Combined Abuse of Clonidine and Amitriptyline in a Patient on Buprenorphine Maintenance Treatment

Buprenorphine/naloxone maintenance therapy is often prescribed in primary care to treat opioid dependence. Previous reports have described concomitant abuse of opioids and clonidine. In this case, a primary care patient on buprenorphine/naloxone maintenance therapy demonstrating altered mental status, hallucinations, falls, and rebound hypertension was found to be concomitantly abusing clonidine and amitryptyline, which share metabolic pathways with buprenorphine. Clinicians should be aware of patients’ combining amitryptyline, clonidine, and gabapentin with buprenorphine to achieve a mood altering state, avoid co-prescribing them if possible, and maintain communication with pharmacies and other providers when they are prescribed. (Source: Journal of Addiction Medicine)

Group Medication Management for Buprenorphine/Naloxone in Opioid-Dependent Veterans

Conclusions:This study found that veterans prescribed buprenorphine/naloxone in a group setting as part of a drug and alcohol treatment program were retained in treatment longer than veterans prescribed this medication individually. Because of inherent limitations in the study design, no causality can be determined; however, given the results found here, group medication management of buprenorphine/naloxone should be explored further. (Source: Journal of Addiction Medicine)

Combined Abuse of Clonidine and Amitriptyline in a Patient on Buprenorphine Maintenance Treatment

Buprenorphine/naloxone maintenance therapy is often prescribed in primary care to treat opioid dependence. Previous reports have described concomitant abuse of opioids and clonidine. In this case, a primary care patient on buprenorphine/naloxone maintenance therapy demonstrating altered mental status, hallucinations, falls, and rebound hypertension was found to be concomitantly abusing clonidine and amitryptyline, which share metabolic pathways with buprenorphine. Clinicians should be aware of patients’ combining amitryptyline, clonidine, and gabapentin with buprenorphine to achieve a mood altering state, avoid co-prescribing them if possible, and maintain communication with pharmacies and other providers when they are prescribed. (Source: Journal of Addiction Medicine)

Group Medication Management for Buprenorphine/Naloxone in Opioid-Dependent Veterans

Conclusions:This study found that veterans prescribed buprenorphine/naloxone in a group setting as part of a drug and alcohol treatment program were retained in treatment longer than veterans prescribed this medication individually. Because of inherent limitations in the study design, no causality can be determined; however, given the results found here, group medication management of buprenorphine/naloxone should be explored further. (Source: Journal of Addiction Medicine)

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Analysis of ‘Revolving Door' Patients in Opioid Dependent Patients: the Impact of Treatment Discontinuation on Relapse Rates and Health Care Costs in us Public Health Insurance Claims

Buprenorphine/naloxone (BUP/NAL) combination is a well known treatment for opioid dependence. As a chronic relapsing disorder, some patients alternate between periods of on treatment and off treatment. The aim of this study was to compare health care resource utilization and costs between these patients and patients treated continuously. (Source: Value in Health)

Diversion of Methadone and Buprenorphine by Patients in Opioid Substitution Treatment in Sweden: Prevalence Estimates and Risk Factors

Dependence on heroin or other opiates is a condition which is difficult to treat. Research has been unable to point to any clear evidence of lasting effects of medication-free treatment. The dominant treatment method is opioid substitution treatment (OST) with methadone or buprenorphine, the latter often combined with naloxone. Metastudies show that OST is effective in light of factors such as mortality, morbidity, illicit drug use, and criminality.(Mattick, Kimber, Breen, & Davoli, 2008; Mattick, Breen, Kimber, & Davoli, 2009; Amato, Minozzi, Davoli, & Vecchi, 2011)OST also carries risks. (Source: International Journal of Drug Policy)

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Diversion of Methadone and Buprenorphine by Patients in Opioid Substitution Treatment in Sweden: Prevalence Estimates and Risk Factors

Dependence on heroin or other opiates is a condition which is difficult to treat. Research has been unable to point to any clear evidence of lasting effects of medication-free treatment. The dominant treatment method is opioid substitution treatment (OST) with methadone or buprenorphine, the latter often combined with naloxone. Metastudies show that OST is effective in light of factors such as mortality, morbidity, illicit drug use, and criminality.(Mattick, Kimber, Breen, & Davoli, 2008; Mattick, Breen, Kimber, & Davoli, 2009; Amato, Minozzi, Davoli, & Vecchi, 2011)OST also carries risks. (Source: International Journal of Drug Policy)

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