COMMENTS ON ARTICLE ON BUPRENORPHINE

The Article appeared in Acta Neuropsychiatrica 16, 246-274, 2004. A few comments: It is stated that Suboxone, which combines naloxone with buprenorphine, "means that withdrawal symptoms are precipitated in those who are dependent on full opioid agonists such as heroin and methadone," but does not state whether and to what extent withdrawal is precipitated when injected by individuals taking no opiate other than Suboxone and/or Subutex.

Secondly, "there is a strong argument for insisting that buprenorphine be given routinely by daily supervised consumption except in exceptional circumstances... The importance of supervised consumption is illustrated by a survey of several hundred opiate users in France (where supervised consumption is not typical), which found a quarter to be injecting only buprenorphine, and a third to be polydrug users who were injecting buprenorphine sometimes."

In the U.S. it is legal at the first encounter to prescribe a month's supply - and with a prescription permitting multiple refills for additional months. While no data on actual practice appear to have been published, the appeal of buprenorphine over methadone seems to be related in large measure to the fact that it can be prescribed for unsupervised use; also, the enormous benefit associated with provision of buprenorphine treatment in the office-based practice setting would be incompatible with daily supervised administration.