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Medline references: 'buprenorphine' as Text Word <and> 'substance abuse treatment' as Keyword <not> 'detox* as Keyword

Last Updated: 11/29/01 - 24 references


1
AU - Gross A
AU - Jacobs EA
AU - Petry NM
AU - Badger GJ
AU - Bickel WK
AD - Substance Abuse Treatment Center, University of Vermont, 1 South Prospect Street, Burlington, VT 05401, USA. agross@zoo.uvm.edu
TI - Limits to buprenorphine dosing: a comparison between quintuple and sextuple the maintenance dose every 5 days
AB - The relative efficacy of quintuple and sextuple buprenorphine dosing in abating withdrawal symptoms for 120 h was compared in opioid-dependent outpatients. Fourteen subjects received buprenorphine in a double-blind, placebo-controlled, cross-over design. Daily sublingual maintenance doses were 4 mg/70 kg (n=4) and 8 mg/70 kg (n=10). After a stabilization period of daily maintenance administration, subjects received quintuple (5x daily maintenance dose) and sextuple (6x daily maintenance dose) doses every 120 h. Measures of opioid agonist and withdrawal effects were assessed daily. Subjective ratings of withdrawal were significantly greater than baseline ratings beyond 96-h post dosing under both regimens. There was no evidence, however, that those subjective ratings of withdrawal differed between the two regimens. Thus, these data suggest that sextuple buprenorphine dosing, administered every 5 days, does not abate opioid-withdrawal beyond 96 hours
UR - PM:11470347
SO - Drug Alcohol Depend 2001 Sep 1 ;64(1):111-116

2
AU - Clark HW
TI - A new era in opioid dependency treatment. Recent law allows qualified physicians to provide care in office setting
UR - PM:11424343
SO - Postgrad Med 2001 Jun ;109(6):15-6, 25

3
AU - Thirion X
AU - Micallef J
AU - Barrau K
AU - Djezzar S
AU - Sanmarco JL
AU - Lagier G
AD - CEIP de Marseille (centre associe) et Laboratoire de Sante Publique, Faculte de Medecine, Marseille, France. oppidum@medecine.univ-mrs.fr
TI - Observation of psychoactive substance consumption: methods and results of the French OPPIDUM programme
AB - This study presents a French programme designed to observe and evaluate psychoactive substance dependence and abuse. Annual surveys lasting 4 weeks are performed with drug users in drug centres. Its usefulness is discussed using examples from the study: potential for antidepressant dependence (amineptine), monitoring benzodiazepine use and consumption associated with maintenance treatments. Flunitrazepam is the most consumed benzodiazepine and often got by deal (29%). There are important differences between buprenorphine consumption in a maintenance treatment context (9/10) and beyond this context (1/10). The main methodology problems encountered are representativeness and validity of data. The limits of the programme and its role in the French health care system are discussed. Copyright 2001 S. Karger AG, Basel
UR - PM:11316923
SO - Eur Addict Res 2001 Mar ;7(1):32-36

