Buprenorphine Implant May Help Opioid-Dependent People Better Adhere to Treatment

Buprenorphine Implant May Help Opioid-Dependent People Better Adhere to Treatment

By Staff

A study published in JAMA by researchers from the Icahn School of Medicine at Mount Sinai, New York, investigated subdermal (under the skin) buprenorphine implants and their effect on opioid-dependent patients. They found that after six months patients maintained very low, or no illicit use of opioids relative to daily sublingual (under the tongue) buprenorphine maintenance treatment.

Ninety-three percent of the patients completed the trial.  Here are some of the findings:

  • Eighty-one of 84 (96 percent) receiving buprenorphine implants and 78 of 89 (88 %) receiving sublingual buprenorphine were responders
  • Urine tests were administered monthly and four times randomly.
  • Seventy-two out of 84 (86 %) receiving buprenorphine implants and 64 of 89 (72 %) receiving sublingual buprenorphine maintained opioid abstinence.
  • Non-implant-related and implant-related adverse events occurred in 48 % and 23 % of the buprenorphine implant group and in 53 % and 13.5 % of participants in the sublingual buprenorphine group, respectively.

“Buprenorphine is an effective treatment for opioid dependence; however, adherence to daily dosing for management of chronic disorders is challenging. An implantable buprenorphine delivery system reduces adherence issues and may improve efficacy,” the authors write.

“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,” noted Wilson M. Compton, M.D., M.P.E., and Nora D. Volkow, M.D., of the National Institute on Drug Abuse, Bethesda, Md., in an editorial that accompanied the study.

“However, buprenorphine implants are currently approved by the U.S. Food and Drug Administration for only up to 1 year of treatment for a subgroup of patients who have already achieved and sustained prolonged clinical stability while receiving low to moderate doses of oral transmucosal buprenorphine, a caveat clearly stated in the product label. Even so, this novel approach to delivering care may open up treatment for new, previously difficult-to-reach populations or for those in the criminal justice system. Although further research is needed to determine which populations would benefit the most from these new formulations, the potential of these agents to have a positive role in the current opioid crisis is undeniable.”

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Authored by: Staff

There are 14 comments for this article
  1. Jesse Grams at 6:38 pm

    Expanded use and availability of medication-assisted treatment is a top priority of federal effort to combat opioid epidemic

  2. Maria Molaro at 5:55 am

    To Kurt, even though you come off as self bloating, all of your message is “spot on”. Keep blogging. Thank you.

  3. connie at 11:52 pm

    Any pain patient who thinks that they have not been labeled an addict needs to think again! Doctors use something like 20 criteria, most of which is totally ridiculous like how you dress or if you talk about pain or medications more than twice a year! There used to be a great website that had a list of what is used against us but it was taken down several years ago. I was on 125 mcg fentanyl for ten years. In my opinion it is the easiest drug for doctors and the government to regulate as you don’t get any extra, can’t refill till you are on the last patch and not changing on time comes with nasty consequences. Had it not been for a wonderful pharmacist I would have had to go cold turkey! He talked to my Dr and her tune changed REAL QUICK! I am down to 25mcg and 1mg dilaudid every 4 hours (previous dose was 4 mg every 3 hours) my pain level is sky high and in the end will have no pain meds at all. I can’t take anything otc because they tear up my stomach. It totally sucks but soon no one without cancer will have REAL pain control.

