engleski

A new approach of conducting rapid transfer to buprenorphine among addicts who did not function even on extremely high methadone doses

Since the initiation of methadone treatment of heroin addicts (1991), the number of heavy and complex cases of drug addicts that could not be stabilized using different approaches, including the usage of high daily doses of methadone, has significantly increased. Even in addicts with whom good cooperation and persistence in therapeutic process has been established, their psychophysical state could not be stabilized and the disturbances which caused them to persistently seek treatment with tranquilization medications (BDZ) and high daily methadone doses, often higher than those that could be attributed to development of tolerance, could not be removed. Research on the possible causes of these problems has revealed that some addicts show a side effect of dysphoria, which is caused by agonistic effect of methadone on kappa opoid receptors. This category, which includes 10-15% of all the treated opiate addicts, poses enormous load on the treatment system. Since the initiation of buprenorphine treatment 4 years ago, the possibility of transferring at least some of these cases from high methadone doses to this partial opiate agonist was explored, under the assumption that they might better react to this drug. In order to begin treatment with this drug considering its antagonizing effect on methadone, the addict first needed to be tapered on a 30 mg daily dose of methadone to avoid provoked withdrawal effect. Nevertheless, even the attempt of dose reduction resulted in destabilization of general state, negative changes in behavior and in purchasing additional doses of methadone or heroine and BZD on the black market. In searching for a way to accomplish the therapeutic goal in spite of this, we developed a method of fast transfer within hospital treatment, which consists of termination of methadone treatment on the day of admission, while the withdrawal crisis is prevented by temporary giving minimal daily doses of MST continus (morphine sulfate) which are necessary until the methadone is naturally eliminated from the addict’ s body, which takes 7-10 days. The application of morphine sulfate is then interrupted and, after the withdrawal symptoms begin, the induction of buprenorphine starts, until the stabilization on the necessary daily dose. After the transfer, we still needed to cancel buprenophrine in some addicts, because due to different experience of drug effects (feeling of clarity in the head and light stimulation), methadone treatment, whose effects (sedation, the feeling of numbness) were simply more suitable for one category of addicts, was again required.

addicition; heroin; treatment; methadone; morphine sulfate

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