Les Rencontres de Biarritz 2007 - THS 10

A NEW PROTOCOL TO FACILITATE THE TRANSFER FROM METHADONE MAINTE-
NANCE THERAPY TO BUPRENORPHINE WITH AN INTERMEDIATE OPIATE
(MIOB-PROTOCOL)
RÉSUMÉ / ABSTRACT
RIESEN J
PIHET S
PAUCHARD E
UEHLINGER C
Buprenorphine as an alternative to methadone maintenance is for now an established treatment
for opioide dependence. However, even if an uncomplicated switching to buprenophine
for patients with low dose methadone treatment is possible, treatments with high dose methadone
have been still requiring a previous dose reduction before the transfer. Thus, to provide
the utmost possibilities for opioid dependent patients, an easy and secure protocol has been
developed, without previous dosage reduction. Nevertheless, a critical discussion is given for
the application of such a procedure and its restrictions on the addicto-psychological level.
Recruitment and methods
Subjects: patients willing to change to buprenorphine, under methadone maintenance treatment
with fixed dosage for at least 2 weeks and dosages from 40mg and higher {80mg and
higher}.
Method: according to the MIOB-protocol (Methadone-IntermediateOpiate-Buprenorphine-protocol):
At first the patients were switched to the methadone-equivalent dose of a short acting opiate
for 24 hours {48 hours for 80mg methadone and higher}.
Secondly the usual treatment-starting procedure for buprenorphine was applied: starting with
an initial test-dosage of 2mg not before slight physical opiate withdrawal-symptoms appear,
and, if there were no withdrawal symptoms within the 30 first minutes, adding 4mg {6mg} after
2 hours. The dosages were gradually adjusted within the next 2 to 4 days to achieve a new
equilibrium. Withdrawal symptoms were measured with an 11-item clinical opiate withdrawal
scale (COW-Scale).
Results : Two typical patients were described to illustrate the procedure.
MOTS CLÉS / KEYWORDS
Methadone maintenance therapy, buprenorphine induction, high-dose transfer.
Substitution de méthadone, induction de tt de buprénorphine, transfer de haute dosage.
Riesen Jeorge Marc1, Pihet Sandrine2, Pauchard Esther1, Uehlinger Claude2
1Suchtfachklinik Selhofen, Kehrsatz, Switzerland
2Unité de Traitement des Addictions, Fribourg, Switzerland
jeorge.riesen@klinikselhofen.ch
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