A prospective, randomized, multicenter acceptability and safety study of direct buprenorphine/naloxone induction in heroin-dependent individuals
Article first published online: 12 OCT 2011
© 2011 The Authors, Addiction © 2011 Society for the Study of Addiction
Volume 107, Issue 1, pages 142–151, January 2012
How to Cite
Amass, L., Pukeleviciene, V., Subata, E., Almeida, A. R., Pieri, M. C., D'Egidio, P., Stankova, Z., Costa, A., Smyth, B. P., Sakoman, S., Wei, Y. and Strang, J. (2012), A prospective, randomized, multicenter acceptability and safety study of direct buprenorphine/naloxone induction in heroin-dependent individuals. Addiction, 107: 142–151. doi: 10.1111/j.1360-0443.2011.03577.x
- Issue published online: 12 DEC 2011
- Article first published online: 12 OCT 2011
- Accepted manuscript online: 12 JUL 2011 03:28PM EST
- Submitted 21 December 2010; initial review completed 22 February 2011; final version accepted 24 June 2011
- opioid dependence
Aims To provide controlled data on direct induction with buprenorphine/naloxone (BNX) versus indirect buprenorphine (BPN)-to-BNX induction.
Design Phase 4, prospective, randomized, active-drug controlled, parallel-group trial consisting of a 2-day, double-blind, double-dummy induction phase followed by 26 days of open-label treatment with BNX.
Setting Nineteen sites in 10 European countries from March 2008 to December 2009.
Participants A total of 187 opioid-dependent men and women ≥15 years of age.
Measurements The primary objective was assessment of patient response to direct and indirect BNX induction [proportion of patients receiving the scheduled 16-mg BNX dose on day 3 (i.e. first day post-induction)]. Secondary assessments included illicit drug use, treatment retention and compliance, withdrawal scale scores, and safety.
Findings Patient response to direct- versus indirect-BNX induction was similar [direct 91.4% (85/93) versus indirect 90.4% (85/94); 95% confidence interval (CI): −7.3%, 9.2%]. Rapid dose induction (16 mg of BPN equivalent on day 2) was acceptable and 72% of patients completed treatment (day 28). There were no significant differences in secondary measures across groups. An average BNX maintenance dose of 15.3 mg across groups was associated with substantial reductions in illicit opioid use and no self-reported intravenous misuse. Treatment compliance and retention rates were similar (98.5% and 81.3%, respectively). Treatment-emergent adverse event rates were comparable: 75% versus 74% for direct- versus indirect-induction groups, respectively.
Conclusions Direct buprenorphine/naloxone induction was a safe and effective strategy for maintenance treatment of opioid dependence. Response to high-dose direct buprenorphine/naloxone induction appears to be similar to indirect buprenorphine-to-buprenorphine/naloxone induction and was not associated with reports of intravenous buprenorphine/naloxone misuse.