SAN DIEGO – The switch from the use of intramuscular buprenorphine to sublingual buprenorphine probably has improved the completion rate of short-term, inpatient opiate detoxification, according to the experience at the Center for Chemical Dependence at Johns Hopkins Bayview Medical Center, Baltimore.
When that 26-bed detoxification unit switched to sublingual buprenorphine, the withdrawal-treatment completion rate went from 73% in the 3 months before the change to 86% in the 3 months after, said Dr. Janet Soeffing of the center at the annual conference of the American Society of Addiction Medicine.
In the 3 months before the switch, which occurred in November 2004, 483 patients were admitted for opiate withdrawal and treated with intramuscular buprenorphine. In the 3 months after, 473 patients were admitted and treated with the sublingual agent.
Among a control group of patients who entered the unit but did not receive treatment for opioid dependence, the rates of treatment completion were 89% in the 3 months before November 2004 and 83% after, a difference that was not statistically significant, Dr. Soeffing said.
The patients who did not complete treatment either left against medical advice or were dismissed by staff for breaking the rules of the unit.
The administration protocol for the intramuscular buprenorphine was a standard one in which patients received 0.3 mg twice daily for 3 days.
The protocol for the sublingual buprenorphine was based on a regimen developed in Australia (Drug Alcohol Depend. 2003;70:287–94); patients received 8 mg the first and second day, 6 mg the third day, and 2 mg on the morning of discharge.
“There are some studies to suggest that the sublingual formulation of buprenorphine may be associated with a faster onset of action or even a greater bioavailability,” said Dr. Soeffing, speculating on the possible reason why completion improved. “But these studies are hard to replicate.”
The sublingual formulation was approved in this country in October 2002 and immediately began to replace intramuscular buprenorphine as the agent of choice for detoxifying, Dr. Soeffing said.
Withdrawal-treatment completion is extremely important because patients who fail to complete tend to drop out of the medical and dependence-recovery system altogether, Dr. Soeffing said.
Previous studies have shown that some of the factors associated with not completing withdrawal treatment include young age, a shorter duration of drug use, female sex, dual diagnosis, and the medication used for symptom control during withdrawal, she added.