To review the pharmacotherapy of opioid dependence focusing on detoxification using buprenorphine, a partial μ-opioid agonist.
Based on a literature review of recent studies, general approaches to the use of buprenorphine and the associated success are summarized.
Like methadone, longer duration of buprenorphine stabilization and associated psychosocial treatment is associated with a better outcome and less relapse. However, a simple detoxification can be done by gradually reducing the dose of buprenorphine from a standard starting dose of 4–8 mg daily over a period of a week to as long as a month. When a transition to the antagonist naltrexone is desired, better success and greater efficiency can be obtained by combining clonidine with naltrexone to precipitate buprenorphine withdrawal than by using a dosage tapering. With a rapid clonidine/naltrexone approach, the induction on to naltrexone can be completed in as little as 1 day.
Buprenorphine can be an effective agent for opiate detoxification and transition to relapse prevention treatment using naltrexone. Ongoing work should make a once-monthly depot form of naltrexone available within a couple of years, thereby facilitating naltrexone adherence in former opiate dependent patients.
From the Yale University School of Medicine, VA Connecticut Healthcare System, Department of Psychiatry.
Supported by the National Institute on Drug Abuse grants R01-DA05626 (TRK), K05-DA0454 (TRK), and P50-DA09250; and the Veterans Administration Mental Illness Research, Education and Clinical Center (MIRECC).
Reprints: Thomas Kosten, MD, VA Connecticut Healthcare System, Psychiatry 151D, 950 Campbell Avenue, Bldg. 35, West Haven CT 06516 (e-mail: firstname.lastname@example.org).