Substitution treatment buprenorphine

The above drugs have been discussed as possible substitute treatments which are more euphoriant than methadone. The evidence relating to their use is limited in comparison to that for methadone, and they seem likely for the time being to remain relatively peripheral possibilities compared to methadone and buprenorphine. The euphoriant properties have been identified as a rationale for treatment, and this has various implications both for the individuals concerned, and in terms of overall treatment within a clinic. 

Table 2.1. Possible advantages of buprenorphine over methadone as substitution treatment in opiate misuse Safer overall...

For those of us in countries where buprenorphine and methadone are absolutely direct alternatives, with very broadly about half of presenting patients choosing one medication and half the other, there are two characteristics of the literature on buprenorphine from other countries which strike unusual notes. For anyone reviewing this area they will soon notice that an exceptional proportion of the literature comes from France (e.g. Auriacombe et al. 1999, Carrier et al. 2006), and this is because even though buprenorphine use in substitution treatment there is recent, as it is everywhere else, methadone had not been... 

Ongoing substitution treatment, usually with methadone or buprenorphine... 

Nielsen S, Dietze P, Lee N, Dunlop A Taylor D (2007). Concurrent buprenorphine and benzodiazepines use and self-reported opioid toxicity in opioid substitution treatment. Addiction, 102, 616-22... 

Rett KF, Hackett LP, Gower S, Doherty DA, Hamilton D, Bartu AE. Estimated dose exposure of the neonate to buprenorphine and its metabolite norbuprenorphine via breastmOk during maternal buprenorphine substitution treatment. Breastfeed Med August 2012 7 269-74. 

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. 

Further situations in which methadone can seem an unsatisfactory substitution agent are towards the other end of the treatment spectrum. In uncomplicated maintenance treatment or for detoxification, the criticisms which are levelled at methadone relate not so much to the subjective effects, but to the aspects of addictiveness, abuse potential and toxicity. The issue of whether methadone is too addictive to be really suitable for detoxification is considered in detail in Chapter 3, and the controversial subject of methadone risks and deaths in Chapter 1. It is in the relatively milder cases of heroin dependence that buprenorphine treatment as an alternative to methadone has risen to great prominence in several countries, although, importantly, the condition definitely does not have to be mild for this medication to be used. Undoubtedly the introduction of buprenorphine is one of... 

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