Getting drug addiction treatment on track

Implants may trump liquid and pills

Methadone has helped countless people hooked on heroin and prescription pain relievers wean themselves off for over 40 years. A methadone alternative may soon outshine the well-known withdrawal aid in some important ways.

Buprenorphine hydrochloride, a semi-synthetic opioid compound used for pain control and detoxification, has been available in pill form for two years. But its downside includes diverting the tablets for sale on the streets and crushing and liquefying them into an injectable – and therefore more potent -- form.

A recent study published in the Journal of the American Medical Association (http://jama.ama-assn.org/cgi/content/short/304/14/1576) shows promise for a buprenorphine implant, called Probuphine by its California makers, Titan Pharmaceuticals.

One hundred and sixty-three opioid-dependent adults (18-65 years of age) received either four 3-cm long (a centimeter shy of the width of a ping-pong ball), ethylene vinyl acetate and buprenorphine implants, or 4 dummy rods for 6 months. The 108 participants with the real deal received 80 mg per implant. All the subjects were given drug counselling, and urine samples were taken to detect illicit drug use.

If anyone felt the slow-release dose from the implants did not combat their cravings sufficiently, they could request sublingual tablets. Over the first 16 weeks, about 60% of the buprenorphine group requested extra doses, while over 90% of the placebo-implanted group did. Urine samples tested negative for illicit opioids more often in the buprenorphine implant group than the placebo group (approximately 40% vs 28%) over the same timeframe. And more of the buprenorphine group opted to stay in the study for the full 24 weeks (66% vs 31%).

Cravings and other withdrawal symptoms were generally reduced in the treatment group, although there were minor adverse reactions reported, i.e. discomfort at the implant site, in both groups.

Considering that Canada ranks almost as high as Germany and the U.S. for prescription opioid use, a six-month implant may be well worth the trouble – as long as it doesn’t dissuade regular visits to the clinic for counselling.
Milena Katz