4
AU - Basu D
AU - Mattoo SK
AU - Malhotra A
AU - Gupta N
AU - Malhotra R
AD - Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India. medinst@pgi.chd.nic.in
TI - A longitudinal study of male buprenorphine addicts attending an addiction clinic in India
AB - AIM: There is a lack of longitudinal studies of buprenorphine dependence, an important opioid dependence in several countries. We investigated the course and outcome of buprenorphine dependence in an Indian clinic-attending cohort. DESIGN: Retrospective longitudinal study. SETTING: An addiction clinic in northern India. PARTICIPANTS: Ninety-four male patients with buprenorphine dependence, registered for treatment between 1987 and 1993. Follow-up analyses were conducted for the 52 patients (55% of the index cohort) who completed more than a year of follow-up. In 48% of these 52 patients data were obtained from their clinical records of follow-up, while 52% were contacted specifically to obtain the required data on follow up. MEASUREMENT: Baseline demographic and clinical variables; time spent in various phases of use or abstinence; outcome at the latest follow up; transition to other drugs during follow-up period. FINDINGS: Over an average follow-up duration of 3 years, 56% of the time was spent in dependent use, 12% in non-dependent use and 32% in abstinence. By the end of follow-up, 6% of patients were dead (annual death rate 1.9%), 33% were unchanged and 61% were classified as "improved". The proportion of patients with "improved" outcome increased over the years. Patients with poor outcome had shorter follow-up and hospital stay, and had used pentazocine and/or antihistaminic injections in the buprenorphine "cocktail" more often than those with better outcome. Thirty-two patients shifted to other drugs over the years, notably heroin or polydrug use. These "transition" patients had a family history of drug use more often, started their drug career earlier, had marital and legal complications more often, spent more time in dependent phase of drug use, underwent multiple hospital admissions but stayed for a shorter period and faced more deaths, when compared to those who did not shift. CONCLUSION: In clinic-attending male patients with buprenorphine dependence who were followed-up although dependent pattern of use of the drug continued for a long time in their career, there was a slow but progressive improvement. Transition to other drugs was associated with a worse course and outcome as compared to being stable on buprenorphine
UR - PM:11048355
SO - Addiction 2000 Sep ;95(9):1363-1372

5
AU - Kuo I
AU - Fischer B
AU - Vlahov D
AD - Department of Epidemiology, Johns Hopkins School of Public Health, 615 North Wolfe Street, Room E6005, 21205, Baltimore, MD, USA
TI - Consideration of a North American heroin-assisted clinical trial for the treatment of opiate-dependent individuals
AB - Untreated opiate addiction remains a major public health problem in North America (US and Canada). Increased morbidity and mortality as well as criminal behavior related to untreated opiate dependence constitute significant social and economic burdens. While the principal treatment modality to opiate addiction in North America has been methadone treatment since the 1960s, its reach and effectiveness has been limited; at any given time, only about 25% (US) and 15-20% (Canada) of all opiate addicts are in methadone treatment. Reasons for low levels of treatment participation among this subset of users include perceptions among users that treatment programs are punitive and that the medication is fraught with side effects. In the meantime, alternatives to methadone have been recently approved or are in development, including levo-alpha acetylmethadol and buprenorphine. However, the extent to which they will solve the current problem is still unknown, and therefore development of additional treatment strategies needs to continue. Recent studies of heroin-assisted treatment in Europe (Switzerland, the Netherlands and Great Britain) produced preliminary yet encouraging results in attracting and retaining long-term, treatment-resistant addicts in treatment, as well as improving treatment outcomes. However encouraging, the North American context differs from Europe. A study performed in North America would provide critical information on whether utilizing injectable opiates enhances the overall therapeutic attractiveness and effectiveness of substance abuse treatment to a subset of recalcitrant users. Implications of positive results would expand the continuum of effective interventions in the US and Canada, and increase the number of long-term, treatment-resistant opiate addicts in treatment
UR - PM:10967518
SO - 2000 Sep 1 ;11(5):357-370

6
AU - Jain R
AD - Department of Psychiatry, Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi. rjain@medinsternet.in
TI - Utility of thin layer chromatography for detection of opioids and benzodiazepines in a clinical setting
AB - This study examined the utility of thin layer chromatography (TLC) for detection of recent use of opioids and benzodiazepines among drug addicts seeking treatment at the Drug Dependence Treatment Centre of All India Institute of Medical Sciences, New Delhi, India. Over a period of 5 years (1991-1995), 6,055 urine samples were analyzed for opioids (morphine, codeine, buprenorphine, dextropropoxyphene, pentazocine) and benzodiazepines (diazepam, nitrazepam) by TLC. Out of all the drug tests (n = 9,922) carried out, 24% of the drugs had been used during the past 72 hr. Averaged across all drugs, the detection rates corresponding to 24, 48, and 72 hr by TLC were 37%, 36%, and 31%, respectively. A high percentage of negative TLC results was observed in these samples. Moderate sensitivity of the TLC assay procedure, low consumption of drug, short time between drug use and urine collection, overreporting by the subjects, and drug use history of the subject obtained from multiple sources led to high negative results. These findings suggest that all the TLC negative results also need further confirmation by an alternative, more sensitive technique in a clinical setting. This will make the drug abuse testing program more meaningful
UR - PM:10890300
SO - Addict Behav 2000 May ;25(3):451-454

