Buprenorphine {Suboxone - PowerPoint PPT Presentation

1 / 15
About This Presentation
Title:

Buprenorphine {Suboxone

Description:

Available Medications for Treatment of Heroin Addiction Agonists Opiate Analgesics Methadone LAAM Partial Agonists Buprenorphine Antagonists Naloxone (short-acting ... – PowerPoint PPT presentation

Number of Views:791
Avg rating:3.0/5.0
Slides: 16
Provided by: bob1228
Category:

less

Transcript and Presenter's Notes

Title: Buprenorphine {Suboxone


1
BuprenorphineSuboxone, Subutex
  • Herbert D. Kleber, M.D.
  • Professor of Psychiatry, Columbia University
    College of Physicians Surgeons
  • Director, Division on Substance Abuse, NYSPI

2
Available Medications for Treatment of Heroin
Addiction
  • Agonists Opiate Analgesics Methadone
  • LAAM
  • Partial Agonists Buprenorphine
  • Antagonists Naloxone (short-acting) Naltrexon
    e (long-acting)

3
How Does Buprenorphine Work?
  • High Affinity for Mu Opioid Receptor
  • Competes with other opioids and blocks their
    effects
  • Displaces heroin or other opiates from
    receptors(This can produce withdrawal if patient
    has opiates in system)
  • Slow Dissociation from Mu Opioid Receptor
  • Prolonged therapeutic effect
  • gt 24 hours
  • Ceiling Effect on Opiate Effects
  • Poor drug for intoxication purposes
  • Safer in an overdose
  • Formulated with Naloxone
  • Naloxone is poorly absorbed if taken orally
  • Naloxone blocks opiate effects if injected

4
  • Agonist
  • Heroin, Morphine, Codeine, Methadone, LAAM
  • Mild-moderate binding to mu receptors
  • Short-acting Powerful opiate high
  • Long-acting Weak opiate high
  • Partial Agonist
  • Buprenorphine
  • Strong and long binding to mu receptors
  • But Relatively weak opiate effect
  • Antagonist
  • Naloxone, Naltrexone
  • Strong binding to mu receptors but does not
    activate them
  • Thus, blocks all opiates with no opiate effects

5
Methadone Maintenance Treatment
  • As part of a comprehensive rehabilitation program
    methadone maintenance has been shown to
  • Decrease illicit opiate use
  • Normalizes immune and endocrine systems
  • Decrease criminal activities
  • Increase pro-social activities

6
Why Not Use Blockers?
  • Naltrexone
  • High non-compliance rates
  • Early gastrointestinal discomfort
  • Possible dysphoric effects
  • No opiate effect benefits
  • Useful only in highly selected, highly
    leveraged, patient populations (i.e., doctors
    nurses)

7
Opiate Potency of Methadone, LAAM, and
Buprenorphine Slide courtesy of Laura McNicholas,
MD, PhD, Univ of Penn.
100 90 80 70 60 50 40 30 20 10 0
Full Agonist (Methadone)
Efficacy
Partial Agonist (Buprenorphine
Antagonist (Naloxone)
-10 -9 -8 -7
-6 -5 -4
Log Dose of Opioid
8
How good is buprenorphine as a treatment for
opiate addiction??
9
Clinical Uses of Buprenorphine
  • Withdrawal Detoxification
  • Maintenance
  • Prevents withdrawal
  • Diminishes craving
  • Does not produce a high
  • Blocks (or reduces effect of) heroin
  • Increases treatment retention

10
Comparison TrialsBUP vs. Methadone
  • Johnson et al. (1992) n162
  • BUP 8 mg vs. METH 20 mg vs. METH 60 mg
  • Strain et al. (1994) n164
  • BUP 8 mg vs. METH 50 mg for 26 weeks
  • Ling et al. (1996) n225
  • BUP 8 mg vs. METH 30 mg vs. METH 80 mg for 52
    weeks,

11
Buprenorphine, Methadone, LAAMUrine Testing for
Opioids
100
All Subjects
80
LAAM
Buprenorphine
60
49
40
Hi Methadone
Mean Negative
40
39
Lo Methadone
20
19
0
1
3
5
7
9
11
13
15
17
Study Week
Adapted from Johnson, et al., 2000
12
Opioid Agonist Medications
Rolley Johnson et al., NEJM, 343(18)1290-1297,
2000
90 Reduction in Heroin Use
13
Buprenorphine Blockade of Hydromorphone Opiate
Effects
Change in Total Score (post-HYD minus Post-BUP)
Buprenorphine Dose (mg/day)
Slide Courtesy of Laura MacNicholas, MD, PhD
14
Buprenorphine Summary
  • A Partial Mu-Opioid Agonist
  • As effective as Methadone or LAAM
  • Lower level of physical dependence
  • Lower risk of respiratory depression
  • Abusable, but the combination with naloxone
    (opiate blocker) reduces diversion to street

15
Buprenorphine Summary
  • WELL ACCEPTED MAINTENANCE THERAPY
  • MILD WITHDRAWAL
  • DECREASES OPIOID USE
  • GREATER SAFETY
  • LOWER DIVERSION POTENTIAL
Write a Comment
User Comments (0)
About PowerShow.com