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The clinical use of buprenorphine in opiate addiction: evidence and practice

Published online by Cambridge University Press:  24 June 2014

Fergus D. Law ,
Judy S. Myles ,
Mark R. C. Daglish  and
David J. Nutt
Fergus D. Law*
Affiliation:
Avon and Wiltshire Mental Health Partnership NHS Trust, Bristol Specialist Drug Service, Cedar House, Blackberry Hill Hospital, Manor Road, Fishponds, Bristol, BS16 2EW, UK Psychopharmacology Unit, Division of Psychiatry, University of Bristol, Dorothy Hodgkin Building, Whitson Street, Bristol, BS1 3NY, UK
Judy S. Myles
Affiliation:
Department of Addictive Behaviour and Psychological Medicine, St Georges Medical School, 6th Floor Hunter Wing, Cranmer Terrace, London, SW17 ORE, UK
Mark R. C. Daglish
Affiliation:
Psychopharmacology Unit, Division of Psychiatry, University of Bristol, Dorothy Hodgkin Building, Whitson Street, Bristol, BS1 3NY, UK
David J. Nutt
Affiliation:
Psychopharmacology Unit, Division of Psychiatry, University of Bristol, Dorothy Hodgkin Building, Whitson Street, Bristol, BS1 3NY, UK
*
Fergus D. Law, BSc, MBChB, MRCPsych, Bristol Specialist Drug Service, Cedar House, Blackberry Hill Hospital, Manor Road, Fishponds, Bristol, BS16 2EW, UK. Tel: +44 117 9754840; Fax: +44 117 9586569; E-mail: fergus.law@awp.nhs.uk
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Abstract

Buprenorphine is a partial μ-opioid receptor agonist that is being increasingly used in clinical practice in the treatment of opioid dependence in the UK, USA, and, elsewhere. Its unique pharmacological properties mean it is a relatively safe drug, it can be given by alternate day dispensing, and it is associated with relatively mild symptoms on withdrawal. The interpretation of the research literature on buprenorphine is however, complex, and often appears to be in conflict with how buprenorphine is used in clinical practice. This article describes these apparent contradictions, their likely explanations, and how these may further inform our clinical practice. The article also describes the clinically relevant pharmacological properties of buprenorphine, compares it to methadone, relates the evidence to clinical experience, and provides practical advice on how to manage the most common clinical techniques. The best quality evidence suggests that very rapid buprenorphine induction is not associated with a higher drop-out rate than methadone, that buprenorphine is probably as good as methadone for maintenance treatment, and is superior to methadone and α-2 adrenergic agonists for detoxification. However, buprenorphine cannot yet be considered the ‘gold standard’ treatment for opiate dependence because of the higher drop-out rates that may occur on induction using current techniques, its high-cost relative to methadone, and because the place of buprenorphine in treatment is still continuing to evolve.

Keywords

α-2 adrenergic agonistsBuprenorphineclinicaldetoxificationmaintenancemethadoneopiatespartial μ-opioid receptor agonistSubutextreatment
Type
Original Article
Information
Acta Neuropsychiatrica , Volume 16 , Issue 5 , October 2004 , pp. 246 - 274
Copyright
Copyright © 2004 Blackwell Munksgaard

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