Methadone, buprenorphine, and naltrexone to treat illicit drug addiction

Methadone, buprenorphine, and naltrexone to treat illicit drug addiction

Being addicted illicit drugs is a worldwide problem that affects millions of individuals. Methadone, buprenorphine, and naltrexone are a few of the known anti-addiction drugs with proven efficacy. The purpose of this paper is to review said anti-addiction drugs. Being addicted illicit drugs, Guest Posting alcohol, or other substances is an issue that affects many millions of individuals in the usa alone. buy weed online australia Drug users may get, and monitor sexually fed infections, and blood borne infections. For instance, 61% of youth between the ages of 15 and 24 have reported using a drug at some point throughout their life; cannabis was found to be the most popular drug (>80%) (1). Drugs can fall into four distinct categories: stimulants, depressants, hallucinogenics, and opioids. Listed here are the most frequently used illicit drugs:

benzodiazepine, opioid, amphetamine, cocaine, ecstasy, and abused volatile substances (4). Substance abuse is typically accompanied by abuse of other drugs, mental illnesses, and anxiety disorders (19). Drugs typically affect serotonin levels most of which lead to the initial of the dopamine system. When a neurotoxin that can deplete dopamine called 6-hydroxydopamine was administered to rats, the rats did not self-administer amphetamine or cocaine (2). Cocaine, amphetamine, and methylphenidate are dopamine reuptake blockers (2). For instance, cocaine has been known to increase release of dopamine, norepinephrine, and serotonin; excessive dopamine results in frustration, aggressiveness, hallucinations, and delusions, amongst other symptoms of psychosis (3). Cocaine intake,

for instance, results in paranoia in 68% to 84% of individuals, as well as suspiciousness; in particular, 29% to 53% of cocaine users develop hallucinations, and delusions (3). Wrong use of illicit drugs can lead to serious intoxication, harmful use (ex: hepatitis or depression), reliance affliction, revulsion, and psychotic disorders (4). The most serious of these is drug activated psychosis. Drug activated psychosis is psychosis activated by psychotomimetic drugs such as cocaine, LSD, pot, methamphetamine, or PCP. Psychosis is a state of mind whereby the individual in question incorrectly feels reality (5). Typically, oral hallucinations, delusions, revulsion, and mental confusion exist. A psychotic episode implies the presence of psychotic symptoms which can subsist for years. Legally, individuals diagnosed with psychosis are not “insane” (5). Alternatively, illicit drugs can lead to death. This season, approximately 40 393 individuals died from drug-related issues; every 13 minutes, an individual is disapated in the usa due to illicit drugs (6). The purpose of this paper is to review the treatment methods of illicit drug addiction.


Methadone, a full µ-opiate-receptor agonist, acts as an antagonist of receptors that are typically bound by opioids, and is utilized for opioid reliance and treating chronic pain (10, Figure 1). Methadone is not recommended for patients whoever drug habits are not severe (< 0. 25g heroin/day) (4), and adverse side effects such as the respiratory system depression with other drugs have been noted (8). Methadone is also accompanied by the following side effects: sweats, constipation, and sexual dysfunction. The average amount of methadone is between 21 years of age and 68 mg (7),

and its half-life is approximately one day (but is as high as 120 hours) (10). In one particular study, patients were administered either 0mg (beginning at 25mg of methadone, and dropping incrementally to 0mg by week 6), 20 mg (beginning at 25 mg and dropping to 20mg at week 5), or 50 mg (beginning at 25mg, and increasing incrementally until at week 6 the amount is 50mg) of methadone. It was shown that patients on the 50 mg treatment had fewer opioid-positive urine by week 4; methadone was not found to affect cocaine positive patients on the three treatments (7). The number of positive urine samples on methadone doses greater than 50 mg is between 21% and 62%; maintenance on methadone doses greater than 50 mg is between 31% and 90% (25). The authors entail larger methadone doses should be

