Opioid Dependence: Rationale for and Efficacy of Existing and New Treatments

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1 SUPPLEMENT ARTICLE Opioid Dependence: Rationale for and Efficacy of Existing and New Treatments David A. Fiellin, 1 Gerald H. Friedland, 1 and Marc N. Gourevitch 2 1 Yale University School of Medicine, New Haven, Connecticut; and 2 New York University School of Medicine, New York, New York Opioid dependence is a chronic and relapsing medical disorder with a well-established neurobiological basis. Opioid agonist treatments, such as methadone and the recently approved buprenorphine, stabilize opioid receptors and the intracellular processes that lead to opioid withdrawal and craving. Both methadone and buprenorphine have been proven effective for the treatment of opioid dependence and can contribute to a decreased risk of human immunodeficiency virus (HIV) transmission. In addition, a buprenorphine/naloxone combination appears to have a decreased potential for abuse or diversion, compared with that associated with methadone. Largely because of these properties, recent legislation now affords an unprecedented opportunity for general physicians to offer opioid agonist treatment through their offices. This review focuses on the neurobiological basis of opioid dependence, the rationale for methadone and buprenorphine treatments, and issues in prescribing these medications to patients with HIV infection. DIAGNOSTIC CRITERIA FOR OPIOID DEPENDENCE Opioid dependence, as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), is characterized by physical dependence on opioids (e.g., tolerance and withdrawal) and loss of control over opioid use (table 1). Commonly referred to as opioid addiction, the characteristic of loss of control over opioid use is the distinguishing feature of the diagnosis. In contrast to patients who have physical dependence on opioids as the result of receiving longterm opioid treatment for relief of a painful condition, patients with opioid dependence (addiction) as defined by DSM-IV criteria must also manifest loss of control over opioid use, resulting in adverse consequences (e.g., employment, legal, or social complications). Reprints or correspondence: Dr. David A. Fiellin, Yale University School of Medicine, 333 Cedar St., PO Box , New Haven, CT (david.fiellin@yale.edu). Clinical Infectious Diseases 2006; 43:S by the Infectious Diseases Society of America. All rights reserved /2006/4312S4-0002$15.00 NEUROBIOLOGICAL ASPECTS OF OPIOID DEPENDENCE The neurobiological pathways of many addictive disorders have been elucidated over the past years, leading to an enhanced understanding of these diseases and allowing targeted treatment strategies [1, 2]. Longterm exposure to opioids affects neurologic pathways in regions of the mesolimbic forebrain specifically, the ventral tegmental area and the nucleus accumbens. Repeated exposure to short-acting opioids can have a profound and lasting impact on opioid receptor kinetics, transmembrane signaling, and postreceptor signal transduction. With chronic exposure to opioids, there are adaptations in the G protein coupled receptors that mediate the reinforcing action of opioids and the upregulation of the cyclic adenosine monophosphate (camp) second-messenger pathway. Preliminary evidence indicates that these alterations are mediated in the locus ceruleus and nucleus accumbens, at least in part at the level of gene expression [3]. For instance, 2 gene transcription factors (camp response element binding protein and DFosB) located in the nucleus accumbens, a major portion of the reward system of the brain, are affected by chronic activation of opioid re- Opioid Dependence Treatment CID 2006:43 (Suppl 4) S173

2 Table 1. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for substance dependence. Substance dependence: a maladaptive pattern of substance use leading to clinical impairment or distress, manifested within a 12-month period by 3 of the following: Tolerance, defined by either increased amounts of the substance used to achieve intoxication or other desired effect or diminished effects with continued use of the same amount of the substance Withdrawal, manifested by the characteristic withdrawal syndrome, or use of the substance to relieve or avoid withdrawal symptoms Use of substance in larger amounts or over a longer period of time than intended Persistent desire or unsuccessful attempts to cut down or control substance use Great deal of time spent obtaining the substance, using the substance, or recovering from the effects of substance