Probuphine, a subcutaneous, implantable formulation: Constant level of buprenorphine for 6 months

First published: 13/03/2019 | Last updated: March 28th, 2019

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Dr Richard Rosenthal

Dr. Rosenthal, a board-certified psychiatrist with subspecialty certification in addiction psychiatry, is Professor, Department of Psychiatry at Stony Brook University School of Medicine; the Inaugural Director of Addiction Psychiatry at Stony Brook Medicine; and since 2003, the Head of Public Policy at the American Academy of Addiction Psychiatry. He has been active in research, education, program development, treatment and public policy related to addiction.

His research has focused on evaluating and treating mentally ill patients with co-occurring addictive disorders and developing novel treatments for substance use disorders, and he has a special interest in medical informatics and the more direct uses of technology in identifying and treating substance use and other mental disorders. Active in clinical trials, he led the pivotal study for FDA approval of buprenorphine implants for opioid use disorder (Rosenthal et al. JAMA 2016;316:282-290).



Medications for substance use disorders are generally intended to stabilize brain and mental function, allowing patients to normalize their real-world learning and adaptation. As such, medication is important, but may not substitute for efforts towards recovery of pre-morbid functioning after impairing use of the target substance is reduced or eliminated. However, medications do not work if one does not take them. In the absence of compelling evidence for the efficacy of psychosocial treatments alone (Amato 2011), this is especially true for medical treatment of opioid use disorders. Daily-dosed medicines such as methadone and especially transmucosal buprenorphine are diverted with substantial frequency, and strategies to improve medication adherence are complex and not very effective (Nieuwlaat et al. 2014). Thus, preparations that reduce patient control over administration may enhance treatment outcomes through improved, and perhaps continuous, exposure. The evidence base for the long-acting buprenorphine implant (Probuphine) pharmacokinetics and clinical efficacy will be presented. This will serve as a platform for discussing the opportunities for providing treatment to diverse populations, and also through new clinical models, given the alteration in the dosing interval from daily to half-yearly.

 

Recent Funding sources:

Research funding: NIAAA, NIDA, Titan Pharmaceuticals; Braeburn Pharmaceuticals

Support for CME/Educational activities: Indivior, Alkermes, Titan Pharmaceuticals

 

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Dr Richard Rosenthal


 

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