combination buprenorphine and naloxone was introduced to help eliminate diversion and IV use of buprenorphine (1)
combination is supposed to have a lower IV abuse potential than buprenorphine alone
sublingual tablet combining buprenorphine and naloxone in a 4:1 ratio (Suboxone) has been developed (2)
taken as directed (sublingually), the naloxone component is not clinically active and so Suboxone is as efficacious as buprenorphine alone (3,4)
when injected the naloxone is clinically active and is likely to precipitate withdrawal in opioid-dependent patients (3)
however a survey of IV drug abusers revealed that 68% of the respondents had tried IV buprenorphine + naloxone and 66% of those who tried it, took it again or even regularly (1)
may indicate that combining naloxone with buprenorphine does not block all agonist effects when used IV
however, the continued usage of the combination product might reflect the fact that the study population was from a needle exchange program accustomed to using drugs IV, and the habit may not have been extinguished by a few non-reinforced attempts
this conclusion is supported by the finding that 80% reported that they had a 'bad' experience with the combination product, while less than 20% reported it 'similar' to experiences with IV buprenorphine
consistent with this finding, respondents were willing to pay a significantly higher street price for buprenorphine than for the combination product
the study authors concluded that treating heroin misuse with the combination buprenorphine + naloxone, could reduce the number using buprenorphine IV on the street (1)
Reference:
Alho H et al. Abuse liability of buprenorphine-naloxone tablets in untreated IV drug users. Drug Alcohol Depend. 2006.
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