administered when one wishes to avoid drug use, and lower doses to regulate revulsion (7). In yet another study conducted in 1979, heroin fans who have been administered 60mg of methadone per day showed a drop being used following a 4 month period; further, criminal confidence rates were double in the no-methadone control versus the methadone treatment group (9). However, it ought to be noted that methadone can lead to mortality in some patients. In Australia, mortality due to methadone – approximately 238 individuals from 1990-1995 — was caused by the fact that proper clinical tests and review of patients was ignored; mortality in these instances were due to drug-related (44%), medical illness (24%; which 53% was due to HIV/AIDS),

injury (17%; which 28% were vehicular accidents, 15% stab wounds, and 13% beatings), suicide (8. 8%), drug and medical (2. 1%), drug and injury (1. 7%), and inaccessible (2. 5%) (11). In 93% of the cases, psychoactive drugs — such as benzodiazepine (55%), morphine (34%), other opioids (20%), alcohol (16%), cannabis (16%), and antidepressants (13%) — were detected during autopsy (11). In another study over a 12 year period, approximately 8% of the patients died, however the mean amount was less than the suggested 60-120 mg; in this case, it was reported that approximately 36% died due to drug dependence/related, 7% due to endocarditis/cardiovascular, 8% due to HIV related, 12% due to cancer, 3% due to pneumonia and related, 8% due to accidents, trauma, and self-harm, 5% due to lean meats disease/hepatitis C, and 20% due to other causes (12). It has been noted that people that have psychiatric illness face a higher chance of mortality (12). Yet in another 7 year study, approximately 1. 85% (515/28554) of patients on methadone died (13); Buster et ing. (14) showed that out of 5200, 44 died on methadone during treatment, and 26 died after treatment.

It’s advocated that all patients on methadone be tested 3 to 5 days following initial amount to ensure that clinical signs of the respiratory system depression or arrhythmia are not present (10). An ECG prior to use of methadone is recommended; initial doses should be low, and titration of amount should be slow (10). In particular, for opioid addiction, initial doses should be between 30 – 40 mg/day; increases should be by no more than 10mg/day (10). Further methadone should not be administered if sedation is observed; administration of other drugs can augment symptoms.


Buprenorphine, a part µ-opiate-receptor agonist and κ-receptor antagonist (17), is typically useful to treat opioid addiction/dependence, and chronic pain (21, Figure 1). In conjunction with naloxone, it is a full µ-opiate-receptor antagonist (17); buprenorphine binds securely to receptors and as such has a slow dissociation rate (21, 25, 26). Relatively speaking, buprenorphine is used by 65 000 individuals while methadone is used by 6000 to 7000 individuals in England (26). Further, buprenorphine is preferentially administered to those that have favorable prognoses (26). Buprenorphine is typically available in 2 or 8 mg amount buprenorphine hydrochloride or as a combination of buprenorphine (2 or 8 mg) and naloxone (0. 5 or 2 mg); usually, the relation of buprenorphine to naloxone is 4: 1 (21).

The initial amount is between 2 to 4 mg administered 12 hours post-abstinence from short-acting opioids; titration is by 2 to 4 mg every 2 hours up to 8-16 mg (days 1, and 2), 12-24 mg (day 3) (21, 26). Doses should not exceed 24 mg per day (26). It is recommended that patients stay away from short-acting opioids for a period of 12 hours, and show signs of opioid revulsion prior to administration of buprenorphine (21). Relative to a placebo treatment, it has been shown that buprenorphine has been proved to be effective in treating drug use.

In a study comparing buprenorphine (max amount of 23. 1 mg) to methadone (max amount of 93. 1 mg), it was found that fewer individuals on buprenorphine (46. 1% with an average of 103. 8 days in treatment) completed the treatment as opposed to methadone (74. 1% with an average of 141. 3 days) following a 24 week period (22). Further, a 60mg amount or above of methadone resulted in 80% maintenance, and doses of 120 mg or more resulted in a 91% of the patients completing the treatment; maintenance on buprenorphine improved with dosage and with a amount of 30-32 mg buprenorphine, the end rate was about 60% (22). The number of positive urine samples (for illicit drugs after administration) on 8 mg buprenorphine is between 32% and 90%, on 12 mg is 58%, and on 8-16 mg of buprenorphine is 62%; maintenance on buprenorphine doses greater than 8 mg is between 20% and 68% (25). Given poor people gastrointestinal intake rates of buprenorphine, it is typically used in conjunction with naloxone,

