New opiate substitute could minimise misuse
Substance misuse clients receiving an opiate substitute can now be treated with a combination product containing buprenorphine and naloxone.
Suboxone, available from Shering-Plough in two tablet strengths, is designed
to provide the opiate substitute buprenorphine in a product that reduces
the potential for, and dangers associated with, misuse.
Kay Roberts, pharmacist and chairman of PharMAG (an advisory group with
special interest in pharmaceutical aspects of substance misuse), told
The Journal that the launch of Suboxone had been expected for some time.
“The combination of buprenorphine with the antagonist naloxone
is intended to improve the safety profile if it is misused by injection,” she
said. However, she added that there are other issues to consider.
“Experience in Australia and New Zealand suggests that the product
may be misused because there is some residual opiate effect when injected,
despite the naloxone component,” she said.
“Furthermore, although naloxone is almost completely inactive when
taken by mouth, there is a small amount of the antagonist activity. Many
clients
therefore need to receive higher doses of Suboxone than buprenorphine — it
is not a straight switch.”
Mrs Roberts also pointed out that there are dosing issues to consider
with the product combination being a fixed ratio.
She added: “If use of the product does increase it is important
that service providers don’t become complacent. Just because the
product contains naloxone, one cannot assume there is no risk.”
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