Abstract
Some sources suggest that significant misuse of opioid drugs exists among patients with chronic pain. However, the risk factors and motivation behind their abuse may differ from those of other opioid abusers. This study sought to examine the abuse liability of oxycodone among patients with chronic, non-malignant pain who met the DSM-IV criteria for opioid abuse. Eighteen opioid-dependent patients with chronic pain lived on an in-patient unit of the New York State Psychiatric Institute during the 7-week study. Participants were given oral oxycodone (0, 10, 20, 40, and 60 mg/70 kg) while maintained on various doses of sublingual buprenorphine/naloxone (Bup/Nx; 2/0.5, 8/2, and 16/4 mg/day). Doses of both medications were administered under double-blind conditions. Oxycodone produced an overall positive, but less robust, subjective profile than previously reported in recreational opioid users without pain. Furthermore, unlike our findings in recreational opioid users and more similar to effects in non-drug-abusing individuals, oxycodone failed to serve as a reinforcer. As for the maintenance drug, Bup/Nx produced a dose-related reduction in some of the effects of acutely administered oxycodone. These data suggest that sublingual Bup/Nx has the potential as an analgesic medication and further research should investigate its use in treating patients with chronic pain who abuse opioids.
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Acknowledgements
The medical assistance of Robert Vorel MD, Ben Bryan MD, Elias Dakwar MD, David Mysels MD, Janet Murray RN, and Claudia Tindall RN, along with the technical assistance of Elisa Payne BA, Debra Wolkenfeld BA, Phillip Saccone BA, and Joseph Lazar BA, is gratefully acknowledged. Funding for this investigation was provided by National Institute on Drug Abuse Grant DA020448 to Dr Maria Sullivan.
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The authors declare that over the past 3 years SDC, JDJ, SKV, JMM, and MAS have all received compensation (in the form of partial salary support) from separate investigator-initiated studies supported by Reckitt-Benckiser Pharmaceuticals and Schering-Plough Corporation, manufacturers of the Bup/Nx used in this investigation. Other companies that provided partial salary support to the manuscript's authors over the past 3 years for other investigations include: Johnson & Johnson Pharmaceutical Research & Development, Endo Pharmaceuticals, and Avigen. However, none of these companies manufactured any drug, product, or device used in this work. In addition, SDC has served as a consultant to the following companies: Abbott, Alpharma, Analgesic Research, BioDelivery Sciences, Cephalon, Inflexxion, King, Neuromed, Purdue, and Shire.
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Jones, J., Sullivan, M., Manubay, J. et al. The Subjective, Reinforcing, and Analgesic Effects of Oxycodone in Patients with Chronic, Non-Malignant Pain who are Maintained on Sublingual Buprenorphine/Naloxone. Neuropsychopharmacol 36, 411–422 (2011). https://doi.org/10.1038/npp.2010.172
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DOI: https://doi.org/10.1038/npp.2010.172
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