Chapter 1: n Pharmacology of High-Dose Buprenorphinen Pierre Marquetn 1 Introductionn 2 Pharmacokinetic Propertiesn 2.1 Absorption and Bioavailabilityn 2.2 Distributionn 2.3 Metabolismn 2.4 Excretionn 3 Pharmacodynamic Propertiesn 4 Administration Schedulesn 5 Clinical Effects of Buprenorphinen 6 Conclusionn Referencesn n Chapter 2:n Controlled Drug Administration Studies of High-Dose Buprenorphine in Humansn Marilyn A. Huestisn 1 Introductionn 2 Bioavailabilityn 3 Dose-Effect Profilesn 4 Abuse Liabilityn 5 Toxicityn 6 Safety and Abuse Liability of High-Dose Intravenous Buprenorphinen 7 Conclusionn Referencesn n Chapter 3:n High-Dose Buprenorphine for Treatment of Opioid Dependencen Eric C. Strainn 1 Introductionn 2 Buprenorphine Solution vs Tabletsn 3 Efficacy of Buprenorphine vs Placebo: Clinical Trialsn 3.1 Summary of Placebo-Controlled Studiesn 4 Efficacy of Buprenorphine vs Other Medications: Clinical Trialsn 4.1 Summary of Studies Comparing Buprenorphine to Other Medicationsn 5 Safety and Side Effects of Buprenorphinen 6 Summary and Conclusionsn Acknowledgmentn Referencesn n Chapter 4:n Forseeable Advantages and Limits of Buprenorphine-Naloxone Associationn Michel Mallaret, Maurice Dematteis, Celine Villier, Claude Elisabeth Barjhoux, and Chantal Gatignoln 1 Introductionn 2 Advantages of Buprenorphine-Naloxone Associationn 2.1Advantages of Opiate-Naloxone Association: Lessons of the Pastn 2.1.1 Epidemic of Pentazocine and Tripelennamine Abuse in the United Statesn 2.1.2 Epidemic of Analgesic Buprenorphine Abuse in New Zealandn 2.2 Buprenorphine and Naloxone: A Complex and Controversial Pharmacologyn 2.3 Clinical Aspectsn 2.3.1 Pharmacokinetic/Pharmacodynamic Advantages of Associated Naloxone in BupNx Combinationn 2.3.2 Sublingual Naloxone in BupNx TabletsDoes Not Decrease Buprenorphine Effectsn 2.3.3 Sublingual Naloxone in BupNx Tablets Does Not Decrease Blockade Effects of Buprenorphine in Opioid-Dependent Patientsn 2.3.4 Sublingual Naloxone in BupNx Tablets Does Not Precipitate Withdrawal Symptoms in Opioid-Dependent Patientsn 2.3.5 Is the BupNx Combination Effective for Detoxification or Treatment of Depressive Symptoms in Opioid-Dependent Patients?n 2.3.6 What Is the Abuse Liability of Intravenous BupNx Combination in Nonopioid-Dependent and Opioid-Dependent Patients?n 2.3.7 Intravenous Naloxone May Decrease Respiratory Depression by Buprenorphinen 2.3.8 What Will Be the Epidemiological Consequences and Potential Economic Impact of the Use of BupNx Combination?n 3 Limits of Buprenorphine-Naloxone Associationn 3.1 Potential Risk of Inefficacy of Naloxone in BupNx Combinationn 3.2 Abuse Liability of Intravenous BupNx Combination: Low But Still Possiblen 3.3 Adverse Buprenorphine Reactions and Sublingual BupNx Combinationn 3.3.1 Respiratory Depressionn 3.3.2 Involuntary Overdosesn 3.3.3 Experimental Buprenorphine Hepatotoxicityn 3.4 Specific Risks in Office-Based Treatment (BupNx Combination) of Opiate Dependencen 4 Conclusionn Referencesn n Chapter 5:n Buprenorphine Maintenance Treatment in Primary Care: An Overview of the French Experience and Insight Into the Prison Settingn Marc Deveaux and Jean Vignaun 1 Introductionn 2 Implementation of BMT Through French Primary Care Systemn 2.1 A Late But Considerable Concession to Harm Reduction Paradigmn 2.2 Legal Framework of Therapeutic Use of Buprenorphinen 2.2.1 Essential Landmarks of French Health Servicesn 2.2.2 Opioid Maintenance Treatmentsn 3 Observable Effects of French Policyn 3.1 Is BMT Accessible and Acceptable?n 3.2 Is BMT Safe?n 3.2.1 Data from Preregistration Studiesn 3.2.2 Data from French Experiencen 3.3 Is BMT Effective in Contr
In Buprenorphine Therapy of Opiate Addiction, participating physicians and toxicologists summarize and evaluate their experiences with five years of intensive buprenorphine therapy. They cover all aspects of its use, including the pharmacology, conditions of delivery, risks from use with other psychoactive drugs, toxicology and related deaths, as well as its testing in blood, urine, tissue, and hair. Special attention is given to comparing the long-term care of opiate-dependent patients using high-dose buprenorphine vs methadone, and to explaining the differences in treatment, administration, and delivery. The authors also describe how buprenorphine is currently prescribed and monitored in France and Australia, and review all the latest advances in analytical techniques for the determination of buprenorphine and its metabolites in biological fluids and tissues.