7
AU - Thirion X
AU - Barrau K
AU - Micallef J
AU - Haramburu F
AU - Lowenstein W
AU - Sanmarco JL
AD - Centre associe du CEIP Marseille (PACA-Corse), Laboratoire de Sante Publique, Faculte de Medecine
TI - [Maintenance treatment for opioid dependence in care centers: the OPPIDUM program of the Evaluation and Information Centers for Drug Addiction]
AB - The aim of this study was to analyze information concerning multiple drug addiction, illicit behaviors and use of the venous route by maintenance treatment patients included in the October 1998 survey of the OPPIDUM program. Among 1,462 observations, 71% of the subjects were taking maintenance treatments (60% high-dose buprenorphine and 40% methadone). High-dose buprenorphine was taken without medical supervision in 10% of cases. Indicators of abuse were high in this case: multiple drug addiction and intravenous use of buprenorphine (28%). Patients maintained by methadone were older and living in better socio-economic conditions than patients maintained by high-dose buprenorphine. However, in the two groups, the percentage of patients using the intravenous route was the same (15% and 21%). More cocaine was used by the methadone group (16% versus 7%). Thirty-seven percent of the subjects maintained on high-dose buprenorphine were followed by a general practitioner. They appeared to be more unbalanced and in more precarious condition than subjects treated in specialized care centers but they were not representative of the patients maintained by buprenorphine. It would be important to determine why these subjects consult a specialized care center
UR - PM:10855372
SO - Ann Med Interne (Paris) 2000 Apr ;151 Suppl A():A10-A17

8
AU - Petry NM
AU - Bickel WK
AD - Department of Psychiatry, Substance Abuse Treatment Center, University of Vermont, Burlington 05401, USA. petry@psychiatry.uchc.edu
TI - Gender differences in hostility of opioid-dependent outpatients: role in early treatment termination
AB - The purpose of this study was to evaluate gender differences in hostility and the role of hostility in predicting early treatment termination of opioid-dependent outpatients. Demographic characteristics and Addiction Severity Index (ASI) ratings were collected from 104 patients (68 males and 36 females) at intake to a buprenorphine treatment program. Hostility was assessed using the Buss-Durkee Hostility Scale. Compared to male opioid-dependent patients, females scored significantly higher on this scale. Early treatment termination was defined as remaining in treatment < 30 days, and 13% percent of males and 25% of females were classified as early terminators. Stepwise logistic regression identified predictors of early treatment termination. Severity of legal and employment problems and the interaction between hostility and gender predicted early treatment termination status. Patients with less severe legal problems and patients with greater employment problems were more likely to terminate early from treatment. Higher levels of hostility predicted early treatment termination of female patients, but hostility levels were not associated with treatment termination in male patients. Results from this study show that female heroin addicts have high levels of hostility and suggest that hostility may be an important predictor of premature discharge from opioid substitution programs, especially among women
UR - PM:10669052
SO - Drug Alcohol Depend 2000 Feb 1 ;58(1-2):27-33

