title: Buprenorphine Response as a Function of Neurogenetic Polymorphic Antecedents: Can Dopamine Genes Affect Clinical Outcomes in Reward Deficiency Syndrome (RDS)?
abstract: There is a plethora of research indicating the successful treatment of opioid dependence with either buprenorphine alone or in combination with naloxone (Suboxone®). However, we encourage caution in long-term maintenance with these drugs, albeit, lack of any other FDA approved opioid maintenance compound to date. Our concern has been supported by severe withdrawal (even with tapering of the dosage of for example Suboxone® which is 40 times more potent than morphine) from low dose of buprenorphine (alone or with naloxone). In addition our findings of a long-term flat affect in chronic Suboxone® patients amongst other unwanted side effects including diversion and suicide attempts provides impetus to reconsider long-term utilization. However, it seems prudent to embrace genetic testing to reveal reward circuitry gene polymorphisms especially those related to dopaminergic pathways as well as opioid receptor(s) as a way of improving treatment outcomes. Understanding the interaction of reward circuitry involvement in buprenorphine effects and respective genotypes provide a novel framework to augment a patient's clinical experience and benefits during opioid replacement therapy.
authors: Department of Psychiatry & McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, USA ; Human Integrated Services Unit University of Vermont Centre for Clinical & Translational Science, College of Medicine, Burlington, VT, USA ; Department of Addiction Research & Therapy, Malibu Beach Recovery Centre, Malibu Beach, CA, USA ; Dominion Diagnostics, LLC, North Kingstown, RI, USA ; Institute of Integrative Omics and Applied Biotechnology, Nonakuri, Purba Medinipur, West Bengal, India ; IGENE, LLC, Austin, Texas, USA.
authors: Kenneth
authors: K
authors: Blum
authors: Departments of Psychiatry, Neurology, and Anatomy & Neurobiology, Boston University School of Medicine, and Boston VA Healthcare System, Boston, MA, 02118, USA.
authors: Marlene
authors: M
authors: Oscar-Berman
authors: Department of Psychiatry & McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, USA.
authors: William
authors: W
authors: Jacobs
authors: Center for Psychiatric Medicine, North Andover, Massachusetts, USA.
authors: Thomas
authors: T
authors: McLaughlin
authors: Department of Psychiatry & McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, USA.
authors: Mark S
authors: MS
authors: Gold
keywords: Buprenorphine; Dopamine & Opioid polymorphic genes; Naloxone; Reward Deficiency Syndrome (RDS); Suboxone