and is considerably less dangerous in the case of an overdose; sublingual bioavailability can lead to higher intake. Short term side effects include headaches, drowsiness, nausea, constipation, insomnia issues, depression, anxiety, weight gain, sweating, break outs, itchiness, abdominal pain, lassitude, menstrual effects, and decreased sexual desire (21, 27). Very little is known about the long-term side effects of buprenorphine. When combined with alcohol, opioids, or CNS depressants, the respiratory system depression might take place; in combination with intravenous benzodiazepines, death might take place (21, 23). In one study, 182 individuals out of a total of 391 individuals (47%) died when on buprenorphine (average buprenorphine in blood = 1. 4 ug/l); of these, benzodiazepine — Diazepam-group drugs (63%), alprazolam (28%), temazepam (23%), and oxazepam (14%) — was found in approximately 82% of these cases (23). Most individuals who died of buprenorphine poisoning had a buprenorphine concentration between 0 and 2 ul/l (23).

However, side effects such as the respiratory system depression are difficult to remedy; intravenous buprenorphine has resulted in fatal buprenorphine-induced the respiratory system depression (19). It is recommended that lean meats function be audited during treatment, and intravenous use is not recommended. Buprenorphine, with a half-life of 37. 5 hours, is deemed safer than other antidotes (ex: methadone), does not require constant monitoring, and is very effective (20); there’s been concern about non-compliance (18). Buprenorphine, unlike methadone, is available everywhere, however it does not carry the name or fame of methadone, and can be abused/misused. Further,

due to stigmatization, and mortality associated with methadone, the patient must utilize methadone for 2 years before being allowed to use of a a couple of weeks supply at home; buprenorphine does not have such strict regulation (19). However, buprenorphine is deemed expensive ($250-$450 per month) (19, 20).

Buprenorphine is not as effective as methadone for severe fans; fans on high doses of methadone have a longer abstinence period, higher number of drug-free urine samples, and tend to adhere to treatment routines longer than do patients on buprenorphine (19). Methadone in addition has been proved to be considerably better buprenorphine in dual addiction – treating opioid and cocaine reliance for example – in particular when combined with dopaminergic drugs (19). Maintenance is also lower on buprenorphine. One study compared maintenance rates of patients on 20 mg and 65 mg methadone and 4 mg and 12 mg buprenorphine. On all four treatments,

the rate of opioid use was found to decrease; abstinence from drug use was higher on high-dose (65mg methadone or 12mg buprenorphine) treatments (24). After 24 weeks in the treatment program, individuals on the 65 mg methadone had the highest maintenance rates (approximately sixty four. 3%), and those on the 4 mg buprenorphine had the lowest maintenance rates (approximately 34. 5%) (24). Further, at least 3 consecutive weeks of abstinence was documented as follows: 65 mg methadone (50%), 20 mg methadone (40%), 12 mg buprenorphine (34. 5%), and 4 mg buprenorphine (20. 7%) (24). It can be said that higher doses are more effective than smaller doses. However, buprenorphine has a threshold effect – the latter means that above settled dosage, there is no treatment effect (which means that individuals on the treatment have a lower risk of the respiratory system depression) (27).