9
AU - Margolin A
AU - Avants SK
AD - Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06519, USA. arthur.margolin@yale.edu
TI - Should cocaine-abusing, buprenorphine-maintained patients receive auricular acupuncture? Findings from an acute effects study
AB - OBJECTIVE: Buprenophrine is a synthetic opioid with micro-agonist properties currently pending Food and Drug Administration (FDA) approval as a maintenance agent for treating heroin-addicted individuals. Unlike methadone, a widely used opioid maintenance agent, buprenorphine is a kappa-receptor antagonist. Research linking the effects of acupuncture to the release of dynorphin, the endogenous ligand for the kappa-receptor, raised the possibility that buprenorphine may block acupuncture's effects. In this study, we sought to gather preliminary data on this issue in order to guide the clinical care of cocaine-abusing, buprenorphine-maintained patients. DESIGN: Between-group analysis comparing buprenorphine- and methadone-maintained patients on ratings of acute effects after a single session of auricular acupuncture. SUBJECTS: Thirty-four (34) cocaine-abusing, opioid-dependent patients, eighteen (18) maintained on buprenorphine, and sixteen (16) maintained on methadone. Intervention: A single, 40-minute session of auricular acupuncture; four needles were inserted in each auricle. OUTCOME MEASURES: Acute effect ratings in four domains: pain, de qi sensations, relaxation effects, subjective experiences. RESULTS: There were no significant differences in acute-effects ratings between the two groups. Patients in both groups reported positive effects. CONCLUSIONS: These preliminary findings are consistent with the interpretation that buprenorphine does not block auricular acupuncture, supporting the provisional recommendation that cocaine-abusing patients maintained on buprenorphine should not be excluded from receiving auricular acupuncture or from participating in clinical studies of this treatment modality. Further, controlled research on this issue, with clinical outcomes, is needed
UR - PM:10630350
SO - J Altern Complement Med 1999 Dec ;5(6):567-574

10
AU - Petry NM
AU - Bickel WK
AU - Badger GJ
AD - University of Vermont, Department of Psychiatry, Substance Abuse Treatment Center, Burlington, USA
TI - A comparison of four buprenorphine dosing regimens in the treatment of opioid dependence
AB - OBJECTIVES: This study compared 24-, 48-, 72-, and 96-hour buprenorphine dosing regimens in opioid-dependent outpatients. METHODS: Fourteen subjects received buprenorphine in a double-blind, placebo-controlled crossover trial. Daily sublingual maintenance doses were 4 mg/70 kg (n = 5) and 8 mg/70 kg (n = 9). After a stabilization period of maintenance administration, subjects received, in a random order, four dosing regimens for five repetitions of each regimen: a maintenance dose every 24 hours, a doubled maintenance dose every 48 hours, a tripled maintenance dose every 72 hours, and a quadrupled maintenance dose every 96 hours. In the latter three dosing regimens, subjects received placebo on the interposed day(s). Study participation was contingent on opioid abstinence and daily clinic attendance. Measures of subjective opioid agonist and withdrawal effects were assessed daily. RESULTS: Relative to standard maintenance dosing, none of the higher doses induced agonist effects. Changes in indices of subjective withdrawal effects were noted as the time since the last active dose increased during intermittent dosing regimens, but the magnitude of these effects was relatively low and was comparable to those found in other alternate-day dosing studies. CONCLUSIONS: These results support the feasibility and safety of twice weekly buprenorphine dosing regimens
UR - PM:10511067
SO - Clin Pharmacol Ther 1999 Sep ;66(3):306-314

11
AU - Petry NM
AU - Bickel WK
AD - Substance Abuse Treatment Center and Department of Psychology, University of Vermont, Burlington, USA. petry@psychiatry.uchc.edu
TI - Therapeutic alliance and psychiatric severity as predictors of completion of treatment for opioid dependence
AB - OBJECTIVE: The role of patient characteristics and the strength of the therapeutic alliance in predicting completion of treatment by opioid-dependent patients was examined. METHODS: Information about patient characteristics and scores on subscales of the Addiction Severity Index (ASI) were obtained for 114 patients at intake to a buprenorphine treatment program lasting three to four months. The strength of the therapeutic alliance was assessed by the Helping Alliance Questionnaire (HAQ). Patients were classified as treatment completers or noncompleters, and logistical regression examined predictors of treatment completion. RESULTS: Only two variables significantly predicted treatment completion: severity of psychiatric symptoms and interaction between HAQ scores and psychiatric severity. Patients with fewer psychiatric symptoms were more likely to complete treatment. The strength of the therapeutic alliance was not related to treatment completion among patients with few psychiatric symptoms, and 62 percent of these patients completed treatment. In contrast, among patients with moderate to severe psychiatric problems, less than 25 percent with weak therapeutic alliances completed treatment, while more than 75 percent with strong therapeutic alliances completed treatment. CONCLUSIONS: The results underscore the importance of early identification of opioid-dependent patients with moderate to severe levels of psychopathology. In this patient subgroup, a strong therapeutic alliance may be an essential condition for successful treatment
UR - PM:10030480
SO - Psychiatr Serv 1999 Feb ;50(2):219-227

