Buprenorphine Case Study

Buprenorphine
Matthew Frei (2010) author of the qualitative piece of literature, Opioid Dependence Management in General Practice, reviewed by the third researcher, (RW). Frei presents a quality overview, albeit based in Australia, of the process and complications of General Practitioners (GP’s) in dealing with opioid addiction within their patient base. The article describes the complexities, socially as well as clinically, of the use of Buprenorphine as a substitute opioid agonist for the purpose of managing opiate dependency. Frei reports, “Buprenorphine initiated for opioid withdrawal has the advantage of being able to be continued as long term maintenance therapy in suitable patients” (2010, para. 16). A case study is provided of a
Where 54 were treated with methadone and 60 with Buprenorphine to see which treatment worked better, the inmates were randomly assigned the drug groups. The dosages were set by physician and patient with a choice of either 30 mg or 70 mg for the Methadone patients, and an initial dosages of 4mg, but could be stepped up to a maximum of 32mg for Buprenorphine patients (Awgu et al., 2010, p. 340). Methadone patients experienced more withdrawal symptoms then Buprenorphine, whereas buprenorphine patients had an absence of medication side effects. Most of the Buprenorphine patients had experience with Methadone in the past and considered Buprenorphine to be superior to Methadone. The limitation to this experiment is that the Methadone users felt stigmatized as a drug user due to having to wait in long line in front of other inmates to receive their treatment, whereas the Buprenorphine patients were able to wait in the clinic in small groups when receiving their dosage (Awgu et al., 2010, p. 345). Another limitation is it is unknown if the information could be used to generalize heroin-dependent offenders in jail in other locations or in the community, due to how strict this jail operated (Awgu et al., 2010, 345). The findings could be affected by the fact that the
(2009) conducted two studies of opioid detoxification using Buprenorphine, that occurred at different times, at an outpatient community-based clinic in Baltimore, Maryland. There were 510 adults that were experiencing opioid withdrawal that entered the trial, 364 that received brief (three or five days) and 146 that received extended (30 days) of treatments with Buprenorphine (Katz et al., 2009, p. 64). In both studies the participants were required to attend a once weekly individual and daily group counseling combined with their dosage of Buprenorphine. After the treatment with Buprenorphine, brief or extended, was over weekly individual and/or group counseling meeting could be attended for up to six months. Brief participants received one Two mg tablet of Buprenorphine sublingually each day for three days, which was later changed to five days when buprenorphine was approved by the FDA for the treatment of opioid dependence (Katz et al., 2009, p. 65). Extended patients were gradually inducted on sublingual Suboxone (which contains a four to one ratio of Buprenorphine/Naloxone mixture) over a period of one week, where on day one participants received four mg of Suboxone and dose induction continued for three to seven days until patients achieved a blocking dose or a maximum dose of 16 mg (Katz et al., 2009, p. 65). The extended patients were responsible for taking their medications on the weekends for the first two weeks and then six days a week for the