The traditional sublingual delivery method of buprenorphine has revealed adherence issues in patients, but the implant version appears to have fixed that problem.
Buprenorphine has been used to treat people with opioid dependence for quite a while. But it wasn’t until this past May that the US Food and Drug Administration (FDA) approved the first buprenorphine implant, Probuphine. The traditional sublingual delivery method has revealed adherence issues in patients. Now, the first study to compare the two methods has released the results.
“There are some individual and public health risks with daily dosing of sublingual buprenorphine, such as missed doses and accidental pediatric exposure, as well as the risk of theft or intentional diversion,” Richard N. Rosenthal, MD, a professor of psychiatry at Icahn School of Medicine at Mount Sinai, said in a news release.
The study included 165 adults — about 40% female and an average age of 39 – who had previously been stabilized on 8 mg or less of sublingual buprenorphine. The participants were split to either receive sublingual (under the tongue) buprenorphine with placebo implant or buprenorphine implants with sublingual placebo. The amount of people who actually responded to the treatments were comparable in both groups, according to the report in The Journal of the American Medical Association (JAMA).
After 24 weeks, 64 out of the 89 (71.9%) people in the sublingual buprenorphine group and 72 out of the 84 (85.7%) people in the buprenorphine implants group were still abstained from opioids.
“Given that transitioning to implants did not lead to increased craving or withdrawal symptoms and that the implants remain in place over the active treatment period, buprenorphine implants are an opportunity to reduce adherence issues and may improve efficacy in stable patients with opioid dependence,” said Rosenthal, who is also the medical director of Addiction Psychiatry at Mount Sinai Behavioral Health System.
Adverse effects related to the treatment were observed in 13.5% of the sublingual buprenorphine group and 23% of the buprenorphine implant group. However, the results showed that the implant did not hurt opioid abstinence — which was the primary outcome.
Further research is needed in order to apply the findings to broader populations and uncover relapse predictors, Rosenthal explained.
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