12
AU - Chatterjee A
AU - Uprety L
AU - Chapagain M
AU - Kafle K
AD - University of California at Los Angeles, Fogarty International Training Program, School of Public Health, Department of Epidemiology, USA
TI - Drug abuse in Nepal: a rapid assessment study
AB - A rapid assessment of drug abuse in Nepal was conducted at different sites, including eight municipalities in the five development regions of the country. To interview various groups of key informants, such methods as semi-structured interviews, in-depth interviews and focus group discussions were used. A snowball sampling strategy for respondents who were drug abusers and a judgemental sampling strategy for the non-drug-using key informants were applied. About one fifth of the sample was recruited from the treatment centres and the rest from the community. Drug abusers in prison were interviewed, and secondary data from treatment centres and prisons analysed. The study revealed that the sample of drug abusers had a mean age of 23.8 years and was overwhelmingly male. Most respondents lived with their families and were either unemployed or students. About 30 per cent of the sample was married. A large majority of the sample had a family member or a close relative outside the immediate family who smoked or drank alcohol and a friend who smoked, drank or used illicit drugs. Apart from tobacco and alcohol, the major drugs of abuse were cannabis, codeine-containing cough syrup, nitrazepam tablets, buprenor-phine injections and heroin (usually smoked, rarely injected). The commonest sources of drugs were other drug-using friends, cross-border supplies from India or medicine shops. The commonest source of drug money was the family. There has been a clear trend towards the injection of buprenorphine by abusers who smoke heroin or drink codeine cough syrup. The reasons cited for switching to injections were the unavailability and rising cost of non-injectable drugs and the easy availability and relative cheapness of injectables. About a half of the injecting drug users (IDUs) commonly reported sharing injecting equipment inadequately cleaned with water. Over a half of IDUs reported visiting needle-exchange programmes at two of the study sites where such programmes were available. Infection by the human immunodeficiency virus (HIV) appears to be low among IDUs, although systematic surveillance is absent. Two thirds of the sample had experienced sexual intercourse. The last sex partners reported by respondents were commercial sex workers, wives or girl friends. Condom use was low with primary partners and relatively high with sex workers. Treatment facilities, mostly located in the central urban areas of the country, are meagre. An overwhelming majority of drug abusers felt the need to stop abusing drugs. Cost-effective drug treatment and HIV prevention programmes for IDUs are urgently needed in all areas of the country
UR - PM:9839033
SO - Bull Narc 1996 ;48(1-2):11-33

13
AU - Vignau J
AU - Brunelle E
AD - Centre Hospitalier et Universitaire, Lille, France. jvignau@nordnet.fr
TI - Differences between general practitioner- and addiction centre-prescribed buprenorphine substitution therapy in France. Preliminary results
AB - The treatment of heroin addiction in France relies on either general practitioners (GP) or specialist Addiction Centres (ACs). In general, the GPs offer a more flexible approach regarding frequency of consultations, urine tests and dosing regimen while the AC approach is more structured. A cohort study was undertaken to compare the treatment strategies of buprenorphine therapy between these medical environments. To determine the efficacy of each treatment, a number of outcomes were measured including the Addiction Severity Index, retention rates at 90 and 180 days, the average dose prescribed, quality of life assessment, body weight and two self-reported measures: treatment perception and predictive total duration. A total of 69 patients were enrolled; 32 treated by GPs and 37 treated in ACs. Significant differences, including average age, addiction severity and employment status were apparent between each group. Nevertheless, significant improvements in the social and medical status were observed in all patients after 3 months, continuing after 6 months in both groups. Treatment retention was good in both groups with 65% of the total sample remaining after 180 days. The usually more flexible GP approach was more rigid in this study, resulting in an equally positive treatment outcome as seen in the ACs. The study highlights the effectiveness of buprenorphine in addicts with different social and medical backgrounds, regardless of the therapeutic approach
UR - PM:9767203
SO - Eur Addict Res 1998 ;4 Suppl 1():24-28

