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Abstract
Fifteen subjects dependent on both opioids and cocaine completed an ascending and tapering schedule of buprenorphine dosing, with maintenance for 21 days at each dose of buprenorphine (4, 8, 12, 16 mg sublingual daily) during both ascending and tapering phases. Higher doses of buprenorphine led to greater reductions in opioid use: 64.7% of subjects were opioid abstinent for 3 weeks at the 16-mg dose compared to 27.3% at the 4-mg ascending dose. The proportion of cocaine-positive urine toxicologies was significantly lower during buprenorphine tapering (12 mg, 8 mg, 4 mg) compared to ascending doses up to 8 mg, with intermediate results at 12 mg and 16 mg during the ascending phase (Fvalue = 6.6, df = 8,813, p < 0.001). Self-reported days, times, and quantity of cocaine used per week showed a similar pattern of intermediate reductions at the 12-mg and 16-mg dose during the ascending phase and significantly reduced values during the descending schedule. There were no significant buprenorphine dose effects on cocaine euphoria. This study indicates that buprenorphine dose has a significant and substantial impact on opioid use and a significant but less robust impact on cocaine use, with higher doses and longer time on buprenorphine leading to attenuated cocaine use.
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References
- Use of contingency contracting in speciality clinics for cocaine abuse.Problems of Drug Dependence. 1982; 41 (NIDA Research Monograph Series): 452-459
- Pulsatile luteinizing hormone secretion in hypothalamic amenorrhea, anorexia nervosa, and polycystic ovarian disease during naltrexone treatment.Fertil Steril. 1992; 57: 762-770
- Desipramine treatment of cocaine dependence in methadone maintenanced patients.Arch Gen Psychiatry. 1992; 49: 888-893
- Cocaine and heroin use by methadone maintenance patients.in: Harris L.S. Proceedings on the Committee on Problems of Drug Dependence. Problems of Drug Dependence. 1989: 328 (NIDA Research Monograph 95, DHHS Pub. No. (ADM)89-1605, Rockville, MD)
- The Effectiveness of Methadone Maintenance Treatment.Springer-Verlag, New York1991
- Buprenorphine: Dose related blockage of opioid challenge effects in opioid dependent humans.J Pharmacol Exper Ther. 1988; 247: 47-53
- Behavioral and nuerochemical interactions between cocaine and buprenorphine: Implications for the pharmacotherapy of cocaine abuse.J Pharmacol Exper Ther. 1991; 256: 119-126
- The incidence of cocaine abuse among methadone maintenance patients.Int J Addict. 1972; 7: 427-441
- Cocaine use by clients in methadone programs: Significance, scope, and behavioral interventions.J Subst Abuse Treat. 1991; 8: 203-212
- Preliminary results of an open trial of buprenorphine in the outpatient treatment of combined heroin and cocaine dependence.in: Harris L.S. Proceedings on the Committeeon Problems of Drug Dependence. Problems of Drug Dependence. 1992: 461 (NIDA Research Monograph 119, DHHS Pub. No. (ADM) 92-1888, Rockville, MD)
- Changing patterns of multiple drug use among applicants to a multimodality drug treatment program.Arch Gen Psychiatry. 1974; 31: 408-413
- Therapeutic application of behavioral techniques: An overview.in: Grabowski J. Stitzer M.L. Henningfield J.E. Behavioral Intervention Techniques in Drug Abuse Treatment. NIDA Research Monograph. 46. US Government Printing Office, Washington, DC1984: 1-7
- An overview of client characteristics, treatment services, and during treatment outcomes for outpatient methadone clinics in the treatment outcome prospective study (TOPS).in: Cooper J.R. Altman F. Brown B.S. Czechowicz D. Research on the Treatment of Narcotic Addiction-State of the Art. National Institute on Drug Abuse, Rockville, MD1983: 714-747
