Manual for long-term pharmacotherapy - All India Institute of Medical ...

N-dealkylation and has an active metabolite norbuprenorphine. Elimination half-life of intravenous
buprenorphine is 3.21 hours and for sublingual buprenorphine is 27.2 hours. Following three times daily
chronic sublingual dosing of 0.4 mg, steady state levels of buprenorphine are achieved at about 4 days.
Effectiveness
A recent study of meta-analysis on buprenorphine maintenance versus placebo or methadone maintenance
has been published by Cochrane Database. This report is based on an extensive search of data up to 2001 from
various sources including medline. This study reported that thirteen studies met the inclusion criteria, all were
randomised controlled trials and all but one was double blind. The methodological quality of these studies
was good. Retention in treatment and drug use were the two important outcome measures.
Retention in Treatment
Buprenorphine maintenance treatment compared favourably with placebo in retaining patients in treatment
although it appeared significantly less effective than methadone in retaining patients in treatment.
Illicit drug use
Buprenorphine was more effective than placebo in suppressing heroin use. However, only high dose and very
high dose buprenorphine suppressed heroin use significantly above placebo. The study concluded that
buprenorphine is an effective intervention for use in the maintenance treatment of heroin dependence, but is
not more effective than methadone at adequate doses. The Indian studies too have documented the efficacy of
buprenorphine in reducing drug use and improving psychosocial functioning.
Buprenorphine substitution programme: Experience from India
The use of buprenorphine maintenance for the treatment of opioid addicts is still very limited in the country. A
project on community-based treatment for heroin addiction using buprenorphine was carried out by the De-
addiction Centre, All India Institute of Medical Sciences as early in 1993. This study included buprenorphine
maintenance as a part of community based treatment in a quasi-experimental pre-post design. The project
included 108 male subjects with heroin dependence. The dosage of buprenorphine used in this project was
low and treatment was provided for a period of 6-11 months. Three sessions on psychosocial intervention
were also carried out. At follow up about 70 percent had improved indicating no use or very little use of heroin
in spite of the low doses used.
Another study that was carried out in Nagaland used buprenorphine maintenance on opioid dependent
subjects. Fifty-four male opioid dependent patients were given buprenorphine in low doses and were
followed up to six-months. The Addiction Severity Index (ASI) scores reduced significantly in the 'drug' and
'family' domain of ASI at six months of follow up indicating reduction in problems in these domains.
Data from SHARAN (a Delhi based NGO) in the year 1995-1997, showed that out of 447 injecting drug users on
buprenorphine, 148 (33%) had stopped injecting while 158 (35%) had reduced the frequency of injecting and
sharing of equipment.
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