14
AU - Levin FR
AU - Fischman MW
AU - Connerney I
AU - Foltin RW
AD - Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York 10032, USA
TI - A protocol to switch high-dose, methadone-maintained subjects to buprenorphine
AB - Buprenorphine (BUP) is an alternative to methadone (METH) maintenance. However, there are few studies on the switching of patients from METH to BUP. Eighteen volunteers who had been maintained on METH for 1-19 years were recruited for a residential cocaine self-administration study. All subjects were maintained on 60 mg METH for up to 1 1/2 weeks before the 7-day changeover (60, 40, 30, 30, 0 mg METH; 4, 8 mg BUP). Fifteen subjects successfully completed the transfer from METH to BUP, experiencing moderate withdrawal symptoms, as measured by the Subjective Opiate Withdrawal Scale (SOWS). Withdrawal symptoms were the highest during the first assessment of the day, at the time of BUP administration. SOWS scores returned to baseline 4 days after the switchover. This study demonstrates that within a supportive inpatient setting, research volunteers can be rapidly switched from high-maintenance doses of METH to BUP with an acceptable degree of tolerability
UR - PM:9134072
SO - Am J Addict 1997 ;6(2):105-116

15
AU - Bouchez J
AU - Khan-Shaghaghi E
AU - Beauverie P
AU - Poisson N
AD - Clinique Liberte, Emmanuel Khan-Shaghaghi, Villejuif
TI - [Substitution treatments. Pharmacological and legislative aspects]
UR - PM:9110879
SO - Soins 1997 Jan ;(612):7-10

16
AU - Wodak A
AD - Alcohol and Drug Service, St Vincent's Hospital, Darlinghurst, New South Wales, Australia
TI - Managing illicit drug use. A practical guide
AB - Illicit drug use is spreading, especially in the developing world, but has begun to stabilise in most developed countries. The phenomenon of illicit drug use is still poorly understood, with responses in most countries influenced largely by cultural factors. A range of psychosocial and pharmacotherapeutic treatments is available; of these, methadone maintenance treatment for heroin dependence has the most evidence of benefit. A large body of literature--including some well designed studies--indicates that methadone reduces heroin use, mortality, criminal activity and risk of human immunodeficiency virus (HIV) infection. Methadone is more likely to be effective if higher doses, longer durations of treatment and more realistic goals are set. However, research findings which would improve outcomes considerably are often not implemented. Methadone maintenance programmes, which attract and retain more illicit drug users than other treatment modalities, are now being made more available in many countries in recognition of their therapeutic effectiveness and utility in reducing the spread of HIV infection among people injecting heroin. HIV infection is now recognised in many countries to be the most serious complication of illicit drug use for both individual drug injectors and their communities. Levo-alpha-acetylmethadol (LAAM) has similar properties to methadone but a longer half-life. This suggests a number of clinical benefits which would also reduce the cost of treatment. However, LAAM has not been approved by regulatory authorities for routine use despite positive findings in some studies. Buprenorphine has shown some promise in the management of heroin dependence but is still undergoing evaluation. It is, however, unlikely to ever be used widely for the management of illicit drug users. Naltrexone may have some advantages for special populations. Pharmacotherapeutic treatment for cocaine and amphetamine users is still at a developmental stage
UR - PM:7514974
SO - Drugs 1994 Mar ;47(3):446-457

