Molecular Neurobiology

, Volume 44, Issue 3, pp 250–268

Can the Chronic Administration of the Combination of Buprenorphine and Naloxone Block Dopaminergic Activity Causing Anti-reward and Relapse Potential?

Authors

    • Department of Psychiatry and McKnight Brain InstituteUniversity of Florida College of Medicine
    • The National Institute for Holistic Addiction Studies (NIFHAS)
    • G & G Holistic Addiction Treatment Center
    • Department of Clinical NeurologyPath Foundation
    • Dominion Diagnostic Laboratory
    • Department of NutrigenomicsLifeGen, Inc.
    • Centre for Genomics and Applied Gene TherapyInstitute of Integrative Omics and Applied Biotechnology (IIOAB)
  • Thomas J. H. Chen
    • Department of Occupational Safety and HealthChang Jung Christian University
  • John Bailey
    • Department of Psychiatry and McKnight Brain InstituteUniversity of Florida College of Medicine
  • Abdalla Bowirrat
    • Department of Neuroscience and Population GeneticsEMMS Nazareth–The Nazareth Hospital
  • John Femino
    • Meadows Edge Recovery Center
  • Amanda L. C. Chen
    • Department of Engineering and Management of Advanced TechnologyChang Jung Christian University
  • Thomas Simpatico
    • Department of PsychiatryUniversity of Vermont College of Medicine
    • Community Mental Health Institute, Center for Clinical & Translational ScienceUniversity of Vermont
  • Siobhan Morse
    • The National Institute for Holistic Addiction Studies (NIFHAS)
    • G & G Holistic Addiction Treatment Center
  • John Giordano
    • The National Institute for Holistic Addiction Studies (NIFHAS)
    • G & G Holistic Addiction Treatment Center
  • Uma Damle
    • Department of Clinical NeurologyPath Foundation
  • Mallory Kerner
    • Department of Clinical NeurologyPath Foundation
  • Eric R. Braverman
    • Department of Clinical NeurologyPath Foundation
    • Department of Neurological SurgeryWeill Cornell College of Medicine
  • Frank Fornari
    • Dominion Diagnostic Laboratory
  • B. William Downs
    • Department of NutrigenomicsLifeGen, Inc.
  • Cynthia Rector
    • Department of Child and Adult PsychiatryAmerican Behavioral Consultants
  • Debmayla Barh
    • Centre for Genomics and Applied Gene TherapyInstitute of Integrative Omics and Applied Biotechnology (IIOAB)
  • Marlene Oscar-Berman
    • Departments of Psychiatry and Anatomy & NeurobiologyBoston University School of Medicine, and Boston VA Healthcare System
Article

DOI: 10.1007/s12035-011-8206-0

Cite this article as:
Blum, K., Chen, T.J.H., Bailey, J. et al. Mol Neurobiol (2011) 44: 250. doi:10.1007/s12035-011-8206-0

Abstract

Opiate addiction is associated with many adverse health and social harms, fatal overdose, infectious disease transmission, elevated health care costs, public disorder, and crime. Although community-based addiction treatment programs continue to reduce the harms of opiate addiction with narcotic substitution therapy such as methadone maintenance, there remains a need to find a substance that not only blocks opiate-type receptors (mu, delta, etc.) but also provides agonistic activity; hence, the impetus arose for the development of a combination of narcotic antagonism and mu receptor agonist therapy. After three decades of extensive research, the federal Drug Abuse Treatment Act 2000 (DATA) opened a window of opportunity for patients with addiction disorders by providing increased access to options for treatment. DATA allows physicians who complete a brief specialty-training course to become certified to prescribe buprenorphine and buprenorphine/naloxone (Subutex, Suboxone) for treatment of patients with opioid dependence. Clinical studies indicate that buprenorphine maintenance is as effective as methadone maintenance in retaining patients in substance abuse treatment and in reducing illicit opioid use. With that stated, we must consider the long-term benefits or potential toxicity attributed to Subutex or Suboxone. We describe a mechanism whereby chronic blockade of opiate receptors, in spite of only partial opiate agonist action, may ultimately block dopaminergic activity causing anti-reward and relapse potential. While the direct comparison is not as yet available, toxicity to buprenorphine can be found in the scientific literature. In considering our cautionary note in this commentary, we are cognizant that, to date, this is what we have available, and until such a time when the real magic bullet is discovered, we will have to endure. However, more than anything else this commentary should at least encourage the development of thoughtful new strategies to target the specific brain regions responsible for relapse prevention.

Keywords

BuprenorphineDopamineNaloxoneOpioid dependenceRelapseSuboxoneSubutex

Copyright information

© Springer Science+Business Media, LLC 2011