use Loss of interest in social, occupational, or recreational activities Substance use despite knowledge of physical/psychological problems ceptors and mediate tolerance, dependence, and symptoms of withdrawal and craving [4, 5]. RATIONALE FOR OPIOID AGONIST TREATMENT The neurobiological changes resulting from opioid exposure help to provide insight into the chronic and relapsing nature of opioid dependence and the failure of detoxification strategies [6 9], and they provide a rationale for specific pharmacotherapies, such as long-acting opioid agonists, that are aimed at stabilizing these complex systems. Opioid agonist maintenance treatment stabilizes brain neurochemistry by replacing short-acting opioids such as heroin or oxycodone, which can create rapid changes in opioid levels in the serum and brain with a long-acting opioid that has relative steady-state pharmacokinetics, such as methadone or buprenorphine. Opioid agonist maintenance treatment is designed to have a minimal euphoric effect, blocks the euphoria associated with administration of exogenous opioids (competitive antagonism), eliminates the risk of infection associated with injection drug use, and prevents the phenomenon of opioid withdrawal. METHADONE AND L-a-ACETYLMETHADOL (LAAM) The first research demonstrating the effectiveness of methadone for the treatment of opioid dependence was published 30 years ago [10]. Methadone hydrochloride is a synthetic medication that is a long-acting agonist at the m-opioid receptor. Peak levels in blood occur 2 6 h after oral ingestion, and peak levels in serum remain within a 2-fold range over 24 h. Methadone at higher doses can effectively block the euphoric effects of exogenous opioids [11]. The efficacy of methadone has been demonstrated empirically in a number of experimental and observational studies [10, 12 15]. In an observational study of 633 subjects, involving 6 methadone treatment programs in New York, Philadelphia, and Baltimore, there was a decrease in the prevalence of injection drug use among the 388 patients who continued to receive treatment, from 81% at admission to 29% at 4 years [13]. These findings have been replicated in a recent large cohort of patients, with the prevalence of weekly heroin use decreasing from 89% before treatment to 28% at the end of 1 year [16]. Methadone treatment has also been associated with decreases in criminal behavior [13], HIV risk behavior, and HIV seroconversion among injection drug users [17 20]. For example, one study of injection heroin users demonstrated HIV seroconversion in 22% of the 103 subjects not receiving treatment, compared with 3.5% of the 152 subjects receiving methadone maintenance treatment over an 18-month period [18]. The methadone dose used can determine the efficacy of the drug. Methadone doses have increased because of an increase in heroin purity and an increase in the number of patients entering methadone treatment programs as a result of misuse of potent prescription opioids. Despite the significant variability seen in methadone dosages and outcomes in community-based methadone programs [21, 22], dose-ranging studies have demonstrated that retention in treatment programs and abstinence from illicit opioid use is improved with doses 150 mg [23 26]. One study revealed fewer opioid-positive urine samples in patients receiving mg of methadone than in those receiving mg (53% vs. 62%; ). LAAM is a long-acting opioid P!.05 agonist with pharmacologic properties and efficacies that are similar to those of methadone, but its use has been discontinued in the United States because of concerns about episodes of QTinterval prolongation and torsades de pointe. The provision of methadone in the United States is highly regulated and is functionally restricted to opioid treatment programs overseen by a federal agency, the Center for Substance Abuse Treatment of the Substance Abuse and Mental Health Services Administration. Federal regulations dictate treatment practices, including frequency of medication dispensing, counseling services, and urine toxicology testing in the 1900 programs in the United States [27]. The concentration of heroin use over the past 40 years in the larger urban regions of the West, East, and Southeast has resulted in the preferential distribution of treatment programs in these areas, to the exclusion of rural and less-populated areas. Efforts to provide methadone in an officebased setting have been successful [28 33], but implementation has been limited because of federal regulations [27]. S174 CID 2006:43 (Suppl 4) Fiellin et al.

