The Pharmaceutical Journal
Vol 270 No 7237 p259
22 February 2003

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Buprenorphine useful in managing dependence

Further evidence for the success of buprenorphine in the management of heroin dependence comes from a Swedish study published in this week's Lancet (2003;361:662).

Forty patients with at least a one-year history of opiate dependence were randomised to receive either maintenance buprenorphine (16mg daily for one year) or a tapered six-day regimen of the drug followed by placebo. Both groups received weekly counselling and were urine tested for illicit drug use three times a week.

The placebo arm was deemed ethically acceptable because of strict requirements for entry to methadone schemes in Sweden (documented four-year history of opiate misuse).

All patients in the placebo group had dropped out of treatment by the end of the one-year study despite counselling. Most had discontinued treatment by two months. However, three-quarters of the buprenorphine group were retained in the scheme for a year. Urine screens were around 75 per cent negative for a range of drugs of abuse in patients remaining in treatment.

Researchers noted an impaired survival in the control group, with four deaths (20 per cent) compared with none in the buprenorphine group.

Buprenorphine (as Subutex) is already used in some parts of the United Kingdom in the treatment of opioid dependence. Dr Trish Shorrock, senior pharmacist, Leicestershire community drug team, told The Journal that although it is not a replacement for methadone, buprenorphine certainly has its uses for maintenance in some clients. It is not suitable for those requiring large opiate doses because its partial antagonist properties could precipitate withdrawal symptoms.

Her unit has used the agent in particular for a "fast track" four-week detoxification scheme involving young users with a short history of dependence. Dr Shorrock added that there was anecdotal evidence that buprenorphine was being bought on the street by addicts attempting "home detox".

Kay Roberts, area pharmacy specialist, drug misuse, Greater Glasgow Primary Care NHS Trust, told The Journal that because of a history of buprenorphine abuse in Scotland, its use for managing opioid dependence had not yet been adopted.