A Single Dose of 55 mg of Buprenorphine for the Treatment of Heroin
Dependence: A New Result
Jamshid Ahmadi*, Firoozeh Ahmadi, Atefeh Torabi, Shahnaz Ahmadi, Farahnaz Ahmadi and
Elizabeth K Robinson
Substance Abuse Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- *Corresponding Author:
- Jamshid Ahmadi
Substance Abuse Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
E-mail: [email protected]
Received date: Jan 21, 2016; Accepted date: July 07, 2015; Published date: July 09, 2015
Citation: Ahmadi J, Ahmadi F, Torabi A, et al. (2016) A Single Dose of 55 mg of Buprenorphine for the Treatment of Heroin Dependence: A New
Result. Ann of Behav Sci 2:21. doi: 10.21767/2471-7975.100021
Copyright: © 2016 Ahmadi J, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Background: Heroin abuse is a growing problem.
Objective: To assess the efficacy of a single dose of 55 mg of sublingual buprenorphine in the treatment of heroin dependence.
Result: Administration of 55 mg of buprenorphine as a single dose is very helpful in the treatment of heroin dependence.
Discussion: The present study clarifies that one dosage of 55 mg of buprenorphine is outstanding for the treatment of heroin dependence. This is a fascinating finding.
Conclusion: We concluded that a single dose of sufficient buprenorphine could treat heroin withdrawal symptoms. This finding is a substantial addition to the literature.
Buprenorphine; Heroin withdrawals
Food and Drug Administration (FDA) approved
buprenorphine and methadone for the treatment of heroin
dependency. Buprenorphine is a partial mu receptor agonist
and is a safe drug such that its sublingual administration has
low possibility of toxicity and overdose .
Different investigations in the management of heroin
dependence, comparing buprenorphine with methadone,
illustrated that buprenorphine is more effective than
methadone [2-4]. In a research study, Johnson, Jaffe and
Fudala stated that 8 mg per day of sublingual buprenorphine is
comparable to 60 mg of methadone regarding retention rates
and opioids negative urines .
Detoxification of buprenorphine is easier than methadone.
Oral use of buprenorphine has little absorption but when
administered sublingually is well absorbed, reaching 60–70%
of the plasma concentration Comparing to other opioids
buprenorphine has less physiological dependence. It can
reduce the incidence of HIV and other connected disorders
following opioids consumption [1,6,7].
Heroin is an opioid mu receptor agonist. It is prepared from
morphine that was earlier considered as a non-addictive
derivative form of morphine .
Opium has been used for a long time and has a long history
of medical and societal approval in several parts of the world,
such as, North America, Europe and Asia [9,10].
Medical and psychiatric disorders are going up globally
[11-30]. Among mental disorders, substance connected
disorders, especially opioids and stimulants induced problems
have been reported as increasing globally dilemma. Now,
opioids and stimulants-linked mental diseases are a
progressive problem and have caused more referrals to
outpatient centers, emergency wards, and psychiatric
inpatients centers [31-72].
At the present time we are experiencing a single dose of 55
mg of buprenorphine for the lessening and cessation of heroin
withdrawal symptoms and craving.
Since there are not considerable reports on this subject,
therefore, our presentation may add to the literature.
We made a reliable and valid scale of measurement [31-33]
to assess the withdrawal pain and craving (based on DSM-5
criteria) for heroin withdrawal pain and craving, covering
scores from 0 to 10 (0 means no pain or craving at all and 10
express harsh pain or craving and desire all the time).
Pain and Craving Scale of measurement:
Patient’s Clinical Assessment
In the current study we are going to explain a patient with
heroin dependence who positively replied to a single dose of
55 mg of buprenorphine.
Our patient was a married 30 year old butcher with 3rd
grade of secondary school education. He lived with his family
in kavar city of Fars province in south part of Iran.
SZ began smoking opium and cannabis at age of 19. Since 5
years prior to admission he began smoking of heroin. He had
few episodes of opioid induced depression in the past few
years. Since 3 months prior to admission his depression
became worse and developed suicidal thoughts, irritability,
insomnia and aggressive behavior.
Due to depression, aggressive behavior, suicidal thoughts
and agitation he was admitted in psychiatric emergency room
and then was transferred to psychiatric ward.
During psychiatric interview and mental status examination
he was agitated, depressed and restless. In physical and
neurological examinations there were not, any significant
abnormal findings. Tests for viral markers (HIV, HCV and HB Ag)
were normal. Urine drug screening test was positive for
According to precise medical, psychiatric, and substance use
history and also DSM-5 criteria, he was diagnosed as “opioid
induced depressive disorder and opioid (heroin) dependent.
In hospital admission, we administered venlafaxine 225 mg,
sodium valproate 800 mg, chlorpromazine 200 mg, tizanidine
8 mg and gelofen 1200 mg per day for the treatment of
depression, agitation and insomnia.
On the first and second days of admission SZ complained of
severe withdrawal pain and severe opioid craving, hence in the
afternoon of 2nd day of admission we administered
buprenorphine 55 mg as a single dose only.
Out of 10, the mean scores of heroin craving for 11 days of
admission were 7.5, 5.3, 0.3, 1, 1, 1.3, 0, 0, 1, 0.3, and 0
With reference to the close monitoring, precise
measurement and interview (3 times a day) for heroin
withdrawal craving, SZ reported a reducing level of craving
after administration of a single dose of 55 mg of sublingual
Our patient was discharged without any significant heroin
withdrawal symptoms after 11 days of hospital admission.
According to the current Iranian drug program if anybody is
found to be consuming illicit substances or drugs, such as,
hashish, marijuana, ecstasy, methamphetamine,
hallucinogens, cocaine, alcohol, opium and heroin (tobacco
products are legal), they must be referred to treatment centers
such as psychiatric hospitals or private clinics to be treated.
In Iran, opioids dependents are usually detoxified and
treated with clonidine, methadone and sometimes with
This report indicates that administration of 55 mg of
sublingual buprenorphine as a single dose is very effective in
the treatment of heroin withdrawal symptoms. Therefore, this
study could be a substantial addition to the literature.
We reach to this conclusion that a single dose of 55 mg of
sublingual buprenorphine could successfully treat heroin
It appears that buprenorphine is very effective in the
treatment of heroin dependence. Overall, 55 mg of
buprenorphine as a single dose is much better than traditional
methods, such as abrupt discontinuation or stepwise
reduction in the heroin dosage.
None to be declared.
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