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Chronic High-Dose Buprenorphine Does Not Block Subjective High from Diacetylmorphine in a Patient in Heroin-Assisted Treatment

Authors :
Marc Vogel
Kenneth M. Dürsteler
Patrick Köck
Gerhard A. Wiesbeck
Marc Walter
Johannes Strasser
Source :
Journal of Psychoactive Drugs. 51:377-382
Publication Year :
2019
Publisher :
Informa UK Limited, 2019.

Abstract

We present the case of a 35-year-old woman in heroin-assisted treatment (HAT) expressing the wish for the transition to oral opioid agonist treatment. After failed attempts to change to oral diacetylmorphine and slow-release oral morphine, respectively, she was induced on overlapping buprenorphine (BUP) treatment with the Bernese method. Gradual dose increases to BUP 48 mg per day did not result in attenuation of subjective effects of IV diacetylmorphine (DAM) 190 mg. Instead, the patient showed increased sedation. BUP was then reduced to 32 mg per day. After the gradual reduction of IV DAM, she reinitiated illicit substance use. IV DAM was again raised to an effective dose leading to stabilization and reduction of illicit substance use. BUP was subsequently reduced to 8 mg per day. This combination was continued as the patient felt comfortable and reported less early morning withdrawal than with exclusive DAM treatment. We discuss possible underlying mechanisms and explanations as well as clinical implications.

Details

ISSN :
21599777 and 02791072
Volume :
51
Database :
OpenAIRE
Journal :
Journal of Psychoactive Drugs
Accession number :
edsair.doi.dedup.....d1d7f4da1d64b9d58bfde06d602ebbe7
Full Text :
https://doi.org/10.1080/02791072.2019.1610200