Transcript The effectiveness of buprenorphine in treating opioid

The effectiveness of buprenorphine
in treating opioid addiction
Skylee Campbell
Outline
1. Background
2. Opioid vs opiate
3. Brief history
4. Treatment
5. Conclusions
Opioid Statistics
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Increased abuse of prescription opioids
and non-medical opioids
Increase in
Admission rate to substance abuse treatment
programs
Opioid-related overdose
Opioid-induced mortality
Wu, Woody, Yang and Blazer (2010)
Background
Opioid vs opiate
Brief history
Treatment
Conclusions
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5.
Background
Opioid vs opiate
Brief history
Treatment
Conclusions
Increased Mortality
Rates
3 main factors:
(1) Direct effects on health
e.g., cardiac arrhythmias, respiratory failure
(2) Indirect effects via exposure
e.g., non-sterile injection equipment
(3) Environmental factors
e.g., suicide, advanced exposure to violence,
poor lifestyle choices, accidents
Hulse, English, Milne, & Holman (1999)
Opioid Statistics
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Background
Opioid vs opiate
Brief history
Treatment
Conclusions
Highest misused drugs in the United States
Lifetime prevalence:
1.7 % of every 19-30 year old has tried heroin
18.7 % have used other opioids
(such as Vicodin and OxyContin)
Wu, Woody, Yang, & Blazer (2010)
Veilleux, Colvin, Anderson, York & Heinz (2009)
Younger
Generations
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Background
Opioid vs opiate
Brief history
Treatment
Conclusions
Increase in non-medical prescription opioids
Average age is 21.2
Most popular prescription drug
is Vicodin
Veilleux, Colvin, Anderson, York, & Heinz (2009)
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Location
Prescription drugs: more in urban
areas rather than large cities
and rural
Possible reasons:
- Heroin not as available as prescription drugs
- Prescription drugs more socially acceptable
- Easier to attain and cheaper
Cicero, Surratt, & Inciardi, (2007)
Background
Opioid vs opiate
Brief history
Treatment
Conclusions
Gender
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Differences
Background
Opioid vs. opiate
Brief history
Treatment
Conclusions
Women are more likely than men to:
- initiate opioid use via prescription opioids
- use for indicated use
- Less likely to seek treatment for an opioid use
disorder
McHugh, DeVito, Dodd, Carroll, Potter, Greenfield, Connery & Weiss, (2013)
Opiate vs. Opioid
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Background
Opioid vs opiate
Brief history
Treatment
Conclusions
Opiate
Natural origin, made from opium (Papaver somniferum)
Examples
- Morphine
- Codeine
- Thebaine
Renner & Levounis (2011)
Opiate vs. Opioid
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Background
Opioid vs opiate
Brief history
Treatment
Conclusions
Opioid
Opiate-like drugs
Basic subgroups
(1) Semisynthetic
e.g., heroin, oxycodone, and buprenorphine
(2) Synthetic:
e.g., methadone and other medical prescription drugs in
opioid group
Renner & Levounis (2011)
Abuse Potential
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Background
Opioid vs opiate
Brief history
Treatment
Conclusions
Many opiates and opioids have a high abuse
potential
A drug will have a higher abuse potential if:
- Route of administration is quicker
Injection > Oral
- Shorter half-life
e.g., Heroin vs. Methadone
- Higher lipophilic properties
Faster route across blood-brain barrier
Renner & Levounis (2011)
History
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Background
Opioid vs opiate
Brief history
Treatment
Conclusions
Opium
- Produced from poppy: Papaver somniferum
- 10 % morphine,
0.5 % codeine,
lower % of thebaine
McKim & Hancock (2013)
History of Opium
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Background
Opioid vs opiate
Brief history
Treatment
Conclusions
6th millenium BCE in the Western Mediterranean
region
Written reference to opium “joy
plant”
Spread to Middle East, North Africa, India, and
China
Primarily used as medicine,
BUT also mentioned non-medical, more
enjoyable properties
McKim & Hancock (2013)
History
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Background
Opioid vs opiate
Brief history
Treatment
Conclusions
Opiate: Morphine
Frederick Serturner
Isolated morphine from opium
1830s: Manufactured and sold commercially
Raise for concern when people became
addicted
Too available
McKim & Hancock (2013)
History
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2.