- A controlled trial of buprenorphine treatment for opioid dependence.JAMA. 1992; 267: 2750-2755
- Agonist and antagonist actions of buprenorphine on three types of opioid receptor in isolated preparations.Jpn J Pharmacol. 1986; 40: 95-101
- Drug abuse patterns of patients on methadone maintenance treatment in New York City.Am J Drug Alc Abuse. 1981; 8: 17-25
- Cocaine conditioned place preference is attenuated by chronic buprenorphine treatment.Life Sci. 1991; 49: 201-206
- Cocaine abuse among opioid addicts: Demographic and diagnostic factors in treatment.Am J Drug Alcohol Abuse. 1986; 12: 1-16
- A 2.5 year follow-up of cocaine use among treated opioid addicts.Arch Gen Psychiatry. 1987; 44: 281-284
- Antecedents and consequences of cocaine abuse among opioid addicts—A 2.5 year follow-up.J Nerv Ment Dis. 1988; 176: 176-181
- Treatment of cocaine abuse with buprenorphine.Biol Psychiatry. 1989; 26: 637-639
- Role of opioid antagonists in treating intravenous cocaine abuse.Life Sci. 1989; 44: 887-892
- Treatment of heroin addicts using buprenorphine.Am J Drug Alcohol Abuse. 1990; 17: 119-128
- Buprenorphine for Cocaine and Opiate Dependence.Psychopharmacol Bull. 1992; 28: 15-19
- Pharmacotherapy for cocaine-abusing methadone maintained patients using amantadine or desipramine.Arch Gen Psychiatry. 1992; 49: 894-898
- Buprenorphine versus methadone for opioid dependence.J Nerv Ment Dis. 1993; 181: 358-364
- Corticotropin-releasing hormone and opioid peptides in reproduction and stress.Ann Med. 1991; 23: 489-496
- Buprenorphine has potent kappa opioid receptor antagonist activity.Neuropharmacology. 1987; 26: 1445-1447
- Buprenorphine—Background to its development.NIDA Research Monograph Series. 1992; 121: 5-11
- Buprenorphine suppresses cocaine self-administration by rhesus monkeys.Science. 1989; 245: 859-862
- Buprenorphine effects on human heroin self-administration: An operant analysis.J Pharmacol Exper Ther. 1981; 223: 30-39
- Buprenorphine attenuates the effects of cocaine on adrenocortropin (ACTH) secretion and mood states in man.Neuropsychopharmacology. 1992; 7: 157-162
- Difficulties in a clinical application of methadone-dose contingency contracting.J Subst Abuse Treat. 1990; 7: 219-224
- Evaluation of TDx cocaine metabolite assay.J Anal Toxicol. 1987; 11: 228-230
- Naltrexone in functional hypothalamic amenorrhea and in the normal luteal phase.Obstet Gynecol. 1990; 76: 1115-1120
- The role mu- and kappa-opioid receptors in cocaine-induced conditioned phase preferences.Jpn J Pharmacol. 1992; 5: 435-442
- Cocaine abuse during narcotic substitution therapy: Three years later.in: Proceedings of the National Conference on Methadone Treatment. 2. 1972: 985-999
- Patterns of multiple drug abuse: 1969–1971.Int J Addict. 1971; 9: 301-314
- Patterns of cocaine use among methadone clients.Int J Addict. 1985; 20: 1163-1175
- An abused drug assay system.American Clinical Products Review. 1987; (Sept): 18-27
- Comparative effectiveness of reducing cocaine abuse among methadone patients using phase lowering or dose reduction.in: Harris L.S. Proceedings of the 50th Annual Scientific Meeting of the Committee on Problems of Drug Dependence. Problems of Drug Dependence. 1989: 71 (NIDA Research Monograph 90, DHHS Pub. No. (ADM)89-1605, Rockville, MD)
- Behavioral Pharmacology of Buprenorphine: Issues Relevant to Its Potential in Treating Drug Abuse.NIDA Research Monograph Series. 1992; 121: 12-27
Article info
Publication history
Received in revised form:
April 15,
1993
Received:
July 21,
1992
Footnotes
☆Supported by the National Institute on Drug Abuse grants P50-DA04060, K02-DA0112, R01-DA05626, R18-DA06190
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© 1993 Published by Elsevier Inc.
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