Selective review and commentary on emerging pharmacotherapies for opioid addiction

Abstract

Pharmacotherapies for opioid addiction under active development in the US include lofexidine (primarily for managing withdrawal symptoms) and Probuphine®, a distinctive mode of delivering buprenorphine for six months, thus relieving patients, clinicians, and regulatory personnel from most concerns about diversion, misuse, and unintended exposure in children. In addition, two recently approved formulations of previously proven medications are in early phases of implementation. The sublingual film form of buprenorphine + naloxone (Suboxone®) provides a less divertible, more quickly administered, more child-proof version than the buprenorphine + naloxone sublingual tablet. The injectable depot form of naltrexone (Vivitrol®) ensures consistent opioid receptor blockade for one month between administrations, removing concerns about medication compliance. The clinical implications of these developments have attracted increasing attention from clinicians and policymakers in the US and around the world, especially given that human immunodeficiency virus/acquired immunodeficiency syndrome and other infectious diseases are recognized as companions to opioid addiction, commanding more efforts to reduce opioid addiction. While research and practice improvement efforts continue, reluctance to adopt new medications and procedures can be expected, especially considerations in the regulatory process and in the course of implementation. Best practices and improved outcomes will ultimately emerge from continued development efforts that reflect input from many quarters.

Keywords:

• buprenorphine
• naltrexone
• probuphine
• lofexidine
• implant buprenorphine
• buprenorphine film

Acknowledgments

The preparation of this article was supported in part by a National Institute on Drug Abuse grant to WL (U10 DA 013045 Clinical Trials Network Pacific Region Node) and a National Institute on Drug Abuse INVEST/Clinical Trials Network fellowship to SN.

Disclosure

WL has received unrestricted education grants from Reckitt/Benckiser and research support from Reckitt/Benckiser and Hythiam Inc, and has also served as an occasional consultant to Reckitt/Benckiser, Titan Pharmaceuticals, US World Med Inc, Alkermes, and DemeRx. MT has in the past participated in the Reckitt/Benkiser “treatment advocate” program. SN has in the past worked on an unrestricted educations grant from Reckitt/Benckiser. KM has received an honorarium from Reckitt/Benckiser. The other authors have no disclosures to report.