Buprenorphine and Naloxone
for Heroin Dependence

Johnson RE, McCagh JC
Johns Hopkins University School of Medicine,
Department of Psychiatry and Behavioral Sciences,
5510 Nathan Shock Drive,
Baltimore, Maryland 21224, USA.
Curr Psychiatry Rep 2000 Dec;2(6):519-526


The pharmacology of buprenorphine is unique because of its partial agonist profile at the mu-opioid receptor (ie, high affinity, low intrinsic activity and slow dissociation). This unique profile results in greater safety, less physical dependence, and greater flexibility in dose scheduling. Buprenorphine has been investigated in combination with the opioid antagonist, naloxone, with the goal of decreasing abuse, misuse, and diversion. When combined with naloxone in a sublingual tablet, buprenorphine has been shown to be effective 1) in retaining patients in treatment, 2) in reducing opioid use and craving, and 3) when dosed less-than-daily. The pharmacologic effects of buprenorphine are not altered by the addition of naloxone when administered to the population in an appropriate combination ratio. However, if taken intravenously by individuals dependent on short- or long-acting opioids a precipitated withdrawal syndrome is observed, which should reduce its abuse potential. This review discusses the rationale for development and evidence supporting the use of a buprenorphine/naloxone combination product. The buprenorphine/naloxone combination product should be considered for use in primary care office-based settings as a safe and effective treatment that is likely to increase the availability of agonist treatment for opioid dependence.
LAAM v methadone
Subutex and Suboxone
Opioids and depression
Buprenorphine and reward
Buprenorphine and naltrexone
Buprenorphine and the receptors
Buprenorphine for speedball users
Buprenorphine as an antidepressant
Buprenorphine : behavioral pharmacology
Buprenorphine versus methadone or placebo
Buprenorphine versus buprenorphine/nalaxone

and further reading

Future Opioids
BLTC Research
Utopian Surgery?
The Abolitionist Project
The Hedonistic Imperative
The Reproductive Revolution
Critique of Huxley's Brave New World

The Good Drug Guide
The Good Drug Guide

The Responsible Parent's Guide
To Healthy Mood Boosters For All The Family