Abuse liability of intravenous buprenorphine/naloxone and buprenorphine alone in buprenorphine-maintained intravenous heroin abusers

Authors

  • Sandra D. Comer,

    Corresponding author
    1. Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York, NY, USA and
      Sandra D. Comer, Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, 1051 Riverside Drive, Unit 120, New York, NY 10032, USA. E-mail: sdc10@columbia.edu, Research Report
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  • Maria A. Sullivan,

    1. Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York, NY, USA and
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  • Suzanne K. Vosburg,

    1. Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York, NY, USA and
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  • Jeanne Manubay,

    1. Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York, NY, USA and
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  • Leslie Amass,

    1. Schering-Plough Corporation, Kenilworth, NJ, USA
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  • Ziva D. Cooper,

    1. Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York, NY, USA and
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  • Phillip Saccone,

    1. Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York, NY, USA and
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  • Herbert D. Kleber

    1. Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York, NY, USA and
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Errata

This article is corrected by:

  1. Errata: Erratum Volume 105, Issue 7, 1322, Article first published online: 8 June 2010

Sandra D. Comer, Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, 1051 Riverside Drive, Unit 120, New York, NY 10032, USA. E-mail: sdc10@columbia.edu, Research Report

ABSTRACT

Background  Sublingual buprenorphine is an effective maintenance treatment for opioid dependence, yet intravenous buprenorphine misuse occurs. A buprenorphine/naloxone formulation was developed to mitigate this misuse risk. This randomized, double-blind, cross-over study was conducted to assess the intravenous abuse potential of buprenorphine/naloxone compared with buprenorphine in buprenorphine-maintained injection drug users (IDUs).

Methods  Intravenous heroin users (n = 12) lived in the hospital for 8–9 weeks and were maintained on each of three different sublingual buprenorphine doses (2 mg, 8 mg, 24 mg). Under each maintenance dose, participants completed laboratory sessions during which the reinforcing and subjective effects of intravenous placebo, naloxone, heroin and low and high doses of buprenorphine and buprenorphine/naloxone were examined. Every participant received each test dose under the three buprenorphine maintenance dose conditions.

Results  Intravenous buprenorphine/naloxone was self-administered less frequently than buprenorphine or heroin (P < 0.0005). Participants were most likely to self-administer drug intravenously when maintained on the lowest sublingual buprenorphine dose. Subjective ratings of ‘drug liking’ and ‘desire to take the drug again’ were lower for buprenorphine/naloxone than for buprenorphine or heroin (P = 0.0001). Participants reported that they would pay significantly less money for buprenorphine/naloxone than for buprenorphine or heroin (P < 0.05). Seven adverse events were reported; most were mild and transient.

Conclusions  These data suggest that although the buprenorphine/naloxone combination has intravenous abuse potential, that potential is lower than it is for buprenorphine alone, particularly when participants received higher maintenance doses and lower buprenorphine/naloxone challenge doses. Buprenorphine/naloxone may be a reasonable option for managing the risk for buprenorphine misuse during opioid dependence treatment.

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