Related Articles Optimising the benefits of unobserved dose administration for stable opioid maintenance patients: Follow-up of a randomised trial. Drug Alcohol Depend. 2008 Apr 17; Authors: Bell JR, Ryan A, Mutch C, Batey R, Rea F BACKGROUND: The registration of combination buprenorphine/naloxone, a formulation designed to reduce risk of diversion, has led some Australian jurisdictional authorities to allow treatment without direct observation of dosing for stable, opioid-dependent patients. AIM: To compare two approaches (1) initiating treatment with observed dosing, then allowing patients who demonstrate stability to change to unobserved dosing; or (2) initiating patients with unobserved dosing, subsequently requiring those who fail to stabilize to change to observed treatment. METHODS: This study builds on an RCT comparing efficacy of observed and unobserved treatment at 3 months. At the conclusion of the RCT, clinically “stable” subjects were allocated to continue without observed dosing, while those who did not demonstrate stability were allocated to observed dosing. Subjects were followed for a further 3 months. Primary end-point was retention in treatment. RESULTS: Of 119 subjects randomised, 70 were retained in treatment to 3 months. Forty-five stable subjects were allocated to unobserved dosing, 25 to observation. Unstable subjects allocated to observed treatment were more likely to drop out thereafter (OR 2.14, 95% CI 1.09-4.19). There was a non-significant trend for people initiated with observed dosing to be better retained during the allocation phase; at 6 months, 13 subjects (22%) from the original unobserved group, and 22 (34%) from the observed group, were retained in treatment (chi(2)=2.10, 1df, p=0.15). CONCLUSIONS: Withdrawal of unobserved doses led to marked attrition from treatment. If access to unobserved dosing is to be restricted to stable patients, it appears preferable to initiate dosing with observation and allow unobserved doses for people who successfully stabilize, than to initiate with unobserved doses and transfer unstable patients to observation. PMID: 18423901 [PubMed - as supplied by publisher] (Source: Drug and Alcohol Dependence)
Urban, office-based buprenorphine/naloxone therapy was linked with better abstinence outcomes at 18 months, in a recent study. Medscape Medical News (Source: Medscape FamilyMedicine Headlines)
Related Articles [Drugs for postoperative analgesia: routine and new aspects : Part 1: Non-opioids.] Anaesthesist. 2008 Apr;57(4):382-390 Authors: Jage J, Laufenberg-Feldmann R, Heid F In part 1 of this review the perioperative aspects of the use of non-opioids (acetaminophen, dipyrone, traditional NSAR, coxibs) and in part 2 of opioids (weak opioids: tramadol, tilidine with naloxone, strong opioids: morphine, piritramide, oxycodone, hydromorphone, fentanyl, methadone, buprenorphine) and coanalgesics (gabapentinoids, ketamine) will be discussed. The main aim is to describe the relationship between analgesic efficacy and side effects to make clinical decisions easier in patients with preoperative renal, gastrointestinal, cardiovascular and other diseases. Some new aspects concerning perioperative administration of gabapentinoids and ketamine in patients with perioperative neuropathic pain are discussed. PMID: 18351305 [PubMed - as supplied by publisher] (Source: Der Anaesthesist)
OBJECTIVE. There are few reports in children of overdoses of buprenorphine, a partial opioid agonist used in the treatment of opioid dependence and pain. The purpose of this study was to analyze buprenorphine overdoses in young children reported by US poison centers to the Researched Abuse, Diversion, and Addiction-Related Surveillance System.
METHODS. A retrospective review of buprenorphine overdoses in children <6 years of age reported to the Researched Abuse, Diversion, and Addiction-Related Surveillance System from November 2002 through December 2005 was performed. Patients lost to follow-up and those ingesting multiple substances were excluded.
RESULTS. Eighty-six cases met inclusion criteria. In the 54 children who developed toxicity, the clinical effects included drowsiness or lethargy (55%), vomiting (21%), miosis (21%), respiratory depression (7%), agitation or irritability (5%), pallor (3%), and coma (2%). There were no fatalities. The mean time to onset of effects was 64.2 minutes, with a range of 20 minutes to 3 hours. Duration of clinical effects was under 2 hours in 11%, 2 to 8 hours in 59%, 8 to 24 hours in 26%, and >24 hours in 4%. Children who ingested ≥2 mg of buprenorphine were more likely to experience clinical effects, and all of the children who ingested >4 mg experienced some effect. No child ingesting <4 mg experienced a severe effect. Of the 22 children administered naloxone, 67% had at least a partial response.
CONCLUSIONS. Buprenorphine overdoses are generally well tolerated in children, with significant central nervous system and respiratory depression occurring in only 7%. Any child ingesting >2 mg and children <2 years of age ingesting more than a lick or taste should be referred to the emergency department for a minimum of 6 hours of observation. Naloxone can be used to reverse respiratory depression. (Source: PEDIATRICS)
Hi Cindy,
I haven’t been to the other site (suboxforum.com) yet, so I don’t know if anyone has answered. I have treated over 100 patients and have not yet had a person develop a rash. That doesn’t mean it can’t happen, but it does suggest to me that it is uncommon. The rash does not sound [...]