Naltrexone, a µ and κ opioid receptor antagonist (competitive antagonism) (35), is typically utilized for opioid and alcohol addiction (28, Figure 1). Naltrexone (half-life of 4 hours) is efficiently absorbed by the gastrointestinal tract, and exclusively metabolized in the lean meats to 6-β-naltrexol (with a half-life of 13 hours) (30). The main problem in using anti-addiction drugs such as methadone or buprenorphine is that it replaces addiction drugs (such as heroin); in other words, an addict might then seek out the anti-addiction drug to abuse (37). Unlike other anti-addiction drugs, naltrexone does not cause dependence on itself (anti-addiction drug) (35). Naltrexone checks the euphoric and analgesic effects of drugs such as heroin – as well as that of alcohol, and amphetamine (36) — in a way that if and when fans you should stop naltrexone, and subsequently use heroin, the effects of said heroin are become more intense which also improves the risk of an overdose (29). However, naltrexone is scientifically less effective than methadone. Moreover, methadone must be stopped approximately 10 to a fortnight prior to administration of naltrexone (31). Naltrexone is capable of addressing cravings accompanied by drug use with notable effects 3 to 5 weeks after induction (35). The effects of naltrexone can last between twenty four and 72 hours, and does not lead to physical reliance (31). Naltrexone can cause hepatotoxicity in large doses; it is contraindicated for folks with hepatitis or lean meats failure (30). Side effects of naltrexone add the following: headaches, sleep hindrance, anxiety, dizziness, nausea, diarrhea,

and rashes (28). Administration of 50 mg, 100 mg and a hundred and fifty mg of naltrexone can suppress 25 mg of heroin for a period of 24, twenty four and 72 hours respectively (31, 35). However, naltrexone is also not accompanied by reinforcing effects and as such maintenance is low (32, 33). In one study on naltrexone, the number of individuals who always been in the treatment for 14-52 weeks was 10/73; in the naltrexone treatment group,

it was noted that 1% of the patients were likely to abide by the treatment (34). Naltrexone is best suited for self-motivated individuals; further, it is quite facile to begin and end treatment with naltrexone (35). The problem with naltrexone can be as such complying. As a result, sustained release products (SRX) – injectable intramuscular suspension and surgically implantable pellets — were developed (36). Polylactide suspensions (380 mg polylactide + naltrexone) are treatments administered approximately every 4 weeks or every month (40);

surgically implanted supplements are implanted subcutaneously (30 pellets results can last 7 months) with with minor side effects such as pain, itchiness and redness due to implantation procedure (36). Maintenance on precise implants (prodetoxon) was found to be 52% in the treatment group (naltrexone) at week 10 and 28% in the placebo group; treatment effect-wise, the naltrexone group showed a 56% significant improvement with no side effects while the placebo group showed a 14% significant improvement (37). In other words,

precise implants increases maintenance on naltrexone, and decreases use of illicit drugs. In another research 380 mg of injectable naltrexone XR-NTX, 45% of patients were completely abstinent on XR-NTX while 28% were completely abstinent in the placebo group; the experiment survived for about 24 weeks, and individuals in the XR-NTX group were abstinent 90% of that time period while those in the placebo group were abstinent 35% of that time period (38). Further, in the XR-NTX group, 50% of individuals has at least one adverse event (32% in the placebo group), and 26% had at least one drug-related adverse event (10% in the placebo group) (38). Naltrexone,

in particular, significantly decreases craving (38). Another study compared NR-NTX administered to patients in non-injectable, and injectable modalities, and found that the length of stay was more achieable in the being injected group (23. 6 days) in comparison to the not-injected group (16. 4) (39). Naltrexone can also be used in conjunction with other anti-addiction drugs such as buprenorphine (40).


Being addicted illicit drugs is a serious problem that affects the health and life of the addict. So far, only a handful of drugs that can control addiction have been taken to the market, and amongst these are methadone, buprenorphine, and naltrexone. Methadone is very effective, but also not easily acquired; buprenorphine is reasonably effective, but quite easily procured, and can be used “at home”. However, both methadone, and buprenorphine are rather enslaving (the patient can become enslaved by the anti-addiction drug), in these instances, naltrexone may be utilized as it does not cause reliance (though also less effective). Further, a combination of drugs can also be used to treat addiction.



Public Health Agency of The us. Canadian Street Youth: Findings from Enhanced Monitoring [Internet]. 1st ed. 2007 [cited 6 August 2015]. Available from: http: //www. publichealth. gc. ca/sti


Robbins T, Everitt B. Drug addiction: bad habits add up. Nature. 1999; 398: 567-570.


Morton WA. Cocaine and Psychiatric Symptoms. Prim Care Companion J Clin Psychiatry. 1999; 1(4): 109–13.


