Buprenorphine, a semisynthetic opioid derivative, has been prescribed widely and uniquely in France as an alternative to methadone for the treatment of heroin-addicted patients during the last five years. In Buprenorphine Therapy of Opiate Addiction, participating physicians and toxicologists summarize and evaluate their experiences with this still uncommon drug, covering all aspects of its use, including the pharmacology, conditions of delivery, risks from use with other psychoactive drugs, toxicology and related deaths, as well as its testing in blood, urine, tissue, and hair. Special attention is given to comparing the long-term care of opiate-dependent patients using high-dose buprenorphine vs methadone, and to explaining the differences in treatment, administration, and delivery. The authors also describe how buprenorphine is currently prescribed and monitored in France and Australia, and review all the latest advances in analytical techniques for the determination of buprenorphine and its metabolites in biological fluids and tissues. Special coverage is given to the use of buprenorphine in the pregnant addict, the risks of buprenorphine overdosing and poisoning, and the effects of combining buprenorphine and naloxone.
Comprehensive and groundbreaking, Buprenorphine Therapy of Opiate Addiction covers all the key topics that both treatment personnel and forensic laboratory scientists in the addiction field need to appreciate the success of buprenorphine therapy, and to prepare for its implementation in their own countries.

Klappentext

In Buprenorphine Therapy of Opiate Addiction, participating physicians and toxicologists summarize and evaluate their experiences with five years of intensive buprenorphine therapy. They cover all aspects of its use, including the pharmacology, conditions of delivery, risks from use with other psychoactive drugs, toxicology and related deaths, as well as its testing in blood, urine, tissue, and hair. Special attention is given to comparing the long-term care of opiate-dependent patients using high-dose buprenorphine vs methadone, and to explaining the differences in treatment, administration, and delivery. The authors also describe how buprenorphine is currently prescribed and monitored in France and Australia, and review all the latest advances in analytical techniques for the determination of buprenorphine and its metabolites in biological fluids and tissues.

Inhalt

Chapter 1: Pharmacology of High-Dose Buprenorphine Pierre Marquet 1 Introduction 2 Pharmacokinetic Properties 2.1 Absorption and Bioavailability 2.2 Distribution 2.3 Metabolism 2.4 Excretion 3 Pharmacodynamic Properties 4 Administration Schedules 5 Clinical Effects of Buprenorphine 6 Conclusion References Chapter 2: Controlled Drug Administration Studies of High-Dose Buprenorphine in Humans Marilyn A. Huestis 1 Introduction 2 Bioavailability 3 Dose-Effect Profiles 4 Abuse Liability 5 Toxicity 6 Safety and Abuse Liability of High-Dose Intravenous Buprenorphine 7 Conclusion References Chapter 3: High-Dose Buprenorphine for Treatment of Opioid Dependence Eric C. Strain 1 Introduction 2 Buprenorphine Solution vs Tablets 3 Efficacy of Buprenorphine vs Placebo: Clinical Trials 3.1 Summary of Placebo-Controlled Studies 4 Efficacy of Buprenorphine vs Other Medications: Clinical Trials 4.1 Summary of Studies Comparing Buprenorphine to Other Medications 5 Safety and Side Effects of Buprenorphine 6 Summary and Conclusions Acknowledgment References Chapter 4: Forseeable Advantages and Limits of Buprenorphine-Naloxone Association Michel Mallaret, Maurice Dematteis, Celine Villier, Claude Elisabeth Barjhoux, and Chantal Gatignol 1 Introduction 2 Advantages of Buprenorphine-Naloxone Association 2.1Advantages of Opiate-Naloxone Association: Lessons of the Past 2.1.1 Epidemic of Pentazocine and Tripelennamine Abuse in the United States 2.1.2 Epidemic of Analgesic Buprenorphine Abuse in New Zealand 2.2 Buprenorphine and Naloxone: A Complex and Controversial Pharmacology 2.3 Clinical Aspects 2.3.1 Pharmacokinetic/Pharmacodynamic Advantages of Associated Naloxone in BupNx Combination 2.3.2 Sublingual Naloxone in BupNx TabletsDoes Not Decrease Buprenorphine Effects 2.3.3 Sublingual Naloxone in BupNx Tablets Does Not Decrease Blockade Effects of Buprenorphine in Opioid-Dependent Patients 2.3.4 Sublingual Naloxone in BupNx Tablets Does Not Precipitate Withdrawal Symptoms in Opioid-Dependent Patients 2.3.5 Is the BupNx Combination Effective for Detoxification or Treatment of Depressive Symptoms in Opioid-Dependent Patients? 2.3.6 What Is the Abuse Liability of Intravenous BupNx Combination in Nonopioid-Dependent and Opioid-Dependent Patients? 2.3.7 Intravenous Naloxone May Decrease Respiratory Depression by Buprenorphine 2.3.8 What Will Be the Epidemiological Consequences and Potential Economic Impact of the Use of BupNx Combination? 3 Limits of Buprenorphine-Naloxone Association 3.1 Potential Risk of Inefficacy of Naloxone in BupNx Combination 3.2 Abuse Liability of Intravenous BupNx Combination: Low But Still Possible 3.3 Adverse Buprenorphine Reactions and Sublingual BupNx Combination 3.3.1 Respiratory Depression 3.3.2 Involuntary Overdoses 3.3.3 Experimental Buprenorphine Hepatotoxicity 3.4 Specific Risks in Office-Based Treatment (BupNx Combination) of Opiate Dependence 4 Conclusion References Chapter 5: Buprenorphine Maintenance Treatment in Primary Care: An Overview of the French Experience and Insight Into the Prison Setting Marc Deveaux and Jean Vignau 1 Introduction 2 Implementation of BMT Through French Primary Care System 2.1 A Late But Considerable Concession to Harm Reduction Paradigm 2.2 Legal Framework of Therapeutic Use of Buprenorphine 2.2.1 Essential Landmarks of French Health Services 2.2.2 Opioid Maintenance Treatments 3 Observable Effects of French Policy 3.1 Is BMT Accessible and Acceptable? 3.2 Is BMT Safe? 3.2.1 Data from Preregistration Studies 3.2.2 Data from French Experience 3.3 Is BMT Effective in Contr