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Medline references: 'buprenorphine' AND 'detoxification' as Text Words
-- 49 references --

Search performed and originally posting: December 1, 2001. Last minor revisions to page: July 16, 2004

1
AU - White R
AU - Alcorn R
AU - Feinmann C
AD - St Lukes Woodside Hospital, Woodside Avenue, Muswell Hill, N10 3HU, London, UK
TI - Two methods of community detoxification from opiates: an open-label comparison of lofexidine and buprenorphine
AB - There is currently no consensus on the best approach to the management of opiate detoxification. In the current open-label study, 69 opiate-dependent individuals requesting outpatient detoxification were allocated to two different medication regimes: lofexidine and buprenorphine. Allocation was dependent on the timing of their presentation. Lofexifidine is a structural analogue of clonidine, and used widely in the UK. Buprenorphine is a partial opiate agonist with unusual pharmacological properties. Outcomes were better for the buprenorphine-receiving group (n=38). Clients receiving buprenorphine had a less severe withdrawal syndrome, and were more likely to complete their detoxification. In addition, for the buprenorphine-receiving group it was found that the withdrawal syndrome was least in those prescribed an initial dose of 4 mg. The findings and their implications are discussed. The design of the study precludes definitive conclusions regarding relative efficacy
UR - PM:11714592
SO - Drug Alcohol Depend 2001 Dec 1 ;65(1):77-83

2
AU - Kutz I
AU - Reznik V
AD - Psychiatric Services, Meir General Hospital, Kfar-Saba, Israel. ikutz@netvision.net.il
TI - Rapid heroin detoxification using a single high dose of buprenorphine
AB - To test the effect of 32 mg of buprenorphine on the withdrawal process from heroin, 10 street-heroin using subjects were given 32 mg of sublingual buprenorphine, following heroin abstinence of 24 hours. Withdrawal symptoms were monitored during the first few hours, and followed for six days after buprenorphine administration, after which naltrexone (50 mg) was introduced to prevent future heroin use. Nine subjects completed detoxification with negligible withdrawal symptoms and a smooth transition to naltrexone. One subject was excluded from the study due to methadone ingestion prior to experiment. These results strongly suggest that painless detoxification from heroin can be obtained by a single high dose of buprenorphine
UR - PM:11476266
SO - J Psychoactive Drugs 2001 Apr ;33(2):191-193

3
AU - Resnick RB
AU - Galanter M
AU - Resnick E
AU - Pycha C
AD - New York University Medical Center, USA
TI - Buprenorphine treatment of heroin dependence (detoxification and maintenance) in a private practice setting
AB - At the conclusion of a 3-year demonstration project in a medical setting in which refusal to accept methadone was an inclusion criterion, 12 subjects were unable to detoxify from buprenorphine and remained adamant in their refusal to enroll in a MMTP. In order to study the feasibility of expanding opportunities for treatment previously unavailable to this under-served population of heroin addicts, these 12 subjects plus an additional 11 subjects (N = 23) were recruited for a 12 months trial of buprenorphine treatment conducted in an office-based setting on a fee-for-service basis. An additional cohort of 40 heroin dependent subjects were entered in a protocol for detoxification only. The findings demonstrate both feasibility and patient acceptance of office based fee-for-service buprenorphine treatment, supporting the need for (1) additional studies of this population and (2) changes in government regulations to reintroduce addiction treatment under physician auspices in private practice settings
UR - PM:11318399
SO - J Addict Dis 2001 ;20(2):75-83

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4
AU - Yui K
AD - Universite Libre de Bruxelles, Brugmann University Hospital, Brussels
TI - [Evolution and update of detoxification techniques for opiate addicts]
UR - PM:11215403
SO - Nihon Shinkei Seishin Yakurigaku Zasshi 2000 Oct ;20(4):175-177

5
AU - Radomska M
AU - Bisaga A
AU - Popik P
AD - Klinika Toksykologii KMPiChS, Collegium Medicum, Uniwersytetu Jagiellonskiego w Krakowie
TI - [Contemporary methods in pharmacotherapy in the opiate dependent treatment]
AB - In this review, we present methods of pharmacotherapy in opiate dependence currently used in Poland and worldwide. As problems associated with drug abuse increase in severity, it is particularly important to bring these methods to the attention of medical professionals, governmental agencies and the general public. Here we describe pharmacotherapeutic approaches used in detoxification as well as relapse prevention. The presented methods of detoxification include classical treatments with clonidine and methadone as well as newer methods of rapid and ultrarapid detoxification. Agonists, partial agonists, and antagonists can be used in preventing relapse in detoxified patients. Experimental therapeutic approaches in the treatment of drug dependence are also presented. Psychotherapy and psychiatric care, central to the successful treatment of opiate dependence, are reviewed as well
UR - PM:11199877
SO - Przegl Lek 2000 ;57(10):509-518

6
AU - Welsh CJ
AU - Cargiulo TP
TI - Response to "detoxification with buprenorphine of a pregnant heroin addict"
UR - PM:11155787
SO - Am J Addict 2000 ;9(4):340-341

7
AU - Hao W
AU - Zhao M
AD - Mental Health Institute, Hunan Medical University, Changsha, Hunan, China. haowei@bigfoot.com
TI - A comparative clinical study of the effect of WeiniCom, a Chinese herbal compound, on alleviation of withdrawal symptoms and craving for heroin in detoxification treatment
AB - WeiniCom is a Chinese herbal compound. The purposes of this double blind study were to evaluate (1) the efficacy of WeiniCom in reducing acute opioid withdrawal symptoms and craving, and (2) the side effects of WeiniCom, in each instance by comparing WeiniCom with buprenorphine, an established opioid detoxification treatment agent. Forty-two heroin addicts meeting the criteria of dependence in DSM-IV were randomly assigned to two treatment groups: a WeiniCom group (21 cases), and a buprenorphine group (21 cases). The Withdrawal Symptom Rating Scale and the Craving Rating Scale were employed to assess acute withdrawal symptoms and craving for heroin, and the Side Effects Rating Scale was used to measure side effects in the 14-treatment period. Both the WeiniCom and buprenorphine treatments are well-tolerated and very safe. Overall, the relief from opioid withdrawal symptoms and craving was better in the WeiniCom group than in the buprenorphine group. The rate of reduction in the severity of the withdrawal symptoms was faster in the WeiniCom group than in the buprenorphine group. By day nine to 10, the WeiniCom group showed very few withdrawal symptoms. In contrast, from day five on, the buprenorphine group continued to report relatively high scores for withdrawal symptoms and craving. WeiniCom demonstrated positive effects quickly, and required a shorter treatment period to achieve a desired degree of elimination of acute withdrawal symptoms and craving
UR - PM:11061678
SO - J Psychoactive Drugs 2000 Jul ;32(3):277-284

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8
AU - Paetzold W
AU - Eronat V
AU - Seifert J
AU - Holze I
AU - Emrich HM
AU - Schneider U
AD - Abteilung Klinische Psychiatrie und Psychotherapie, Medizinische Hochschule Hannover
TI - [Detoxification of poly-substance abusers with buprenorphine. Effects on affect, anxiety, and withdrawal symptoms]
AB - We used an open-labeled, 21-day inpatient detoxification treatment to compare the short-term effects of a 10-day buprenorphine plus 19-day carbamazepine regimen (n = 15) to a 14-day oxazepam plus 19-day carbamazepine regimen (n = 12) during rapid detoxification from opioids and other abused drugs. Somatic and psychopathological changes were assessed using the following rating scales: ASI, HAMD, SCL-90-R, and SOWS. Eighteen of 27 patients (67%) completed the study. Four dropouts (27%) were treated with buprenorphine/carbamazepine (BPN/CBZ) and the other five dropouts (42%) were treated with oxazepam/carbamazepine (OXA/CBZ). Repeated measures analysis of variance showed that SOWS scores were significantly less pronounced with BPN-CBZ than with OXA/CBZ. On the first day of admission, no significant difference in HAMD scores was detected (BPN/CBZ 11.6, BPN/CBZ 1.0). On day 14, HAMD was significantly less pronounced in BPN/CBZ (3.0) than in OXA/CBZ (6.1). BPN/CBZ showed a significant improvement in the ASI score on days 7 and 14 compared with OXA/CBZ. Three of nine items of the SCL-90-R showed a trend toward less pronounced outcome in BPN-CBZ. No severe side effects occurred during treatment in either group. The buprenorphine/carbamazepine regimen provided significantly more effective relief from affect disturbances and withdrawal syndromes than the oxazepam/carbamazepine regimen. The pharmacological basis of these effects of buprenorphine (kappa-antagonism activity,mu-agonism activity) are discussed
UR - PM:11042867
SO - Nervenarzt 2000 Sep ;71(9):722-729

