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Buprenorphine and the NIDA CTN: Research to Practice

Buprenorphine and the NIDA CTN: Research to Practice. Walter Ling & Richard Rawson ISAP/UCLA XIII World Congress of Psychiatry September 14, 2005 Cairo, Egypt rrawson@mednet.ucla.edu www.uclaisap.org. Full agonist. -. Super agonist. -. fentanyl. morphine/heroin. hydromorphone.

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Buprenorphine and the NIDA CTN: Research to Practice

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  1. Buprenorphine and the NIDA CTN: Research to Practice Walter Ling & Richard Rawson ISAP/UCLA XIII World Congress of Psychiatry September 14, 2005 Cairo, Egypt rrawson@mednet.ucla.edu www.uclaisap.org

  2. Full agonist - Superagonist - fentanyl morphine/heroin hydromorphone Positive effect Potentiallylethal dose Agonist+partial agonist Partialagonist = - buprenorphine addictive potential Antagonist - naltrexone dose Negative Antagonist + agonist/partial agonist effect Mu efficacy and opiate addiction

  3. Buprenorphine: Clinical Pharmacology Partial Agonist • high safety profile/ceiling effect • low dependence Tight Receptor Binding • long duration of action • slow onset mild abstinence

  4. Good Effect

  5. Respiration

  6. 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Intensity of abstinence Buprenorphine Morphine 60 50 40 30 20 10 0 Himmelsbach scores Days after drug withdrawal

  7. Buprenorphine detoxificationin community clinics Buprenorphine : Very brief pharmacology CTN Protocols 0001 & 0002 Buprenorphine vs clonidine: Inpatient detoxification Outpatient detoxification Treatment success /Number needed to treat Looking ahead: Implementation: Successes and barriers The rest of the world

  8. The First CTN Protocols • Short term inpatient detoxification • Buprenorphine/naloxone vs clonidine • (CTN 0001) • Short term outpatient detoxification • Buprenorphine/naloxone vs clonidine • (CTN 0002)

  9. Study Design Open Randomized Study Bup/Nx:Clonidine = 2:1 Buprenorphine/Naloxone 13 days detoxification Clonidine 13 days detoxification

  10. N remaining in treatment X N giving drug free urines Total N of subjects N remaining in treatment Joint Probability

  11. Demographics 0001 (Inpatient)

  12. Present and Clean0001 (Inpatient)

  13. Percent Present and Clean0001 (Inpatient)

  14. Demographics 0002 (Outpatient)

  15. Present and Clean0002 (Outpatient)

  16. Percent Present and Clean0002 (Outpatient)

  17. NNT: Number Needed to Treat CTN 0001 (Inpatient) • NNT for Bup/Nx 77/59 = 1.31 • NNT for Clonidine 36/8 = 4.5 NNT Clonidine : BupNx = 3.44 CTN 0002 (Outpatient) • NNT for Bup/Nx: 157/46 = 3.4 • NNT for Clonidine: 74/4 = 18.5 NNT Clonidine : Bup/Nx = 5.44 NNT= Number of patients needed to treat to achieve 1 treatment success

  18. Buprenorphine: what does it really mean? • The great social experiment: return of opioid addiction treatment to medicine • Slow progress in implementation: • External barriers: legislative compromises • Inertia and resistance: medication and recovery • Application to the world and the region

  19. Pharmacotherapy and Recovery • Medications and recovery: incompatible? • “Medication is not recovery” • The great chemistry paradox • Addiction: chemistry went wrong • Role of “chemistry” (medicine) in recovery

  20. Remember…. You Can Change the Brain with Either Biological or Behavioral Treatments Alan Leshner

  21. How People Change • “You can change some one’s life by altering his genes; but you can also do that by paying off his credit card” James Watson

  22. Thanks to XIII Congress of Psychiatry: symposia organizing committee National Institute on Drug Abuse NIDA Clinical Trials Network Staff CTN Publications Committee Participating CTN Nodes and CTPs Reckitt Benckiser: supplier of study med Participating Patients You the audience

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