Some odds and ends about opiates

Case report of 3 patients showing cessation of intrathecal opiates causes withdrawal similar to other opiates and can be treated with similar protocols. These authors gave clonidine  for CIWA > 8 and IM buprenorphine for CIWA > 15.

Pain Pract. 2012 Aug 28.
Intentional Intrathecal Opioid Detoxification in 3 Patients: Characterization of the Intrathecal Opioid Withdrawal Syndrome.
Jackson TP, Lonergan DF, Todd RD, Martin PR.
Vanderbilt University Medical Center, Nashville, Tennessee
PMID: 22925591

---

Not much LFT elevation with either methadone or buprenorphine

1269 patients randomized to either methadone or buprenorhine.  9 BUP and 15 MET participants showed extreme liver test elevations. These were attributed to hepatitis B and C during the study, or to active illicit drugs use during the first 8 weeks of treatment. They did note methadone patients were retained longer in treatment than buprenorphine patients.

Drug Alcohol Depend. 2012 Aug 22
Buprenorphine/Naloxone and methadone effects on laboratory indices of liver health: A randomized trial.
Saxon AJ, Ling W, Hillhouse M, Thomas C, Hasson A, Ang A, Doraimani G, Tasissa G, Lokhnygina Y, Leimberger J, Bruce RD, McCarthy J, Wiest K, McLaughlin P, Bilangi R, Cohen A, Woody G, Jacobs P.
Veteran's Affairs Puget Sound Health Care System, Seattle, WA 98108
PMID: 22921476

---

A nice review of the treatment of opiate dependence in pregnancy

Psychosomatics. 2012 Aug 14. [Epub ahead of print]
Evaluation and Management of Opioid Dependence in Pregnancy.
Park EM, Meltzer-Brody S, Suzuki J.
Department of Psychiatry, University of North Carolina, Chapel Hill, NC.
PMID: 22902085

---

Sci Transl Med. 2012 Aug 8;4(146):146ra110.
A combination of buprenorphine and naltrexone blocks compulsive cocaine intake in rodents without producing dependence.
Wee S, Vendruscolo LF, Misra KK, Schlosburg JE, Koob GF.
Committee on the Neurobiology of Addictive Disorders, The Scripps Research Institute, La Jolla, CA 92037, USA.
PMID: 22875830

The authors find that giving buprenorphine together with full dose naltrexone blocks cocaine use, presumably due to kappa antagonism

Buprenorphine has potent μ opioid receptor partial agonist actions and κ opioid receptor antagonist actions. As a result, we hypothesized that the potent κ opioid receptor antagonist action of buprenorphine may decrease compulsive cocaine seeking. However, one major concern with the use of buprenorphine is that its μ agonist action during prolonged treatment may result in opioid dependence in previously non–opioid-dependent cocaine abusers. One way to minimize this effect would be to attenuate the μ action of buprenorphine by coadministering a μ receptor antagonist such as naltrexone. Naltrexone is a highly potent μ opioid antagonist with weaker δ and κ antagonist properties. 

There is an ongoing trial testing this in humans now.  Seattle's own RCKC is a study site.