11 March 2011


Adding quetiapine (Seroquel) to naltrexone makes no difference to alcohol abstinence rates 61-72% at 4 months (Guardia et al in Barcelona).

No effect demonstrated in a good quality RCT of acamprosate for cocaine dependence (Kampman, O'Brien et al, Philadelphia).

Simojoki, Linzteris and Finland patients: “.. crushing of Subutex tablets does not significantly alter serum .. levels or the drug’s clinical effect ..”. They say crushing has no effect on dissolution time, contrary to our own experience (some chemists, cooks or clients may also disagree).

Cunningham et al compare buprenorphine induction at home with standard daily clinic initiation, finding some advantages in the home strategy … and few problems. This may be just what we need to reduce early treatment drop-outs for this otherwise excellent drug.

Extensive interviews with over 1000 pharmacotherapy patients show bimodal distribution for many aspects of dependency, indicating two categories of patients which are clinically distinct, justifying the DSM categories or levels of opioid dependence.

Strain et al compare cravings at induction of pure buprenorphine films (non-registered) versus buprenorphine/naloxone soluble-films (sometimes called wafers). It is disappointing that only the latter is being marketed because it is contraindicated in pregnancy yet women with young children are a target for measures against diversion and misuse which are claimed benefits of this formulation.

Pharmacist McNamara and colleagues select patients prescribed methadone for pain treatment and then report a (spurious) association with QT prolongation! Their paper has some interesting information but is no scientific treatise. One ‘high risk’ patient is on 5mg daily! One out of 7 patients died - not of torsade de pointes - but of ‘toxic shock’. Like most such papers, there are no cases of torsade. Nearly all (male) patients had QTc > 430ms BEFORE taking methadone(!). This is similar to Reddy’s paper from the Anderson Cancer Center.

The Iguana column in Addiction has rarely been a high point of scientific publication but this month makes no sense at all, at least to this antipodean reader. p685 [Full citations below]

Dear Colleagues,

These items are sent for your interest. I have not read them all fully but it is nice to see that our research colleagues are still working on basic efficacy trials using various combinations and comparisons. Some of these ‘stand up’ (like the superiority of methadone in pregnancy) while others reverse initial encouragement, such as the use of acamprosate for cocaine cravings. Both positive and negative findings are important to clinicians. The possibility of giving one or two initial doses of buprenorphine to candidates to take away and consume WHEN THEY ARE IN WITHDRAWAL may be a safe and beneficial innovation (Cunningham; Lee).

The first three items are high quality scientific comparisons (RCTs) while the last two items are here despite their poverty of content and rigour.

I hope they are of interest to readers.

Andrew Byrne ..


Guardia J, Roncero C, Galan, J, Gonzalvo B, Burguete T, Casas M. A double-blind, placebo-controlled, randomized pilot study comparing quetiapine with placebo, associated to naltrexone, in the treatment of alcohol-dependent patients. Addictive Behaviors 2011 36;3:265-269

Kampman KM, Dackis C, Pettinati HM, Lynch KG, Sparkman T, O'Brien CP. A double-blind, placebo-controlled pilot trial of acamprosate for the treatment of cocaine dependence. Addictive Behaviors 2011 36;3:217-221

Simojoki K, Lillsunde P, Linzteris N, Alho H. Bioavailability of buprenorphine from crushed and whole buprenorphine (Subutex) tablets. Euro Addiction Res 2010 16;2:85-90

Cunningham CO, Giovanniello A, Li X, Kunins HV, Roose RJ, Sohler NL. A comparison of buprenorphine induction strategies: Patient-centered home-based inductions versus standard-of-care office-based inductions. Journal of Substance Abuse Treatment 2011

Lee JD, Grossman E, DiRocco D, Gourevitch MN. Home buprenorphine/naloxone induction in primary care. Journal of General Internal Medicine 2009 24:226-232

Shand FL, Slade T, Degenhardt L, Baillie A, Nelson EC. Opioid dependence latent structure: two classes with differing severity? Addiction 2011 106:590-598 http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2010.03217.x/abstract

Strain EC, Harrison JA, Bigelow GE. Induction of Opioid-Dependent Individuals Onto Buprenorphine and Buprenorphine/Naloxone Soluble-Films. Clinical Pharmacology and Therapeutics 26th Jan 2011 published on line ahead of print.

McNamara JK, Shinkazh N, Rim F, Zunga R, Cristian A. Methadone-Associated Prolongation of the QTc Interval at Doses Used for Chronic Pain. P&T February 2011 36;2:78-82 [references and conclusion on p107] http://www.nxtbook.com/nxtbooks/medimedia/pt_201102/#/28

News and Notes. Addiction 2011 p685