Abstract
Background: Opioid use is a serious global
problem and the problem is increasing over years.
Buprenorphine has been approved as a substitution
therapy in Nepal, but there are few long-term
studies of its effectiveness.Aim:This study aimed
to assess the 1-year efficacy of buprenorphine and
reasons for dropout.
Materials and Methods: This
study was conducted at Western Regional Hospital,
Pokhara from 29th August 2016 to 31st August 2017.
The Buprenorphine Maintenance Treatment Program
(BMT) was started on 29th August 2016 and all the
clients enrolled in the program within 1 year of
starting BMT were included in the study.
Results: 75% of the enrolled clients dropped out in 1-year
period.
Conclusion: Adherence to Buprenorphine was
better in flexible dose adjustment group. Combination
of buprenorphine and psychosocial treatment would
have been related with better outcome.
References
1. Survey Report on Current Hard Drug Users
in Nepal - 2069 done by Government of Nepal,
Ministry of Home Affairs
2. Ambekar A, Rao R, Pun A, Kumar S, Kishore K.
The trajectory of methadone maintenance treatment
in Nepal. Int J Drug Policy. 2013 Nov;24(6):e57-60
DOI: 10.1016/j.drugpo.2013.06.001.
3. Opioid substitution therapy in Nepal. Learnings
from building a national programme
A publication in the German Health Practice
Collection
www. health.bmz.de/ghpc
4.LingW,CharuvastraC,CollinsJF,BatkiS,Brown
LS Jr, Kintaudi P et al. Buprenorphine maintenance
treatment of opiate dependence: A multicenter,
randomized clinical trial. Addiction.1998Apr; 93(4). Research Library pg. 475
DOI:10.1046/j.1360-0443.1998.9344753.x
5. Pani PP, Maremmani I, Pirastu R, Tagliamonte A,
Gessa GL. Buprenorphine: A controlled trial in the
treatment of opioid dependence. Drug and Alcohol
Dependence 2000;60 (1):39–50.
6. Amass L, Kamien JB, Mikulich SK. Efficacy of
daily and alternate-day dosing regimens with the
combination buprenorphine-naloxone tablet. Drug
and Alcohol Dependence. 2000;58:143–152.
7. Bickel WK, Stitzer ML, Bigelow GE, Liebson
IA, Jasinski DR, Johnson RE. A clinical trial of
buprenorphine: Comparison with methadone
in the detoxification of heroin addicts. Clinical
Pharmacology and Therapeutics 1988;43 (1):72–8.
DOI:10.1038/clpt.1988.13
8. Montoya ID, Gorelick DA, Preston KL, Schroeder
JR, Umbricht A, Cheskin LJ, et al. Randomized trial
of buprenorphine for treatment of current opiate
and cocaine dependence. Clinical Pharmacology
and Therapeutics 2004; 75(1):34–48.
9. West S, O’Neal K, Graham C. A meta-analysis
comparing the effectiveness of buprenorphine
and methadone. Journal of Substance Abuse
2000;12(4):405–14.
10. Barnett PG, Rodgers JH, Bloch D. A meta-
analysis comparing buprenorphine to methadone
for treatment of opiate dependence. Addiction
2001;96(5):683–90.
11. Muruganandam P, Shukla L, Sharma P,
Kandasamy A, Chand P, Murthy P. ‘Too little
dose–too early discontinuation?’—Effect of
buprenorphine dose on short term treatment
adherence in opioid dependence. Asian journal of
psychiatry. 2019 Aug;44:58-60
12. Balhara YP, Jain R. A urinalysis-based
comparative study of treatment adherence on
buprenorphine and buprenorphine/naloxone
combination used as opioid substitution therapy.
Innovations in clinical neuroscience. 2012 Jul;9(7-
8):24
13. Fareed A, Vayalapalli S, Casarella J, Drexler
K. Treatment outcome for flexible dosing
buprenorphine maintenance treatment. The
American journal of drug and alcohol abuse. 2012
Mar;38(2):155-60
14.Mattick RP, Breen C, Kimber J, Davoli M.
Buprenorphine maintenance versus placebo or
methadone maintenance for opioid dependence.
Cochrane Database of Systematic Reviews 2014,
Issue 2.
