U.O. Ser.T. 31 and S.C. Tutela della Salute Dipartimento Farmacodipendenze, ASL Napoli 1 Centro, Napoli, Italy.
Eur Rev Med Pharmacol Sci. 2011 Aug;15(8):871-4.
Buprenorphine and methadone are widely used for the treatment of opioid dependence, but their diversion and/or misuse are frequent. In principle, buprenorphine/naloxone combination therapy should be associated with a lower frequency of drug abuse/misuse than methadone. This study assessed the efficacy of the substitution of buprenorphine treatment with the buprenorphine/naloxone combination in opioid-dependent patients.
3812 drug-addicted outpatients selected from 10 Italian Public Services for Addiction (Ser.T.) centres in Naples (Italy) were enrolled: 3105 (81.5%) were treated with methadone and 707 (18.5%) with buprenorphine. The buprenorphine treatment was switched to buprenorphine/naloxone (4:1), and the patients were followed for about 1 year. The number of subjects still on treatment after 1 year, their status according to social, educational and toxicologic (assessed by a urine toxicology test) parameters were assessed.
1 year after the therapy switch, the number of patients still on treatment was similarly reduced with methadone (2883; -7.5%) and buprenorphine/naloxone (632; -10.6%; p=0.369). However, in patients treated with buprenorphine/naloxone, a significant improvement was reported in social life status (63% versus 39% of the buprenorphine/naloxone and methadone treated subjects, respectively, were married/cohabiting p<0.001), in the educational level (43% of buprenorphine/naloxone treated versus 32% of the methadone treated subjects obtained at least a high school certificate, p<0.001) and in the toxicological conditions (53% of buprenorphine/naloxone treated subject versus 30% of methadone treated individuals had opioid- and cocaine- negative urine tests, p<0.001).
These preliminary data suggest that buprenorphine/naloxone treatment of opioid dependence reduces the percentage of treated subjects similarly to methadone, and is associated with an improvement in social life, educational and toxicological conditions, compared with methadone treatment. However, we cannot exclude a selection bias, i.e. patients who were more likely to stabilize their opiate dependence switched to buprenorphine/naloxone.
丁丙诺啡和美沙酮被广泛用于治疗阿片类药物依赖，但它们的转移和/或滥用很常见。原则上，丁丙诺啡/纳洛酮联合治疗与美沙酮相比，药物滥用/误用的频率应较低。本研究评估了将丁丙诺啡治疗转换为丁丙诺啡/纳洛酮联合治疗在阿片类药物依赖患者中的疗效。
从意大利那不勒斯的 10 个意大利公共服务成瘾中心（Ser.T.）招募了 3812 名吸毒成瘾的门诊患者：3105 名（81.5%）接受美沙酮治疗，707 名（18.5%）接受丁丙诺啡治疗。丁丙诺啡治疗转换为丁丙诺啡/纳洛酮（4：1），并随访约 1 年。评估 1 年后仍在接受治疗的患者人数，以及根据社会、教育和毒理学（通过尿液毒理学测试评估）参数评估他们的状况。
治疗转换 1 年后，美沙酮（-7.5%）和丁丙诺啡/纳洛酮（-10.6%）的治疗患者数量同样减少（分别为 2883 名和 632 名；p=0.369）。然而，在接受丁丙诺啡/纳洛酮治疗的患者中，社会生活状况显著改善（丁丙诺啡/纳洛酮治疗组的 63%与美沙酮治疗组的 39%结婚/同居，p<0.001），教育水平（丁丙诺啡/纳洛酮治疗组的 43%与美沙酮治疗组的 32%获得高中以上学历，p<0.001）和毒理学状况（丁丙诺啡/纳洛酮治疗组的 53%与美沙酮治疗组的 30%尿液阿片类药物和可卡因检测阴性，p<0.001）。
这些初步数据表明，丁丙诺啡/纳洛酮治疗阿片类药物依赖与美沙酮相似，可降低接受治疗的患者比例，并与社会生活、教育和毒理学状况的改善相关，与美沙酮治疗相比。然而，我们不能排除选择偏倚，即更有可能稳定阿片类药物依赖的患者转向丁丙诺啡/纳洛酮。