9
AU - Zubieta J
AU - Greenwald MK
AU - Lombardi U
AU - Woods JH
AU - Kilbourn MR
AU - Jewett DM
AU - Koeppe RA
AU - Schuster CR
AU - Johanson CE
AD - Neurosciences, University of Michigan, Ann Arbor 48104-1687, USA
TI - Buprenorphine-induced changes in mu-opioid receptor availability in male heroin-dependent volunteers: a preliminary study
AB - A principle of opioid pharmacotherapy is that high medication doses should occupy fractionally more opioid receptors that mediate heroin effects. In this preliminary study we examined in vivo mu opioid receptor (muOR) binding in three healthy opioid-dependent volunteers during maintenance on 2 and 16 mg sublingual buprenorphine (BUP) liquid, and after detoxification (0 mg) under double-blind, placebo-controlled conditions, and once in matched controls. Binding measures were obtained with the muOR-selective radioligand [11C]carfentanil (CFN) and PET 4 hrs after BUP administration. BUP induced dose-dependent reductions in muOR availability, 36-50% at 2 mg and 79-95% at 16 mg relative to placebo. Heroin abusers also had greater muOR binding potential in the inferofrontal cortex and anterior cingulate regions during placebo, compared to matched controls. Further studies are warranted to examine the relationship of muOR availability with BUP therapeutic actions, and the clinical implications of increased muOR binding during withdrawal
UR - PM:10942856
SO - Neuropsychopharmacology 2000 Sep ;23(3):326-334

10
AU - Annitto WJ
TI - Detoxification with buprenorphine of a pregnant heroin addict
AB - This is a case report and literature review concerning the use of buprenorphine for detoxification in a pregnant addict. It presents the clinical management of the complexities of opiate addiction and pregnancy. I suggest a more vigorous study of buprenorphine for opiate withdrawal in motivated pregnant addicts
UR - PM:10914298
SO - Am J Addict 2000 ;9(1):92-93

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11
AU - Gowing L
AU - Ali R
AU - White J
AD - Evidence-Based Practice Unit, Drug and Alcohol Services Council, 161 Greenhill Road, Parkside, SA, Australia, 5067. gowing.linda@saugov.sa.gov.au
TI - Buprenorphine for the management of opioid withdrawal
AB - BACKGROUND: Managed withdrawal, or detoxification, is not in itself a treatment for opioid dependence, but it is a required first step for many forms of longer-term treatment. It may also represent the end point of an extensive period of treatment such as methadone maintenance. As such, managed withdrawal is an essential component of an effective treatment system. This review is one of a series that aims to assess the evidence as to the effectiveness of the variety of approaches to managing opioid withdrawal. OBJECTIVES: To assess the effectiveness of interventions involving the short-term use of buprenorphine to manage the acute phase of opioid withdrawal. SEARCH STRATEGY: Multiple electronic databases, including Medline, Embase, Psychlit, Australian Medical Index and Current Contents, were searched using a strategy designed to retrieve references broadly addressing the management of opioid withdrawal. Reference lists of retrieved studies, reviews and conference abstracts were handsearched. SELECTION CRITERIA: We included randomised or quasi-randomised controlled clinical trials or prospective controlled cohort studies comparing buprenorphine (treatment 10 days or less) with another form of treatment. Studies were required to provide detailed information on the type and dose of drugs used and the characteristics of patients treated. Studies were also required to provide information on the nature of withdrawal signs and symptoms experienced, the occurrence of adverse effects OR rates of completion of the withdrawal episode. DATA COLLECTION AND ANALYSIS: Potentially relevant studies were assessed for inclusion by one reviewer (LG). Inclusion decisions were confirmed by consultation between reviewers. Included studies were assessed by all reviewers. One reviewer (LG) undertook data extraction with the process confirmed by consultation between all three reviewers. MAIN RESULTS: Five studies met the criteria for inclusion in the review. No data tables are included in this review and no meta-analysis has been undertaken because of differences in treatment regimes and the assessment of outcomes in these studies. Four studies compared buprenorphine with clonidine. All found withdrawal to be less severe in the buprenorphine treatment group. In three of these studies all participants were withdrawing from heroin. Participants in one study were withdrawing from methadone, with doses reduced to 10mg/day prior to treatment with buprenorphine. Three of the studies commented on residual symptoms experienced by participants treated with buprenorphine to manage heroin withdrawal. Aches, restlessness, yawning, mydriasis, tremor, insomnia, nausea and mild anxiety were reported as being experienced by some participants. Rates of completion of withdrawal were able to be calculated for all studies included in the review but the definition of completion varied between studies. Rates ranged from 65% to 100%. None of the studies included in the review reported adverse effects. However, approximately approximately Lintzeris 1999a approximately approximately (a single-group study which therefore did not meet the inclusion criteria) reported 50% of participants withdrawing from heroin experienced headaches, 28% sedation, 21% nausea, 21% constipation, 21% anxiety, 17% dizziness and 17% itchiness during withdrawal. These adverse effects were most common in the first 2-3 days of treatment and then subsided. In four of the five studies treatment was undertaken on an inpatient basis. Only approximately approximately O'Connor 1997 approximately approximately provided outpatient treatment. However, two studies that did not meet the inclusion criteria ( approximately approximately Diamant 1998 approximately approximately and approximately approximately Lintzeris 1999a approximately approximately ) also provided outpatient treatment. The findings of these studies support the feasibility of heroin withdrawal being managed with buprenorphine on an outpatient basis
UR - PM:10908521
SO - Cochrane Database Syst Rev 2000 ;(3):CD002025

12
AU - Blennow G
AU - Fergusson A
AU - Medvedeo A
AD - Universitetssjukhuset MAS, Malmo. blennow@swipnet.se
TI - [Buprenorphine as a new alternative for detoxification of heroin addicts. It causes only mild withdrawal problems, abating quickly]
AB - Buprenorphine might be an alternative drug to be used in opiate detoxification. Its main advantage is that it carries a low risk for respiratory depression, it gives less euphoria and limited withdrawal effects. In a pilot detoxification project ten heroin addicts were given buprenorphine; seven completed the course. Before detoxification seven patients showed five or more signs on the Himmelsbach scale [6]. After the second day four patients showed no signs, four patients displayed one sign, two patients two signs. Buprenorphine may be a valuable alternative to clonidine, dextropropoxiphene and methadone in the detoxification of opiate addicts
UR - PM:10815411
SO - Lakartidningen 2000 Apr 12 ;97(15):1830-1833

