Single high-dose buprenorphine for opioid craving during withdrawal

Jamshid Ahmadi, Mina Sefidfard Jahromi, Dara Ghahremani, Edythe D London, Jamshid Ahmadi, Mina Sefidfard Jahromi, Dara Ghahremani, Edythe D London

Abstract

Background: Opioid use disorder is one of the most prevalent addiction problems worldwide. Buprenorphine is used as a medication to treat this disorder, but in countries where buprenorphine is unavailable in combination with naloxone, diversion can be a problem if the medication is given outside a hospital setting.

Objective: The objective of this research is to evaluate the effect of a single, high dose of buprenorphine on craving in opioid-dependent patients over 5 days of abstinence from use of other opioids. The primary goal was to determine the safety and efficacy of buprenorphine during withdrawal in a hospital setting.

Methods: Ninety men who used opium, heroin, or prescribed opioids and met DSM-5 criteria for opioid use disorder (severe form) were randomized to three groups (n = 30 per group) to receive a single, sublingual dose of buprenorphine (32, 64, or 96 mg). The study was conducted in an inpatient psychiatric ward, with appropriate precautions and monitoring of respiratory and cardiovascular measures. Buprenorphine was administered when the patients were in moderate opiate withdrawal, as indicated by the presence of four to five symptoms. A structured clinical interview was conducted, and urine toxicology testing was performed at baseline. Self-reports of craving were obtained at baseline and on each of the 5 days after buprenorphine administration.

Findings: Craving decreased from baseline in each of the three groups (p < 0.0001), with a significant interaction between group and time (p < 0.038), indicating that groups with higher doses of buprenorphine had greater reduction.

Conclusions: A single, high dose of buprenorphine can reduce craving during opioid withdrawal; additional studies with follow-up are warranted to evaluate safety.

Keywords: Buprenorphine; Craving; Opioid dependence; Opioid withdrawal.

Conflict of interest statement

Ethics approval and consent to participate

Professor Hashemi Vice chancellor for research, Shiraz University of Medical Sciences verified ethical approval for the study. Informed consent has been obtained from all participants.

Consent for publication

The patients in the study have agreed to the publication of their data.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Consolidated Standards of Reporting Trials (CONSORT) flowchart of the patients in this trial

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