Turning junkies on to a good needle habit

New study gives the dope on depot injected buprenorphine,
offering heroin addicts an alternative to methadone

By Katherine Addelman

The addiction drug buprenorphine, when administered as a time-release depot injection, could be just what the doctor ordered for opioid addicts who are trying to kick the habit, a new study suggesteds. Unlike the most frequently prescribed drug, methadone, the study reports that depot buprenorphine provides the same relief but without methadone's attendant high. With drugs like methadone, the patient faces the risk of substituting one addiction for another. But depot buprenorphine may prove to be more effective than methadone in enabling addicts to finally cut the cord to all meds.

In the study, published in the January issue of Drug and Alcohol Dependence, researchers demonstrated the advantages of injected buprenorphine, which used polymer microcapsule depot sustained-release. The drug, a partial mu-opioid agonist, is currently available only in pill form and has been shown to effectively quell an opioid addict's craving for heroin. Unlike the injected version it still produced a feeling of euphoria and had some abuse potential -- though this and the respiratory effects are still less than other opiates. The depot form has the added convenience of a single injection that could be administered in a doctor's office or neighbourhood clinic. The author of the study, Dr George E Bigelow of the Johns Hopkins University School of Medicine, noted that there is "less potential for diversion or abuse" with this treatment. Whereas methadone must be taken orally each day, Dr Bigelow and his team developed a way of administering a single shot of buprenorphine that lasts up to six weeks. The injection introduces tiny biodegradable capsules, which are steadily and gradually released. So, along with allowing rehab patients to avoid falling into the morass of methadone misuse, buprenorphine makes their lives much easier by obviating the daily trip to the clinic for an oral medication.

Buprenorphine is not yet approved by Health Canada, but it has been OK'd in pill form by the Food and Drug Administration in the US. A downside is that the daily pills are very expensive at about $20 US per day, putting the drug out of reach for most addicts. If a physician in Canada wants to prescribe buprenorphine, they can apply for it through Canada's Special Access Program under the Food and Drug Regulations. It can be acquired in tablet form under the name of Subutex (buprenorphine only) and Suboxone (buprenorphine/ naloxone in combination). No depot formulations are being marketed anywhere at this time.