DDN December 2021 December 2021 - Page 7

WHAT DO PATIENTS THINK ABOUT BUPRENORPHINE ?

We asked some patients what their experience was of being prescribed buprenorphine and received both positive and negative feedback

RIPTION

the USA . It was fully recognised by then that even if a safe and side-effect free alternative was discovered , the addiction problems countries faced would not be resolved in totality due to the complex factors that influence addiction . Therefore , it was suggested that antagonists may assist in managing the problems associated with addiction , rather than completely resolving them . During the 1960s there was a shift from attempting to cure addiction to finding a medicine that alleviated some of the risk .
Naltrexone , an opioid antagonist , was produced in the 1960s but only used as a supplementary treatment from the 1980s .
DISCOVERY In the mid-1960s buprenorphine was discovered . Longer acting relapse prevention methods such as antagonist depot injections were studied in the 1970s , while researchers also explored whether naloxone could be added to opioid medicines , and it was around this time that the search for a medicine with both antagonist
POSITIVE EXPERIENCE OF BUPRENORPHINE ‘ Buprenorphine is far better than methadone – when I came off it [ methadone ] I had to go through six weeks of hell . I felt like an old man , with aches and pains , hallucinating . I did a 14-day detox . When I came off buprenorphine it was much easier , just a few days of restless legs and that was it If I ’ d have known what it was like coming off of methadone I ’ d rather have just stopped off the heroin . Methadone is worse than heroin itself . I went down to 2mg on methadone – three weeks after coming off methadone I felt so bad I took a total of 100mg diazepam , and they didn ’ t even touch the sides .’
‘ You feel like an old man , the pain is unbelievable – 18 years ago this happened , they kept me on maintenance .’
‘ I came off buprenorphine a few times , no issues like I said , just restless legs the first night , then the second night a full night ’ s sleep . I was a lot younger back then , the helpful thing is to exercise .’
NEGATIVE EXPERIENCE OF BUPRENORPHINE ‘ I didn ’ t get on with buprenorphine at all , although most people I know have got on with it . The first time they didn ’ t bring me down to 30 mg of methadone before I switched onto it , I was on 70mg . I left it two to three days to be in withdrawal , took one and then I was ill , I was actually going to a job interview that day – 20 minutes before I went for the job interview it felt like a super cluck . I had to go out and get something .’
‘ I tried to get onto buprenorphine three times . This was seven or eight years ago .’
‘ I prefer the methadone . It ’ s something mental I suppose , I ’ ve been on it for so long .’

THE FRENCH MODEL

In France in the 1980s , the widespread off-label use of buprenorphine was being used to treat addiction . In 1995 , it was the first country to approve the use of buprenorphine for the treatment of opioid dependence .
There was an acknowledgement at the time of increasing levels of overdoses and it was suggested that the majority of people who were opioid dependent were not receiving treatment . GPs were enabled to prescribe buprenorphine and they adopted
a low threshold , far-reaching approach .
This approach incorporating GPs had the benefit of normalising addiction treatment into mainstream care . Financial barriers were reduced for GPs and patients . The outcomes were :
The number of people treated for opioid dependence with buprenorphine vastly overtook the numbers prescribed methadone .
The majority of buprenorphine treated patients in Europe were in France .
Overdoses reduced enormously .
Pharmacists saw an increase in retention into treatment rates .
HIV infections in people who injected drugs fell dramatically .
However , France saw a higher number of patients injecting their buprenorphine , particularly when lower dosing was used .
The French model is an example of where reducing the financial , procedural and stigmatising barriers associated with treatment has resulted in positive outcomes for patients .
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DECEMBER 2021 – JANUARY 2022 • DRINK AND DRUGS NEWS • 7