Monday, July 31, 2006

REPORTED PREFERENCE OF IVDUs FOR BUPRENORPHINE OVER METHADONE:

A colleague has advise that in Australia there is an extremely high preference for buprenorphine over methadone among potential patients - 9:1! I'm a firm believer in ensuring availability of ANYTHING that offers help and hope to those who want it, which is why I have been enthusiastic in praise of France bringing some 100,000 people into treatment - overwhelmingly with buprenorphine - in precisely the way I've been ecstatic about Germany achieving much the same with methadone. If Russia (estimated opiate dependent population in the millions, essentially zero treatment of any kind available!) were some day to boast a few hundred thousand ivdu's in treatment I could care less if it was with one medication or the other.

BUT I do have concerns over what underlies the preference, and if it is a false expectation, then sooner or later it will haunt us. Specifically, if heroin addicts (and doctors, and politicians, and the voting public) see in buprenorphine a medication that "cures" - that can be taken for a while and then stopped and lasting asbtinence subsequently be the rule rather than exception, it's only a matter of time ...(I say this based on my belief that there's never been a study of post-buprenorphine sustained abstinence - I may have overlooked something).

I am painfully reminded of the first public media discussion of methadone in late 60s (just before my time) where it was described as the "Cinderalla drug" and heralded as a magic panacea that would end addiction in our time (only a tiny bit over-stated). Could probably find the reference if someone wanted it.

Anyone consider a disinterested party doing a focus group and reporting what heroin users prefer, and why . . . ? Would be fascinating, especially if comparing land of Oz with US, Canada, France, etc.

10 Comments:

At 10:39 AM, Anonymous cayuela7@hotmail.com said...

I also concern over what underlies buprenorphine preference, less legal regulation is a point and never forget pharmacocinetic properties, so that buprenorphine will more likely give e "high" . Buprenorphine never will be as good as methadone in reaching "steady state" plasma levels. In Spain, 25 years ago, we had a small epidemic buprex® abuse, It is my opinion, and I will like to ask, Could buprenorphine give up a different and special kind of opioid tolerance, that makes subject more sensible to opiods, in future?

 
At 8:24 AM, Blogger RGNewman, MD said...

Estimada colega - we share the same concern, and have some of the same questions. There is much I do not understand about buprenorphine - to my embarrassment! Clearly, for some it is very effective, for many others, methadone is very effective. Both should be available. But false expectations are a prescription for disaster, and the most serious, unsupported, expectation is that buprenorphine is more likely to lead to permanent abstinence. To my knowledge, no one has even reported a study to look into this critical issue. AS FOR SPAIN AND SUBUTEX - I recall about 15-20 years ago a report of major diversion and perhaps deaths in southern Spain - do you happen to know where that report appeared? RGN

 
At 10:29 PM, Anonymous Kristan Hilchey said...

I would be VERY interested in reading the report as well.

In the US Suboxone seems to have been given a PR push to the public as the new "cure" for opiate addiction that doesn't cause a high, can't be abused and NEVER causes death. But the fact is, Suboxone treatment is the same premise as Methadone treatment, only with a different drug.

This is a recipe for disaster only because the expectations have been set too high. Buprenorphine is only a drug not a miracle cure. There will always be patients that don't respond to it, people who try to abuse it or sell it and it wont turn a person into a responsible determined person if they never were one.

Until people are willing to face the fact that drug addiction is a CHRONIC disease there is litte hope that people will see Suboxone or Methadone as the true medical break throughs they really are. No one seems to be willing to accept any treatment that doesn't result in total and complete remission from all the symptoms of addiction as viable treatment options. If we expected out of most of the medications on the market today, what we expect out of suboxone and methadone, there would be no medications for heart disease, diabetes, depression or schizophrenia. If no one is willing to accept that treatment doesn't have to lead to CURE, but can lead to IMPROVEMENT in addiction treatment then all of our break throughs are forever doomed to end in bitter disappointment.

 
At 6:24 AM, Anonymous cayuela7@hotmail.com said...

I have found 3 papers from those days (1989-1991) , I am afraid nothing about, but I will continue looking for. To my knowledge, buprenorphine has limited utility, because it is a partial opioid agonist, so that to prefer for short term treatment not maintenance treatment.

 
At 9:34 AM, Anonymous WARRORIZ4JESUS@ HOTMAIL.COM said...

I SUPPOSE I AM THE VETERAN HERE. I FIRST TRIED METHADONE THROUGH THE METHADONE CLINIC AT THE VA HOSPITAL IN 1976. SINCE THEN OUT OF THE LAST THIRTY YEARS I HAVE BEEN ON METADONE FIFTEEN YEARS THE LONGEST PEROID OF SEVEN YEARS.I HAVE HAD HEP. C FOR AT LEAST 18 YEARS. I NOW TAKE ABOUT 70 TO 90 MGS A DAY. I LOVE IT IT TAKES SEVERE PAIN FROM MY 56 YEAR BODY AND I FEEL MORE LEVELED OUT.

 
At 4:13 PM, Anonymous mcain, msw said...

My experience with trying to help a heroin addicted relative find a doctor who is willing to prescribe buprenorphine on an on-going basis has been incredibly frustrating. Most seem to want to use it to do a "detox" over 2 weeks or so, max.
This simply doesn't work for a long-term heroin user, IMO, and it's almost fraudulent to present it as if it does. My relative has been doing well for the past 4 months on 60-70 mg. of methadone daily. Key seemed to be finding a methadone clinc that didn't involve a 70-80 mile roundtrip for him and that wasn't in the area where he used to buy heroin. Also key was his getting to the point where he had no other options.

 
At 10:45 PM, Anonymous Anonymous said...

My son is a heroin addict and we have been through hell for the past 2 years. I was quite surprised when his withdrawal symptoms- after an agonizing 28 hours of non-stop shakes, shits and pain- did NOT respond to Suboxone at all. We even upped the dose 4x the prescribed dose. We both thought it so unfair that he had gone through so much agony with withdrawal, only to have the Suboxone let him down. We are now going to the methadone clinic. I was wondering if anyone else had had this experience with Suboxone. Can it simply not work for some people? And with Methdone you don't have to wait to experience the worst of the withdrawal symptoms before it kicks in, like you do the Suboxone and Bupronorphine.

 
At 12:59 PM, Anonymous Anonymous said...

I've been an opioid addict for 5-6 years, but primarily on methadone for the last year and a half. I have never obtained methadone at a clinic only from friends. Yesterday, I was "induced" onto suboxone. Well unfortunately my system still had small amount of methadone in it. Soon I went into severe withdrawal. Horrible. Anyway I'm ok. yet, I haven't seemed to respond to the suboxone. I am not withdrawing, but I just don't feel well. Maybe it's too early to say.To quit an individual must be truly determined to quit.

 
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