3 BUPRENORPHINE Buprenorphine hydrochloride, a partial agonist at the m-opioid receptor, has efficacy in the treatment of opioid dependence and was approved for this indication by the US Food and Drug Administration in late Buprenorphine is a Schedule III narcotic, according to the Drug Enforcement Administration, and, therefore, on the basis of the Drug Addiction Treatment Act of 2000, can be prescribed by certified physicians in officebased settings [34]. There is a ceiling to the opioid agonist effects of buprenorphine, which leads to a lower potential for abuse of the drug, compared with full opioid agonists. The most commonly prescribed formulation is one that incorporates naloxone, which is designed to deter misuse of the preparation by the injection route. Buprenorphine is reasonably well absorbed sublingually, whereas naloxone is not well absorbed sublingually. Therefore, sublingual administration of buprenorphine/naloxone allows for adequate absorption of the buprenorphine with minimal absorption of the naloxone. The naloxone serves as a deterrent, however, to those who would take the medication and attempt to inject it, because this would result in precipitated opioid withdrawal due to immediate occupation of the opioid receptor by naloxone. The lack of appreciable naloxone absorption with sublingual administration of this drug combination results in no adverse effects. Clinical trials have demonstrated the efficacy of buprenorphine over placebo in decreasing illicit opioid use. In addition, daily and alternate-day buprenorphine dosing is possible and effective [35 37]. Clinical trials comparing buprenorphine and methadone have demonstrated similar treatment retention and decreases in illicit opioid use, compared with those associated with low doses (20 30 mg) of methadone [38, 39]. Comparisons with more-adequate doses (35 90 mg) of methadone have yielded mixed results. One trial demonstrated improved efficacy [40], another demonstrated reduced [41] efficacy, and a third demonstrated equivalent reductions in opioid use for the buprenorphine and high-dose methadone groups [42]. Dose-ranging studies with buprenorphine have demonstrated improved treatment outcomes with doses of 6 16 mg/day, compared with doses of 1 4 mg/day [41, 43]. MEDICATION INTERACTIONS Methadone. Methadone interacts with medications metabolized by the cytochrome P450 pathway, and levels in plasma can be increased by concomitant administration of such medications as cimetidine, erythromycin, ketoconazole, and fluvoxamine [44]. Induction of hepatic microsomal enzymes leads to decreased levels of methadone in plasma and to withdrawal resulting from interactions with alcohol, barbiturates, phenytoin, carbamazepine, isoniazid, rifampin [44, 45], ritonavir [46], nevirapine [47], and, potentially, efavirenz [48]. Buprenorphine. Although the data on drug interactions between methadone and HIV medications are more extensive, the literature on drug interactions between buprenorphine and the pharmacotherapies utilized in antiretroviral regimens is limited [49]. Many medications used to treat HIV infection are metabolized via the cytochrome P450 3A4 system, the same pathway as buprenorphine. A study of the interaction between buprenorphine and the nucleoside reverse-transcriptase inhibitor zidovudine found that buprenorphine did not increase zidovudine concentrations and, therefore, was less likely to lead to zidovudine toxicity, as opposed to methadone, which had been found to increase zidovudine levels [50, 51]. In contrast, one in vitro study of interactions between buprenorphine and the HIV protease inhibitors ritonavir, indinavir, and saquinavir revealed significant inhibition of the metabolism of buprenorphine by these HIV medications, which could, potentially, lead to significant increases in buprenorphine levels [46]. Although it is important to monitor patients for clinical sequelae, this interaction is of less concern with buprenorphine, given the ceiling to its agonist effects and the decreased likelihood of such adverse events as respiratory