The clinical use of buprenorphine in opiate addiction: evidence and practice

Law, F. D., Myles, J. S., Daglish, M. R. C. and Nutt, D. J. (2004) The clinical use of buprenorphine in opiate addiction: evidence and practice. Acta Neuropsychiatrica, 16 5: 246-274. doi:10.1111/j.0924-2708.2004.00095.x

Author Law, F. D.
Myles, J. S.
Daglish, M. R. C.
Nutt, D. J.
Title The clinical use of buprenorphine in opiate addiction: evidence and practice
Journal name Acta Neuropsychiatrica   Check publisher's open access policy
ISSN 0924-2708
Publication date 2004-10
Sub-type Article (original research)
DOI 10.1111/j.0924-2708.2004.00095.x
Volume 16
Issue 5
Start page 246
End page 274
Total pages 29
Place of publication Copenhagen
Publisher Blackwell Munksgaard
Language eng
Subject 110319 Psychiatry (incl. Psychotherapy)
11 Medical and Health Sciences
17 Psychology and Cognitive Sciences
Abstract Buprenorphine is a partial mu-opioid receptor agonist that is being increasingly used in clinical practice in the treatment of opioid dependence in the UK, USA, and, elsewhere. Its unique pharmacological properties mean it is a relatively safe drug, it can be given by alternate day dispensing, and it is associated with relatively mild symptoms on withdrawal. The interpretation of the research literature on buprenorphine is however, complex, and often appears to be in conflict with how buprenorphine is used in clinical practice. This article describes these apparent contradictions, their likely explanations, and how these may further inform our clinical practice. The article also describes the clinically relevant pharmacological properties of buprenorphine, compares it to methadone, relates the evidence to clinical experience, and provides practical advice on how to manage the most common clinical techniques. The best quality evidence suggests that very rapid buprenorphine induction is not associated with a higher drop-out rate than methadone, that buprenorphine is probably as good as methadone for maintenance treatment, and is superior to methadone and alpha-2 adrenergic agonists for detoxification. However, buprenorphine cannot yet be considered the 'gold standard' treatment for opiate dependence because of the higher drop-out rates that may occur on induction using current techniques, its high-cost relative to methadone, and because the place of buprenorphine in treatment IS Still continuing to evolve.
Keyword Neurosciences
Alpha-2 adrenergic agonists
Partial mu-opioid receptor agonist
Opioid-dependent Patients
High-dose Buprenorphine
Methadone-maintained Subjects
Human Liver-microsomes
Reported Heroin Use
Intravenous Buprenorphine
Respiratory Depression
Dosing Regimens
Relative Bioavailability
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 16 times in Thomson Reuters Web of Science Article | Citations
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Created: Fri, 25 Jan 2008, 16:28:25 EST