DOI: 10.1002/14651858.CD002207.pub4
15. Ambekar A, Rao R, Agrawal A, Kathiresan P.
Research on opioid substitution therapy in India: A
brief, narrative review. Indian journal of psychiatry.
2018 Jul;60(3):265.
16. Rao R, Agrawal A, Ambekar A. Opioid
substitution therapy under National AIDS Control
Programme: Clinical practice guidelines for
treatment with buprenorphine. Department of AIDS
Control, Ministry of Health and Family Welfare,
Government of India, New Delhi. 2014.
17. Ghosh A, Basu D, Avasthi A. Buprenorphine-
based opioid substitution therapy in India: A few
observations, thoughts, and opinions. Indian journal
of psychiatry. 2018 Jul;60(3):361.
18. Adhikari A & Ghimire M& Khatiwada K&
Pathak K & Thapa R. (2019). Status of Drug User
in Buprenorphine Opioid Substitution Treatment
(OST) Center of Kathmandu Valley. International
Journal of New Technology and Research. 5.
10.31871/IJNTR.5.1.15.
19. Impact of Buprenorphine Opioid Substitution
Therapy Program in Nepal December 2014;book
20. Andrew J. Saxona,b,*, Yih-Ing Hserc, George
Woodyd, and Walter Ling. Medication-assisted
treatment for opioid addiction: methadone and
buprenorphine.J Food Drug Anal. 2013 December;
21(4): S69–S72. doi:10.1016/j.jfda.2013.09.037
21. Ruadze and Todadze. Retention in Georgia
opioid substitution therapy program and associated
factors. Harm Reduction Journal (2016) 13:35 DOI
10.1186/s12954-016-0124-z
22. Dangol, K., Chapagain, M., & Tulachan, P.
(2013). A Study on Treatment Compliance among
Methadone Clients in MMTP Program TUTH,
Nepal. Journal ofNobelMedicalCollege. 2013;2(2),
50-56. https://doi.org/10.3126/jonmc.v2i2.8806
23. BentzleyB S, Barth K S,Back S E, Book S W.
Discontinuation of Buprenorphine Maintenance
Therapy: Perspectives and Outcomes. Journal of
Substance Abuse Treatment. 2015 May;52,48-57.
https://doi.org/10.1016/j.jsat.2014.12.011
24.Kakko J,Svanborg K D, Kreek M J,HeiligM.1-
year retention and social function after
buprenorphine-assisted relapse prevention treatment
for heroin dependence in Sweden: a randomised,
placebo-controlled trial.The Lancet.2003
Feb;361,(9358):662-668
https://doi.org/10.1016/S0140-6736(03)12600-1
in Nepal - 2069 done by Government of Nepal,
Ministry of Home Affairs
2. Ambekar A, Rao R, Pun A, Kumar S, Kishore K.
The trajectory of methadone maintenance treatment
in Nepal. Int J Drug Policy. 2013 Nov;24(6):e57-60
DOI: 10.1016/j.drugpo.2013.06.001.
3. Opioid substitution therapy in Nepal. Learnings
from building a national programme
A publication in the German Health Practice
Collection
www. health.bmz.de/ghpc
4.LingW,CharuvastraC,CollinsJF,BatkiS,Brown
LS Jr, Kintaudi P et al. Buprenorphine maintenance
treatment of opiate dependence: A multicenter,
randomized clinical trial. Addiction.1998Apr; 93(4). Research Library pg. 475
DOI:10.1046/j.1360-0443.1998.9344753.x
5. Pani PP, Maremmani I, Pirastu R, Tagliamonte A,
Gessa GL. Buprenorphine: A controlled trial in the
treatment of opioid dependence. Drug and Alcohol
Dependence 2000;60 (1):39–50.
6. Amass L, Kamien JB, Mikulich SK. Efficacy of
daily and alternate-day dosing regimens with the
combination buprenorphine-naloxone tablet. Drug
and Alcohol Dependence. 2000;58:143–152.
7. Bickel WK, Stitzer ML, Bigelow GE, Liebson
IA, Jasinski DR, Johnson RE. A clinical trial of
buprenorphine: Comparison with methadone
in the detoxification of heroin addicts. Clinical
Pharmacology and Therapeutics 1988;43 (1):72–8.
