ALTERNATE-DAY DOSING DURING BUPRENORPHINE TREATMENT OF OPIOID DEPENDENCE

Thirteen opioid-dependent outpatients participated in a double-blind, placebo-controlled, crossover trial. Twenty-one days of daily sublingu al buprenorphine administration were compared to 21-days of alternate- day buprenorphine administration where patients received twice their d aily maintenance dose every other day with placebo on the interposed d ay. Observer- and subject-rated measures of opioid agonist and withdra wal effects, pupillary diameter, and dose identifications were collect ed daily. Ten subjects (77%) completed the study (n=6, 4 mg/70 kg; n=4 , 8 mg/70 kg); 8 subjects (62%) participated in a second crossover. Si xteen of seventeen measures of opioid agonist and withdrawal effects o btained during alternate-day administration did not differ significant ly from those obtained during daily dosing in the ten subjects complet ing the study. The only significant difference observed was in subject -rated agonist effects, which were significantly lower during alternat e-day than daily administration. No differences were observed between treatments on any measure for the eight subjects completing a second c rossover. These data suggest that buprenorphine can be administered sa fely every 48 hours by doubling the maintenance dose. This alternate-d ay schedule permits patients to attend the clinic less frequently with out the risk of diversion associated with take-home doses, may be cost -effective for programs, and may be useful in settings in which travel to the clinic is a barrier to treatment.