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13
AU - Rothman RB
AU - Gorelick DA
AU - Heishman SJ
AU - Eichmiller PR
AU - Hill BH
AU - Norbeck J
AU - Liberto JG
AD - National Institute on Drug Abuse, National Institutes of Health, 5500 Nathan Shock Drive, Baltimore, MD 21224, USA. rrothman@intra.nida.nih.gov
TI - An open-label study of a functional opioid kappa antagonist in the treatment of opioid dependence
AB - Several lines of evidence, including the well-established observation that kappa opiate agonists produce dysphoria and psychotomimetic effects in humans, suggest that dysfunction of the endogenous kappa opioid system may contribute to opioid and cocaine addiction. The objective of this open-label study was to determine the effectiveness of a functional kappa antagonist as a treatment for opioid dependence. This was accomplished by combining a partial mu agonist/kappa antagonist (buprenorphine, 4 mg, sublingual) with a mu antagonist (naltrexone, 50 mg by mouth), theoretically leaving kappa antagonism as the major medication effect. Subjects were treatment-seeking heroin-dependent (as per Diagnostic and Statistical Manual of Mental Disorders, 4th ed.) men (41 +/- 7 years old; 19 +/- 8 years heroin use) eligible for methadone maintenance. After inpatient detoxification and a naloxone-challenge test to verify that they were not physically dependent on opioids, subjects received naltrexone. Starting on the fourth day, patients also received liquid buprenorphine. All patients received medication at the clinic 6 days per week and a full program of psychosocial treatment. The major endpoints of the study were: pupil diameter to determine if the mu agonist effects of buprenorphine were blocked by naltrexone, urine toxicology, and retention in treatment. Five patients (33%) completed the 3-month study. Four were abstinent from opioids and cocaine for the entire study, and one was abstinent from opioids and cocaine for the last 9 weeks. Six subjects dropped out due to either minor side effects or disliking the sensation of sublingual buprenorphine. There were no significant changes in pupillary diameter. The positive response to treatment exceeds that expected from naltrexone alone (90% dropout). These promising results suggest that controlled studies of this medication combination should be conducted
UR - PM:10742642
SO - J Subst Abuse Treat 2000 Apr ;18(3):277-281

14
AU - Umbricht A
AU - Montoya ID
AU - Hoover DR
AU - Demuth KL
AU - Chiang CT
AU - Preston KL
AD - NIDA Intramural Research Program, Addiction Research Center, Baltimore, MD, USA. aumbri@intra.nida.nih.gov
TI - Naltrexone shortened opioid detoxification with buprenorphine
AB - This double-blind, randomized, placebo-controlled clinical trial evaluated the impact on withdrawal symptoms of (i) combining naltrexone with a 4-day buprenorphine taper for short opioid detoxification (NB Group), compared to (ii) using a 4-day buprenorphine taper alone, followed by naltrexone on day 8 (PB Group). Sublingual buprenorphine was administered on days 1-4 (26 mg total). For the NB Group (n = 32) escalating doses of oral naltrexone were given on days 2-8 (placebo day 1). For the PB Group (n = 28) placebo was given on days 1-7 and naltrexone on day 8. Main outcome measures were Observed Opioid Withdrawal scores (OOW, 0-30) and use of medications to treat opioid withdrawal. Of 32 patients in the NB group, 59% experienced clinically relevant withdrawal (defined as OOW > or = 5) on day 2, but, after day 5, none experienced withdrawal. In the PB group, the number of patients experiencing withdrawal increased over time. The first naltrexone dose induced comparable withdrawal in both groups: peak OOW scores were (mean +/- SD) 5.2 +/- 3.3 on day 2 for the NB group, and 4.0 +/- 3.9 on day 8 for the PB group (NS), though, on day 2, 7 patients dropped out in the NB group and none in the PB group, while only one patient dropped out in the PB group on day 8. Throughout the 8-day study, patients in both groups received similar amount of adjunct medication: 0.64 +/- 0.07 mg (NB group) of clonidine vs 0.73 +/- 0.15 mg (PB group; NS). Only 25% of patients required use of sedatives (up to 20 mg diazepam). Starting naltrexone on day 2 appeared to abolish withdrawal symptoms after day 5 and, thus, to shorten the duration of withdrawal symptoms. Peak withdrawal symptoms after naltrexone were of moderate intensity, suggesting that naltrexone combined with buprenorphine is an acceptable and safe treatment for shortened opioid detoxification and induction of naltrexone maintenance
UR - PM:10529020
SO - Drug Alcohol Depend 1999 Oct 1 ;56(3):181-190

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15
AU - Liu ZM
AU - Cai ZJ
AU - Wang XP
AU - Ge Y
AU - Li CM
AD - National Institute on Drug Dependence, Beijing Medical University, China
TI - Rapid detoxification of heroin dependence by buprenorphine
AB - AIM: To evaluate the clinical efficacy of buprenorphine (Bup) in treatment of acute heroin withdrawal. METHODS: Bup was given sublingually daily to 60 cases of heroin addicts in 3 groups: low, medium, and high doses. Withdrawal signs and symptoms of heroin were rated by Clinical Institute Narcotic Assessment. Craving for heroin during detoxification was assessed by Visual Analogue Scale. The side effects of Bup was assessed by Treatment Emergent Symptom Scale. RESULTS: The mean daily consumption of Bup in low, medium, and high group was 2.0, 2.9, and 3.6 mg, respectively. Bup not only suppressed objective signs and withdrawal symptoms for heroin withdrawal, but also reduced the duration for heroin detoxification over 7-8 d. CONCLUSION: Bup is an effective and rapid detoxification agent with fewer side effects for treatment of acute heroin withdrawal
UR - PM:10072959
SO - Zhongguo Yao Li Xue Bao 1997 Mar ;18(2):112-114

16
AU - Diamant K
AU - Fischer G
AU - Schneider C
AU - Lenzinger E
AU - Pezawas L
AU - Schindler S
AU - Eder H
AD - Drug Addiction Outpatient Clinic, Department of General Psychiatry, University Hospital of Vienna, Austria
TI - Outpatient opiate detoxification treatment with buprenorphine. Preliminary investigation
AB - In an open study design, 50 opioid-dependent subjects (DSM-IV: 304. 0) were investigated in a gradual detoxification treatment with buprenorphine. The study was performed at the drug addiction outpatient clinic of the Department of General Psychiatry at the University of Vienna. Subjects had to contact the outpatient clinic on a daily basis and buprenorphine was administered according to their clinical status. Withdrawal symptoms were evaluated by applying the WANG scale. Urine samples were screened for drug toxicology to exclude additional consumption. In this investigation buprenorphine was applied sublingually in a free dosage scheme aimed at completing detoxification treatment within 10 days by reducing buprenorphine on a daily basis. A mean daily dosage of 2.3 mg buprenorphine was required by patients on day 1 of the treatment period. The highest mean daily buprenorphine dosage was given on day 2, followed by a daily reduction over the study period. The result of this open study design revealed that a gradual daily reduction of buprenorphine might be a successful alternative outpatient detoxification treatment in opioid-dependent subjects. Compliance was 70%, the reported and evaluated withdrawal symptoms during the study period were moderate
UR - PM:9852372
SO - Eur Addict Res 1998 Dec ;4(4):198-202

17
AU - Vignau J
AD - Centre Hospitalier et Universitaire, Lille, France. jvignau@nordnet.fr
TI - Preliminary assessment of a 10-day rapid detoxification programme using high dosage buprenorphine
AB - The original French therapeutic strategy for the treatment of opioid addiction was a rapid detoxification occasionally accompanied by treatment for withdrawal symptoms. In 1995, substitution therapy using opioids was introduced with the aim of maintenance, utilising methadone and the partial agonist buprenorphine, introduced in 1996. As well as being a maintenance agent, buprenorphine has been prescribed for rapid detoxification due to its reduced tendency to cause any withdrawal effects and its ability to block the effects of other opioids. This trial was initiated to measure the efficacy of buprenorphine in rapid detoxification and to assess whether additional medication would be required. Participants in this open study had requested rapid detoxification and were referred to the addiction clinic as inpatients. Patients were assessed by the clinician and during counselling sessions, and an initial dose was agreed upon. This dose was then gradually decreased over ten days in a flexible dosing schedule, with concurrent toxicological urinalysis to ensure no illicit drug use. During the trial, 25% of patients transferred to a maintenance programme and 58% remained in the study. The large transfer of patients to maintenance programmes may indicate that many people requesting rapid detoxification are actually asking for a more generalised form of assistance. No opioid-positive urines were noted after the fourth day in any patients, and the study indicates that buprenorphine should prove to be a useful detoxification agent, particularly in less hardened addicts. Step-down buprenorphine detoxification minimises withdrawal symptoms and, therefore, reduces the need for concurrent medication
UR - PM:9767204
SO - Eur Addict Res 1998 ;4 Suppl 1():29-31

