Use of microdoses for induction of buprenorphine treatment with overlapping full opioid agonist use: the Bernese method.

IF 5.1 Q1 SUBSTANCE ABUSE
Substance Abuse and Rehabilitation Pub Date : 2016-07-20 eCollection Date: 2016-01-01 DOI:10.2147/SAR.S109919
Robert Hämmig, Antje Kemter, Johannes Strasser, Ulrich von Bardeleben, Barbara Gugger, Marc Walter, Kenneth M Dürsteler, Marc Vogel
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引用次数: 124

Abstract

Background: Buprenorphine is a partial µ-opioid receptor agonist used for maintenance treatment of opioid dependence. Because of the partial agonism and high receptor affinity, it may precipitate withdrawal symptoms during induction in persons on full µ-opioid receptor agonists. Therefore, current guidelines and drug labels recommend leaving a sufficient time period since the last full agonist use, waiting for clear and objective withdrawal symptoms, and reducing pre-existing full agonist therapies before administering buprenorphine. However, even with these precautions, for many patients the induction of buprenorphine is a difficult experience, due to withdrawal symptoms. Furthermore, tapering of the full agonist bears the risk of relapse to illicit opioid use.

Cases: We present two cases of successful initiation of buprenorphine treatment with the Bernese method, ie, gradual induction overlapping with full agonist use. The first patient began buprenorphine with overlapping street heroin use after repeatedly experiencing relapse, withdrawal, and trauma reactivation symptoms during conventional induction. The second patient was maintained on high doses of diacetylmorphine (ie, pharmaceutical heroin) and methadone during induction. Both patients tolerated the induction procedure well and reported only mild withdrawal symptoms.

Discussion: Overlapping induction of buprenorphine maintenance treatment with full µ-opioid receptor agonist use is feasible and may be associated with better tolerability and acceptability in some patients compared to the conventional method of induction.

Abstract Image

使用微剂量诱导丁丙诺啡治疗与重叠的全阿片激动剂使用:伯尔尼方法。
背景:丁丙诺啡是一种局部微阿片受体激动剂,用于阿片依赖的维持治疗。由于部分激动作用和高受体亲和力,在使用全μ阿片受体激动剂的患者诱导过程中可能会出现戒断症状。因此,目前的指南和药物标签建议在使用丁丙诺啡之前,在最后一次使用完全激动剂后留出足够的时间,等待明确和客观的戒断症状,并减少已有的完全激动剂治疗。然而,即使有这些预防措施,对许多患者诱导丁丙诺啡是一个困难的经历,由于戒断症状。此外,逐渐减少完全激动剂有重新使用非法阿片类药物的风险。案例:我们提出了两个案例成功启动丁丙诺啡治疗伯尔尼方法,即逐渐诱导重叠与充分激动剂的使用。第一位患者在常规诱导过程中反复出现复发、戒断和创伤再激活症状后,开始使用丁丙诺啡并重叠使用街头海洛因。第二例患者在诱导期间维持高剂量的二乙酰吗啡(即药物海洛因)和美沙酮。两名患者对诱导过程耐受良好,仅报告轻微的戒断症状。讨论:与传统的诱导方法相比,丁丙诺啡维持治疗与完全使用微阿片受体激动剂的重叠诱导是可行的,并且在一些患者中可能具有更好的耐受性和可接受性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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审稿时长
16 weeks
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