  4. Jessica Agee at 1:53 pm

    In reply to Connie..that doesn’t make no sense. I would think that outfit would be cute! No need to put in a medical record. That’s crazy!! Yeah my doctor I have now was going to send me to a pain clinic because he changed my medicine I was on for four years to something else & he had me come in to see how I was doing & he could clearly see without me saying a word I was in massive pain & the medicine he put me on wasn’t working,so he decided to refer my to pain management. So I not only did some research on this pain doctor I was told by other’s that I shouldn’t go because he treated patients badly & some other issues . I also seen on my referral that my doctor suggested I should be put on suboxone vs methadone. Right then I knew he was pretty much saying since the medicine didn’t work I was an “addict” so I called a mth or so later ( my family doctor ) & asked to stay with him & that I’d stay on this medicine even though it doesn’t work like my other med had. I’m doing this until I can find the right pain clinic for me. I refuse to be labeled an addict. I’m not,I’m in pain and I’m addicted to life!!! I take my meds as prescribed , I signed the contract & have clean UA & always go to the same pharmacist & my doctor checks Ohios thing to make sure I don’t see other doctors or pharmacys. My pain is well documented . This medicine took about 3 mths too help some, so I’m in a better place than most. I’m so sorry to those who get nothing & been cut off for no reason. I Do not get the logic on how they think opioid medication doesn’t help us in chronic pain?? I know for a fact it does. I’ve been off my pain meds in the almost 10 yrs in chronic pain and I hurt so bad I couldn’t move. I had to go back on pain medication. Plus suboxone is to get people off opioids all together , so how’s that supposed to help us? I was on methadone for 6 year’s ,now that honestly helped my pain,before it was used for addiction it was used for pain & that’s why I was on it,it worked for me. The only reason I’m not on is because the pain clinic I use to go to stop taking my insurance & though the medicine was cheap the clinic was not. It was the best PM I’ve ever been to. Anyhow I agree if we was all on a dose we needed we would lead more productive life’s & I would be able to do more with my family of 5. I wish I never was in pain & never had my surgery in 07 but I did and now they will more than likely take all of us off opioid medication all together. That’s scary! Do they think we really wanna be on this medication ,I’d give anything not to be in pain but it’s my reality until the day a cure comes along opioids help my pain & so many other’s.

  5. connie at 7:22 pm

    Reply to Jessica Agee. I had a doctor comment in my record that I was”dressed inappropriately” I was wearing a midcalf length dress and sandals. My hair was in a neat braid. Tell me what I was dressed like had any bearing on my medical needs?

  6. connie at 7:16 pm

    Personally I believe that those patients who have problems with their opiate pain meds are being UNDER treated. If a person is getting a proper therapeutic dose there is no reason to want or need to take medication other than prescribed. Some people NEED more than others to get adequate pain control. A minimum dose for me would have a lot of people drooling and non-functional. They need to quit trying to fit everyone into the same mold!

  7. Kurt WG Matthies at 11:37 pm

    Buphrenorphine, the partial opioid agonist in Suboxone, is effective for some pain, but has a therapeutic maximum, unlike the full opioid agonists morphine, hydromorphone, etc.

    The other ingredient of Suboxone is a full opioid antagonist, naloxone, and prevents the pain relieving activity of opioids from reaching the opioid receptor through a process pharmacologists call “receptivity.” Taking breakthrough medications with Suboxone will not work, nor will taking extra doses.

    Suboxone treats addiction and pain. If a person with chronic pain has proven addictive behaviors (not pseudo addictive behaviors), then Suboxone is a compassionate way to provide some level of pain relief while avoiding those addictive behaviors.

    But since study after study proves that the vast majority of chronic pain patients dependent on opioids do not exhibit addictive behaviors, there is no need to prescribe suboxone to a chronic pain patient.

    Suboxone also cost 100 times as much as methadone, and must be prescribed by a physician with a special licence. Most PCPs treat pain — they do not have this license. Pain doctors usually do not have this licences.

    For the most part, doctors who treat addiction have this license. So do certain specialties, like cancer doctors, and hospital generalists who treat these patients.

    If the discussion is how to treat patients who suffer from opioid addiction and chronic pain, then Suboxone is a viable, humanistic solution.

    If the chronic pain patient on opioids does not exhibit addictive behaviors, and has been titrated to an effective dose to lead a functional life, then the discussion of treating with Suboxone is irrelevant attempt to label pain patients, dependent on opioid pain medication to treat chronic pain, as addicts.

