Eder H, Fischer G, Gombas W, Jagsch R, Stühlinger G, Kasper S
Department of General Psychiatry, University Hospital of Psychiatry, Währinger Gürtel, Vienna, Austria.
Eur Addict Res. 1998;4 Suppl 1:3-7. doi: 10.1159/000052034.
As a maintenance agent for opioid dependency, buprenorphine offers advantages such as a lower level of dependence and minimal withdrawal symptoms, due to its partial agonist properties at the micro-opioid receptor. Previous studies have shown 8 mg sublingual buprenorphine to be equivalent to 60 mg oral methadone in terms of retention rate and opioid-negative urine levels. In a 24-week, ongoing European study, 34 opioid-dependent subjects were assessed; 16 receiving buprenorphine and 18 methadone. A free dosing schedule was used with no upper limit for methadone dosing but with a maximum buprenorphine dose of 8 mg. Screening prior to the study excluded subjects with polysubstance dependence, somatic disease and/or HIV infection. Primary outcome measures were abstinence from other drugs, for which subjects provided weekly urine samples for analysis of opioids, cocaine and benzodiazepines, and retention in treatment. Patients in the buprenorphine group provided a greater proportion of negative urine samples, in particular cocaine-negative samples, compared with the methadone group, although this was not statistically significant. Retention in the buprenorphine group was significantly lower than in the methadone group, suggesting that the 8 mg buprenorphine limit may have biased the results in favour of methadone, and that this dose may have been too low for those subjects with high levels of dependence. However, buprenorphine is clearly effective in the more motivated subjects and further investigation in this subgroup is recommended.
作为一种阿片类药物依赖的维持治疗药物，丁丙诺啡具有一些优势，比如由于其对微阿片受体具有部分激动剂特性，依赖性较低且戒断症状轻微。先前的研究表明，就保留率和阿片类药物阴性尿液水平而言，8毫克舌下含服丁丙诺啡等同于60毫克口服美沙酮。在一项正在进行的为期24周的欧洲研究中，对34名阿片类药物依赖者进行了评估；其中16人接受丁丙诺啡治疗，18人接受美沙酮治疗。采用了自由给药方案，美沙酮给药无上限，但丁丙诺啡最大剂量为8毫克。研究前的筛查排除了存在多药依赖、躯体疾病和/或艾滋病毒感染的受试者。主要结局指标是戒除其他药物，受试者每周提供尿液样本以分析阿片类药物、可卡因和苯二氮䓬类药物，以及治疗保留率。与美沙酮组相比，丁丙诺啡组的患者提供的阴性尿液样本比例更高，尤其是可卡因阴性样本，尽管这在统计学上并不显著。丁丙诺啡组的治疗保留率显著低于美沙酮组，这表明8毫克丁丙诺啡的剂量限制可能使结果偏向美沙酮，而且对于那些依赖性较高的受试者来说，这个剂量可能过低。然而，丁丙诺啡对积极性较高的受试者显然有效，建议对该亚组进行进一步研究。