Gerada C, Ashworth Michael. ABC of mental health: Addiction and dependence—I: Illicit drugs. 315. 1997; BMJ: 297-300.


George Wa University Michael T Compton Department of Psychiatry and Attitudinal Sciences, Sciences GWUBBDoPaB. The first Episode of Psychosis: Tips for Patients and Their own families: Tips for Patients and Their own families: Oxford University Press; 2009.


Consequences of Illicit Drug Utilization in America2014. Available from: internet. wh. gov/drugpolicyreform.


Strain E, Stitzer Michael, Liebson I, Bigelow Grams. Methadone amount and treatment outcome. Drug and Alcohol Reliance. 1993; 33(2): 105-117.


Herrlin Okay, Segerdahl Michael, Gustafsson D, Kalso E. Methadone, ciprofloxacin, and adverse drug reactions. The Lancet. 2000; 356(9247): 2069-2070.


Newman Ur, Whitehill W. Double-blind comparison of methadone and placebo maintenance treatments of narcotic fans in Hong Kong. The Lancet. 1979; 314(8141): 485-488.


Chou Ur, Cruciani Ur, Fiellin D, Compton P, Farrar J, Haigney Michael et ing. Methadone Safety: A Clinical Practice Guideline From the American Pain Society and College on Problems of Drug Reliance, in Collaboration With the Heart Beat Society. The Journal of Pain. 2014; 15(4): 321-337.


Zador D, Sunjic S. Fatalities in methadone maintenance treatment in New South Wales, Australia 1990-1995. Addiction. 2000; 95(1): 77-84.


McCowan C, Kidd B, Fahey T. Factors associated with mortality in Scottish patients receiving methadone in primary care: retrospective cohort study. BMJ. 2009; 338(jun16 4): b2225-b2225.


Krebs E, Becker W, Zerzan J, Bair Michael, McCoy Okay, Hui S. Comparative mortality among Department of Veterans Affairs patients prescribed methadone or long-acting morphine for chronic pain. Pain. 2011; 152(8): 1789-1795.


Buster Michael, Brussel Grams, Brink W. An increase in overdose mortality during the first two weeks after entering or re-entering methadone treatment in Amsterdam. Addiction. 2002; 97(8): 993-1001.


DrugBank. Methadone [Internet]. [cited 28 September 2015]. Available from: http: //www. drugbank. ca/drugs/DB00333


DrugBank. Buprenorphine [Internet]. [cited 28 September 2015]. Available from: http: //www. drugbank. ca/drugs/DB00921


Molfenter T, Sherbeck C, Zehner Michael, Quanbeck A, McCarty D, Ellie J et ing. Implementing buprenorphine in addiction treatment: payer and provider views in Tennesse. Subst Abuse Treat Prev Policy. 2015; 10(1).


Ling W, Mooney D, Hillhouse Michael. Prescription opioid abuse, pain and addiction: Clinical issues and ramifications. Drug and Alcohol Review. 2011; 30(3): 300-305.


Bonhomme J, Shim Ur, Gooden Ur, Tyus D, Rust Grams. Opioid Addiction and Abuse in Primary Care Practice: An evaluation of Methadone and Buprenorphine as Treatment plans. J Natl Scientif Assoc. 2012; 104(0): 342–350.


Quest, BALONEY T, Merrill, MARYLAND J, Roll, PhD J, Saxon, MARYLAND A, Rosenblatt, MARYLAND, MPH Ur. Buprenorphine therapy for opioid addiction in countryside Wa: The experience of the early adopters. Journal of Opioid Management. 2012; 8(1): 29-38.

21 years of age.

Ling W, Mooney D, Torrington Michael. Buprenorphine for opioid addiction. Pain Manag. 2012; 2(4): 345–350.


Hser Ymca, Saxon A, Huang D, Hasson A, Thomas C, Hillhouse Michael et ing. Treatment maintenance among patients randomized to buprenorphine/naloxone compared to methadone in a multi-site trial. Addiction. 2013; 109(1): 79-87.


