Banys P, Clark H W, Tusel D J, Sees K, Stewart P, Mongan L, Delucchi K, Callaway E
Substance Abuse Programs, VA Medical Center, San Francisco, CA 94121.
J Subst Abuse Treat. 1994 Jan-Feb;11(1):9-15. doi: 10.1016/0740-5472(94)90059-0.
Buprenorphine (BPN) is a prescription analgesic with mixed opioid agonist and antagonist properties. This pilot study conducted detailed case studies with 15 methadone dependent patients. The study sought to determine whether repeated low doses (0.15 to 0.3 mg) of sublingual BPN would relieve opioid withdrawal symptoms. Subjects developed mild to moderate withdrawal symptoms within 26 to 31 hours of methadone discontinuation. Once in withdrawal, the subjects received 0.15 mg of BPN sublingually. A second dose of 0.15 mg was administered in an hour, and a 0.30 mg dose in 2 hours, if the subject obtained no relief of withdrawal symptoms. In 6 subjects a low dose of 0.15 to 0.30 mg sublingual BPN resulted in the disappearance of subjective and objective withdrawal symptoms within 10 minutes to 2.5 hours. Four others had brief, partial relief of symptoms. Five subjects failed to experience any relief of withdrawal symptoms after a total of 0.6 mg BPN administered over 3 hours. One nonresponder suffered what appeared to be a severe precipitated withdrawal reaction similar to that which can be produced in addicts by a naloxone challenge. The 4 Caucasian responders required 1 to 2 hours to respond to BPN, whereas the 2 African-American responders required only 10 to 20 minutes. Low (analgesic) doses of BPN were sufficient to treat all methadone withdrawal symptoms in 6 of 15 subjects. There may be ethnic differences in response to BPN. Low dose BPN may play a role in carefully monitored heroin detoxification treatment.
丁丙诺啡（BPN）是一种具有阿片类激动剂和拮抗剂混合特性的处方镇痛药。这项试点研究对15名美沙酮依赖患者进行了详细的案例研究。该研究旨在确定重复低剂量（0.15至0.3毫克）的舌下丁丙诺啡是否能缓解阿片类药物戒断症状。受试者在停用美沙酮后的26至31小时内出现了轻至中度的戒断症状。一旦进入戒断状态，受试者舌下含服0.15毫克丁丙诺啡。如果受试者的戒断症状没有缓解，一小时后给予第二剂0.15毫克，两小时后给予0.30毫克。在6名受试者中，低剂量（0.15至0.30毫克）的舌下丁丙诺啡在10分钟至2.5小时内使主观和客观戒断症状消失。另外4名受试者的症状得到了短暂的部分缓解。5名受试者在3小时内总共服用0.6毫克丁丙诺啡后，戒断症状没有得到任何缓解。一名无反应者出现了似乎是严重的急性戒断反应，类似于纳洛酮激发试验在成瘾者中产生的反应。4名白种人反应者对丁丙诺啡的反应需要1至2小时，而2名非裔美国反应者仅需10至20分钟。低剂量（镇痛剂量）的丁丙诺啡足以治疗15名受试者中的6名的所有美沙酮戒断症状。对丁丙诺啡的反应可能存在种族差异。低剂量丁丙诺啡可能在严格监测的海洛因脱毒治疗中发挥作用。