17
TI - Drug injectors in Glasgow: a community at risk? A report from a multidisciplinary group. The Possilpark Group
AB - In 1987 it became apparent that the number of drug injectors with HIV infection living in a district in the north of Glasgow was increasing. As this area was well served by a wide variety of clinical, epidemiological and laboratory facilities, a multidisciplinary group was convened to examine the extent and spread of infection, and its relationship to behavioural and environmental factors. By 1989 a World Health Organisation working group had developed a standardised methodology, consisting of an interview schedule and voluntary anonymous HIV testing procedures. The study has been implemented annually in Glasgow since 1990, with a collateral project evaluating prevalence of injecting drug use in the general population. The Glasgow HIV Behavioural and Prevalence Study was designed to yield as representative as possible a sample of the city's injectors, respondents being drawn from a variety of in-treatment and out-of-treatment sites. Of the estimated 8,500 injectors in Glasgow (1.35% of the population aged 15-55), 503 and 535 injectors were recruited to the study in 1990 and 1991 respectively. Over 90% of respondents injected daily and reported injecting, on average, four different types of drugs in the six months prior to interview, the three most commonly injected drugs being buprenorphine, heroin and temazepam. There is evidence of HIV risk reduction for sharing of injecting equipment and for using condoms with casual sexual partners. Salivary testing has proved to be successful, less than 5% of respondents refusing to be tested; the prevalence rate was 1.8% in 1990 and 1.1% in 1991. While HIV prevalence remains low, all-cause mortality among injectors in Glasgow is high; drug injecting is probably responsible for more deaths among people aged under 40 than any other factor. At the present time, the drug injecting epidemic in Glasgow poses a considerable challenge to the city's public health services
UR - PM:8307755
SO - Health Bull (Edinb ) 1993 Nov ;51(6):418-429

18
AU - Jutel J
TI - [Substitution treatments]
UR - PM:8115870
SO - Soins Psychiatr 1993 Oct ;(156):34-37

19
AU - Brooke D
AU - Fudala PJ
AU - Johnson RE
AD - Department of Psychiatry, St. George's Hospital, London, UK
TI - Weighing up the pros and cons: help-seeking by drug misusers in Baltimore, USA
AB - Forty drug misusers receiving treatment in Baltimore completed questionnaires, originally administered to drug misusers in London, about their reasons for seeking help and their worries about the treatment. Seeking help was related to the experiences of addiction, loss of control over life and financial and family difficulties. The main fears were of failing treatment. These responses are similar to those obtained in the London group. There was little correlation between objective assessment and subjects' views of their problems. This study illustrates the complexities of coming for treatment and it emphasises the need for social and medical help
UR - PM:1330471
SO - Drug Alcohol Depend 1992 Oct ;31(1):37-43

20
AU - Strain EC
AU - Preston KL
AU - Liebson IA
AU - Bigelow GE
AD - Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
TI - Acute effects of buprenorphine, hydromorphone and naloxone in methadone-maintained volunteers
AB - Buprenorphine is an opioid agonist-antagonist being evaluated for treatment of opioid dependence. This study characterized the effects of buprenorphine in comparison to naloxone, hydromorphone and saline, in methadone-dependent volunteers. In a residential laboratory, 6 volunteer male opioid abusers maintained on 30 mg of methadone daily underwent pharmacological challenges 2 to 3 times per week. Pharmacological challenges consisted of a double-blind i.m. injection of: buprenorphine (dose range 0.5-8.0 mg), hydromorphone (5 and 10 mg), naloxone (0.1 and 0.2 mg) or saline. Injections were given 20 hr after the last dose of methadone. Measures included physiologic indices, and self-report and observer ratings of drug effects. Naloxone and hydromorphone produced characteristic antagonist-like and agonist-like effects, respectively, on subjective, observer and physiologic indices. None of the doses of buprenorphine were consistently or systematically identified as an opioid agonist or antagonist on any of the measures. Thus buprenorphine produced minimal effects in methadone-dependent patients. The lack of agonist effects suggests buprenorphine has a low abuse potential in methadone-dependent patients. The lack of antagonist effects suggests buprenorphine can be administered safely to subjects dependent on a low dose of methadone. This lack of effect of buprenorphine distinguishes it from other mixed agonist antagonists previously tested, which produced antagonist effects in this procedure
UR - PM:1376362
SO - J Pharmacol Exp Ther 1992 Jun ;261(3):985-993