depression or coma. Similarly, one of the less frequently used nonnucleoside reverse-transcriptase inhibitors, delavirdine, is a cytochrome P450 3A4 inhibitor and thus, in theory, increases buprenorphine levels. The remainder of the medications in this class are considered to be inducers and could, theoretically, decrease buprenorphine levels. A study examining patients receiving buprenorphine and the nonnucleoside reverse-transcriptase inhibitor efavirenz (an inducer) concluded that these patients did not develop opioid withdrawal syndrome during the administration of efavirenz, despite having decreased levels of buprenorphine in serum [52]. In addition, because of the ceiling to the analgesic properties of buprenorphine and the ability of the drug to block the effects of other opioids used for pain relief, patients receiving longacting opioids for chronic severe pain may not be good candidates for buprenorphine treatment. This phenomenon has significant implications for patients with HIV infection. Pain disorders are more common among patients with HIV disease than among other primary care patients, with the prevalence of painful syndromes ranging from 30% to 97% [53]. In addition, pain is frequently undertreated in patients with HIV infection or AIDS, particularly in those individuals with a history of substance abuse [54, 55]. Clinicians should be knowledgeable about potential medication interactions when managing patients who are receiving concurrent treatment for opioid dependence and HIV infection. Awareness of potential drug interactions between buprenorphine and HIV antiretroviral medications is important Opioid Dependence Treatment CID 2006:43 (Suppl 4) S175

4 for optimizing outcomes by avoiding drug interactions that may lead to suboptimal levels of the HIV medication or buprenorphine, as well as for minimizing adverse events such as toxicity or overdose, although there is a lack of known clinically significant interactions from rigorous clinical studies. In addition, as efforts continue with the goal of integrating buprenorphine into HIV care, further studies will be needed to confirm these interactions. CONCLUSION The clinical manifestations of opioid dependence are caused by neurobiological changes resulting from repeated exposure to opioid compounds. These changes are stabilized by long-acting noneuphorigenic medications, such as methadone and buprenorphine, that bind to m-opioid receptors, thereby preventing withdrawal and blocking the effects of exogenous opioids. These medications are effective in promoting treatment retention, decreasing illicit opioid use, decreasing the risk of HIV transmission, and promoting prosocial activities among opioid-dependent patients. Buprenorphine can serve an important role in the care of HIV-infected, opioid-dependent patients, on the basis of its lessregulated distribution and the current lack of known interactions with antiretroviral medications. Acknowledgments Supplement sponsorship. This article was published as part of a supplement entitled Buprenorphine and HIV Primary Care: New Opportunities for Integrated Treatment, sponsored by the National Institute on Drug Abuse, National Institutes of Health, Public Health Service, US Department of Health and Human Services. Potential conflicts of interest. All authors: no conflicts. References 1. Nestler EJ, Aghajanian GK. Molecular and cellular basis of addiction. Science 1997; 278: Vocci FJ, Acri J, Elkashef A. Medication development for addictive disorders: the state of the science. Am J Psychiatry 2005; 162: Nestler EJ. Basic neurobiology of opiate addiction. In: Stine SM, Kosten TR, eds. New treatments for opiate dependence. New York: The Guilford Press, 1997: Nestler EJ. Molecular mechanisms of drug addiction. Neuropharmacology 2004; 47(Suppl 1): Cami J, Farre M. Drug addiction. N Engl J Med 2003; 349: Collins ED, Kleber HD, Whittington RA, Heitler NE. Anesthesia-assisted vs buprenorphine- or clonidine-assisted heroin detoxification and naltrexone induction: a randomized trial. JAMA 2005; 294: Kakko J, Svanborg