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      A Retrospective Survey of Buprenorphine Substitute Treatment With Minimal Dosage in Heroin Use Disorder

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          Objectives: It is widely accepted that buprenorphine maintenance treatment (BMT) with dosages above 8 mg daily is effective for patients with heroin use disorder. In this study, the authors evaluated the effectiveness of long-term BMT for heroin users in China, with dosages kept on a much smaller level.

          Methods: This is a retrospective observational study of 72 patients who had undergone detoxification and continued with buprenorphine maintenance between 2007 and 2016. Measurements such as self-reported relapse status, buprenorphine doses, protracted symptoms, general health condition, and self-reported side effects were included.

          Results: At the time of interview, 51 patients had remained abstinent at follow-up (including 13 who were opioid-free). The dosages of buprenorphine were 1.33 ± 0.88 (ranging 0.3–3.5) mg/day when maintenance treatment was initiated and 1.2 ± 0.8 (ranging 0.2–3.2) mg/day at the last follow-up. The remaining patients had either relapsed on heroin (n = 11) or switched to compulsory treatment (n=10). In general, abstinent patients had minimal protracted symptoms, especially in physical symptoms. Opioid-free abstainers were more likely to report good physical health than patients on buprenorphine. Predictors of worse outcomes (relapsed or switched to compulsory treatment) were lower education levels, younger age, and younger onset of illicit drug use.

          Conclusions: This study shows promising results of minimal-dosage BMT in treating heroin use disorder. We recommend further studies applying minimal-dosage BMT in China and worldwide.

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          Most cited references 30

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          Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence

          Cochrane Database of Systematic Reviews
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            Addiction is a Reward Deficit and Stress Surfeit Disorder

             George F Koob (2013)
            Drug addiction can be defined by a three-stage cycle – binge/intoxication, withdrawal/negative affect, and preoccupation/anticipation – that involves allostatic changes in the brain reward and stress systems. Two primary sources of reinforcement, positive and negative reinforcement, have been hypothesized to play a role in this allostatic process. The negative emotional state that drives negative reinforcement is hypothesized to derive from dysregulation of key neurochemical elements involved in the brain reward and stress systems. Specific neurochemical elements in these structures include not only decreases in reward system function (within-system opponent processes) but also recruitment of the brain stress systems mediated by corticotropin-releasing factor (CRF) and dynorphin-κ opioid systems in the ventral striatum, extended amygdala, and frontal cortex (both between-system opponent processes). CRF antagonists block anxiety-like responses associated with withdrawal, block increases in reward thresholds produced by withdrawal from drugs of abuse, and block compulsive-like drug taking during extended access. Excessive drug taking also engages the activation of CRF in the medial prefrontal cortex, paralleled by deficits in executive function that may facilitate the transition to compulsive-like responding. Neuropeptide Y, a powerful anti-stress neurotransmitter, has a profile of action on compulsive-like responding for ethanol similar to a CRF1 antagonist. Blockade of the κ opioid system can also block dysphoric-like effects associated with withdrawal from drugs of abuse and block the development of compulsive-like responding during extended access to drugs of abuse, suggesting another powerful brain stress system that contributes to compulsive drug seeking. The loss of reward function and recruitment of brain systems provide a powerful neurochemical basis that drives the compulsivity of addiction.
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              History and development of mixed opioid agonists, partial agonists and antagonists.

               WR Martin (1979)

                Author and article information

                Front Psychiatry
                Front Psychiatry
                Front. Psychiatry
                Frontiers in Psychiatry
                Frontiers Media S.A.
                04 December 2019
                : 10
                1Ningbo Addiction Research and Treatment Center, Zhejiang Provincial Key Lab. of Addiction, Ningbo University School of Medicine , Ningbo, China
                2Ningbo University School of Medicine , Ningbo, China
                3Vivantes Wenckebach-Klinikum, Klinik für Psychiatrie, Psychotherapie und Psychosomatik , Berlin, Germany
                Author notes

                Edited by: Carlos Roncero, University of Salamanca Health Care Complex, Spain

                Reviewed by: Francina Fonseca, Parc de Salut Mar, Spain; Chiara Montemitro, G. d’Annunzio University of Chieti and Pescara, Italy

                This article was submitted to Addictive Disorders, a section of the journal Frontiers in Psychiatry

                Copyright © 2019 Shen, Wang, Zhang, Ping, Zhang, Ye, Hu, Cerci and Zhou

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                Page count
                Figures: 3, Tables: 3, Equations: 0, References: 34, Pages: 8, Words: 4660
                Funded by: Natural Science Foundation of Ningbo Municipality 10.13039/501100005315
                Award ID: 2017A610224
                Funded by: National Natural Science Foundation of China 10.13039/501100001809
                Original Research


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