Rationale: One therapeutic benefit of
mu opioid agonist or antagonist maintenance is the resultant attenuation of the effects of illicit opioids. It is important
to characterize the development and duration of opioid blockade produced by buprenorphine, a novel opioid dependence pharmacotherapy.
Objective: This study characterized the ability of buprenorphine to attenuate opioid effects during treatment initiation and discontinuation
compared to naltrexone and placebo.
Methods: Opioid-experienced volunteers (
n = 8) participated in this 10-week, inpatient, double-blind, within-subject, crossover study. Five randomized conditions [buprenorphine
(2 and 8 mg, sublingually), naltrexone (25 and 100 mg, PO) and placebo] were each examined during a 2-week period; the test
drug was given for 7 days followed by a 7-day placebo wash-out. Cumulative doses of hydromorphone (0, 2 and 4 mg, IM, 45 min
apart) were administered thrice-weekly corresponding with treatment and wash-out days 1, 3, and 5; behavioral, physiological
and pharmacokinetic measures were collected.
Results: Buprenorphine alone produced dose-related prototypic agonist effects during induction (i.e., positive mood, respiratory
depression, miosis); tolerance developed only to the subjective effects. Buprenorphine 2 mg partially attenuated the effects
of hydromorphone, while nearly complete attenuation was observed with 8 mg that lasted up to 72 h after discontinuation. Both
naltrexone doses produced complete hydromorphone blockade after a single dose; blockade of the behavioral, but not physiological,
effects persisted for 5 days after discontinuation of 100 mg.
Conclusions: These data suggest that 2 mg buprenorphine is a sub-therapeutic maintenance dose, both buprenorphine 8 mg and naltrexone
produce immediate and efficacious opioid blockade, and adequate protection against illicit opioids may be achieved with less-than-daily
dosing.
Key words Opioid blockade - Buprenorphine - Naltrexone - Human
Received: 2 October 1998/Final version: 4 February 1999