A study conducted in 16 Spanish centers identified profiles of patients with heroin addiction. The results open up the possibility of reducing the severity of the addiction and the psychological suffering of those affected thanks to individualized doses of buprenorphine-naloxone, the most effective alternative to methadone.
Methadone was the only pharmacological option approved in Spain for the treatment of patients with heroin addiction until little more than 8 years ago, when a combination of buprenorphine and naloxone was approved. However, studying the adjustment of doses and patient satisfaction is still necessary for the improvement and effectiveness of treatments.
A recent work, published in Drug and Alcohol Dependence, identified for the first time profiles of patients in these new treatments. The results reinforce the need for individualized opioid maintenance therapies.
“Our work made it possible to identify that patients treated with different dosing approaches of buprenorphine can benefit from the positive results of maintenance treatments, such as less psychological suffering and less serious dependence on heroin,” says Esperanza Vergara, co-author of the study and researcher at the International University of La Rioja (UNIR).
The researchers studied 316 patients from 16 Spanish centers who were receiving maintenance treatment with buprenorphine-naloxone and who were in the stabilization phase of this treatment.
The patients were grouped based on three key indicators of treatment with buprenorphine: dose, adequacy according to the doctor and adjustment according to the patient.
Based on that, four groups of buprenorphine-consuming patients were identified: 1) Clinically adequate and adjusted to the low dose desired by the patient; 2) Clinically adequate and adjusted to the high dose desired by the patient; 3) Low dose reduction clinically appropriate and desired by the patient; and 4) Clinically inadequate and adjusted to the moderate dose desired by the patient.
The results showed significant differences between the groups of patients with respect to the level, adequacy and the desired adjustment of the dose of buprenorphine. “In addition, we found a unique group of patients who received a dose of clinically inadequate buprenorphine, which was characterized by the poorest clinical condition,” says Vergara.
Compared with the other patients, participants in the fourth group reported more frequent heroin and cocaine use during the previous week of the study, lower satisfaction with buprenorphine-naloxone as a medication, higher prevalence of adverse effects, and less psychological adaptation.
The other three groups showed better clinical results. “This supports the idea that patients treated with different buprenorphine dosing approaches can benefit from the positive results of maintenance treatments with this drug,” says the UNIR researcher. “Our data reinforce the need for individualized maintenance treatments of opioids,” he emphasizes.