Buprenorphine Maintenance More Effective Than Detox

Opioid Dependent Patients Who Detox More Likely to Relapse

Subutex Package
Buprenorphine Maintenance More Effective. Schering-Plough

Patients who seek treatment for dependence on prescription opioid pain pills typically want to become completely abstinent as quickly as possible, and primary care providers try to oblige them by starting them on buprenorphine and then slowing weaning them off the medication.

But, that approach may not produce the desired results.

Since 2002, buprenorphine has been approved by the U.S. Food and Drug Administration for the treatment of heroin and prescription opioid addiction.

The medication works by preventing the symptoms of withdrawal when the patient stops using heroin or opiate pain pills, while not producing the euphoric effects.

Treatment for Opioid Addiction

Subutex contains buprenorphine only and is usually used in the initial stages of treatment for opioid dependence. Suboxone contains both buprenorphine and naloxone and is usually used in a long-term maintenance treatment for opioid addiction.

Adding naloxone to buprenorphine helps prevent patients from abusing buprenorphine by injecting it. The naloxone blocks the "high" that injecting the medication might produce, the FDA said.

Buprenorphine was the first narcotic drug approved by the FDA for use in the primary care office setting by specially trained physicians. This allows the patient to manage his own medication, rather than having to go to a specialized clinic to receive treatment with methadone.

Patients Seeking Abstinence

Generally, when someone with an addiction decides to seek help, their tendency is to try to achieve complete abstinence as quickly as possible.

"It is very common for patients seeking treatment to request detoxification," said Dr. David Fiellin of Yale School of Medicine. "They want to be off of everything as soon as possible as opposed to considering long-term treatment, but unfortunately there's no quick fix for the disease.

The majority of patients will do better if they receive ongoing maintenance treatment."

Detox or Maintenance?

To prove that theory, Dr. Fiellin and his colleagues conducted a 14-week randomized clinical study of 113 patients who sought treatment for prescription opioid dependence. They were divided into two groups - one receiving buprenorphine-assisted detoxification and the other receiving buprenorphine maintenance therapy.

The detox group received six weeks of stable doses of buprenorphine and then three weeks of tapering doses. The maintenance group received ongoing buprenorphine therapy throughout the trial.

Both groups received physician and nurse support as well as drug counseling for the entire 14 weeks.

Less Likely to Abstain

The findings of the Yale School of Medicine study included:

  • Detox group patients tested positive for opioids more often.
  • Maintenance group patients were less likely to use illicit opioids.
  • Few detox patients remained in treatment.
  • Few detox patients were able to abstain after treatment.

    For the researchers, the results were clear.

    "For prescription opioid dependence, buprenorphine detoxification is less effective than ongoing maintenance treatment, and increases the risk of overdose and other adverse events," said Fiellin. "We found that a number of providers were offering patients buprenorphine detoxification. This is not consistent with how the disease process works."

    Guidelines for Determining Treatment

    Fiellin said his findings are important because of the increase in prescription opioid dependence over the past 15 years. The rates of addiction for opioid pain pills now surpasses heroin addiction in the U.S., he said.

    Also, doctors are writing more prescriptions for pain management than in the past, which has led to an increase in experimentation and addiction rates.

    Fiellin hopes his study will provide evidence-based guidelines for physicians to help them decide between detoxification for their addicted patients, or providing them with ongoing maintenance therapy.

    Source: Fiellin, DA et al "Primary Care–Based Buprenorphine Taper vs Maintenance Therapy for Prescription Opioid Dependence." JAMA Internal Medicine 20 October 2014

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