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Urinalysis-based comparative evaluation of pattern of use of dextropropoxyphene and buprenorphine among opioid-dependent subjects

Yatan Pal Singh Balhara, MD, DNB (Psychiatry), MNAMS, Raka Jain, PhD, CChem, FRSC

Abstract


Objective: In view of increasing safety concerns, there is a need to assess benefits of use of dextropropoxyphene as opioid substitution treatment, if any. This study aims at urinalysis-based comparative evaluation of pattern of use of dextropropoxyphene and buprenorphine among opioid-dependent subjects.
Setting: Laboratory of a tertiary care drug-dependence treatment center.
Participants: Patients on buprenorphine and dextropropoxyphene therapy and their urinalysis records.
Interventions: Nonexperimental chart review method.
Main outcome measure(s): “Use,” “abuse,” and “prescribed but not used rates” for buprenorphine and dextropropoxyphene were compared, using χ2-test with level of significance at p < 0.05.
Results: Rate of “use” and “abuse” was significantly high for dextropropoxyphene. Rate of “prescribed but not used” was significantly high for buprenorphine (p < 0.05).
Conclusions: Despite apparent benefits of dextropropoxyphene use in terms of better rates of “use” and “prescribed but not used” as compared to buprenorphine, one needs to review the situation in light of recent reports of adverse effects with dextropropoxyphene and limited resources available.

Keywords


buprenorphine, dextropropoxyphene, opioid abuse, opioid substitution therapy

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References


UNODC: World Drug Report 2010. 2010. Available at http://www.unodc.org/documents/wdr/WDR_2010/World_Drug_Report_2010_lo-res.pdf. Accessed February 15, 2011.

Mattick RP, Kimber J, Breen C, et al.: Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev. 2004; (3): CD002207.

NACO: Oral Substitution Therapy for Injecting Drug Users: Update. 2009. Available at http://www.unodc.org/pdf/india/Dr%20Rao%20NACO.pdf. Accessed February 15, 2011.

NACO: Standard Operating Procedure for Oral Substitution Therapy with Buprenorphine. 2008. Available at http://www.nacoonline.org/Quick_Links/Publication/NGO__Targeted_Interventions/Operational__Technical_guidelines_and_policies/Standard_Operating_Procedures-Buprenorphine_NACO/. Accessed February 15, 2011.

Brattwall M, Turan I, Jakobsson J: Musculoskeletal pain: Prescription of NSAID and weak opioid by primary health care physicians in Sweden 2004-2008–A retrospective patient record review. J Pain Res. 2010; 3: 131-135.

Raj L, Chavan BS, Bala C: Community ‘de-addiction’ camps: A follow-up study. Indian J Psychiatry. 2005; 47: 44-47.

Hutchison LC: Why pick on propoxyphene? The evidence demands it. J Ark Med Soc. 2010; 107(2): 36-37.

Aschenbrenner DS: FDA raises safety issues concerning propoxyphene. Am J Nurs. 2010; 110(1): 59-60.

Barkin RL, Barkin SJ, Barkin DS: Propoxyphene (dextropropoxyphene): A critical review of a weak opioid analgesic that should remain in antiquity. Am J Ther. 2006; 13(6): 534-542.

Al Khaja KA, Al-Haddad MK, Al-Offi AR, et al.: Use of dextropropoxyphene + acetaminophen fixed-dose combination in psychiatric hospital in Bahrain: Is there a cause for concern? Fundam Clin Pharmacol. 2009; 23(2): 253-258.

Reith DM, Fountain JS, Tilyard M: ‘Opioid poisoning deaths in New Zealand (2001-2002)’ and the UK’s recent decision to withdraw the pain killer coproxamol. N Z Med J. 2005; 118(1209): U1294.

Jenkinson RA, Clark NC, Fry CL: Buprenorphine diversion and injection in Melbourne, Australia: An emerging issue? Addiction. 2005; 100(2): 197-205.

Panda S, Kumar MS, Lokabiraman S, et al.: Risk factors for HIV infection in injection drug users and evidence for onward transmission of HIV to their sexual partners in Chennai, India. J Acquir Immune Defic Syndr. 2005; 39(1): 9-15.

United Nations Office on Drugs and Crime: South Asia 2005-2007: Strategic Programme Framework. Vienna: United Nations Office on Drugs and Crime, 2007.

Panda S, Sharma M: Needle syringe acquisition and HIV prevention among injecting drug users: A treatise on the “good” and “not so good” public health practices in South Asia. Subst Use Misuse. 2006; 41(6-7): 953-977.

Jain R: Utility of thin layer chromatography for detection of opioids and benzodiazepines in a clinical setting. Addict Behav. 2000; 25: 451-454.

Jain R: Analytical methods. In Jain R (ed.): Detection of Drugs of Abuse in Body Fluids: A Manual for Laboratory Personnel. Drug Dependence Treatment Centre, New Delhi: All India Institute of Medical Sciences, 1998: 18-44.

Margoob MA, Majid AB, Dhuha M, et al.: Thin layer chromatography (TLC) in detection of current nature of drug abuse in Kashmir. JK-Practitioner. 2004; 11(4): 257-260.

Ng B, Alvear M: Dextropropoxyphene addiction–A drug of primary abuse. Am J Drug Alcohol Abuse. 1993; 19(2): 153-158.

Bhalla A, Dutta S, Chakrabarti A: A profile of substance abusers using the emergency services in a tertiary care hospital in Sikkim. Indian J Psychiatry. 2006; 48: 243-247.

Ray R, Mondal AB, Gupta K, et al.: The Extent, Pattern and Trends of Drug Abuse in India: National Survey. New Delhi: United Nations Office on Drugs and Crimes and Ministry of Social Justice and Empowerment, Government of India, 2004.

Basu D, Banerjee A, Harish T, et al.: Disproportionately high rate of epileptic seizure in patients abusing dextropropoxyphene. Am J Addict. 2009; 18(5): 417-421.

Bateman DN, Afshari R: Co-proxamol and suicide: Licence needs to be changed. BMJ. 2003; 327: 287.

Sandilands EA, Bateman DN: Co-proxamol withdrawal has reduced suicide from drugs in Scotland. Br J Clin Pharmacol. 2008; 66(2): 290-293.




DOI: https://doi.org/10.5055/jom.2012.0095

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