title: [Pharmacologic criteria for medical substitution in opiate dependence].
abstract: Our goal was to establish new pharmacological criteria for a drug to be used in the treatment of opioid dependence. We propose the following six pharmacodynamic and pharmacokinetic criteria: (i) the same pharmacodynamic properties as the drug being substituted; (ii) a long duration of action (minimum 24 hours, not requiring several daily doses) in order to prevent fluctuations in effect and especially withdrawal symptoms; (iii) few euphoric effects together with a minimal reinforcing effect for the drug itself and other drugs; (iv) oral or sublingual administration without any special affinity for other routes, especially the intravenous; (v) a New Drug Application (NDA) in this indication, after submission of a dossier including both clinical randomised comparative trials and security data; and (vi) compatibility with a socially satisfying quality of life. These criteria were applied to methadone, buprenorphine and other drugs that were proposed in the treatment of opioid dependence (such as morphine or codeine).
authors.affiliation: Service de Pharmacologie Clinique, Centre d'Evaluation et d'Informations sur la Pharmacodépendance (CEIP), CHU de Toulouse, Toulouse, France. montastruc@cict.fr
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Montastruc
authors.forename: Philippe
authors.initials: P
authors.lastname: Arnaud
authors.forename: Catherine
authors.initials: C
authors.lastname: Barbier
authors.forename: Ivan
authors.initials: I
authors.lastname: Berlin
authors.forename: Chantal
authors.initials: C
authors.lastname: Gatignol
authors.forename: Françoise
authors.initials: F
authors.lastname: Haramburu
authors.forename: Georges
authors.initials: G
authors.lastname: Lagier
authors.forename: Maryse
authors.initials: M
authors.lastname: Lapeyre-Mestre
authors.forename: Michel
authors.initials: M
authors.lastname: Mallaret
authors.forename: Joëlle
authors.initials: J
authors.lastname: Micaleff
mesh_terms: D003061:Codeine / Q000627:therapeutic use; D005059:Euphoria / Q000187:drug effects; D006801:Humans; D008691:Methadone / Q000627:therapeutic use; D009020:Morphine / Q000627:therapeutic use; D009294:Narcotics / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D011788:Quality of Life
chemical_list: D009294:Narcotics; D009020:Morphine; D008691:Methadone; D003061:Codeine