21
AU - San L
AU - Cami J
AU - Fernandez T
AU - Olle JM
AU - Peri JM
AU - Torrens M
AD - Seccion de Toxicomanias, Hospital del Mar, Barcelona, Spain
TI - Assessment and management of opioid withdrawal symptoms in buprenorphine-dependent subjects
AB - The spontaneous physical dependence of buprenorphine was assessed in opioid addicts who switched from heroin to sublingual or intravenous buprenorphine. Twenty-two patients were randomly assigned to double-blind administration of methadone (n = 11) or placebo (n = 11) for 13 days after abrupt withdrawal of buprenorphine. Methadone was administered according to four pre-established dosing schedules depending on the previous amount of daily consumed buprenorphine. No methadone-treated patient required modification of the therapeutic regimen, whereas eight of eleven placebo-treated patients needed treatment with methadone. Buprenorphine withdrawal syndrome was of opioid type, began somewhat more slowly, and showed a peak until day 5. The occurrence, time-course and characteristics of buprenorphine withdrawal syndrome make it necessary to reconsider the abuse potential of this analgesic
UR - PM:1311974
SO - Br J Addict 1992 Jan ;87(1):55-62

22
AU - Rosen MI
AU - Kosten TR
AD - Substance Abuse Treatment Unit, Connecticut Mental Health Center, New Haven 06511
TI - Buprenorphine: beyond methadone?
AB - This month's guest authors are affiliated with the substance abuse treatment and treatment research unit of the Connecticut Mental Health Center and the department of psychiatry at Yale University School of Medicine, where Dr. Rosen is instructor and Dr. Kosten is associate professor. They discuss a promising new treatment that may reduce abuse of cocaine by drug addicts who use intravenous heroin and may indirectly reduce risk-taking behavior associated with transmission of the human immunodeficiency virus

23
AU - Kosten TA
AU - Marby DW
AU - Nestler EJ
AD - Substance Abuse Treatment Unit, Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519
TI - Cocaine conditioned place preference is attenuated by chronic buprenorphine treatment
AB - Previous research shows that buprenorphine (BUP), a mixed opioid agonist-antagonist, reduces cocaine use in humans and suppresses cocaine self-administration in monkeys. The present study found that BUP reduces cocaine's ability to condition a place preference in rats. Compared to vehicle treated rats, rats treated with BUP 2 times/day for 2 weeks spent significantly less time in the cocaine conditioned place compared to their respective saline trained controls. No conditioned place preference was shown for BUP alone. These results further implicate a role for the opioid system in cocaine use and stress the importance of differentiating chronic vs. acute opioid effects
UR - PM:1943479
SO - Life Sci 1991 ;49(24):L201-L206

24
AU - Kosten TR
AU - Krystal JH
AU - Charney DS
AU - Price LH
AU - Morgan CH
AU - Kleber HD
AD - Substance Abuse Treatment Unit, Yale University School of Medicine, New Haven, CT 06519
TI - Opioid antagonist challenges in buprenorphine maintained patients
AB - Following one month of sublingual buprenorphine treatment, 15 patients at either 2 mg (n = 7) or 3 mg (n = 8) were hospitalized and the buprenorphine was abruptly stopped by placebo substitution. On the morning following their last dose of buprenorphine, 10 patients were given 1 mg oral naltrexone and 5 were given 0.5 mg/kg intravenous naloxone in a double blind placebo controlled challenge. The naltrexone challenges produced no increase in opioid withdrawal symptoms, plasma MHPG levels, or blood pressure compared to placebo, while naloxone produced significant symptoms and blood pressure increases compared to placebo challenges
UR - PM:2323312
SO - Drug Alcohol Depend 1990 Feb ;25(1):73-78 



Alexander DeLuca, M.D., FASAM.
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