title: Buprenorphine/naloxone as a promising therapeutic option for opioid abusing patients with chronic pain: reduction of pain, opioid withdrawal symptoms, and abuse liability of oral oxycodone.
abstract: Few studies have examined abuse of prescription opioids among individuals with chronic pain under buprenorphine/naloxone (Bup/Nx) maintenance. The current 7-week inpatient study assessed oral oxycodone self-administration by patients with chronic pain who had a history of opioid abuse. Participants (n=25) were transitioned from their preadmission prescribed opioid to Bup/Nx. All of the participants were tested under each of the sublingual Bup/Nx maintenance doses (2/0.5, 8/2 or 16/4 mg) in random order. During each maintenance period, participants could self-administer oxycodone orally (0, 10, 20, 40 or 60 mg prescription opioids) or receive money during laboratory sessions. Drug choice (percentage) was the primary dependent variable. Subjective ratings of clinical pain and withdrawal symptoms also were measured. Mann-Whitney tests compared percentage of drug choice for each active oxycodone dose to placebo. Logistic regression analyses identified correlates of oxycodone preference, defined as 60% or greater choice of oxycodone compared to money. Pain was significantly reduced while participants were maintained on Bup/Nx compared to preadmission ratings. No differences in percentage drug choice were observed between the active oxycodone doses and placebo under each Bup/Nx maintenance dose. However, factors associated with oxycodone preference were lower Bup/Nx maintenance dose, more withdrawal symptoms and more pain. These data suggest that Bup/Nx was effective in reducing pain and supplemental oxycodone use. Importantly, adequate management of pain and withdrawal symptoms by Bup/Nx may reduce oxycodone preference in this population.
authors.affiliation: Division on Substance Abuse, New York State Psychiatric Institute, Department of Psychiatry, and College of Physicians and Surgeons, Columbia University, 1051 Riverside Dr, Unit 120, New York, NY 10032, USA. perrine.roux@inserm.fr
authors.forename: Perrine
authors.initials: P
authors.lastname: Roux
authors.forename: Maria A
authors.initials: MA
authors.lastname: Sullivan
authors.forename: Julien
authors.initials: J
authors.lastname: Cohen
authors.forename: Lionel
authors.initials: L
authors.lastname: Fugon
authors.forename: Jermaine D
authors.initials: JD
authors.lastname: Jones
authors.forename: Suzanne K
authors.initials: SK
authors.lastname: Vosburg
authors.forename: Ziva D
authors.initials: ZD
authors.lastname: Cooper
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Manubay
authors.forename: Shanthi
authors.initials: S
authors.lastname: Mogali
authors.forename: Sandra D
authors.initials: SD
authors.lastname: Comer
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D002047:Buprenorphine / Q000627:therapeutic use*; D059350:Chronic Pain / Q000188:drug therapy; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009270:Naloxone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment / Q000379:methods*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D010098:Oxycodone / Q000627:therapeutic use*; D018709:Statistics, Nonparametric
chemical_list: D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D009270:Naloxone; D002047:Buprenorphine; D010098:Oxycodone