By Pascal Kintz, Pierre Marquet
In Buprenorphine treatment of Opiate habit, engaging physicians and toxicologists summarize and evaluation their reviews with 5 years of in depth buprenorphine treatment. They hide all points of its use, together with the pharmacology, stipulations of supply, dangers from use with different psychoactive medications, toxicology and comparable deaths, in addition to its trying out in blood, urine, tissue, and hair. particular cognizance is given to evaluating the long term care of opiate-dependent sufferers utilizing high-dose buprenorphine vs methadone, and to explaining the variations in therapy, management, and supply. The authors additionally describe how buprenorphine is at present prescribed and monitored in France and Australia, and assessment all of the most modern advances in analytical suggestions for the choice of buprenorphine and its metabolites in organic fluids and tissues.
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Additional resources for Buprenorphine Therapy of Opiate Addiction (Forensic Science and Medicine)
REFERENCES 1. Lewis JW, Readhead MJ. Novel analgestics and molecular rearrangements in the morphine-thebaine group. XVIII. 3-deoxy-6,14-endo-etheno-6,7,8,14-tetrahydrooripavines. J Med Chem 1970;13:525-7. 2. Jasinski DR, Pevnick JS, Griffith JD. Human pharmacology and abuse potential of the analgesic buprenorphine. Arch. Gen. Psychiatry 1978;35:501–16. 3. McQuay HJ, Moore RA, Bullingham RES. Buprenorphine kinetics. , New York: Raven, 1986. 4. Iribarne C, Picart D, Dreano Y, Bail JP, Berthou F. Involvement of cytochrome P450 3A4 in n-dealkylation of buprenorphine in human liver microsomes.
However, these studies tested the effects of doses higher than those used for pain control. For example, in a study conducted by Mello and Mendelson (2), subjects were maintained on doses of up to 8 mg/d of subcutaneous (sc) buprenorphine. These laboratory studies of buprenorphine allowed high-dose administration under the controlled and supervised conditions of an inpatient experimental research unit. However, testing of buprenorphine for the outpatient treatment of opioid dependence meant delivery could no longer be reasonably administered by daily injections, and control of the subject population was diminished (because patients would leave the clinic after dosing).
The study compared 2 mg of buprenorphine solution (n = 22) to 30 mg of daily methadone (n = 23); while the total study duration was 13 wk, stable dosing occurred for only the first 3 wk. Participants then underwent a withdrawal between wk 4 and 7 and received placebo dosing between wk 8 and 13. A unique feature of this study was the inclusion of a 6-mg intramuscular (im) hydromorphone challenge during the second week of treatment. Hydromorphone is a prototypic µ agonist opioid, and response to the challenge provided an assessment of the blockade efficacy of buprenorphine and methadone.
Buprenorphine Therapy of Opiate Addiction (Forensic Science and Medicine) by Pascal Kintz, Pierre Marquet