DOI:10.1038/clpt.1988.13
8. Montoya ID, Gorelick DA, Preston KL, Schroeder
JR, Umbricht A, Cheskin LJ, et al. Randomized trial
of buprenorphine for treatment of current opiate
and cocaine dependence. Clinical Pharmacology
and Therapeutics 2004; 75(1):34–48.
9. West S, O’Neal K, Graham C. A meta-analysis
comparing the effectiveness of buprenorphine
and methadone. Journal of Substance Abuse
2000;12(4):405–14.
10. Barnett PG, Rodgers JH, Bloch D. A meta-
analysis comparing buprenorphine to methadone
for treatment of opiate dependence. Addiction
2001;96(5):683–90.
11. Muruganandam P, Shukla L, Sharma P,
Kandasamy A, Chand P, Murthy P. ‘Too little
dose–too early discontinuation?’—Effect of
buprenorphine dose on short term treatment
adherence in opioid dependence. Asian journal of
psychiatry. 2019 Aug;44:58-60
12. Balhara YP, Jain R. A urinalysis-based
comparative study of treatment adherence on
buprenorphine and buprenorphine/naloxone
combination used as opioid substitution therapy.
Innovations in clinical neuroscience. 2012 Jul;9(7-
8):24
13. Fareed A, Vayalapalli S, Casarella J, Drexler
K. Treatment outcome for flexible dosing
buprenorphine maintenance treatment. The
American journal of drug and alcohol abuse. 2012
Mar;38(2):155-60
14.Mattick RP, Breen C, Kimber J, Davoli M.
Buprenorphine maintenance versus placebo or
methadone maintenance for opioid dependence.
Cochrane Database of Systematic Reviews 2014,
Issue 2.
DOI: 10.1002/14651858.CD002207.pub4
15. Ambekar A, Rao R, Agrawal A, Kathiresan P.
Research on opioid substitution therapy in India: A
brief, narrative review. Indian journal of psychiatry.
2018 Jul;60(3):265.
16. Rao R, Agrawal A, Ambekar A. Opioid
substitution therapy under National AIDS Control
Programme: Clinical practice guidelines for
treatment with buprenorphine. Department of AIDS
Control, Ministry of Health and Family Welfare,
Government of India, New Delhi. 2014.
17. Ghosh A, Basu D, Avasthi A. Buprenorphine-
based opioid substitution therapy in India: A few
observations, thoughts, and opinions. Indian journal
of psychiatry. 2018 Jul;60(3):361.
18. Adhikari A & Ghimire M& Khatiwada K&
Pathak K & Thapa R. (2019). Status of Drug User
in Buprenorphine Opioid Substitution Treatment
(OST) Center of Kathmandu Valley. International
Journal of New Technology and Research. 5.
10.31871/IJNTR.5.1.15.
19. Impact of Buprenorphine Opioid Substitution
Therapy Program in Nepal December 2014;book
20. Andrew J. Saxona,b,*, Yih-Ing Hserc, George
Woodyd, and Walter Ling. Medication-assisted
treatment for opioid addiction: methadone and
buprenorphine.J Food Drug Anal. 2013 December;
21(4): S69–S72. doi:10.1016/j.jfda.2013.09.037
21. Ruadze and Todadze. Retention in Georgia
opioid substitution therapy program and associated
factors. Harm Reduction Journal (2016) 13:35 DOI
10.1186/s12954-016-0124-z
22. Dangol, K., Chapagain, M., & Tulachan, P.
(2013). A Study on Treatment Compliance among
Methadone Clients in MMTP Program TUTH,
Nepal. Journal ofNobelMedicalCollege. 2013;2(2),
50-56. https://doi.org/10.3126/jonmc.v2i2.8806
23. BentzleyB S, Barth K S,Back S E, Book S W.
Discontinuation of Buprenorphine Maintenance
Therapy: Perspectives and Outcomes. Journal of
Substance Abuse Treatment. 2015 May;52,48-57.
https://doi.org/10.1016/j.jsat.2014.12.011
24.Kakko J,Svanborg K D, Kreek M J,HeiligM.1-
year retention and social function after
buprenorphine-assisted relapse prevention treatment
for heroin dependence in Sweden: a randomised,
placebo-controlled trial.The Lancet.2003
Feb;361,(9358):662-668
https://doi.org/10.1016/S0140-6736(03)12600-1
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