Abstract
Rationale
Buprenorphine may be a useful alternative option to methadone in addicts. Opioids can produce severe changes in the immune system.
Objectives
The objectives of this study are to compare the effect of sublingual buprenorphine and methadone on the immune system and to compare the two substances on the drying-out program compliance.
Methods
We studied 62 randomized outpatients for a period of 12 months. Subjects (55 males and 7 females; mean age 25±4 years; average history of heroin abuse being 2 years) on maintenance treatment were assigned in two groups (A and B). Methadone chloride (medium dose 100 mg/day) was administered to group A, whereas group B received sublingual buprenorphine (32.40±2.8 mg/day). Urine toxicological screening, plasma levels of TNF-alpha interleukin-1, interleukin-beta, lymphocyte CD14 and a self-rating depression questionnaire were measured.
Results
Urine screening was negative for opiates in 17.6% of group A and in 10.7% of group B (p<0.001; r=0.62). Depression score was 62±2 in group A and 55±3 in group B (p<0.01). Cytokine and CD14 revealed higher concentrations both in groups A and B without significant differences (p>0.05) between the two groups.
Conclusions
The effects of buprenorphine and methadone tested on the immune system were overlapping in our patients. The elevated cytokine levels observed may suggest that the two drugs stimulate immunologic hyperactivation of an immune system that was formerly inhibited by heroin. Furthermore, our data suggest that buprenorphine can be a valid alternative to methadone in maintenance treatment of chronic heroin abuse and referred a marked decline in depression.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Auriacombe M, Franques P, Tignol J (2001) Deaths attributable to methadone vs buprenorphine in France. JAMA 285:45
Curran HV, Bolton J, Wanigaratne S, Smyth C (1999) Additional methadone increases craving for heroin: a double blind, placebo controlled study of chronic opiate users receiving methadone substitution treatment. Addiction 94:665–674
Greenwald MK, Joanson CF, Moody DE, Kilbown MR, Koeppe RA, Schuster CR, Zubieta JK (2003) Effects of buprenorphine maintenance dose on μ-opioid receptor availability, plasma concentrations, and antagonist blockade in heroin-dependent volunteers. Neuropsychopharmacology 28:2000–2009
Johnson RE, Chutuape MA, Strain EC, Walsh SL, Stitzer ML, Bigelow CE (2000) A comparison of buprenorphine and methadone for opiate dependence. N Engl J Med 343:1290–1297
Kakko J, Svanborg KD, Kreek MJ, Heilig M (2003) 1-Year retention and social function after buprenorphine-assisted relapse prevention treatment for heroin dependence in Sweden: a randomized, placebo-controlled trial. Lancet 361:662–668
Kreek MJ (1996) Long-term pharmacotherapy for opiate addiction: opioid agonists. In: Schuster CR, Kuhar MJ (eds) Pharmacological aspects of drug dependence, vol. 118. Springer, Berlin Heidelberg New York, pp 487–562
Krook AL, Brors O, Dahlberg J, Grouff K, Magnus P, Roysamb et al (2002) A placebo-controlled study of high dose buprenorphine in opiate dependents waiting for medication-assisted rehabilitation in Oslo, Norway. Addiction 97(5):533–542
Neri S, Bruno CM, Abate G, Ierna D, Mauceri B, Cilio D et al (2002) Controlled clinical trial of assess the response of recent heroin abusers with chronic hepatitis C virus infection to treatment with interferon alpha-n2b. Clin Ther 24(10):1627–1635
Obadia Y, Perrin V, Feroni I, Vlahov D, Moatti JP (2001) Injecting misuse of buprenorphine among French drug users. Addiction 96:267–272
O’Connor PG, Fiellin DA (2000) Pharmacological treatment of heroin-dependent patients. Ann Intern Med 133:40–54
Pacifici R, Di Carlo S, Bacosi A et al (2000) Pharmaceutics and cytokine production in heroin and morphine-treated mice. Int J Immunopharmacol 22:603–614
Peterson PK, Molitor TW, Chao CC (1993) Mechanisms of morphine-induced immunomodulation. Biochem Pharmacol 46:343–348
Roy S, Loh HH (1996) Effects of opioids on the immune system. Neurochem Res 21:1375–1386
Varescon I, Vidal-Trecan G, Nabet N, Boissonnas A (2002) Buprenorphine deviated from normal use: the buprenorphine injection. Encephale 28:397–402
Vidal-Trevan G, Varescon I, Nebert N, Boissonnes A (2003) Intravenous use of prescribed sublingual buprenorphine tablets by drug user receiving maintenance therapy in France. Drug Alcohol Depend 69:175–181
West JP, Lysle DT, Dykstra LA (1997) Tolerance development to morphine-induced alterations of immune status. Drug Alcohol Depend 45:147–157
Willmann K, Dunne JF (2000) A flow cytometric immune function assay for human peripheral blood dendritic cells. J Leukoc Biol 67:536–544
Zung WWK (1965) A self-rating depression scale. Arch Gen Psychiatry 12:63–70
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Neri, S., Bruno, C.M., Pulvirenti, D. et al. Randomized clinical trial to compare the effects of methadone and buprenorphine on the immune system in drug abusers. Psychopharmacology 179, 700–704 (2005). https://doi.org/10.1007/s00213-005-2239-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00213-005-2239-x