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Review
, 19 (3), 299-308

Treatment of Opioid Dependence With Buprenorphine: Current Update

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Review

Treatment of Opioid Dependence With Buprenorphine: Current Update

Michael Soyka. Dialogues Clin Neurosci.

Abstract

Opioid maintenance treatment is the first-line approach in opioid dependence. Both the full opioid agonist methadone (MET) and the partial agonist buprenorphine (BUP) are licensed for the treatment of opioid dependence. BUP differs significantly from MET in its pharmacology, side effects, and safety issues. For example, the risk of respiratory depression is lower than with MET. The risk of diversion and injection of BUP have been reduced by also making it available as a tablet containing the opioid antagonist naloxone. This review summarizes the clinical effects of BUP and examines possible factors that can support decisions regarding the use of BUP or MET in opioid-dependent people.

Keywords: buprenorphine; methadone; opioid; opioid dependence; outcome; treatment.

Figures

Figure 1
Figure 1. Factors contributing to the risk of developing a substance-use disorder.
Figure 2
Figure 2. Chemical structure of buprenorphine.
Figure 3.
Figure 3.. Parametric images of μ-opioid receptor availability from a representative heroin-dependent volunteer during daily maintenance on buprenorphine placebo (row 2 from the top, Bup 0), 2 mg (Bup 2), 16 mg (Bup 16), and 32 mg (Bup 32). Images are scaled so that binding in the occipital cortex, an area devoid of u-receptors, is equal to 1. Four transverse sections from superior (column 1) to inferior (column 4) and one sagittal section (column 5) are shown, which correspond to T1-weighted anatomical MRI images (row 1). The pseudocolor scale depicts DVR values from 1 to 4. Reproduced from reference 42: Greenwald MK, Johanson CE, Moody DE, et al. Effects of buprenorphine maintenance dose on mu-opioid receptor availability, plasma concentrations, and antagonist blockade in heroin-dependent volunteers. Group. BUP, buprenorphine; DVR, direct volume rendering; MRI, magnetic resonance imaging. Figure reproduced with permission from ref 42: Greenwald MK, Johanson CE, Moody DE, et al. Effects of buprenorphine maintenance dose on mu-opioid receptor availability, plasma concentrations, and antagonist blockade in heroin-dependent volunteers. Neuropsychopharmacology. 2003;28(11):2000-2009. © 2003 Nature Publishing Group

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