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Letters to the Editor
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Opiate addiction
Patches not the answer for codeine addiction
From Miss R. Tasgaonkar, MRPharmS
I would like to respond to Bob
Dunkley’s letter (PJ, 30 June,
p774) about codeine addiction. Is he suggesting that we put patients
addicted to codeine tablets of 8mg on to the lowest strength of buprenorphine
patch that releases 5µg/h for seven days?
So we have 8mg of codeine taken orally (bear in mind that oral absorption
is poor in cases of gastrointestinal disorders like diverticulitis, Crohn’s
disease, etc) versus transdermal absorption of an even more potent morphine
analogue (where absorption can be substantially increased with body temperature,
eg, fever, and where the whole drug load is delivered rapidly into the
circulation).
Let me propose a hypothesis: the patient becomes addicted to buprenorphine.
What now? What type of transdermal delivery system should we put our
patients on?
I appreciate Mr Dunkley’s concern, but what evidence does he have
that his proposed theory works? Surely pharmacy is an evidence-based
science.
Ravina Tasgaonkar
Portsmouth, Hampshire
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BOB DUNKLEY responds:
Addiction to codeine is as
profound as addiction to heroin, albeit that the withdrawal is not
as intense. I suggested
the buprenorphine patches as a way of mitigating the withdrawal symptoms
of codeine that, although not life-threatening, are distressing to
people who would not consider themselves addicts and who, nevertheless,
experience
a syndrome that is unpleasant. A low-level buprenorphine dose, would,
I think, alleviate the symptoms of opiate withdrawal. The only alternative
is a dose of methadone.
We are dealing with patients who might have been taking codeine for
a number of years and the dose is suddenly stopped. I would again
direct readers to the
Solpadeine websites for them to see how devastating codeine addiction is.
Buprenorphine
is a partial agonist at the mu opiate receptors and goes some way to mitigate
the withdrawal syndrome from codeine. It can then be gradually withdrawn
and with psychosocial counselling, the patient may be opiate-free. The
stories
on Solpadeine websites tell how hard it is to come off codeine — buprenorphine
would help. |
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The
Pharmaceutical Journal