3.
4.
5.
Background
Opioid vs opiate
Brief history
Treatment
Conclusions
Opiate: Codeine
Pierre J. Robiquet
Used new process of isolating morphine
Discovered codeine
Prescription currently legal in U.S.
McKim & Hancock (2013)
History
Opiate: Thebaine
Not used for therapeutic purposes
Used for semisynthetic opioids
Examples
- Percocet
- Percodan
- OxyContin (oxycodone)
McKim & Hancock (2013)
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Background
Opioid vs opiate
Brief history
Treatment
Conclusions
History
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Background
Opioid vs opiate
Brief history
Treatment
Conclusions
Opioid: Heroin
Discovered in 1874 as first semisynthetic form of
opioid
More lipid soluble than morphine
Originally seen as not as addictive
McKim & Hancock (2013)
Treatment
Considerations
Mu receptor
Full agonist
Antagonists
Partial agonist
Renner & Levounis (2011)
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Background
Opioid vs. opiate
Brief history
Treatment
Conclusions
Treatment
Considerations
Full Agonist
• Prescription opioids
• Morphine
• Heroin
• Methadone
Renner & Levounis (2011)
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Background
Opioid vs. opiate
Brief history
Treatment
Conclusions
Treatment
Considerations
Antagonist
• Do not produce any opioid effects
• Naloxone:
- Reverses effects of opioids
• Naltrexone:
- Blocks agonist from binding to mu receptor
Renner & Levounis (2011)
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Background
Opioid vs. opiate
Brief history
Treatment
Conclusions
Treatment
Considerations
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Background
Opioid vs. opiate
Brief history
Treatment
Conclusions
Partial Agonist
• Buprenorphine
- Longer half-life
- Can relieve opioid and opiate withdrawal
symptoms
Renner & Levounis (2011)
Buprenorphine
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Background
Opioid vs. opiate
Brief history
Treatment
Conclusions
Originally developed in the 1970s
Developed because
- Opioid addiction is costly to the government
- Methadone treatment had
many associated limitations
Renner & Levounis (2011)
Buprenorphine
Administration Routes
(1) Subutex form
• Administered orally
• Buprenorphine alone
(2) Suboxone form
• Administered orally
• Mix of buprenorphine/naloxone
(3) Implants
(4) Injections
Renner & Levounis (2011)
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Background
Opioid vs. opiate
Brief history
Treatment
Conclusions
Buprenorphine
Implants
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Background
Opioid vs. opiate
Brief history
Treatment
Conclusions
•
Implant = polymetric matrix composed of ethylene
vinyl acetate and buprenorphine
•
Advantages
(1) Delivers buprenorphine over 6 months
- Initial pulse release  constant, low level
of buprenorphine released
(2) To address problems with adherence and
nonmedical use
(Ling, Casadonte, Bigelow, Kampman, Patkar, Bailey, Rosenthal & Beebe, 2010)
Buprenorphine
Injections
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Background
Opioid vs. opiate
Brief history
Treatment
Conclusions
Produces a gradual release of buprenorphine
Advantages
Gradual opioid detoxification with minimal
withdrawal symptoms
Reduces frequency of clinic visits
Eliminates need for take-home medication
(Sigmon, Wong, Chausmer, Liebson & Bigelow, 2004)
Buprenorphine naloxone
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Background
Opioid vs. opiate
Brief history
Treatment
Conclusions
Adding naloxone discourages parenteral use
BUT preserves the therapeutic effect on opiate
addiction when used sublingually as intended
(Harris, Jones, Welm, Upton, Lin & Mendelson, 2000)
Gender
Differences
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Background
Opioid vs. opiate
Brief history
Treatment
Conclusions
• No significant gender differences in treatment
outcome indicators including:
• Maximum daily dose of buprenorphine–naloxone
• Achievement of a successful opioid treatment
outcome
• Treatment retention
(Kelly, Schwartz, O'Grady, Mitchell, Reisinger, Peterson, Agar & Barry, 2009)
Conclusions
Advantages of Buprenorphine
• Partial agonist
• Improved overall safety margin
• Long-lasting effect
• Reduces severity of withdrawal
Renner & Levounis (2011)
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2.
