Related Experiment Video
Updated: Jun 23, 2025
10:35
A Procedure to Study the Effect of Prolonged Food Restriction on Heroin Seeking in Abstinent Rats
Published on: November 11, 2013
11.1K
Extended-Release Injection vs Sublingual Buprenorphine for Opioid Use Disorder With Fentanyl Use: A Post Hoc Analysis
Edward V Nunes1,2, Sandra D Comer1,2, Michelle R Lofwall3
1Division on Substance Use Disorders, New York State Psychiatric Institute, New York.
JAMA Network Open
|June 25, 2024
Summary
Extended-release subcutaneous buprenorphine may be more effective for treating opioid use disorder (OUD) in patients using fentanyl. This medication showed better results in reducing fentanyl use compared to sublingual buprenorphine-naloxone.
Area of Science:
- Addiction Medicine
- Pharmacology
- Clinical Trials
Background:
- Fentanyl's prevalence has worsened the opioid use disorder (OUD) and overdose epidemic.
- Limited data exist on OUD medication effectiveness for patients using fentanyl.
Purpose of the Study:
- To compare the effectiveness of sublingual and extended-release injectable buprenorphine formulations for OUD treatment.
- To specifically assess outcomes in patients with and without baseline fentanyl use.
Main Methods:
- Post hoc analysis of a 24-week randomized, double-blind trial comparing sublingual buprenorphine-naloxone with extended-release subcutaneous buprenorphine (CAM2038).
- Participants were subgrouped based on baseline fentanyl or norfentanyl presence in urine.
- Outcomes included treatment retention, opioid-negative urine samples, and withdrawal/craving scores.
Main Results:
- Study completion rates were similar between fentanyl-positive and fentanyl-negative subgroups.
- Patients using fentanyl had fewer opioid-negative urine samples compared to those without fentanyl use.
- In the fentanyl-positive subgroup, subcutaneous buprenorphine showed a higher percentage of fentanyl-negative urine samples (74.6%) versus sublingual buprenorphine-naloxone (61.9%).
Conclusions:
- Buprenorphine demonstrates effectiveness in treating OUD among patients with fentanyl use.
- Extended-release subcutaneous buprenorphine may offer superior efficacy in reducing fentanyl use compared to sublingual formulations.
- Opioid withdrawal and craving symptoms decreased across all treatment groups.
Related Concept Videos
01:15Opioid Analgesics: Synthetic and Semisynthetic Opioids
275
Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
275
01:20Opioid Analgesics: Morphine and Other Natural Cogeners
231
Opioids are a class of drugs that mimic endogenous opioid peptides and act on opioid receptors, and help in pain relief. These compounds are classified as natural, synthetic, or semi-synthetic. Natural opioids, like morphine, codeine, and thebaine, are derived from the opium poppy plant (Papaver somniferum or Papaver album) and are termed opiates. Synthetic opioids are artificial, while semi-synthetic opioids combine natural and synthetic compounds. Morphine, a prototypical opioid, possesses a...
231
01:25Analgesia and Pain Management
575
Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
575
01:22Opioid Receptors: Overview
714
Opioid receptors, including the mu (μ, MOR), delta (δ, DOR), and kappa (κ, KOR) types, belong to the rhodopsin family of G protein-coupled receptors. These receptors are located throughout the central and peripheral nervous systems and in non-neuronal tissues such as macrophages and astrocytes. Opioid receptor ligands can be categorized into agonists or antagonists. Highly selective agonists include [d-Ala2, MePhe4, Gly(ol)5]-enkephalin or DAMGO for MOR, [D-Pen2,...
714
01:15Drug Abuse and Addiction: Pharmacological Phenomena
464
Drug dependence, abuse, and addiction are complex phenomena that can precipitate various abnormal states. Physical dependence refers to a state of pharmacological adaptation to a drug. This adaptation often results in tolerance—a reduced response to the drug after repeated administrations. When the drug use is abruptly stopped, withdrawal symptoms occur due to the body's need to readjust from the pharmacologically induced imbalance. However, tolerance and withdrawal symptoms do not...
464
01:24Parenteral Anesthetics: Overview
118
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
118