sildenafil, methadone, buprenorphine, diphenhydramine, trimeprazine, acepromazine, thiopental, pentobarb, doxylamine, and cyamemazine, have also been reported in DFC cases. 

Methadone/buprenorphine script dose, prescriber, dispensing pharmacy, supervised consumption weaning off or continuing long-term ... 

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. 

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. 

Alfentanil, codein, dihydromorphine, etor-phine, fentanyl, heroin, hydromorphone, levo-methadone, morphine, oxycodone, pethidine, piritramide, remifentanil, sufentanil, tilidine, tramadol Buprenorphine, pentazocine Naloxone, naltrexone... 

The initial dose of buprenorphine should be given at least 12-24 hours after the last heroin dose, 24 hours after the last methadone dose, or 48 hours after the last LAAM dose (see Table 2-3). The methadone dosage of methadone maintenance patients should be reduced to 30 mg/day before the transfer to buprenorphine is attempted. Ideally patients should show clear evidence of opiate withdrawal before receiving the first dose of buprenorphine, to avoid the risk that buprenorphine will precipitate more severe withdrawal. For the first day, sublingual buprenorphine/naloxone doses of 2/0.5-4/1 mg can be given every 2-4 hours, up to a maximum total dose of 8/2 mg/day. On the... 

The approval of buprenorphine for the office-based treatment of opioid dependence represents a major departure from the earlier methadone clinic system. Physicians with addiction specialist credentials or those who have completed 8 hours of approved training can become qualified to treat up to 30 patients in their private offices. Stable patients may be given prescriptions for up to a month of medication. The combination buprenorphine/naloxone tablet is expected to have minimal risk for diversion. When taken subhnguaUy, as prescribed, naloxone has minimal biologic activity and does not interfere with the buprenorphine dose. However, if an attempt is made to inject the drug, the addict will experience the full antagonist effect of the naloxone. 

It is anticipated that buprenorphine will be an acceptable treatment for younger addicts and for individuals with smaller habits and shorter histories of dependence, thus permitting earlier intervention in the course of the addiction. Clinical experience suggests that buprenorphine is less effective for individuals with larger opioid habits. Methadone or LAAM remains the preferred medication for those patients. 

Johnson RE, Chutuape MA, Strain EC, et al A comparison of levomethadyl acetate, buprenorphine, and methadone for opioid dependence. N EnglJ Med 343 1290-1297, 2000... 

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Ling W, Weiss DG, Charuvastra VC, et al Use of disulfiram for alcoholics in methadone maintenance programs. Arch Gen Psychiarry 40 851—854, 1983 Ling W, Charuvastra C, Collins JF, er al Buprenorphine maintenance treatment of opiate dependence a multi-center, randomized clinical trial. Addiction 93 475-486, 1998... 

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Sporadic use (e.g., for the induction of sleep after a psychostimulant binge) does not require specific detoxification. Sustained use can be treated as described in the previous sections on detoxification from therapeutic or high dosages but with added caution. In mixed opioid and benzodiazepine abuse, the patient should be stabilized with methadone (some clinicians use other oral preparations of opioids) and a benzodiazepine. Buprenorphine should not be administered with benzodiazepines, because a pharmacodynamic interaction is possible (Ibrahim et al. 2000 Kilicarslan and Sellers 2000) and fatalities have been reported with the combination (Reynaud et al. 1998). Sedative-hypnotic withdrawal is the more medically serious procedure, and we usually... 

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