The quest for improved outcomes in the treatment of opioid addiction is accelerating on several fronts. Buprenorphine is widely used for the treatment of opioid dependence. Studies have shown that it’s an effective means to reduce opioid cravings and help prevent withdrawal symptoms. However, there is still potential for diversion and/or abuse of these drugs. As a result, researchers are working to develop new modes of administration to reduce these risks. Simultaneously, work is underway on other modalities of treatment, such as deep brain stimulation (DBS), as potential alternative therapies for treating opioid addiction.
In June 2014, the FDA approved the first buprenorphine and naloxone buccal film that is indicated for the maintenance treatment of opioid dependence. Created by BioDelivery Sciences International, the product works differently from existing sublingual film formulations of buprenorphine and naloxone. The new product features buccal film that uses a proprietary muco-adhesive technology in the form of a thin film that sticks to the inside of the cheek and dissolves minutes after placement. Clinical studies suggest this formulation provides twice the bioavailability of buprenorphine when compared with sublingual formulations. This helps halve the dose of drug required and, thus, potentially cuts the risk of abuse and diversion.
A separate novel approach to the delivery of buprenorphine involves a subdermal implant formulation for the maintenance treatment of opioid dependence. The experimental implant is designed to deliver continuous, around-the-clock blood levels of buprenorphine for 6 months following a single treatment. The subdermal implant is made from a mixture of ethylene-vinyl acetate and a drug substance that is released at a slow and steady rate. It is normally placed in the upper arm and removed at the end of the treatment period.
Beyond pharmacologic innovations, some researchers in the United States and overseas are exploring the potential of DBS to treat addiction to substances, including opioids. Beginning in 2006, several reports have been published demonstrating the benefit of DBS to the nucleus accumbens, a brain region involved in addictive behavior, in smoking and drinking. Individual case reports have indicated that DBS can be successful when administered to patients with alcohol and heroin addiction. Several clinical trials are currently underway for DBS in addiction, including a randomized double-blinded study that is testing the procedure for the treatment of severe opioid addiction.
These and other initiatives reflect the ongoing innovation in the treatment of opioid addiction. As research continues and new treatments emerge, it’s hoped that clinicians will have more ammunition to potentially improve future outcomes for these health issues.
Readings & Resources (click to view)
Professional. 2014 June 11. Available at: http://www.addictionpro.com/article/active-buprenorphine-market-continues-approval-new-mode-administration.
Kuhn J, Möller M, Müller U, Bogerts B, Mann K, Gründler TOJ. Deep brain stimulation for the treatment of addiction [letter]. Addiction. 2011;106:1534-1538.
Soper RG. Pandemic or not, addiction deserves attention. Tenn Med. 2009 Jul;102:9.
Sullivan JG, Vasisht N, Stark J, Finn A. Buprenorphine/naloxone buccal film optimizes delivery of buprenorphine and provides a novel approach in the treatment of opioid dependence. Poster presentation. American Society of Addiction Medicine 2014 Meeting. Available at: http://www.author-talk.com/bdsi/.
Sullivan JG, Webster L, Warneke T, Finn A. Buprenorphine/naloxone buccal film is well-tolerated in opioid-dependent patients converted from buprenorphine/naloxone sublingual tablet or film. Poster presentation. American Society of Addiction Medicine 2014 Meeting. Available at: http://www.author-talk.com/bdsi/.
Vasisht N, Stark J, Bai SA, Finn A. Buprenorphine/naloxone buccal film has a relative buprenorphine bioavailability approximately twice that of buprenorphine/naloxone sublingual tablet. Poster presentation. American Society of Addiction Medicine 2014 Meeting. Available at: http://www.author-talk.com/bdsi/.