title: Clinical experience with fortnightly buprenorphine/naloxone versus buprenorphine in Italy: preliminary observational data in an office-based setting.
abstract: Buprenorphine/naloxone is a new option for the management of opioid dependence. It has a reduced potential for abuse or misuse compared with methadone and buprenorphine alone, and has a long half-life allowing less frequent dosing. Buprenorphine/naloxone appears to be well suited for the management of opioid dependence in an office-based setting. The aim of this study was to evaluate the efficacy and safety of a buprenorphine/naloxone combination treatment in an office-based setting. Therefore, we evaluated the effect on misuse/diversion, quality of care, quality of life and service delivery. Seventy-eight patients were switched to buprenorphine/naloxone from either methadone or buprenorphine alone; the median duration of previous buprenorphine or methadone treatment was 10 years. Patients received buprenorphine/naloxone and were evaluated throughout a 1-year follow-up period. Treatment was self-administered by the patients every 2 weeks and the mean buprenorphine dosage at 1 year was 8 mg/day. Comparisons were made before and after the switch for patients who switched from buprenorphine alone to buprenorphine/naloxone. Switching to buprenorphine/naloxone was not associated with clinically relevant problems in 50% of patients studied. Buprenorphine/naloxone provided satisfactory coverage of withdrawal symptoms in 78.1% of patients, and 50% of patients were satisfied with buprenorphine/naloxone therapy. Seventy-eight per cent of patients reported improved psychosocial functioning. The majority of patients (approximately 85%) were negative for opioids during toxicological testing. A significantly higher proportion of treatment recipients were highly satisfied during buprenorphine/naloxone administration (p < 0.001 compared with buprenorphine given before the switch). Other outcomes were similar during buprenorphine and buprenorphine/naloxone administration. Fortnightly self-administration of buprenorphine/naloxone appeared to be cost saving for the clinic. Buprenorphine/naloxone is an effective and safe treatment option for the outpatient management of opioid dependence.
authors.affiliation: Ser.T, Cava dei Tirreni ASL, Salerno, Italy. patriziamato@virgilio.it
authors.forename: Patrizia
authors.initials: P
authors.lastname: Amato
mesh_terms: D000286:Administration, Sublingual; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D016739:Behavior, Addictive; D002047:Buprenorphine / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D003362:Cost-Benefit Analysis; D003376:Counseling; D003695:Delivery of Health Care; D004334:Drug Administration Schedule; D004338:Drug Combinations; D016527:Drug Costs; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D007558:Italy; D008297:Male; D009270:Naloxone / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D009292:Narcotic Antagonists / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D009819:Office Visits / Q000191:economics; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000191:economics / Q000523:psychology; D017060:Patient Satisfaction; D011787:Quality of Health Care; D015813:Substance Abuse Detection; D015819:Substance Abuse, Intravenous / Q000175:diagnosis / Q000517:prevention & control; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy* / Q000191:economics / Q000523:psychology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D004338:Drug Combinations; D009292:Narcotic Antagonists; D009270:Naloxone; D002047:Buprenorphine
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