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18
AU - Budney AJ
AU - Bickel WK
AU - Amass L
AD - University of Vermont, Department of Psychiatry, S. Burlington 05403, USA. abudney@zoo.uvm.edu
TI - Marijuana use and treatment outcome among opioid-dependent patients
AB - AIMS: Information concerning the association between marijuana use and opioid dependence and its treatment is needed to determine effective clinical guidelines for addressing marijuana use among opioid abusers. SETTING AND PARTICIPANTS: Marijuana use was assessed in 107 people enrolled in treatment for opioid dependence. DESIGN AND MEASUREMENT: Univariate comparisons of marijuana users and non-users and multivariate regression analyses were performed to examine associations between marijuana use and socio-demographic, psychosocial, medical and substance-use variables. The relationship between marijuana use and treatment outcome was also explored in a subset of this sample who received treatment that included buprenorphine detoxification and behavior therapy (N = 79). FINDINGS: Sixty-six per cent of participants were current marijuana users and almost all (94%) continued to use during treatment. Users were less likely to be married than non-users, and more likely to report financial difficulties, be involved in drug dealing and engage in sharing of needles (p < 0.05). A unique effect of marijuana use on drug dealing and sharing needles was retained after statistically controlling for the influence of heroin and alcohol use and other socio-demographic variables. No significant adverse relations were observed between marijuana use and treatment outcome. CONCLUSION: Pending a more comprehensive understanding of the function and consequences of marijuana use on psychosocial functioning, it appears that progress in treatment for opioid dependence can be made without mandating that patients abstain from marijuana use
UR - PM:9684388
SO - Addiction 1998 Apr ;93(4):493-503

19
AU - Regini P
AU - Cutrone M
AU - Donzelli F
AU - Flora PG
AU - Montesanto G
AD - Divisione di Pediatria, Ospedale Umberto I di Mestre (VE), Italia
TI - [Neonatal buprenorphine withdrawal syndrome, what is the right therapy?]
AB - Buprenorphine is a new substance now widely used in detoxification of heroin addicts. In this report we describe the case of a newborn baby who suffered from a neonatal withdrawal syndrome characterized by a severe and prolonged course. This syndrome was followed by marked symptoms of impaired neurological development and by epilepsy. The ineffectiveness of methadone in relieving withdrawal symptoms from buprenorphine and its potential dangerous effects in this case are also outlined, whereas the efficacy of therapy with phenobarbytal is stressed. We think that this case is noteworthy, since the widespread use of buprenorphine among drug addicts will probably provoke an increase in the number of cases of buprenorphine withdrawal syndrome in the next years
UR - PM:9658424
SO - Pediatr Med Chir 1998 Jan ;20(1):67-69

20
AU - Bickel WK
AU - Amass L
AU - Higgins ST
AU - Badger GJ
AU - Esch RA
AD - Department of Psychiatry, University of Vermont, Burlington 05401, USA
TI - Effects of adding behavioral treatment to opioid detoxification with buprenorphine
AB - This trial assessed whether behavioral treatment improves outcome during a 26-week outpatient opioid detoxification. Thirty-nine opioid-dependent adults were assigned randomly to a buprenorphine dose-taper combined with either behavioral or standard treatment. Behavioral treatment included (a) a voucher incentive program for providing opioid-free urine samples and engaging in verifiable therapeutic activities and (b) the community reinforcement approach, a multicomponent behavioral treatment. Standard treatment included lifestyle counseling. Fifty-three percent of the patients receiving behavioral treatment completed treatment, versus 20% receiving standard treatment. The percentage of patients achieving 4, 8, 12, and 16 weeks of continuous opioid abstinence were 68, 47, 26, and 11 for the behavioral group and 55, 15, 5, and 0 for the standard group, respectively. Behavioral treatment improved outcomes during outpatient detoxification
UR - PM:9337499
SO - J Consult Clin Psychol 1997 Oct ;65(5):803-810

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21
AU - O'Connor PG
AU - Carroll KM
AU - Shi JM
AU - Schottenfeld RS
AU - Kosten TR
AU - Rounsaville BJ
AD - Yale New Haven Hospital Primary Care Center, Yale University School of Medicine, CT 06520-8025, USA
TI - Three methods of opioid detoxification in a primary care setting. A randomized trial
AB - BACKGROUND: Opioid detoxification in a primary care setting followed by ongoing substance abuse treatment may be appropriate for selected opioid-dependent patients. OBJECTIVE: To compare three pharmacologic protocols for opioid detoxification in a primary care setting. DESIGN: Randomized, double-blind clinical trial with random assignment to treatment protocols. SETTING: A free-standing primary care clinic affiliated with drug treatment programs. PATIENTS: 162 heroin-dependent patients. INTERVENTIONS: Three detoxification protocols: donidine, combined donidine and naltrexone, and buprenorphine. MEASUREMENTS: Successful detoxification (that is, when study participants received a full opioid-blocking dose [50 mg] of naltrexone), treatment retention (8 days), and withdrawal symptoms. RESULTS: Overall, 65% of participants (36 of 55) who received clonidine, 81% (44 of 54) who received combined clonidine and naltrexone, and 81% (43 of 53) who received buprenorphine were successfully detoxified. Retention did not differ significantly across the groups: 65% of participants (36 of 55) who received clonidine, 54% (29 of 54) who received combined clonidine and naltrexone, and 60% (32 of 53) who received buprenorphine. Participants who received buprenorphine had a significantly lower mean withdrawal symptom score than those who received clonidine or combined clonidine and naltrexone. CONCLUSIONS: Participants in the combined clonidine and naltrexone group and those in the buprenorphine group were more likely to complete detoxification, although retention at 8 days did not differ among the groups. Participants who were assigned to the buprenorphine group experienced less severe withdrawal symptoms than those assigned to the other two groups
UR - PM:9313020
SO - Ann Intern Med 1997 Oct 1 ;127(7):526-530

22
AU - Kintz P
AU - Tracqui A
AU - Mangin P
AU - Edel Y
AD - Institut de Medecine Legale, Strasbourg, France
TI - Sweat testing in opioid users with a sweat patch
AB - For many years, toxicologists have detected the presence of drugs of abuse in biological materials using blood or urine. In recent years, remarkable advances in sensitive analytical techniques have enabled the analysis of drugs in unconventional samples such as sweat. In a study conducted in a detoxification center, sweat patches were applied to 20 known heroin abusers. Subjects wore the patch with minimal discomfort for five days. During the same period, two urine specimens were also collected. Target drugs analyzed either by gas chromatography-mass spectrometry (GC-MS) or liquid chromatography-mass spectrometry (LC-MS) included opiates (heroin, 6-monoacetylmorphine, morphine, codeine), cocaine (cocaine, benzoylecgonine, ecgonine methyl ester), delta 9-tetrahydrocannabinol, benzodiazepines (nordiazepam, oxazepam), amphetamines (amphetamine, methamphetamine, methylenedioxyamphetamine [MDA], methylenedioxymethamphetamine [MDMA], methylenedioxyethylamphetamine [MDEA]), and buprenorphine. Patches were positive for opiates in 12 cases. Heroin (37-175 ng/patch) and/or 6-acetylmorphine (60-2386 ng/patch) were identified in eight cases, and codeine exposure (67-4018 ng/patch) was determined in four cases. When detected, heroin was always present in lower concentrations than 6-acetylmorphine, which was the major analyte found in sweat. Cocaine (324 ng/patch) and metabolites were found in only one case. delta 9-Tetrahydrocannabinol (4-38 ng/patch) was identified in nine cases. Benzodiazepine concentrations were very low, ranging from 2 to 44 and from 2 to 15 ng/patch for nordiazepam and oxazepam, respectively. MDEA (121 ng/patch) and its metabolite, MDA (22 ng/patch), were detected in one case. Buprenorphine, which was administered as therapy under close medical supervision, was detected in the range 1.3-153.2 ng/patch with no apparent relationship between the daily dose and amount excreted in sweat. All the urine tests were consistent with the sweat findings, but to identify the same drugs it was necessary to test two urine specimens along with only one sweat specimen. It was concluded that sweat testing appears to offer the advantage of being a relatively noninvasive means of obtaining a cumulative estimate of drug exposure over the period of a week. This new technology may find useful applications in the treatment and monitoring of substance abusers, as the patch provides a long-term continuous monitor of drug exposure or noncompliance
UR - PM:8889674
SO - J Anal Toxicol 1996 Oct ;20(6):393-397