KD, Kreek MJ, Heilig M. 1-year retention and social function after buprenorphine-assisted relapse prevention treatment for heroin dependence in Sweden: a randomised, placebo-controlled trial. Lancet 2003; 361: Kosten TR, O Connor PG. Management of drug and alcohol withdrawal. N Engl J Med 2003; 348: O Connor PG. Methods of detoxification and their role in treating patients with opioid dependence. JAMA 2005; 294: Dole VP. A medical treatment for diacetylmorphine (heroin) addiction. JAMA 1965; 193: Dole VP, Nyswander ME, Kreek MJ. Narcotic blockade. Arch Intern Med 1966; 118: National Consensus Development Panel on Effective Medical Treatment of Opiate Addiction. Effective medical treatment of opiate addiction. JAMA 1998; 280: Ball JC, Ross A. The effectiveness of methadone maintenance treatment. New York: Springer-Verlag, Gunne L, Gronbladh L. The Swedish methadone maintenance program: a controlled study. Drug Alcohol Depend 1981; 7: Newman RG, Whitehill WB. Double-blind comparison of methadone and placebo maintenance treatments of narcotic addicts in Hong Kong. Lancet 1979; 2: Hubbard RL, Craddock SG, Flynn PM, Anderson J, Etheridge RM. Overview of 1-year follow-up outcomes in the Drug Abuse Treatment Outcome Study (DATOS). Psychol Addict Behav 1997; 11: Metzger DS, Navaline H, Woody GE. Drug abuse treatment as AIDS prevention. Public Health Rep 1998; 113(Suppl): Metzger DS, Woody GE, McLellan AT, et al. Human immunodeficiency virus seroconversion among intravenous drug users in-and out-oftreatment: an 18-month prospective follow-up. J Acquir Immune Defic Syndr 1993; 6: Sullivan LE, Fiellin DA. Buprenorphine: its role in preventing HIV transmission and improving the care of HIV-infected patients with opioid dependence. Clin Infect Dis 2005; 41: Sullivan LE, Metzger DS, Fudala PJ, Fiellin DA. Decreasing international HIV transmission: the role of expanding access to opioid agonist therapies for injection drug users. Addiction 2005; 100: D Aunno T, Pollack HA. Changes in methadone treatment practices: results from a national panel study, JAMA 2002; 288: D Aunno TD, Vaughn TE. Variations in methadone treatment practices. JAMA 1992; 267: Caplehorn JRM, Bell J. Methadone dosage and retention of patients in maintenance treatment. Med J Aust 1991; 154: Caplehorn JRM, Bell J, Kleinbaum DG, Gebski VJ. Methadone dose and heroin use during maintenance treatment. Addiction 1993; 88: Strain EC, Bigelow GE, Liebson IA, Stitzer ML. Moderate- vs highdose methadone in the treatment of opioid dependence: a randomized trial. JAMA 1999; 281: Strain EC, Stitzer ML, Liebson IA, Bigelow GE. Dose-response effects of methadone in the treatment of opioid dependence. Ann Intern Med 1993; 119: Fiellin DA, O Connor PG. New federal initiatives to enhance the medical treatment of opioid dependence. Ann Intern Med 2002; 137: Fiellin DA, O Connor PG, Chawarski M, Pakes JP, Pantalon MV, Schottenfeld RS. Methadone maintenance in primary care: a randomized controlled trial. JAMA 2001; 286: King VL, Stoller KB, Hayes M, et al. A multicenter randomized evaluation of methadone medical maintenance. Drug Alcohol Depend 2002; 65: Merrill JO, Jackson TR, Schulman BA, et al. Methadone medical maintenance in primary care: an implementation evaluation. J Gen Intern Med 2005; 20: Salsitz EA, Joseph H, Frank B, et al. Methadone medical maintenance (MMM): treating chronic opioid dependence in private medical practice a summary report ( ). Mt Sinai J Med 2000; 67: Schwartz RP, Brooner RK, Montoya ID, Currens M, Hayes M. A 12- year follow-up of a methadone medical maintenance program. Am J Addict 1999; 8: Senay EC, Barthwell AG, Marks R, Boros P, Gillman D, White G. Medical maintenance: a pilot study. J Addict Dis 1993; 12: Drug Addiction Treatment Act of Public Law , title XXXV, sections , Available at: Accessed 6 November Amass L, Bickel WK, Higgins ST, Badger GJ. Alternate-day dosing during buprenorphine treatment of opioid dependence. Life Sci 1994; 54: Fudala PJ, Jaffe JH, Dax EM, Johnson RE. Use of buprenorphine in S176 CID 2006:43 (Suppl 4) Fiellin et al.