    In simple terms, we’re talking apples and oranges, and here we are with another wasted study.

    What causes addiction?

    Why do 5-10% of chronic pain patients have trouble managing their opioid medications?

    How do we better treat chronic pain patients so that their opioid dose is more effective, and there is no need for them to seek non-medical sources of pain relief?

    Where is the data we need for the National Pain Strategy? Treating pain patients with a partial opioid agonist isn’t going to solve the problem — otherwise all pain patients would be well maintained on pentazocine for dozens of years.

    Who else is sick of research exploring the patient with intractable pain who benefits from opioid agonist therapy, for the purpose of treating him or her like an addict?

    When does America wake up to the skewed arithmetic where the treatment of 100 million in pain is determined by the death of a few thousand opioid overdoses each year, especially in an environment where fentanyl analogs are doing who knows how much of that killing?

    Opioids are effective and safe when used expeditiously.

    When people are fired from practices, when state medical boards remove the licenses of physicians who treat pain, when fear abounds in the pain community, millions of Americans are being under served, over charged, and must suffer daily.

    I’m sick of it. Aren’t you?

  8. Christine Taylor at 8:35 pm

    Could the results be because most pain patients do not abuse their meds ?

  9. Teresa haney at 7:30 pm

    I know several people who use the sublingual buprenorphine. The problem is they make them jump through hoops to get it. Not enough docs can prescribe it. In a lot of cases they have to attend counseling 3 or 4 times a week and see doc once a week. If they could get the implantable and get on with life. I believe there would be a lot more success stories. The people I’ve seen succeed only go to doc once a month to check progress and get prescription. They work and live fulfilling lives. Having to go everyday is like living the life of an addict chasing the dragon.

  10. Jessica Agee at 5:47 pm

    Robert I agree! How’s that fair to put on my medical records that I’m consider an “addict ” & could possibly be put on this drug? All because back in 07 I started having back pain & had a botched up cervical spinal fusion leaving me to be in pain the rest of my life. Since then I have just gotten worse with nerve damage ,fibromyalgia , degenerative disc disease , osteoarthritis ,more herniateddisc & more. And have been put on pain pills by my doctor that I take as prescribed & I tried Odviously surgery ,PT,injections, tens units, chiropractic care ,exercise on my own etc.. before pain pills .I alway did as I was told even if I knew I’ve tried before or it could harm me,I can’t even count how many of those things I’ve tried more than once. What has happened to our country?? This is crazy & the only thing left to do as pharmacist Steve would say VOTE THE BUMS OUT! So Frustrating!!

  11. Catherine Sutton at 12:12 pm

    What does this have to do with pain management? I want help with my pain! I am not nor have ever been an addict of anything. I thought this site was to help with the chronic pain crisis, not to lump us all as dependent and addicted, which are two very different things. Also Buphenorphine is highly addictive and much more difficult to get off than trafitional legal opiods. Do your research and have some respect.

  12. Cheri Furr at 10:01 am

    84 people. GREAT number to have in a clinical trial. To have this low a number is an insult to all pain sufferer. You can brag that it worked for 96%, and no one will no that the percentage is based on a total of 94 people. This is a total farce and a lack of responsibility in the researching of this AND that you would print information on this!!!

  13. connie at 9:40 am

    Once again we are all a bunch of junkies who cannot be trusted to take our medication as prescribed

  14. Robert Brown at 6:37 am

    What’s in a Word? Addiction Versus Dependence in DSM-V
    http://ajp.psychiatryonline.org/doi/full/10.1176/ajp.2006.163.5.764
    (by Charles O’Brien, who chaired the committee that did the revisions to the substance use disorders section; co-signed by Nora Volkow, head of N.I.D.A., and T.K. Li, former head of N.I.A.A.A.)

    Addiction and dependence in DSM-V
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3812919/

    Can we please stop conflating physiological dependence with “addiction” or, more P.C., a “substance use disorder?”

    Please?

    Please?