Early experience with Suboxone maintenance therapy in Hungary.
BACKGROUND
Suboxone (Buprenorphine/naloxone) is a novel drug used in opiate substitution therapy. In Hungary, it was introduced in November 2007. Suboxone is a product for sublingual administration containing the partial mu-receptor agonist buprenorphine and antagonist naloxone in a 4:1 ratio.


OBJECTIVE
Objectives of our study were to monitor and evaluate the effects of Suboxone treatment.


METHODS
6 outpatient centers participated in the study, 3 from Budapest and 3 from smaller cities in Hungary. At these centers, all patients entering Suboxone maintenance therapy between November 2007 and March 2008, altogether 80 persons (55 males, 35 females, mean age = 30.2 years, SD=5.48) were included in the study sample. During the 6-month period of treatment, data were collected 4 times; when entering treatment, 1 month, 3 months, and 6 months after entering treatment. Applied measures were the Addiction Severity Index, SCID-I, SCID-II, Hamilton Depression Scale, Hamilton Anxiety Scale, STAI-S State Anxiety Inventory, Beck Depression Inventory, Heroin Craving Questionnaire, WHO Well-being Inventory, Perceived Stress Scale, ADHD retrospective questionnaire, TCI short version, and Ways of Coping questionnaire.


RESULTS
Nearly fourth of the altogether 80 heroin dependent patients (18 persons, 22.5%) dropped out of treatment during the first month (the majority, 12 persons [15%] during the first week) or chose methadone substitution instead. Following this period however, dropout rate decreased and the six-month treatment period was completed by 32 patients (40%). During the first month of treatment significant positive changes were experienced in all studied psychological and behavioral dimensions that proved to be stabile throughout the studied period.


CONCLUSIONS
According to the early experience with Suboxone treatment, it is a well tolerable and successfully applicable drug in the substitution therapy of opiate addicts. A critical phase seems to be the first one or two weeks of treatment. Dropout rate is high during this early period, while after a successful conversion clients presumably remain in therapy for a long period. At the beginning of administration special emphasis must be put on informing patients, especially concerning withdrawal symptoms that might be present during the first week, which highly contributes to better retention in treatment.
Eötvös Loránd University, Institutional Group on Addiction Research, Budapest, Hungary. demetrovics@t-online.hu
Zsolt
Z
Demetrovics
Judit
J
Farkas
József
J
Csorba
Attila
A
Németh
Barbara
B
Mervó
János
J
Szemelyácz
Enikö
E
Fleischmann
Akos
A
Kassai-Farkas
Zsolt
Z
Petke
Tibor
T
Oroján
Sándor
S
Rózsa
Péter
P
Rigó
Sándor
S
Funk
Máté
M
Kapitány
Anna
A
Kollár
József
J
Rácz
D000328:Adult; D001007:Anxiety / Q000517:prevention & control; D002047:Buprenorphine / Q000008:administration & dosage / Q000627:therapeutic use*; D000069479:Buprenorphine, Naloxone Drug Combination; D003863:Depression / Q000517:prevention & control; D004338:Drug Combinations; D005260:Female; D006801:Humans; D006814:Hungary; D007508:Irritable Mood; D008297:Male; D009270:Naloxone / Q000008:administration & dosage / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D009294:Narcotics / Q000008:administration & dosage / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D011569:Psychiatric Status Rating Scales; D013315:Stress, Psychological / Q000517:prevention & control; D016320:Substance Abuse Treatment Centers; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000069479:Buprenorphine, Naloxone Drug Combination; D004338:Drug Combinations; D009292:Narcotic Antagonists; D009294:Narcotics; D009270:Naloxone; D002047:Buprenorphine