5 the treatment of opioid addiction. II. Physiologic and behavioral effects of daily and alternate-day administration and abrupt withdrawal. Clin Pharmacol Ther 1990; 47: Johnson RE, Eissenberg T, Stitzer ML, Strain EC, Liebson IA, Bigelow GE. Buprenorphine treatment of opioid dependence: clinical trial of daily versus alternate-day dosing. Drug Alcohol Depend 1995; 40: Johnson RE, Jaffe JH, Fudala PJ. A controlled trial of buprenorphine treatment for opioid dependence. JAMA 1992; 267: Ling W, Wesson DR, Charuvastra C, Klett CJ. A controlled trial comparing buprenorphine and methadone maintenance in opioid dependence. Arch Gen Psychiatry 1996; 53: Strain EC, Stitzer ML, Liebson IA, Bigelow GE. Buprenorphine versus methadone in the treatment of opioid-dependent cocaine users. Psychopharmacology (Berl) 1994; 116: Kosten TR, Schottenfeld R, Ziedonis D, Falcioni J. Buprenorphine versus methadone maintenance for opioid dependence. J Nerv Ment Dis 1993; 181: Johnson RE, Chutuape MA, Strain EC, Walsh SL, Stitzer ML, Bigelow GE. A comparison of levomethadyl acetate, buprenorphine, and methadone for opioid dependence. N Engl J Med 2000; 343: Ling W, Charuvastra C, Collins JF, et al. Buprenorphine maintenance treatment of opiate dependence: a multicenter, randomized clinical trial. Addiction 1998; 93: Kreek MJ. Drug interactions with methadone in humans. NIDA Res Monogr 1986; 68: Kreek MJ. Opiate-ethanol interactions: implications for the biological basis and treatment of combined addictive diseases. NIDA Res Monogr 1988; 81: Iribarne C, Berthou F, Carlhant D, et al. Inhibition of methadone and buprenorphine N-dealkylations by three HIV-1 protease inhibitors. Drug Metab Dispos 1998; 26: Altice FL, Friedland GH, Cooney EL. Nevirapine induced opiate withdrawal among injection drug users with HIV infection receiving methadone. AIDS 1999; 13: Malaty LI, Kuper JJ. Drug interactions of HIV protease inhibitors. Drug Saf 1999; 20: Bruce RD, McCance-Katz E, Kharasch ED, Moody DE, Morse GD. Pharmacokinetic interactions between buprenorphine and antiretroviral medications. Clin Infect Dis 2006; 43(Suppl 4):S (in this supplement). 50. McCance-Katz EF, Rainey PM, Friedland G, Kosten TR, Jatlow P. Effect of opioid dependence pharmacotherapies on zidovudine disposition. Am J Addict 2001; 10: McCance-Katz EF, Rainey PM, Jatlow P, Friedland G. Methadone effects on zidovudine disposition (AIDS Clinical Trials Group 262). J Acquir Immune Defic Syndr Hum Retrovirol 1998; 18: McCance-Katz EF, Pade P, Friedland G, Morse G, Moody D, Rainey PM. Efavirenz decreases buprenorphine exposure, but is not associated with opiate withdrawal in opioid dependent individuals [abstract 653]. In: Program and abstracts of the 12th Conference on Retroviruses and Opportunistic Infections (Boston). Alexandria, VA: Foundation of Retrovirology and Human Health, Hewitt DJ, McDonald M, Portenoy RK, Rosenfeld B, Passik S, Breitbart W. Pain syndromes and etiologies in ambulatory AIDS patients. Pain 1997; 70: Breitbart W, Rosenfeld, B, Passik SD, Kaim M, Funesti-Esch J, Stein K. A comparison of pain report and adequacy of analgesic therapy in ambulatory AIDS patients with and without a history of substance abuse. Pain 1997; 72: Breitbart W, Rosenfeld BD, Passik SD, McDonald MV, Thaler H, Portenoy RK. The under-treatment of pain in ambulatory AIDS patients. Pain 1996; 65: Opioid Dependence Treatment CID 2006:43 (Suppl 4) S177

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