Buprenorphine implant improves Opioid abstinence with reduced risk diversion

Buprenorphine implant improves Opioid abstinence with reduced risk diversion

A study published online July 19 in JAMA provides results of a randomized, but controlled trial that found Buprenorphine implant to work at least, if not better, to maintain treatment for opioid dependence than sublingual buprenorphine.

According to Richard N. Rosenthal, MD, medical director of addiction psychiatry, Mount Sinai Behavioral Health System, and professor of psychiatry, Icahn School of Medicine at Mount Sinai in New York City, the trial is first to determine safety and efficacy of buprenorphine implants and daily sublingual buprenorphine on long-term remission opioid use disorder in patients who were able to maintain treatment for opioid dependence using 8 mg or less of sublingual buprenorphine.

Dr. Rosenthal added that buprenorphine implants was found inferior to sublingual buprenorphine in the main outcome measure, which was maintaining abstinence from illicit opioids in at least 4 or the 6 study months. Moreover, greater number of patients receiving the implant was able to maintain abstinence than the sublingual treatment group during a period of full 6-month study.

Sublingual buprenorphine may have some individual and public health risks such as missed doses, accidental pediatric exposure, and the risk of theft or intentional diversion. On the other hand, the implant was not clinically destabilizing and remained in place over the active treatment period. Thus, buprenorphine implants could strengthen the maintenance of abstinence and at the same time reduces risk of diversion and adverse events.

“This novel implant system may help buttress patients' decision-making deficits that are a core component of the addiction by making these lifesaving medication adherence decisions far more infrequent”, wrote Wilson M. Compton, MD, and Nora D. Volkow, MD, director of the National Institute on Drug Abuse, Bethesda, Maryland.

A report published in Medscape revealed, "Buprenorphine implants work as well if not better than sublingual buprenorphine as maintenance treatment of opioid dependence, according to results of a randomized controlled trial released today."

"This is presumably the first head-to-head safety and efficacy trial of buprenorphine implants and daily sublingual buprenorphine on long-term remission opioid use disorder in patients who were previously stabilized on 8 mg or less of sublingual buprenorphine,"

"Given that transitioning to implants was not clinically destabilizing (eg, increased craving or withdrawal symptoms) and that the implants remain in place over the active treatment period, buprenorphine implants are an opportunity to boost maintenance of abstinence while reducing the risk of diversion and adverse events," he added.

According to a report in USNEWS by Dennis Thompson, "Buprenorphine is an anti-addiction drug designed to combat the cravings that come with opioids like heroin or powerful prescription painkillers like Percocet or OxyContin. Only 14 percent of patients with the implant slipped back into drug abuse during the clinical trial, compared with 28 percent of patients who took buprenorphine in its traditional pill form."

"Everybody did really well, but the implants did a little bit more well," said lead researcher Dr. Richard Rosenthal, medical director of Mount Sinai Hospital's Center for Addictive Disorders in New York City. "The implants are not only non-inferior, but if you're looking at total abstinence, they are better."

"Anything you take by mouth is going to have a peak and trough in terms of its blood level, every day," he said. "When you're dealing with psychoactive medications, those differences in peaks and troughs probably translate to changes in mood and craving in people who are opioid-dependent."

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