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23
AU - Kouri EM
AU - Lukas SE
AU - Mendelson JH
AD - Clinical Neuropsychopharmacology Laboratory, Alcohol and Drug Abuse Research Center, McLean Hospital, Belmont, Massachusetts, USA
TI - P300 assessment of opiate and cocaine users: effects of detoxification and buprenorphine treatment
AB - We assessed cognitive function following heroin and cocaine detoxification and investigated whether buprenorphine treatment improves the disruptive effects of detoxification. Three groups of male volunteers meeting DSM-III-R criteria for concurrent opiate and cocaine dependence were tested using an auditory oddball paradigm before and after detoxification, and again on the 15th day of either buprenorphine or placebo treatment. There were no significant differences in P300 amplitude, latency, or topographic distribution between drug-dependent subjects and controls on admission day. Following detoxification there was a significant decrease in P300 amplitude in the drug-dependent group at a time when self-reported signs of withdrawal were minimal. Buprenorphine treatment significantly reversed the P300 amplitude decrement following detoxification, whereas placebo-treated subjects continued to show depressed P300 amplitudes. These data demonstrate that buprenorphine treatment is effective in eliminating detoxification-induced impairments in one measure of cognitive ability
UR - PM:8886295
SO - Biol Psychiatry 1996 Oct 1 ;40(7):617-628

24
AU - Levin JM
AU - Mendelson JH
AU - Holman BL
AU - Teoh SK
AU - Garada B
AU - Schwartz RB
AU - Mello NK
AD - Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
TI - Improved regional cerebral blood flow in chronic cocaine polydrug users treated with buprenorphine
AB - Chronic cocaine and polydrug abuse have been associated with regional abnormalities in cerebral perfusion. The authors have previously demonstrated that these abnormalities are partially reversible after drug addiction treatment with buprenorphine. This study was designed to separate the effect on cerebral perfusion of abstinence from drug use from that of buprenorphine directly. METHODS: Fifteen cocaine- and heroin-dependent men were studied with 99mTc-hexamethylpropyleneamine oxime (HMPAO) brain SPECT. The men, all part of an inpatient drug abuse treatment research program, were randomly assigned after detoxification to receive placebo or either 6 or 12 mg daily buprenorphine treatment. SPECT studies were performed at baseline, after maximum dosage was reached and after tapering off the study drug. Studies were compared visually with regard to the number and location of perfusion defects by reviewers blinded to treatment assignment. RESULTS: Subjects receiving buprenorphine had a significant reduction in the number of defects per study between baseline and maximum buprenorphine dose as compared with those receiving placebo (decrease of 4 +/- 5.4 versus increase of 4.8 +/- 4.7, p = 0.006). These differences were dose-related. Improvement with buprenorphine was temporary, with return to baseline after tapering off. CONCLUSION: Buprenorphine treatment, and not abstinence from drug use alone, leads to improvement in regional cerebral perfusion abnormalities in chronic cocaine- and heroin-dependent men
UR - PM:7790946
SO - J Nucl Med 1995 Jul ;36(7):1211-1215

25
AU - Kintz P
AU - Cirimele V
AU - Edel Y
AU - Jamey C
AU - Mangin P
AD - Institut de Medecine Legale, Strasbourg, France
TI - Hair analysis for buprenorphine and its dealkylated metabolite by RIA and confirmation by LC/ECD
AB - Hair samples were obtained from 14 subjects admitted 2 or 3 months previously to a detoxification center. All reported an history of intravenous heroin abuse. After decontamination by two dichloromethane washes, about 50 mg hair were pulverized in a ball mill and incubated at 56 degrees C overnight in 1 mL 0.1 HCl. After neutralization, buprenorphine analyzed by RIA was in the range of 0.01 to 0.47 ng/mg. To confirm buprenorphine, liquid chromatography was used. After neutralization, drugs were extracted with toluene at pH 8.5 during a 3-step extraction procedure. A portion of the reconstituted residue was injected into a Lichrosorb CN column, with a mobile phase of phosphate buffer (pH 4.0)-acetonitrile-1-heptane sulfonic acid-butylamine (85:17:2:0.01, v/v). Detection was achieved by coulometry, and the potential of the electrodes was 0.15 and 0.50 V, respectively. Linear calibration curves were obtained from 0.02 to 2.0 ng/mg with a correlation coefficient r > 0.99 for both drugs. The detection limit for the major metabolite was about 0.01 ng/mg and 0.02 ng/mg for buprenorphine, using a 50 mg hair sample. Recovery (at 0.2 ng/mg) was 54 and 62% for norbuprenorphine and buprenorphine, respectively. Drugs concentrations in hair were in the range 0.02-0.59 and not detected--0.15 ng/mg for buprenorphine and norbuprenorphine, respectively. Results suggest that a dose-response relationship exists between the concentration of buprenorphine in hair and the administered dose
UR - PM:7815029
SO - J Forensic Sci 1994 Nov ;39(6):1497-1503

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26
AU - Janiri L
AU - Mannelli P
AU - Persico AM
AU - Serretti A
AU - Tempesta E
AD - Department of Psychiatry and Psychology, Catholic University of the Sacred Heart, Rome, Italy
TI - Opiate detoxification of methadone maintenance patients using lefetamine, clonidine and buprenorphine
AB - Thirty-nine methadone maintenance patients were included in a 9-day, double blind, randomized, inpatient detoxification trial. Methadone was tapered to 10 mg/day and then patients were assigned to one of these 3 protocols: clonidine (0.3-0.9 mg/day), lefetamine (60-240 mg/day), buprenorphine (0.15-0.9 mg/day). Buprenorphine treatment was significantly superior to clonidine and to lefetamine (F = 3.96 df = 2, 29 P < 0.05) in controlling objective, subjective and psychological withdrawal symptomatology. Clonidine was more effective than lefetamine in suppressing withdrawal in the first 3 days of treatment (day 3: F = 4.10 df = 2, 30 P < 0.05), and this trend was apparent on the objective and psychological items. In addition to evaluations of the efficacy of the single drugs used, the study showed that tapering methadone to low doses before entering the pharmacologically assisted discontinuation phase was clinically acceptable in detoxification from long-term methadone treatment
UR - PM:7851281
SO - Drug Alcohol Depend 1994 Oct ;36(2):139-145

27
AU - Cheskin LJ
AU - Fudala PJ
AU - Johnson RE
AD - National Institute on Drug Abuse's Intramural Research Program, Baltimore, MD
TI - A controlled comparison of buprenorphine and clonidine for acute detoxification from opioids
AB - We compared the short-term efficacy of a high-dose, 3 day regimen of buprenorphine to a standard 5-day course of clonidine in attenuating the signs and symptoms of the acute opioid abstinence syndrome during rapid detoxification from heroin in 25 men and women admitted to a closed inpatient research ward for this randomized, double-blind, parallel-group trial. Among the 18 completers, there were no significant differences between the buprenorphine and clonidine groups on five subjective and six physiological measures. However, clonidine lowered blood pressure and buprenorphine provided more effective early relief of withdrawal symptoms
UR - PM:7851278
SO - Drug Alcohol Depend 1994 Oct ;36(2):115-121