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Background
Opioid vs. opiate
Brief history
Treatment
Conclusions
Conclusions
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Disadavantages of Buprenorphine
• Concern of abuse
• Need to be aware of potential for abuse
Cicero, Surratt, Inciardi, & Munoz (2007)
Background
Opioid vs. opiate
Brief history
Treatment
Conclusions
“Holy Grail of
Opioid Research”
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Background
Opioid vs.
opiate
Brief history
Treatment
Conclusions
STILL in search for drug that has same analgesic
effects of morphine but does NOT have side effects such
as addiction
Developed thousands of new opioids
All have addictive properties
Have NOT found perfect drug
McKim & Hancock (2013)
Acknowledgments
• Conference organizers
• Behavioral Science Department
• Drs. David Yells and Richard Nance
• Dr. Claudia Lieberwirth
References
Cicero, T. J., Surratt, H. L., & Inciardi, J. (2007). Use and misuse of buprenorphine in the management of opioid addiction. Journal of Opioid Management , 3(6), 1-7.
Harris, D. S., Jones, R. T., Welm, S., Upton, R. A., Lin, E., & Mendelson, J. (2000). Buprenorphine and naloxone co-administration in opiate-dependent patients stabilized on
sublingual buprenorphine. Drug and Alcohol Dependence, 61, 85-94. doi: S0376-8716(00)00126-5
McHugh, R. K., DeVito, E. E., Dodd, D., Carroll, K. M., Potter, J. S., Greenfield, S. F., Connery, H. S., & Weiss, R. D. (2013). Gender differences in a clinical trial for
prescription opioid dependence. Journal of Substance Abuse Treatment, 45, 38-43. Retrieved from http://dx.doi.org/10.1016/j.jsat.2012.12.007
Hulse, G. K., English, D. R., Milne, E., & Holman, C. D. J. (1999). The quantification of mortality resulting from the regular use of illicit opiates. Society for the Study of
Addiction and Other Drugs, 94(2), 221-229. doi: 0965-2140/99/020221-09
Kelly, S. M., Schwartz, R. P., O'Grady, K. E., Mitchell, S. G., Reisinger, H. S., Peterson, J. A., Agar, M. H., & Barry, B. S. (2009). Gender differences among in- and out-oftreatment opioid-addicted individuals. The American Journal of Drug and Alcohol Abuse, 35, 38-42. doi: 10.1080/00952990802342915
References
Ling, W., Casadonte, P., Bigelow, G., Kampman, K. M., Patkar, A., Bailey, G. L., Rosenthal, R. N., & Beebe, K. L. (2010). Buprenorphine implants for treatment of opioid
dependence: A randomized controlled trial. American Medical Association, 304(14), 1576-1582. Retrieved from http://jama.jamanetwork.com/
McKim, W. A., & Hancock, S. D. (2013). Drugs and behavior: An introduction to behavioral pharmacology. (7th ed., pp. 255-276). New Jersey: Pearson.)
Renner, J. A., & Levounis, P. (2011). Handbook of office-based buprenorphine treatment of opioid dependence. (1st ed.). Virginia: American Psychiatric Publishing, Inc.
Sigmon, S. C., Wong, C. J., Chausmer, A. L., Liebson, I. A., & Bigelow, G. E. (2004). Evaluation of an injection depot formulation of buprenorphine: placebo comparison.
Society for the Study of Addiction, 99, 1439-1449. doi: 10.1111/j.1360-0443.2004.00834.x
Veilleux, J. C., Colvin, P. J., Anderson, J., York, C., & Heinz, A. J. (2010). A review of opioid dependence treatment: Pharmacological and psychosocial interventions to treat
opioid addiction. Clinical Psychology Review, 30, 155-166. doi: 10.1016/j.cpr.2009.10.006
Wu, L., Woody, G. E., Yang, C., & Blazer, D. G. (2010). Subtypes of nonmedical opioid users: Results from the national epidemiologic survey on alcohol and related conditions.
Drug and Alcohol Dependence, 112, 69-80. doi: 10.1016/j.drugalcdep.2010.013
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