The effectiveness of buprenorphine in treating opioid addiction

The effectiveness of buprenorphine in treating opioid addiction

Skylee Campbell

Outline1. Background

2. Opioid vs opiate

3. Brief history

4. Treatment

5. Conclusions

Opioid Statistics

Increased abuse of prescription opioids and non-medical opioids

Increase in Admission rate to substance abuse treatment programs Opioid-related overdoseOpioid-induced mortality

Wu, Woody, Yang and Blazer (2010)

1.Background2.Opioid vs opiate3.Brief history4.Treatment5.Conclusions

Increased Mortality Rates

3 main factors: (1) Direct effects on health

e.g., cardiac arrhythmias, respiratory failure

(2) Indirect effects via exposuree.g., non-sterile injection equipment

(3) Environmental factorse.g., suicide, advanced exposure to violence,

poor lifestyle choices, accidents

Hulse, English, Milne, & Holman (1999)

1. Background2. Opioid vs opiate3. Brief history4. Treatment5. Conclusions

Opioid Statistics

Highest misused drugs in the United States

Lifetime prevalence:

1.7 % of every 19-30 year old has tried heroin

18.7 % have used other opioids (such as Vicodin and OxyContin)

Wu, Woody, Yang, & Blazer (2010)Veilleux, Colvin, Anderson, York & Heinz (2009)


Younger Generations

Increase in non-medical prescription opioids

Average age is 21.2

Most popular prescription drug is

Vicodin

Veilleux, Colvin, Anderson, York, & Heinz (2009)


Location

Prescription drugs: more in urban and rural areas rather than large cities

Possible reasons:

- Heroin not as available as prescription drugs

- Prescription drugs more socially acceptable

- Easier to attain and cheaper

Cicero, Surratt, & Inciardi, (2007)


Gender Differences

Women are more likely than men to:

- initiate opioid use via prescription opioids

- use for indicated use

- Less likely to seek treatment for an opioid use disorder

1. Background2. Opioid vs. opiate3. Brief history4. Treatment5. Conclusions

McHugh, DeVito, Dodd, Carroll, Potter, Greenfield, Connery & Weiss, (2013)

Opiate vs. Opioid

Opiate

Natural origin, made from opium (Papaver somniferum)

Examples

- Morphine

- Codeine

- Thebaine

Renner & Levounis (2011)


Opiate vs. Opioid

Opioid

Opiate-like drugs

Basic subgroups

(1) Semisynthetic e.g., heroin, oxycodone, and buprenorphine

(2) Synthetic: e.g., methadone and other medical prescription drugs in opioid group



Abuse Potential

Many opiates and opioids have a high abuse potential

A drug will have a higher abuse potential if:- Route of administration is quicker

Injection > Oral

- Shorter half-life e.g., Heroin vs. Methadone

- Higher lipophilic propertiesFaster route across blood-brain barrier



History

Opium

- Produced from poppy: Papaver somniferum

- 10 % morphine, 0.5 % codeine, lower % of thebaine

McKim & Hancock (2013)


History of Opium

6th millenium BCE in the Western Mediterranean region

Written reference to opium “joy plant”

Spread to Middle East, North Africa, India, and China

Primarily used as medicine,

BUT also mentioned non-medical, more enjoyable properties



History

Opiate: Morphine

Frederick Serturner

Isolated morphine from opium

1830s: Manufactured and sold commercially

Raise for concern when people became addicted

Too available



History

Opiate: CodeinePierre J. Robiquet

Used new process of isolating morphine

Discovered codeine

Prescription currently legal in U.S.



History

Opiate: ThebaineNot used for therapeutic purposes

Used for semisynthetic opioids

Examples

- Percocet

- Percodan

- OxyContin (oxycodone)



History

Opioid: Heroin

Discovered in 1874 as first semisynthetic form of opioid

More lipid soluble than morphine

Originally seen as not as addictive



Treatment Considerations

Mu receptor

Full agonist

Antagonists

Partial agonist




Full Agonist

•Prescription opioids

•Morphine

•Heroin

•Methadone




Antagonist

•Do not produce any opioid effects

• Naloxone:

- Reverses effects of opioids

• Naltrexone:

- Blocks agonist from binding to mu receptor




Partial Agonist

•Buprenorphine

- Longer half-life

- Can relieve opioid and opiate withdrawal symptoms



Buprenorphine

Originally developed in the 1970s

Developed because

- Opioid addiction is costly to the government

- Methadone treatment had

many associated limitations



Buprenorphine

Administration Routes(1) Subutex form

• Administered orally

• Buprenorphine alone

(2) Suboxone form• Administered orally

• Mix of buprenorphine/naloxone

(3) Implants

(4) Injections



Buprenorphine Implants

• Implant = polymetric matrix composed of ethylene vinyl acetate and buprenorphine

• Advantages(1) Delivers buprenorphine over 6 months

- Initial pulse release constant, low level of buprenorphine released

(2) To address problems with adherence and nonmedical use


(Ling, Casadonte, Bigelow, Kampman, Patkar, Bailey, Rosenthal & Beebe, 2010)

