Buprenorphine dosing choices in specific populations: review of expert opinion

ABSTRACT

Introduction: Treatment of opioid dependence with buprenorphine improves outcomes. Typical dosing ranges for all patients from clinical evidence and as defined in the product information are wide. For specific groups with complex clinical scenarios, there is no clear consensus on dosing choices to achieve best possible outcomes.

Areas covered: The doses of buprenorphine used in 6 European countries was reviewed. A review of published evidence supported rapid induction with buprenorphine and the benefits of higher doses but did not identify clearly useful guidance on dosing choices for groups with complex clinical scenarios. An expert group of physicians with experience in addiction care participated in a discussion meeting to share clinical practice experience and develop a consensus on dosing choices.

Expert opinion: There was general agreement that treatment outcomes can be improved by optimising buprenorphine doses in specific subgroups. Specific groups in whom buprenorphine doses may be too low and who could have better outcomes with optimised dosing were identified on the basis of clinical practice experience. These groups include people with severe addiction, high tolerance to opioids, and psychiatric comorbidities. In these groups it is recommended to review dosing choices to ensure buprenorphine dosing is sufficient.

KEYWORDS:

• Buprenorphine
• dosing
• opioid dependence
• special groups

Declaration of interest

All authors were sponsored to attend the Expert Faculty meeting and received an honorarium for their participation. I Maremmani served as board member for Indivior, Molteni, Mundipharma, D&A Pharma, Lundbeck, Gilead and Merk Sharp & Dohme. B Rolland has occasional financial relationships with Bouchard-Recordati, Indivior, Lundbeck, Ethypharm, Jansen-Cliag, Bristol-Myers Squibb, Astra-Zeneca and Servier. L Somaini has served as a consultant/advisory board member for Molteni Farmaceutici, Bruno Farmaceutici and Indivior. C Roncero received lecture fees from: Janssen-Cilag, Bristol-Myers Squibb, Ferrer-Brainfarma, Pfizer, Indivior, Lundbeck, Otsuka, Servier, Lilly, GlaxoSmithKline, Rovi and Astra. He has also received financial compensation for his participation as a member of the Janssen-Cilag, Lilly, and Gilead board and carried out the PROTEUS project, which was funded by a grant from Reckitt-Benckiser/Indivior. J Reimer has acted as advisor to Bristol-Myers Squibb and Gilead; received study grants from: AbbVie, Bristol-Myers Squibb and Janssen-Cilag: and has participated in a speakers bureau for: AbbVie and Gilead. R Littlewood is the founder of Applied Strategic, a strategic firm working for pharmaceutical companies and healthcare providers. Has worked for healthcare providers, commissioners and pharmaceutical companies in the therapy area. H Alho received grant/research support from the National Institute of Health and Welfare, Finnish Foundation for Alcohol Research, S. Juselius Foundation, Ministry of Social Affairs and Health, Finland; has acted as a consultant/been on the advisory board for H Lundbeck, Indivior PLC, Mundipharma Inc, Actavis, Novartis; and have been on the speaker bureau for H Lundbeck, Indivior PLC and Profession Inc. O. D’Agnone has served as a board member for Indivior, Lundbeck, and Britannia. N Simon has acted as a consultant for: Lundbeck, Ethypharm and Indivior.

Additional information

Funding

The authors gratefully acknowledge financial support from Indivior Ltd in support of this work (meeting attendance) and in support of professional editorial assistance for the production of this manuscript. The manuscript represents the work of the authors with editorial assistance from applied strategic. Indivior Ltd have not reviewed the manuscript or had any other influence on its content.