28
AU - Banys P
AU - Clark HW
AU - Tusel DJ
AU - Sees K
AU - Stewart P
AU - Mongan L
AU - Delucchi K
AU - Callaway E
AD - Substance Abuse Programs, VA Medical Center, San Francisco, CA 94121
TI - An open trial of low dose buprenorphine in treating methadone withdrawal
AB - Buprenorphine (BPN) is a prescription analgesic with mixed opioid agonist and antagonist properties. This pilot study conducted detailed case studies with 15 methadone dependent patients. The study sought to determine whether repeated low doses (0.15 to 0.3 mg) of sublingual BPN would relieve opioid withdrawal symptoms. Subjects developed mild to moderate withdrawal symptoms within 26 to 31 hours of methadone discontinuation. Once in withdrawal, the subjects received 0.15 mg of BPN sublingually. A second dose of 0.15 mg was administered in an hour, and a 0.30 mg dose in 2 hours, if the subject obtained no relief of withdrawal symptoms. In 6 subjects a low dose of 0.15 to 0.30 mg sublingual BPN resulted in the disappearance of subjective and objective withdrawal symptoms within 10 minutes to 2.5 hours. Four others had brief, partial relief of symptoms. Five subjects failed to experience any relief of withdrawal symptoms after a total of 0.6 mg BPN administered over 3 hours. One nonresponder suffered what appeared to be a severe precipitated withdrawal reaction similar to that which can be produced in addicts by a naloxone challenge. The 4 Caucasian responders required 1 to 2 hours to respond to BPN, whereas the 2 African-American responders required only 10 to 20 minutes. Low (analgesic) doses of BPN were sufficient to treat all methadone withdrawal symptoms in 6 of 15 subjects. There may be ethnic differences in response to BPN. Low dose BPN may play a role in carefully monitored heroin detoxification treatment
UR - PM:8201637
SO - J Subst Abuse Treat 1994 Jan ;11(1):9-15

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29
AU - Amass L
AU - Bickel WK
AU - Higgins ST
AU - Hughes JR
AD - Department of Psychiatry, University of Vermont, Burlington 05401, USA
TI - A preliminary investigation of outcome following gradual or rapid buprenorphine detoxification
AB - Eight opioid-dependent individuals were maintained on daily sublingual buprenorphine (8 mg) for 28 days and assigned randomly to one of two outpatient detoxification schedules under double-blind, double-dummy conditions. The two detoxification schedules were buprenorphine gradual (36 days; N = 3) or buprenorphine rapid (12 days; N = 5). Outcome variables were subject- and observer-ratings of opioid withdrawal, treatment retention and illicit-opioid use. Outcome measures were similar for the two groups during buprenorphine maintenance. Increases in subject-rated opioid withdrawal and illicit-opioid use, and a drop in treatment retention occurred during rapid detoxification. Stable subject-rated opioid withdrawal and treatment retention, and less illicit-opioid use occurred during gradual detoxification. These data suggest that gradual reduction in buprenorphine dose is likely to produce superior treatment outcomes than more rapid buprenorphine detoxification
UR - PM:7734458
SO - J Addict Dis 1994 ;13(3):33-45

30
AU - Carr VM
AU - Farbman AI
AD - Department of Neurobiology and Physiology, Northwestern University, Evanston, IL 60208-3520
TI - Effect of ketamine on stress protein immunoreactivities in rat olfactory mucosa
AB - Administration of 9 mg ketamine per 100 g b.wt. to rats leads to transient enhancement of immunoreactivity to monoclonal antibodies against two stress proteins, ubiquitin and human 70 kDa heat shock protein (HSP70), in the supranuclear region of supporting cells of the olfactory epithelium and in the Bowman's gland acinar cells in the subepithelial lamina propria. In the supporting cells the enhanced immunoreactivities are not caused by other drugs used in our surgical anesthetic/antibiotic regimen (xylazine, buprenorphine, and gentamicin), but in Bowman's glands they are. Results are discussed in terms of possible ketamine binding to phencyclidine receptors (either NMDA-associated or not) and possible direct stress-inducing interactions of ketamine or ketamine breakdown products with the inhalant detoxification or secretory systems in the reactive cells
UR - PM:8298074
SO - Neuroreport 1993 Dec 13 ;5(3):197-200

31
AU - Torrens M
AU - San L
AU - Cami J
AD - Substance Abuse Treatment Unit, Hospital del Mar, Barcelona, Spain
TI - Buprenorphine versus heroin dependence: comparison of toxicologic and psychopathologic characteristics
AB - Sociodemographic, toxicologic, and psychopathologic characteristics of 22 buprenorphine addicts and 45 heroin addicts admitted for inpatient detoxification were compared. Although the buprenorphine addicts were older, clinically significant differences were not apparent. The availability of buprenorphine may be the main reason for its abuse
UR - PM:8480833
SO - Am J Psychiatry 1993 May ;150(5):822-824

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32
AU - Teoh SK
AU - Mendelson JH
AU - Mello NK
AU - Kuehnle J
AU - Sintavanarong P
AU - Rhoades EM
AD - Alcohol and Drug Abuse Research Center, McLean Hospital-Harvard Medical School, Belmont, Massachusetts 02178
TI - Acute interactions of buprenorphine with intravenous cocaine and morphine: an investigational new drug phase I safety evaluation
AB - Recent preclinical and clinical studies suggest that buprenorphine, an opioid mixed agonist-antagonist, may be useful for the treatment of dual dependence on cocaine and opiates. This report describes an inpatient clinical evaluation of the safety of buprenorphine alone and in combination with single doses of cocaine and morphine. Twenty subjects with a DSM-III-R diagnosis of concurrent cocaine and opioid dependence were randomly assigned to maintenance treatment with single daily doses of 4 or 8 mg of sublingual buprenorphine for 21 days. Side effects and vital signs were evaluated every day once every 8 hours and for 2 hours after daily buprenorphine administration. The physiologic effects of a single-blind challenge dose of cocaine (30 mg intravenously), morphine (10 mg intravenously), and intravenous saline placebo were measured before and during buprenorphine maintenance. Before buprenorphine maintenance, subjects underwent methadone detoxification followed by a 9-day drug-free period. Three baseline single-blind challenge dose studies were conducted on study days 7, 8, and 9 during the drug-free period. Cardiovascular responses to cocaine and to morphine were equivalent under drug-free and buprenorphine maintenance conditions. Respiration and temperature changes in response to cocaine were also equivalent before and during buprenorphine maintenance. Respiratory rates were slightly lower after morphine administration during maintenance on 8 mg of buprenorphine, but this was not statistically significant. Mild opioid agonist-like side effects were reported during buprenorphine induction and maintenance. These included headache, sedation, nasal discharge, abdominal discomfort, and anxiety. Most opioid agonist side effects decreased within 12 to 14 days. An electrocardiogram and blood chemistry measures were normal before and during buprenorphine maintenance. These data suggest that daily maintenance on buprenorphine is not associated with adverse side effects or toxic interactions with a single acute dose of intravenous cocaine or morphine
UR - PM:8463453
SO - J Clin Psychopharmacol 1993 Apr ;13(2):87-99

