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A potentially better way to treat opioid addiction

October 13, 2010


Addiction to opioids is a huge problem in the United States. In addition to heroin addiction, a growing number of people are getting hooked on prescription painkillers, such as hydrocodone and oxycodone. In a 2009 survey, more than 5.3 million people reported prescription opioid abuse in the past month.

Researchers reported Tuesday on a new method for treating opioid addiction that takes one big problem out of the equation: getting the addict to adhere to treatment. The study showed that the partially synthetic opioid, buprenorphine, which was approved for opioid treatment in 2002, can be administered as an implant under the skin to continually release the drug. Buprenorphine, which is most commonly known by the brand name Suboxone, works in the brain to reduce craving while the addict undergoes counseling and additional treatment to achieve long-term sobriety. However, for the tablet form of buprenorphine to be effective, the addict has to take it. Previous studies have shown a problem with this kind of dedicated, daily compliance.

The study, performed by Dr. Walter Ling of UCLA, assigned 163 adults to receive buprenorphine implants or placebo implants. The implants were inserted below the skin on the inner side of the arm. The participants also received standard drug counseling and underwent urine screens to detect drug use. Ling found that, after four months, the participants receiving the buprenorphine implants had more negative urine samples (meaning no illicit opioid drugs were present) than the placebo group: 40.4% compared with 28.3%. In addition, 65% of the treatment group stayed in the study until completion compared with 30.9% of the placebo group patients. The buprenorphine patients also reported fewer withdrawal symptoms and cravings. Minor side effects were common but related mostly to insertion problems. A few patients had to have the implant removed due to side effects.

The treatment isn't a cure, notes the author of an accompanying editorial, Dr. Patrick G. O'Connor of Yale University. The study showed that, even in the buprenorphine group, more than half of the urine screens were positive for illicit drugs. Still, if additional research shows the implant is superior to the tablet form of buprenorphine, it could be of significant help to addicts, he said.

"While counseling is critical for all substance abuse treatment, opioid dependence is uniquely susceptible to pharmacologic therapy," O'Connor wrote. "Patients and their physicians are often tempted to use 'quick fix' detoxification in which short-term medication and treatment is provided rather than longer-term maintenance. However, for most opioid-dependent patients there is no quick fix."

The study appears this week in the Journal of the American Medical Assn.

-- Shari Roan / Los Angeles Times

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