Installing slow-release drug under skin enables some abusers to get through withdrawal
People addicted to heroin or prescription opiates might have a hands-free device for getting through the rigors of drug withdrawal. The medication buprenorphine implanted under the skin and released over 24 weeks can ease drug cravings and helps some patients stay clean, researchers report in the Oct. 13 Journal of the American Medical Association.
“In the addiction field, there’s a pretty close relationship between sticking around in treatment — what we call retention — and how well you are doing,” says study coauthor Walter Ling, a psychiatrist at the UCLA School of Medicine.
Providing take-home doses of medication is problematic because it allows drugs such as buprenorphine to be used inappropriately or sold on the black market. “The use of implants provides a degree of flexibility for clients, while also maintaining medication with minimal risk of misuse,” she says.
The treatment consists of four matchstick-sized implants placed under the skin of the inner arm. Titan Pharmaceuticals of South San Francisco, Calif., which developed the implantable form of the drug and calls it Probuphine, is currently conducting another trial to confirm the findings. Results are due out in 2011.
In the JAMA study, Ling and his colleagues excluded people with chronic diseases or psychiatric conditions. While that limited some factors that might muddy the results, it also left the trial with “the best patients, in a sense,” says Douglas Bruce, a physician at Yale University School of Medicine. By screening out people whose addictions are complicated by mental illness, AIDS or hepatitis, he says, “that means it’s not necessarily a real-life experience.”
Bruce also notes that implants may have a downside: People with them may not show up for regular counseling as reliably as they would if they were receiving weekly supplies of buprenorphine tablets. “Most people become drug users because of sexual trauma as kids or other violence. Bad things happen to people, and drugs make them feel better.” To break the addiction cycle, Bruce says, medication must be complemented with counseling. “They will always have to take the meds if they never deal with the root issue.”
Nevertheless, Bruce says, the study shows promise. “It’s a great start. One of the things we want to know is what sort of therapy will people need to stay engaged [in a drug program] and how long do people need this treatment — is three to six months really sufficient?”
W. Ling et al. Buprenorphine implants for treatment of opioid dependence: A randomized controlled trial. Journal of the American Medical Association. Vol. 304, October 13, 2010, p. 1576.
H. Alho et al. Abuse liability of buprenorphine-naloxone tablets in untreated IV drug users. Drug and Alcohol Dependence. Vol. 88, 2007, p. 75.
G. Fischer et al. Buprenorphine versus methadone maintenance for the treatment of opioid dependence. Addiction. Vol. 94, 1999, p. 1337.
J. White et al. Open-label dose finding trial of buprenorphine implants (Probuphine) for treatment of heroin dependence. Drug and Alcohol Dependency. Vol. 103, 2009, p. 37.