Is there enough naloxone to deter the diversion? Effect of concurrent administration of intravenous naloxone on opioid agonist effects of intravenous buprenorphine: A randomised, double-blind, within-subject, crossover study among opioid-dependent subjects.

Autor: Dhagudu NK; Department of Psychiatry, Viswabharathi Medical College, Kurnool, India., Ambekar A; Department of Psychiatry and National Drug Dependence Treatment Center, National Drug Dependence Treatment Center, All India Institute of Medical Sciences, New Delhi, India., Agrawal A; Department of Psychiatry and National Drug Dependence Treatment Center, National Drug Dependence Treatment Center, All India Institute of Medical Sciences, New Delhi, India., Rao R; Department of Psychiatry and National Drug Dependence Treatment Center, National Drug Dependence Treatment Center, All India Institute of Medical Sciences, New Delhi, India., Mishra AK; Department of Psychiatry and National Drug Dependence Treatment Center, National Drug Dependence Treatment Center, All India Institute of Medical Sciences, New Delhi, India., Jain R; Department of Psychiatry and National Drug Dependence Treatment Center, National Drug Dependence Treatment Center, All India Institute of Medical Sciences, New Delhi, India., Singh S; Department of Psychiatry and National Drug Dependence Treatment Center, National Drug Dependence Treatment Center, All India Institute of Medical Sciences, New Delhi, India.
Jazyk: angličtina
Zdroj: Drug and alcohol review [Drug Alcohol Rev] 2020 Jul; Vol. 39 (5), pp. 595-603. Date of Electronic Publication: 2020 Mar 11.
DOI: 10.1111/dar.13057
Abstrakt: Introduction and Aims: We aimed to evaluate and compare the effect of different intravenous doses of naloxone on reinforcing effect of intravenous buprenorphine (2 mg) in patients stabilised on sublingual buprenorphine.
Design and Methods: This is a double-blind, within-subject, randomised, crossover study. Opioid-dependent patients, with history of intravenous drug use, stabilised on buprenorphine maintenance treatment were included after informed consent (n = 14). We administered and assessed the reinforcing effects of six test conditions: buprenorphine and naloxone co-formulation (BNX) in 4:1, 2:1 and 1:1 dose ratio (i.e. buprenorphine 2 mg + naloxone 0.5, 1 and 2 mg, respectively), buprenorphine alone (2 mg), pheniramine maleate (45.5 mg) and saline at 24 hourly intervals.
Results: No significant opioid withdrawals were precipitated during any test conditions. Compared to buprenorphine alone, 4:1 BNX had comparable euphoria, drug recognition, subjective opiate sensations and drug liking (P > 0.05); 2:1 BNX condition had significantly different subjective euphoria (P = 0.001), opioid recognition (P = 0.002), subjective opioid sensations at 60 min (P = 0.027) and drug liking (P < 0.001), while 1:1 BNX had significantly different objective euphoria (P = 0.002), opioid recognition (P = 0.030), subjective opioid sensations (P < 0.001) and drug liking (P < 0.001). No significant difference was noted on sedation scores between buprenorphine alone and all three combinations of BNX.
Discussion and Conclusions: The 4:1 BNX condition did not impact the reinforcing agonist effects of buprenorphine. None of the intravenous BNX combination ratios precipitated opioid withdrawals. Findings emphasise the need for exploring more abuse deterrent mechanisms.
(© 2020 Australasian Professional Society on Alcohol and other Drugs.)
Databáze: MEDLINE
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