Häkkinen Michael, Launiainen T, Vuori E, Ojanperä I. Benzodiazepines and alcohol are associated with cases of fatal buprenorphine poisoning. Western european Journal of Clinical Pharmacology. 2011; 68(3): 301-309.


Schottenfeld Ur, Pakes J, Oliveto A. Buprenorphine versus Methadone Maintenance Treatment for Concurrent Opioid Reliance and Cocaine Abuse. Posture Gen Psychiatry. 1997; 54(8): 713.


Simoens S, Matheson C, Bond C, Inkster Okay, Ludbrook A. Pharmaco-economics of community maintenance for opiate reliance: A review of evidence and technique. Drug and Alcohol Reliance. 2006; 84(1): 28-39.


Kahan Michael, Srivastava A, Ordean A, Cirone S. Buprenorphine New treatment of opioid addiction in primary care. Canadian Family Physician. 2011; 57: 281-289.


Saxon A, Hser Ymca, Woody Grams, Ling W. Medication-assisted treatment for opioid addiction: Methadone and buprenorphine. Journal of Food and Drug Analysis. 2013; 21(4): S69-S72.


You. S. National Library of Medicine. Naltrexone [Internet]. 2015 [cited 12 October 2015]. Available from: http: //livertox. nih. gov/Naltrexone. htm


Rea F, Bell J, Young Michael, Mattick Ur. A randomised, controlled trial of low amount naltrexone for treating opioid reliance. Drug and Alcohol Reliance. 2004; 75(1): 79-88.


Center for Substance abuse Treatment. Chapter 4—Oral Naltrexone [Internet]. National Center for Biotechnology Information. 2009 [cited 12 October 2015]. Available from: http: //www. ncbi. nlm. nih. gov/books/NBK64042/


Karch S. Substance abuse Guide, Second Edition. 2nd ed. CRC Press; 2006.


Tai B, Blaine J. Naltrexone An Antagonist Therapy for Heroin Addiction [Internet]. National Institute on Substance abuse (NIDA), You. S. Department of Health and Human Services. 2015 [cited 13 October 2015]. Available from: http: //archives. drugabuse. gov/meetings/Naltrexone. html


Bell J, Young Michael, Masterman S, Morris A, Mattick Ur, Bammer Grams. A preliminary study of naltrexone-accelerated detoxification in opioid reliance. MJA. 1999; 171: 26-30.


Hollister D, Schwin Ur, Kasper P. Naltrexone treatment of opiate-dependent persons. Drug and Alcohol Reliance. 1977; 2(3): 203-209.


Kleber They would. Naltrexone. Journal of Substance abuse Treatment. 1985; 2: 117-122.


Kunøe In, Lobmaier P, Ngo They would, Hulse Grams. Injectable and implantable sustained release naltrexone in treating opioid addiction. British Journal of Clinical Pharmacology. 2014; 77(2): 264-271.


Tiihonen J, Krupitsky E, Verbitskaya E, Blokhina E, Mamontova I, Föhr J et ing. Naltrexone Implant for treating Polydrug Reliance: A Randomized Controlled Trial. American Journal of Psychiatry. 2012; 169(5): 531-536.


Krupitsky E, Nunes E, Ling W, Illeperuma A, Gastfriend D, Silverman B. Injectable extended-release naltrexone for opioid reliance: a double-blind, placebo-controlled, multicentre randomised trial. The Lancet. 2011; 377(9776): 1506-1513.


Leslie D, Milchak W, Gastfriend D, Herschman P, Bixler E, Velott D et ing. Effects of injectable extended-release naltrexone (XR-NTX) for opioid dependence on residential treatment outcomes and early follow-up. The American Journal on Addictions. 2015; 24(3): 265-270.


Mannelli P, Wu D, Peindl Okay, Swartz Michael, Woody Grams. Extended release naltrexone hypodermic injection is completed in the majority of opioid dependent patients receiving outpatient induction: A very low amount naltrexone and buprenorphine open label trial. Drug and Alcohol Reliance. 2014; 138: 83-88.

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