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Evaluation of Buprenorphine Dosage Adequacy in Opioid Receptor Agonist Substitution Therapy for Heroin Dependence

First Use of the Buprenorphine-Naloxone Dosage Adequacy Evaluation (BUDAVA) Questionnaire

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Abstract

Background: The dosing of opioid receptor agonist medications adequately and on an individual basis is crucial in the pharmacotherapy of opioid dependence. Clinical tools that are able to measure dose appropriateness are sorely needed. The recently developed and validated Opiate Dosage Adequacy Scale (ODAS) comprehensively evaluates the main outcomes relevant for methadone dose optimization, namely relapse, cross-tolerance, objective and subjective withdrawal symptoms, craving and overdose. Based on the ODAS, we developed a new assessment tool (BUprenorphine-naloxone Dosage Adequacy eVAluation [BUDAVA]) for evaluating dosage adequacy in patients in treatment with buprenorphine-naloxone.

Objective: The main goal of this observational study was to explore whether the BUDAVA questionnaire could be used to assess buprenorphine-based, long-term substitution therapy for heroin addiction.

Methods: The study included heroin-dependent patients who had been in treatment with buprenorphine-naloxone for at least 3 months. Patients (n = 196) were recruited from 11 drug abuse treatment centres in Italy. Dosage adequacy was assessed with the BUDAVA questionnaire. Patients classified as inadequately treated had their dosage modified. After 1 week, they were again administered the questionnaire to assess the adequacy of the new dosage.

Results: The buprenorphine-naloxone dosage was found to be inadequate in 61 of the 196 patients. In 13 patients, the treatment scored as inadequate only in the subjective withdrawal symptoms item of the questionnaire and therefore no dosage adjustment was made in the 2 weeks that have characterized this work. The remaining 48 inadequately treated patients had their dosage modified (42 dose increases and six dose decreases). After 1 week on the modified dosage, in 24 of these patients the new regimen was found by the assessment with the questionnaire to be adequate.

Conclusion: These preliminary results suggest that the BUDAVA questionnaire may be useful for guiding buprenorphine-naloxone maintenance dose adjustments in heroin-dependent patients.

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Acknowledgements

We thank Jane Caple of inScience Communications, Springer Healthcare, who provided medical writing assistance and English language editing. This assistance was funded by Reckitt Benkiser.

The authors have no conflicts of interest that are directly relevant to the content of this article.

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Authors and Affiliations

  1. Servizio Tossicodipendenze (SerT), Aversa, Italy

    Antonio D’Amore

  2. SerT, Avellino, Italy

    Filomena Romano

  3. SerT, Benevento, Italy

    Vincenzo Biancolillo

  4. SerT, Capua, Italy

    Guglielmo Lauro

  5. SerT, Cava dei Tirreni, Salerno, Italy

    Ciro Armenante &  Patrizia Amato

  6. SerT, Marcianise, Italy

    Anna Pizzirusso

  7. SerT, Napoli 1, DS 33, Italy

    Salvatore Del Tufo

  8. SerT, Napoli 1, DS 30, Italy

    Ciro Ruoppolo

  9. SerT, Napoli 1, DS 25, Italy

    Francesco Auriemma

  10. SerT, Napoli 3 Sud Pomigliano d’Arco, Italy

    Francesco Cassese

  11. SerT, Salerno, Italy

    Patrizia Oliva

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  1. Antonio D’Amore
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  2. Filomena Romano
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  3. Vincenzo Biancolillo
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  5. Ciro Armenante
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  7. Salvatore Del Tufo
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  8. Ciro Ruoppolo
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  9. Francesco Auriemma
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  10. Francesco Cassese
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  11. Patrizia Oliva
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  12. Patrizia Amato
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Corresponding author

Correspondence to Patrizia Amato.

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D’Amore, A., Romano, F., Biancolillo, V. et al. Evaluation of Buprenorphine Dosage Adequacy in Opioid Receptor Agonist Substitution Therapy for Heroin Dependence. Clin Drug Investig 32, 427–432 (2012). https://doi.org/10.2165/11633230-000000000-00000

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  • DOI: https://doi.org/10.2165/11633230-000000000-00000

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