A recent clinical breakthrough in the treatment of opiate addiction has been the development of Buprenorphine for the treatment of opiate withdrawal symptoms. Buprenorphine is a synthetic medication that has both opiate and "anti-opiate" properties. When administered to the patient undergoing opiate withdrawal symptoms, it rapidly reduces and often eliminates those symptoms within an hour. Previously, withdrawal meant 3 - 6 days of severe muscle aching and spasm, profuse sweating, abdominal cramping and diarrhea. With Buprenorphine these symptoms are essentially avoided, while the patient is gradually tapered on decreasing doses of the medication over a period of one to several weeks (depending on such variables as the duration and intensity of the patient's previous dependency, physical health, and degree of motivation).
Buprenorphine's opiate-like properties allow it to be substituted for the patient's previous addictive opiate medication(s), while itself providing essentially no sedation, euphoria or other 'dangerously reinforcing' effects. In addition, larger amounts can be taken (even overdoses) with no increased effect and no reduction or loss of consciousness. (In this respect it is distinctly safer than methadone, which has historically been used in similar settings.)
Notably, while Buprenorphine is being used, no other opiate will have any effect -- oxycontin, morphine, even heroin cannot replace it from nerve receptors, thus minimizing, to some degree, the risk of sudden or impulsive return to opiate use.
Finally, one great advantage of this medication in the treatment setting concerns use of the patient's time. Instead of 3 - 6 days bedridden in anguish, patients instead can almost immediately begin attending recovery groups and practicing the non-pharmacologic techniques of stretching, deep-breathing, visualization and meditation, which become dramatically more effective in the slowly detoxing, non-sedated, newly motivated patient.
One of the obstacles to patients seeking treatment for opiate addiction, has been the debilitating withdrawal - the prospect of which is so abhorrent that the addict would rather break the law and seek the drug than commit to a treatment program. Now that we can offer such patients a significantly more comfortable, manageable detox experience, we are confident we'll see better recovery rates and continuing success stories with this group.
Methadone has been studied as a therapy for cancer pain and other chronic pain states. It is an appropriate replacement opioid when pain remains poorly controlled or when side effects of other opioids limit dosage escalation. Available data suggest that methadone is effective in relieving cancer pain and has a similar analgesic efficacy and side effect profile to morphine.
In a study of cancer patients with uncontrolled pain or significant side effects from opioids, 80 percent of patients reported improvement in pain control and reduction of adverse effects following transition to methadone. It may be used in patients with morphine allergy because methadone is synthetic and offers no cross-allogenicity. However, a 2004 Cochrane Review stated several considerations in evaluating trials of methadone for cancer pain. The majority of studies reviewed involved single-dose comparisons or short-term use, which does not adequately represent clinical practice.
Therefore, there is a highly significant danger that the trials do not reflect delayed adverse effects from methadone accumulation during chronic administration. The same review reported there is no trial evidence to support the proposal that methadone has a particular role in neuropathic pain of malignant origin.