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Open Access Highly Accessed Research

A retrospective evaluation of patients switched from buprenorphine (subutex) to the buprenorphine/naloxone combination (suboxone)

Kaarlo Simojoki1, Helena Vorma2 and Hannu Alho34*

Author Affiliations

1 Espoo Treatment and Rehabilitation Center, A-clinic Foundation, Espoo, Finland

2 Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland

3 Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland

4 Unit of Substance Abuse Medicine, University of Helsinki, Helsinki, Finland

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Substance Abuse Treatment, Prevention, and Policy 2008, 3:16  doi:10.1186/1747-597X-3-16

Published: 17 June 2008

Abstract

Background

In Finland, buprenorphine (Subutex) is the most abused opioid. In order to curb this problem, many treatment centres transferred ("forced transfer") their buprenorphine patients to the buprenorphine plus naloxone (Suboxone) combination product in late 2003.

Methods

Data from a retrospective study involving five different treatment centers, examining the effects of switching patients to Suboxone, were gathered from 64 opioid-dependent patients who had undergone the medication transfer.

Results

Most patients (90.6%) switched to Suboxone at the same dose of buprenorphine that they had been receiving as Subutex (average 22 mg). The majority of these patients (71.9%) were maintained at the same dose of Suboxone throughout the 4-week study period. During the first 4 weeks, 50% of the patients reported adverse events and at the four month time point, 26.6% reported adverse events. However, due to adverse events one patient only discontinued treatment with Suboxone during the 4-week study period, and five during the four month follow-up period. Of the 26 patients in the follow-up period, Suboxone was misused intravenously once each by 4 patients and twice by 1 patient. These 5 patients all reported that injecting Suboxone was like injecting "nothing" with any euphoria, or that it was a bad experience.

Conclusion

We conclude that when patients are transferred from high doses (> 22 mg) of buprenorphine to the combination product, dose adjustments may be necessary especially in the later phase of the treatment. We recommend that a transfer from Subutex to Suboxone should be carefully discussed and planned in advance with the patients and after the transfer adverse events should be regularly monitored. With regard of buprenorphine IV abuse, the combination product seems to have a less abuse potential than buprenorphine alone.