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Abuse Liability of Suboxone Versus Subutex

NCT ID: NCT00710385

Last Updated: 2016-12-05

Study Results

Results available

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

19 participants

Study Classification

INTERVENTIONAL

Study Start Date

2007-09-30

Study Completion Date

2008-08-31

Brief Summary

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The study is designed to compare the abuse liabilities of intravenous buprenorphine and buprenorphine/naloxone in individuals who are physically dependent on sublingual buprenorphine. We hypothesize that the abuse liability of buprenorphine/naloxone is lower than that of buprenorphine alone.

Detailed Description

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Drug dependence is a major international public health problem of which opioid dependence, notably involving heroin, is a major component. Opioid dependence affects an estimated 13 million injection drug users (IDUs) worldwide. The high health service costs for the treatment of diseases related to non-medical drug use and the high cost to society of drug-related behavior have prompted researchers to seek new medications and treatment strategies for opioid dependence. Buprenorphine, a mu-opiate receptor partial agonist and kappa-opiate receptor antagonist, is one such new medication that has had a significant role in expanding access to effective opioid dependence treatment. It is available as Subutex (buprenorphine alone) or Suboxone (a combination of buprenorphine and naloxone). Although it is commonly believed that the abuse potential of buprenorphine is low, numerous countries have reported illicit diversion of buprenorphine and a growing population of buprenorphine abusers. Theoretically, Suboxone would have lower abuse potential. When used sublingually, as prescribed, the amount of naloxone absorbed is negligible. However, if a patient crushes the tablet and attempts to inject or sniff the medication, the naloxone will become effective as an opioid antagonist and may precipitate withdrawal signs and symptoms in individuals dependent on full opioid agonists and/or attenuate the euphoric effects of the buprenorphine that is also contained in the medication. To date, few laboratory studies have evaluated the abuse liability of buprenorphine in humans using a drug self-administration protocol. We are proposing to evaluate the abuse potential of intravenous (IV) buprenorphine compared to IV buprenorphine/naloxone in buprenorphine-maintained injection drug users (IDUs), incorporating self-administration procedures with other measures of opioid effects. The proposed study will investigate the conditions that affect the self-administration of IV buprenorphine by buprenorphine abusers. The primary aim of the study is to compare the reinforcing effects of IV buprenorphine and IV buprenorphine/naloxone in IDUs maintained on different doses of sublingual buprenorphine (2, 8, and 24 mg/day). Secondary aims of the study are to compare the subjective, performance and physiological effects of IV buprenorphine and IV buprenorphine/naloxone. IV-administered placebo (saline), naloxone alone, and heroin alone will be tested as neutral, negative, and positive control conditions, respectively. Participants (N=12 completers) will reside on an inpatient unit (the General Clinical Research Unit, GCRU) during a 7 to 8-week study. This research will provide useful information for clinicians treating opioid dependent individuals with buprenorphine, and importantly, will provide information about the abuse potential and effects of buprenorphine on multiple measures of human functioning.

Conditions

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Opioid-related Disorders

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Primary Study Purpose

BASIC_SCIENCE

Blinding Strategy

DOUBLE

Participants Outcome Assessors

Study Groups

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Heroin

Heroin 25 mg. Administered intravenously, while participants were under 2, 8 and 24 sublingual (SL) Bup maintenance conditions.

Group Type ACTIVE_COMPARATOR

Heroin

Intervention Type DRUG

Heroin (25 mg)

Naloxone

Naloxone (NAL) .4 mg. Administered intravenously, while participants were under 2, 8 and 24 sublingual (SL) Bup maintenance conditions.

Group Type ACTIVE_COMPARATOR

Naloxone

Intervention Type DRUG

.4 mg

Low Bup Dose

Combined dosing groups of (4 mg and 8mg of Buprenorphine) for participants who administered a maximum of 8 mg of Bup during the qualification phase. Administered intravenously, while participants were under 2, 8 and 24 sublingual (SL) Bup maintenance conditions.

Group Type EXPERIMENTAL

Low Bup Dose

Intervention Type DRUG

4 and 8 mg

Low Bup/Nal Dose

Combined dosing groups of (4/1 mg and 8/2mg of Buprenorphine + Naloxone) for participants who administered a maximum of 8 mg of Bup during the qualification phase. Administered intravenously, while participants were under 2, 8 and 24 sublingual (SL) Bup maintenance conditions.

