Laird Harrison

October 22, 2013

The combination of buprenorphine and naloxone (Suboxone) helped more than half of patients addicted to opioids in a new study.

"I found this regimen to be more effective than most of the other options I have," said researcher Wain Allen, MD, from the Coalville Health Center in Utah. Often those options are limited, he added.

Of the 307 patients in the study, 53% stopped abusing opioid drugs, he reported.

Dr. Allen presented the findings at the American Academy of Family Physicians 2013 Scientific Assembly in San Francisco.

Some of the patients Dr. Allen treats for opioid addiction developed the problem after receiving a prescription to treat pain; others became addicted after recreationally using the drugs.

There is fair amount of oil-field activity in Coalville, which has a population of about 1400 people. "Oil-field workers have a big drug culture going on. A man camps out a hundred miles from nowhere, with nothing to do, and drugs come into play," he explained.

But the oil industry has been clamping down on drug activity, leading some of these men to seek help, he said.

Other patients are teenagers who began using heroin, which is "cheap and available," said Dr. Allen.

You have to do the tough love. Set up your protocol before you see patients, and stick to it. Don't let sad stories ease your rules and requirements.

To help these patients, Dr. Allen became certified to prescribe buprenorphine and naloxone. He only treats patients who volunteer for treatment, not those referred by a court.

From January 2008 to April 2013, he followed 307 patients as he gradually tapered the dose of buprenorphine and naloxone.

"You have to do the tough love," he said. "Set up your protocol before you see patients, and stick to it. Don't let sad stories ease your rules and requirements."

Dr. Allen doesn't write new prescriptions to patients reporting lost or stolen medicine.

Buprenorphine and naloxone minimize withdrawal symptoms as the patients give up the drugs they were abusing, said Dr. Allen. The combination doesn't provide the euphoria of other opioids, but it can be addicting if patients stay on it too long without tapering their dose.

It is impressive that half of Dr. Allen's patients recovered from their addictions, said Ted Michna, MD, from Harvard University in Cambridge, Massachusetts, and a spokesperson for the American Pain Society.

"For addiction issues, it's pretty good," said Dr. Michna, who was not involved in this study.

To achieve such good results requires staying with patients for a long time. "It's not just a drug," he said. "It's watching them, counseling them, and providing support when they get into trouble."

It would be interesting to know what became of the patients after the 5-year study follow-up, said Dr. Michna. "After that, what's the recidivism?"

Dr. Michna pointed out that some patients stay on buprenorphine and naloxone indefinitely to manage their pain, even if they want to break their addiction to other opioid drugs.

Training sessions on buprenorphine and naloxone are available on the Substance Abuse and Mental Health Services Administration Web site.

Dr. Allen has disclosed no relevant financial relationships. Dr. Michna is a consultant for Purdue Pharma.

American Academy of Family Physicians (AAFP) 2013 Scientific Assembly: Abstract 109. Presented September 25 - 28, 2013.


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