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Buprenorphine Group Treatment For Opioid Addiction

Buprenorphine Group Treatment For Opioid Addiction. Ken Saffier , MD, Natasha Pinto, MD And Patients CCRMC/HC Noon Conference February 18, 2010. Disclosures.

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Buprenorphine Group Treatment For Opioid Addiction

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  1. Buprenorphine Group Treatment For Opioid Addiction Ken Saffier, MD, Natasha Pinto, MD And Patients CCRMC/HC Noon Conference February 18, 2010

  2. Disclosures Drs. Pinto and Saffier have no financial interest or other relationship with the manufacturer of any commercial product discussed in this presentation.

  3. Learning Objectives At the end of this presentation, participants will be able to: • List at least 2 patient criteria needed for buprenorphine treatment. • Explain why an opioid dependent patient must be in opioid withdrawal prior to taking their first dose of buprenorphine. • Understand and experience aspects of what a buprenorphine treatment group is like.

  4. Number of mentions . Oxycodone and hydrocodone both registered substantial increases in emergency department mentions in the last 5 years Source: SAMHSA, Drug Abuse Warning Network. 2/2004

  5. Past Year Dependent/Abusers, Ages 12 or Older (in Thousands) • Over 2 million are estimated to be dependent on or abusingprescription drugsin the past year. Source: SAMHSA, 2002 National Survey on Drug Use and Health. 1/2004

  6. Issues of Concern Percent of 12th Graders Reporting Nonmedical Use of OxyContin and Vicodin in the Past Year Remained High 12.0 10.5 9.6 9.3 10.0 8.0 Percent 6.0 5.0 4.5 4.0 4.0 2.0 0.0 OxyContin Vicodin 2002 2003 2004 No year-to-year differences are statistically significant.

  7. Opioids – a brief overview • Agonist • Heroin, hydrocodone, oxycodone, fentanyl • Antagonist • Naloxone, naltrexone • Mixed agonist/antagonist • Pentozacine, butorphanol (Stadol) • Partial agonist • Buprenorphine

  8. Intrinsic mu Activity: Full Agonist (Methadone), Partial Agonist (Buprenorphine), Antagonist (Naloxone) 100 90 Full Agonist (Methadone) 80 70 Intrinsic Activity 60 Partial Agonist 50 (Buprenorphine) 40 30 20 10 Antagonist (Naloxone) 0 -10 -9 -8 -7 -6 -5 -4 Log Dose of Opioid

  9. Buprenorphine– a partial agonist • High affinity for the mu opioid receptor • Competes with other opioids and blocks their effects • Can precipitate withdrawal in highly opioid dependent individuals • Slow dissociation from the mu receptor • Prolonged therapeutic effect for opioid dependence treatment • “Ceiling effect” for stimulation of a given receptor

  10. Zubieta et al., 2000

  11. Buprenorphine– a partial agonist • Poor oral bioavailability • Fair sublingual bioavailability • Takes about 10 minutes to dissolve • Schedule III drug • With naloxone (4:1) (Suboxone) or without (Subutex) • Analgesic dose for mild to moderate pain is 0.3 – 0.6 mg. (0.4 mg = ~10 mg morphine)

  12. Who is an appropriate patient? • Opioid dependent • Wants to stop using • Psychiatrically stable • Interested in office-based care • Reliable – can keep appointments • Agrees to urine tox screens • Has social support

  13. Meet Ryan - • Went to the ED in withdrawal. • Longstanding use of OxyContin. • $100/day “habit”. • Snorts q day for months, then stops. • Moves back to the Bay Area and within days, he’s back to using.

  14. “I’m tired of snorting Oxies, Doc. Can you help me?” • I’m snorting 5 oxies per day – it’s an insane amount to be putting into my body. • My palms are sweaty in the morning. • Then I have intense pain in my thighs. • I feel fidgety to an extreme. • So much physical and mental anguish. • I don’t want to waste money on this. It’s destroying my life.

  15. Dysphoric mood Craving Irritability Tearing, rhinorrhea Fever, chills Sweating Gooseflesh (cold turkey) Dilated pupils Muscle aches Back pain Tremor Yawning Restless sleep, then Insomnia Anorexia N/V, diarrhea, cramps Opioid Withdrawal

  16. Uses of Buprenorphine • Buprenorphine maintenance • Short acting opioids • Long acting opioids • Buprenorphine detox • Buprenorphine taper • (As an analgesic (buprenex))

  17. Buprenorphine vs. Placebo for Heroin DependenceKakko, Lancet 2003 20 15 Remaining in treatment (nr) 4 Subjects in Control Group Died 10 Detoxification 5 Maintenance 0 0 50 100 150 200 250 300 350 Treatment duration (days)

  18. Special Thanks: • Our patients, especially Ryan. • Drs. Michael Saxon and Mary Jeanne Kreek • Chris Verdugo, CCTV • Gary Larson

  19. Buprenorphine Clinical Guidelines Substance Abuse and Mental Health Administration Center for Substance Abuse Treatment Treatment Improvement Protocol (TIP) Series Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction # 40 National Clearinghouse for Alcohol and Drug Information (800) 729 – 6686 or (301) 468 – 2600 http://ncadi.samhsa.gov

  20. Buprenorphine Course www.buppractice.com (discounted for residents)

  21. For further information: • Buprenorphine at CCRMC & HC’s: • 925 370 5868 (leave message) or • 925 370 5859 (leave message) • Call Ken Saffier, MD, pager 334 • http://buprenorphine.samhsa.gov/about.html#top • www.csam-asam.org

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