You are here: Home > Contents > Selected issue 3: Buprenorphine - treatment, misuse and prescription practices
Overview | Introduction: legislation and pharmacological action | Treatment provision of buprenorphine | Misuse of buprenorphine | Conclusions | References
The use of pharmacological agents is one of the most common approaches in the treatment of opiate dependence. Early in the twentieth century (Ministry of Health, 1926), authorities in some European countries realised the value of prescribing an opioid drug either as an aid to withdrawal or as a substitution medicine for patients who were addicted to heroin, morphine or opium. Today the most commonly used opioid substitution drug in Europe and the developed world is methadone, which was first introduced in the USA. A number of factors make this drug a popular therapeutic agent: it has a relatively long half-life (22 to 36 hours); it can be administered orally; and there is a strong scientific evidence base for its therapeutic efficacy. However, despite its popularity, the use of methadone continues to cause some concern, for example regarding the potential for it to be diverted to the illicit market, the level of withdrawal distress associated with cessation of the drug and the potential for overdose when used outside therapeutic settings. These concerns have been partly responsible for the development of interest in other withdrawal agents that can provide the same benefits as methadone but which may be more appropriate to some clinical settings or better suited to the needs of some client groups.
One drug that appears to deliver some of these benefits is buprenorphine. This mixed agonist/antagonist has historically been used for the short-term treatment of moderate to severe pain. Since the mid-1990s buprenorphine has increasingly become available in Europe as an alternative to methadone for the treatment of opiate dependence. In this special issue, the reasons why clinicians are attracted to this drug, as well as the costs and benefits of buprenorphine in comparison with other treatment options, are explored in detail, and, for the first time, the increasing popularity of buprenorphine for the treatment of opiate dependence in many European countries is documented.