ALTERNATE-DAY BUPRENORPHINE DOSING IS PREFERRED TO DAILY DOSING BY OPIOID-DEPENDENT HUMANS

Alternate-day buprenorphine dosing was compared to daily dosing in opi oid-dependent outpatients and choice of alternate-day versus daily dos ing was assessed. Four dosing schedules were presented in random order under blind and open dosing conditions. Subjects received two exposur es to each dosing schedule. During daily dosing, subjects received mai ntenance doses every 24 h. During blind alternate-day dosing, subjects received double maintenance doses every 48 h; placebo was interposed on intervening days. During open alternate-day dosing, subjects receiv ed twice their maintenance dose on Monday. Wednesday and Friday and ma intenance doses on Sunday. After completing two exposures to each dosi ng schedule, subjects chose either daily or alternate-day schedules ea ch week for 1 month. Study participation was contingent on daily atten dance and opioid abstinence. Ten subjects were exposed to the four con ditions once. Seven subjects repeated these conditions and participate d in the choice phase. The effects of daily versus alternate-day dosin g were not influenced by blind or open dosing conditions. Subjects' ra tings of withdrawal, ''sick'' and sedation were lower during daily tha n during alternate-day dosing, but the difference between treatments w as small. Nonetheless, subjects still chose alternate-day dosing on 96 % of occasions, suggesting that the subject-rated differences between dosing schedules were not influential. These results extend prior find ings to open-dosing conditions, and replicate the safety and acceptabi lity of alternate-day buprenorphine treatment. Choice of alternate-day buprenorphine administration underscores the procedure's clinical uti lity and potential use as a positive reinforcer to enhance opioid trea tment.