33
AU - Gold MS
AD - Department of Neuroscience, University of Florida College of Medicine, Gainesville
TI - Opiate addiction and the locus coeruleus. The clinical utility of clonidine, naltrexone, methadone, and buprenorphine
AB - Detoxification from opiate addiction has been a medical problem for as long as opiate drugs have been available. Treatment before the discovery of clonidine involved giving another opioid drug with less dangerous consequences of chronic use, such as the long-acting and orally administered once a day methadone, for another opioid mu agonist like heroin, which must be taken intravenously many times a day, thus making rehabilitation, work, and avoidance of hepatitis, HIV, and other illnesses difficult. Although methadone has proved to be very beneficial, it still has significant abuse potential. Naltrexone, because it blocks the effects of all opiates, has facilitated the transformation from addiction to a drug-free state for many recovering addicts. By alleviating withdrawal symptoms and by lessening the detoxification period, clonidine similarly has improved the prospect of recovery from opiate addiction. Relapse, whether withdrawal is treated with clonidine or other new agents or not, occurs with great regularity because repeated opiate use can induce a new acquired drive state--the drive for opiates. In addition, with powerful withdrawal symptoms during abstinence, opiate relapse is difficult to prevent without an adequate treatment program. The efficacy of clonidine and other medical magic bullets for withdrawal distress needs to be given as part of a long-term recovery program which not only allows the brain to re-establish normal homeostatic changes in the drug-free state but also provides sufficient motivation for new approaches to achieving and sustaining pleasurable existence
UR - PM:8456048
SO - Psychiatr Clin North Am 1993 Mar ;16(1):61-73

34
AU - Fishbain DA
AU - Rosomoff HL
AU - Cutler R
AD - Comprehensive Pain and Rehabilitation Center, South Shore Hospital, University of Miami, School of Medicine, Florida
TI - Opiate detoxification protocols. A clinical manual
AB - The purpose of any opiate detoxification protocol is to minimize or eliminate the signs and symptoms associated with opiate withdrawal, thereby decreasing the chances of relapse to opiate dependence. In the last few years, because of the development of new medications such as clonidine, for the treatment of opiate withdrawal, a number of new protocols have been developed. Four different types of protocols are reviewed and outlined: methadone substitution/detoxification, codeine or other opiate substitution/detoxification, opiate of choice detoxification, and buprenorphine substitution/detoxification. In addition, six protocols utilizing clonidine are presented, including a protocol utilizing opiate antagonist precipitated withdrawal. Finally, two protocols that utilize naltrexone are outlined, and adjunct medications potentially useful in opiate detoxification are reviewed. Some suggestions for the treatment of drug-seeking behavior during detoxification and the advantages and disadvantages of the various protocols are summarized
UR - PM:8394176
SO - Ann Clin Psychiatry 1993 Mar ;5(1):53-65

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35
AU - Singh RA
AU - Mattoo SK
AU - Malhotra A
AU - Varma VK
AD - Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, India
TI - Cases of buprenorphine abuse in India
AB - Buprenorphine was introduced as a potent analgesic with low abuse potential. Reports of buprenorphine abuse by opiate abusers have accumulated over the years, highlighting its use as a cheap alternative to heroin. The lower potency compared with heroin is being compensated by using a cocktail of buprenorphine with benzodiazepines or cyclizine. This study of 18 cases seen over 3 years broadly confirms these findings. Four cases reported haematemesis during acute withdrawal, a symptom not reported in earlier studies
UR - PM:1414399
SO - Acta Psychiatr Scand 1992 Jul ;86(1):46-48

36
AU - Stine SM
AU - Kosten TR
AD - Department of Psychiatry, West Haven VA Hospital, Connecticut 06516
TI - Use of drug combinations in treatment of opioid withdrawal
AB - During the last 10 years new approaches for rapid opioid detoxification have included drug combinations such as clonidine and naltrexone to speed and ease the transition from opioid agonist to antagonist maintenance. Other drug combinations include naloxone with midazolam or methohexitone for inpatients, but rapid outpatient methods are more desirable. Clonidine combined with naltrexone enables abrupt opioid withdrawal in 3-5 days in an outpatient/day setting. This approach can be further improved by transition to the partial agonist buprenorphine from either heroin or methadone followed by a 1 day detoxification using naltrexone precipitated withdrawal, ameliorated by clonidine
UR - PM:1629388
SO - J Clin Psychopharmacol 1992 Jun ;12(3):203-209

37
AU - Johnson RE
AU - Jaffe JH
AU - Fudala PJ
AD - Addiction Research Center, National Institute on Drug Abuse, Baltimore, Md
TI - A controlled trial of buprenorphine treatment for opioid dependence
AB - OBJECTIVE--To assess the efficacy of buprenorphine for short-term maintenance/detoxification. DESIGN--A randomized, double-blind, parallel group study comparing buprenorphine, 8 mg/d, methadone, 60 mg/d, and methadone, 20 mg/d, in a 17-week maintenance phase followed by an 8-week detoxification phase. SETTING--Outpatient facilities at the Addiction Research Center, Baltimore, Md. PATIENTS--One hundred sixty-two volunteers seeking treatment for opioid dependence. INTERVENTION--In addition to the medication, counseling using a relapse prevention model was offered but not required. PRIMARY OUTCOME MEASURES--Retention time in treatment, urine samples negative for opioids, and failure to maintain abstinence. RESULTS--Throughout the maintenance phase, retention rates were significantly greater for buprenorphine (42%) than for methadone, 20 mg/d (20%, P less than .04); the percentage of urine samples negative for opioids was significantly greater for buprenorphine (53%, P less than .001) and methadone, 60 mg/d (44%, P less than .04), than for methadone, 20 mg/d (29%). Failure to maintain abstinence during the maintenance phase was significantly greater for methadone, 20 mg/d, than for buprenorphine (P less than .03). During the detoxification phase, no differences were observed between groups with respect to urine samples negative for opioids. For the entire 25 weeks, retention rates for buprenorphine (30%, P less than .01) and methadone, 60 mg/d (20%, P less than .05), were significantly greater than for methadone, 20 mg/d (6%). All treatments were well tolerated, with similar profiles of self-reported adverse effects. The percentages of patients who received counseling did not differ between groups. CONCLUSIONS--Buprenorphine was as effective as methadone, 60 mg/d, and both were superior to methadone, 20 mg/d, in reducing illicit opioid use and maintaining patients in treatment for 25 weeks
UR - PM:1578593
SO - JAMA 1992 May 27 ;267(20):2750-2755

38
AU - Sopelana P
AU - Dieguez A
AU - Bautista L
AD - Hospital Psiquiatrico Provincial, Carretera de Colmenar Viejo, Madrid
TI - [Profile of drug addicts admitted to a hospital detoxification unit during a four-and-a-half year period]
AB - It realize a overall and evolutionarily (6 months periods) study concerning the 1,313 drug dependents that were admitted to the Detoxication Unit of the Hospital Psiquiatrico de Madrid, since October 1985 to March 1990. The sociodemographic, drug dependence history, the Physical and toxicological state at admittance, the inpatient evolution, and the familiar and personal psychopathological history variables were evaluated. It bring out that the 45% are dependents to another drug apart from the heroin, the gradual increase in the mean age and in the use of the cocaine, a decrease in the use of the cannabis, anyway the appearance of the buprenorphine addition. There is a gradual decrease, in the period studied, of the antibodies HIV carrier rates. It shows that there is a relationship between this. The poly drug dependents have more legal incidences, psychopathological personal histories (heroin and alcohol and/or benzodiazepines addiction), use more the i.v. route and the HIV seroprevalence are the greatest
UR - PM:1317659
SO - Actas Luso Esp Neurol Psiquiatr Cienc Afines 1992 Mar ;20(2):81-91

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39
AU - Kosten TR
AU - Morgan C
AU - Kleber HD
AD - Psychiatry Department, Yale University School of Medicine, New Haven, CT 06519
TI - Phase II clinical trials of buprenorphine: detoxification and induction onto naltrexone
UR - PM:1406906
SO - NIDA Res Monogr 1992 ;121():101-119

40
AU - Westermeyer J
TI - Rapid opioid detoxification with electrosleep and naloxone
UR - PM:2393441
SO - Am J Psychiatry 1990 Jul ;147(7):952-953