Buprenorphine Injections

Produces a gradual release of buprenorphine

Advantages

Gradual opioid detoxification with minimal withdrawal symptoms

Reduces frequency of clinic visits

Eliminates need for take-home medication


(Sigmon, Wong, Chausmer, Liebson & Bigelow, 2004)

Buprenorphine -naloxone

Adding naloxone discourages parenteral use

BUT preserves the therapeutic effect on opiate addiction when used sublingually as intended


(Harris, Jones, Welm, Upton, Lin & Mendelson, 2000)

Gender Differences

• No significant gender differences in treatment outcome indicators including:

• Maximum daily dose of buprenorphine–naloxone

• Achievement of a successful opioid treatment outcome

• Treatment retention


(Kelly, Schwartz, O'Grady, Mitchell, Reisinger, Peterson, Agar & Barry, 2009)

Conclusions

Advantages of Buprenorphine• Partial agonist

• Improved overall safety margin

• Long-lasting effect

• Reduces severity of withdrawal



Conclusions

Disadavantages of Buprenorphine• Concern of abuse

• Need to be aware of potential for abuse


Cicero, Surratt, Inciardi, & Munoz (2007)

“Holy Grail of Opioid Research”

STILL in search for drug that has same analgesic effects of morphine but does NOT have side effects such as addiction

Developed thousands of new opioids

All have addictive properties

Have NOT found perfect drug


1. Background2. Opioid vs.

opiate3. Brief history4. Treatment5. Conclusions

Acknowledgments

• Conference organizers

• Behavioral Science Department

• Drs. David Yells and Richard Nance

• Dr. Claudia Lieberwirth

References

Cicero, T. J., Surratt, H. L., & Inciardi, J. (2007). Use and misuse of buprenorphine in the management of opioid addiction. Journal of Opioid Management , 3(6), 1-7.

Harris, D. S., Jones, R. T., Welm, S., Upton, R. A., Lin, E., & Mendelson, J. (2000). Buprenorphine and naloxone co-administration in opiate-dependent patients stabilized on sublingual buprenorphine. Drug and Alcohol Dependence, 61, 85-94. doi: S0376-8716(00)00126-5

McHugh, R. K., DeVito, E. E., Dodd, D., Carroll, K. M., Potter, J. S., Greenfield, S. F., Connery, H. S., & Weiss, R. D. (2013). Gender differences in a clinical trial for prescription opioid dependence. Journal of Substance Abuse Treatment, 45, 38-43. Retrieved from http://dx.doi.org/10.1016/j.jsat.2012.12.007

Hulse, G. K., English, D. R., Milne, E., & Holman, C. D. J. (1999). The quantification of mortality resulting from the regular use of illicit opiates. Society for the Study of Addiction and Other Drugs, 94(2), 221-229. doi: 0965-2140/99/020221-09

Kelly, S. M., Schwartz, R. P., O'Grady, K. E., Mitchell, S. G., Reisinger, H. S., Peterson, J. A., Agar, M. H., & Barry, B. S. (2009). Gender differences among in- and out-of-treatment opioid-addicted individuals. The American Journal of Drug and Alcohol Abuse, 35, 38-42. doi: 10.1080/00952990802342915

References

Ling, W., Casadonte, P., Bigelow, G., Kampman, K. M., Patkar, A., Bailey, G. L., Rosenthal, R. N., & Beebe, K. L. (2010). Buprenorphine implants for treatment of opioid dependence: A randomized controlled trial. American Medical Association, 304(14), 1576-1582. Retrieved from http://jama.jamanetwork.com/

McKim, W. A., & Hancock, S. D. (2013). Drugs and behavior: An introduction to behavioral pharmacology. (7th ed., pp. 255-276). New Jersey: Pearson.)

Renner, J. A., & Levounis, P. (2011). Handbook of office-based buprenorphine treatment of opioid dependence. (1st ed.). Virginia: American Psychiatric Publishing, Inc.

Sigmon, S. C., Wong, C. J., Chausmer, A. L., Liebson, I. A., & Bigelow, G. E. (2004). Evaluation of an injection depot formulation of buprenorphine: placebo comparison. Society for the Study of Addiction, 99, 1439-1449. doi: 10.1111/j.1360-0443.2004.00834.x

Veilleux, J. C., Colvin, P. J., Anderson, J., York, C., & Heinz, A. J. (2010). A review of opioid dependence treatment: Pharmacological and psychosocial interventions to treat opioid addiction. Clinical Psychology Review, 30, 155-166. doi: 10.1016/j.cpr.2009.10.006

Wu, L., Woody, G. E., Yang, C., & Blazer, D. G. (2010). Subtypes of nonmedical opioid users: Results from the national epidemiologic survey on alcohol and related conditions. Drug and Alcohol Dependence, 112, 69-80. doi: 10.1016/j.drugalcdep.2010.013

Questions?

Date post:	03-Feb-2016
Category:	Documents
Upload:	cameo
View:	73 times
Download:	0 times

The effectiveness of buprenorphine in treating opioid addiction

Documents