Group Type EXPERIMENTAL

Low Bup/Nal Dose

Intervention Type DRUG

Buprenorphine/Naloxone 4/1 mg, 8/2 mg

High Bup Dose

Combined dosing groups of (8mg and 16mg of Bup) for participants who administered a maximum of 16 mg of Bup during the qualification phase. Administered intravenously, while participants were under 2, 8 and 24 sublingual (SL) Bup maintenance conditions.

Group Type EXPERIMENTAL

High Bup Dose

Intervention Type DRUG

8mg and 16 mg

High Bup/Nal Dose

Combined dosing groups of (8/2mg and 16/4mg of Buprenorphine + Naloxone) for participants who administered a maximum of 16 mg of Bup during the qualification phase. Administered intravenously, while participants were under 2, 8 and 24 sublingual (SL) Bup maintenance conditions.

Group Type EXPERIMENTAL

High Bup/Nal Dose

Intervention Type DRUG

Buprenorphine/Naloxone 8/2 mg, 16/4 mg

Placebo

Intravenous placebo (PCB) administration. Administered intravenously, while participants were under 2, 8 and 24 sublingual (SL) Bup maintenance conditions.

Group Type PLACEBO_COMPARATOR

Placebo (PCB)

Intervention Type DRUG

Placebo control administration

Interventions

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Heroin

Heroin (25 mg)

Intervention Type DRUG

Naloxone

.4 mg

Intervention Type DRUG

Low Bup Dose

4 and 8 mg

Intervention Type DRUG

High Bup Dose

8mg and 16 mg

Intervention Type DRUG

Low Bup/Nal Dose

Buprenorphine/Naloxone 4/1 mg, 8/2 mg

Intervention Type DRUG

High Bup/Nal Dose

Buprenorphine/Naloxone 8/2 mg, 16/4 mg

Intervention Type DRUG

Placebo (PCB)

Placebo control administration

Intervention Type DRUG

Other Intervention Names

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Diacetylmorphine Naloxone Hydrochloride (HCl) Subutex Subutex Suboxone Suboxone 0 mg

Eligibility Criteria

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Inclusion Criteria

* Diagnostic and Statistical Manual (DSM) IV criteria for heroin dependence
* No major mood, psychotic, or anxiety disorder
* Physically healthy
* Able to perform study procedures
* 21-45 years of age
* Normal body weight
* Current use of i.v. opioids in amounts and/or frequencies that meet or exceed those used in the proposed study (1-2 bags of heroin per occasion at least twice per day)
* Self-administer at least 4 mg i.v. buprenorphine above placebo levels during the dose run up phase

Exclusion Criteria

* DSM IV criteria for dependence on drugs other than opioids, nicotine or caffeine
* Participants requesting treatment
* Participants on parole or probation
* Pregnancy or lactation
* Birth, miscarriage or abortion within 6 months
* Current or recent history of significant violent behavior
* Current major Axis I psychopathology, other than opioid dependence (e.g., mood disorder with functional impairment or suicide risk, schizophrenia), that might interfere with ability to participate in the study
* aspartate aminotransferase (AST) or alanine aminotransferase (ALT) \> 3 times the upper limit of normal
* Significant suicide risk
* Current chronic pain
* Sensitivity, allergy, or contraindication to opioids
* Current or recent (past 30 days) physical dependence on or treatment with methadone, buprenorphine, or the buprenorphine/naloxone combination
Minimum Eligible Age

21 Years

Maximum Eligible Age

45 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Schering-Plough

INDUSTRY

Sponsor Role collaborator

New York State Psychiatric Institute

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Sandra D Comer, PhD

Role: PRINCIPAL_INVESTIGATOR

Columbia University/New York State Psychiatric Institute

Locations

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New York State Psychiatric Institute/Columbia University

New York, New York, United States

Site Status

Countries

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United States

References

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Comer SD, Sullivan MA, Vosburg SK, Manubay J, Amass L, Cooper ZD, Saccone P, Kleber HD. Abuse liability of intravenous buprenorphine/naloxone and buprenorphine alone in buprenorphine-maintained intravenous heroin abusers. Addiction. 2010 Apr;105(4):709-18. doi: 10.1111/j.1360-0443.2009.02843.x.

Reference Type RESULT
PMID: 20403021 (View on PubMed)

Other Identifiers

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5518

Identifier Type: -

Identifier Source: org_study_id