41
AU - Kosten TR
AD - Substance Abuse Treatment Unit, Yale University School of Medicine, New Haven, CT 06511
TI - Current pharmacotherapies for opioid dependence
AB - Pharmacotherapy of intravenous opioid abusers has taken on increased urgency with the acquired immunodeficiency syndrome (AIDS) epidemic, because in major cities intravenous drug abuse now accounts for half of new AIDS cases. The pharmacotherapy of acute dependence and withdrawal has benefited from the use of clonidine, particularly in combination with antagonist-precipitated withdrawal. However, protracted abstinence and its associated risk of relapse to drug abuse has underscored the need for maintenance pharmacotherapies. Maintenance pharmacotherapies such as methadone and naltrexone are frequently needed to sustain outpatient retention and abstinence from heroin. Methadone is more widely used than is naltrexone, an oral, long acting heroin blocker that can maintain drug abstinence after detoxification. Because of limitations in both of these maintenance agents, two investigational maintenance treatments have been tested: levo-alpha-acetylmethadol (LAAM), a long-acting form of methadone, and buprenorphine, a long-acting mixed opioid agonist-antagonist with properties similar to either methadone or naltrexone, depending on dose. Clinical use, limitations, and outcome with each medication are reviewed
UR - PM:2196628
SO - Psychopharmacol Bull 1990 ;26(1):69-74

42
AU - Kosten TR
AU - Krystal JH
AU - Charney DS
AU - Price LH
AU - Morgan CH
AU - Kleber HD
TI - Rapid detoxification from opioid dependence
UR - PM:2675644
SO - Am J Psychiatry 1989 Oct ;146(10):1349

43
AU - Johnson RE
AU - Fudala PJ
AU - Collins CC
AU - Jaffe JH
AD - NIDA, Addiction Research Center, Baltimore, MD
TI - Outpatient maintenance/detoxification comparison of methadone and buprenorphine
UR - PM:2641003
SO - NIDA Res Monogr 1989 ;95():384

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44
AU - Kosten TR
AU - Kleber HD
AD - Yale University School of Medicine, Psychiatry Department, New Haven, Ct. 06519
TI - Buprenorphine detoxification from opioid dependence: a pilot study
AB - Sixteen opioid dependent patients were assigned to treatment with buprenorphine for one month at three doses--2 mg (n = 10), 4 mg (n = 4), 8 mg (n = 2). Treatment retention was excellent--only one patient left due to withdrawal symptoms. Illicit opioid use was infrequent, with only 22% of the urines containing illicit opioids. Although buprenorphine dose was not associated with retention or illicit opioid use, patterns of withdrawal symptoms differed among dosage groups during the 30 day study. The 4 mg group had a substantial decline in symptoms, while the other two groups did not. Symptom levels were comparable to those during successful clonidine detoxification and much lower than those found in clonidine failures
UR - PM:3276999
SO - Life Sci 1988 ;42(6):635-641

45
AU - Bickel WK
AU - Stitzer ML
AU - Bigelow GE
AU - Liebson IA
AU - Jasinski DR
AU - Johnson RE
AD - Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Md
TI - A clinical trial of buprenorphine: comparison with methadone in the detoxification of heroin addicts
AB - The efficacy of buprenorphine and methadone was compared in the outpatient detoxification of heroin addicts. Forty-five patients were randomized to receive either sublingual buprenorphine or oral methadone under double-dummy and double-blind conditions to study the pharmacology of buprenorphine in a 90-day detoxification protocol. The patients were administered either 2 mg buprenorphine or 30 mg methadone for 3 weeks followed by 4 weeks of dose reductions and 6 weeks of placebo medication. No significant between-group differences were seen on measures of treatment retention, drug use, or symptom report. During the hydromorphone challenge, methadone attenuated opioid effects to a greater extent than did buprenorphine on both physiologic (pupil constriction) and self-report measures. However, this did not result in greater abuse of illicit opioid drugs by subjects taking buprenorphine. The results of this clinical trial indicated that buprenorphine was acceptable to patients and as effective as methadone in the detoxification treatment of heroin addicts
UR - PM:3275523
SO - Clin Pharmacol Ther 1988 Jan ;43(1):72-78

46
AU - Bickel WK
AU - Johnson RE
AU - Stitzer ML
AU - Bigelow GE
AU - Liebson IA
AU - Jasinski DR
AD - Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
TI - A clinical trial of buprenorphine: I. Comparison with methadone in the detoxification of heroin addicts. II. Examination of its opioid blocking properties
UR - PM:2449618
SO - NIDA Res Monogr 1987 ;76():182-188

47
AU - Seow SS
AU - Quigley AJ
AU - Ilett KF
AU - Dusci LJ
AU - Swensen G
AU - Harrison-Stewart A
AU - Rappeport L
TI - Buprenorphine: a new maintenance opiate?
AB - Heroin-dependent out-patients who had been prescribed buprenorphine by general practitioners took part in a controlled study in which 2 mg or 4 mg of buprenorphine were administered by the sublingual route to assess its acceptability as a maintenance opiate and to determine the effects of its abrupt withdrawal and reintroduction a week later. Subjects who received 4 mg of buprenorphine reported being more intoxicated and having fewer symptoms of opiate withdrawal than did the subjects who received the 2-mg dose. Subjects who received the higher dose also abused opiate and benzodiazepine drugs less frequently. When buprenorphine was ceased abruptly, the subjects reported mild withdrawal discomfort for which many requested symptomatic treatment. The reintroduction of buprenorphine caused their condition to restabilize. The subjects' use of opiate drugs, as shown by urine assay, rose from a prevalence of around 15% of specimens at the beginning to about 50% of specimens at the end of the five-week study period. Sublingual buprenorphine was acceptable to opiate-addicted outpatients as a maintenance treatment. However, daily doses of greater than 4 mg will probably be required to suppress concurrent opiate abuse, and detoxification will need to be undertaken gradually
UR - PM:3959968
SO - Med J Aust 1986 Apr 14 ;144(8):407-411

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48
AU - Preston KL
AU - Bigelow GE
TI - Pharmacological advances in addiction treatment
AB - In the past 20 years significant advances in the pharmacological treatment of opioid dependence have been made, and research in this area is continuing. Therapeutic applications and current research in the use of pharmacological agents in maintenance therapy, treatment with narcotic antagonists, and narcotic detoxification are discussed. In addition, an overview is presented of recent developments in opioid pharmacology and of recently developed novel pharmacological agents which may prove useful in the future treatment and/or prevention of opioid dependence

49
AU - Mello NK
AU - Mendelson JH
AU - Sellers ML
AU - Kuehnle JC
TI - Effects of heroin self-administration on cigarette smoking
AB - Cigarette smoking increased during heroin self-administration in comparison to drug-free and methadone detoxification conditions in eight heroin addicts given naltrexone placebo (P less than 0.01) and three heroin addicts given buprenorphine placebo. Cigarette smoking was stable across conditions for one subject who did not use heroin during naltrexone blockade of heroin effects. Five subjects smoked significantly more (P less than 0.01) during the hour following a heroin injection than during the preceding hour, and two subjects in the same group smoked significantly less following a heroin injection (P less than 0.05). Subjects smoked significantly more during the evening and night when self-administering heroin than during baseline conditions (P less than 0.05), but subjects did not sleep significantly less during heroin self-administration. The peak of the intercigarette interval distribution remained between 16-30 min during baseline and heroin conditions. However, the increased smoking during heroin use appeared to reflect a higher rate of smoking rather than a generalized increase across intercigarette intervals. These data extend previous findings, that alcohol consumption is associated with increased cigarette smoking, to IV heroin self-administration
UR - PM:6768078
SO - Psychopharmacology (Berl) 1980 Jan ;67(1):45-52

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Dr. DeLuca's Addiction, Pain, and Public Health Website

Alexander DeLuca, M.D.,  FASAM.

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Originally posted:  12/1/2001

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