Rapid effect of a single-dose buprenorphine on reduction of opioid craving and suicidal ideation: A randomized, double blind, placebo-controlled study

OBJECTIVE: Opioid use disorder is a prevalent addiction problem that can be treated with buprenorphine, but dependence, diversion, and abuse of buprenorphine occur. Although including naloxone reduces these problems, the combination formulation is not available worldwide. The administration of the medication under supervision may also be useful in decreasing unintended uses of the medication. The objective is to assess the influence of a single, physician-administered dose of buprenorphine on withdrawal craving and suicidal ideation in opioid-dependent patients over a period of 4 days of abstinence from opioids. MATERIALS AND METHODS: Sixty-one men who used heroin, opium, or prescription opioids and met Diagnostic and Statistical Manual of Mental Disorders Five Edition criteria for opioid use disorder were randomized to receive a single, sublingual dose of buprenorphine (16 mg, 32 mg, or placebo; n's = 20, 20, and 21 per group). The study was carried out in an inpatient psychiatric ward, with appropriate precautions and monitoring of cardiovascular and respiratory measures. Buprenorphine was administered when the patients were in moderate opioid withdrawal, exhibiting four to five symptoms. Self-reports of craving (The Opioid Craving Scale) and suicidal ideation (Beck Scale for Suicidal Ideation) were taken at baseline and on each of the 4 days after treatment. RESULTS: The group did not differ significantly on demographic features, and all of the patients completed the 4-day study. Craving was reduced from baseline during the observation period in each of the three groups, demonstrating a significant effect of treatment (P < 0.0005), and the dose-by-time interaction (P < 0.0005). Both 32 mg and 16 mg groups differed significantly from the placebo group. No significant differences were observed between the 32 and 16 mg groups, suggesting that the maximal effect on craving reduction was achieved with the 16-mg dose. Suicidal ideation was decreased from baseline during the observation period in each of the three groups, demonstrating a significant effect of treatment (P < 0.0005), and the dose-by-time interaction (P < 0.017).The 32 mg group differed significantly from the placebo group. No significant differences were observed between the 16 and placebo groups, suggesting that the maximal effect on suicidal ideation reduction was achieved with the 32 mg dose. CONCLUSIONS: A single high dose of 16 mg or 32 mg buprenorphine reduces opioid craving, but a single high dose of only 32 mg buprenorphine reduces suicidal ideation.