Buprenorphine alcohol
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Buprenorphine and Alcohol: Effects and Interactions
Buprenorphine's Impact on Alcohol Consumption
Buprenorphine and NOP Receptor Activation
Research has shown that buprenorphine, a partial agonist at both micro-opioid and NOP receptors, can influence alcohol consumption. In a study involving Marchigian Sardinian alcohol-preferring rats, it was found that low doses of buprenorphine increased ethanol intake, while higher doses reduced it. This dual effect is attributed to the activation of different receptors: low doses stimulate classic opioid receptors, increasing alcohol consumption, whereas higher doses activate NOP receptors, reducing it1.
Buprenorphine in Comorbid Alcohol Use Disorder and PTSD
Combination Treatment with Naltrexone
A proof-of-concept study explored the combination of buprenorphine and extended-release naltrexone for treating comorbid alcohol use disorder (AUD) and post-traumatic stress disorder (PTSD). The study found no significant improvement in alcohol consumption or PTSD symptoms compared to placebo. This suggests that while buprenorphine has potential in treating opioid dependence, its efficacy in treating comorbid AUD and PTSD remains unproven2.
Risks of Buprenorphine and Alcohol Co-Use
Fatal Poisoning and Polydrug Use
Several studies have highlighted the risks associated with the concomitant use of buprenorphine and alcohol. Fatal poisonings often involve the combination of buprenorphine with other substances such as benzodiazepines and alcohol. In Finland, a significant number of buprenorphine-related deaths involved alcohol, with polydrug use being a common factor5 9. Another study reported fatal poisonings due to snorting buprenorphine combined with alcohol, emphasizing the high risk of this mode of administration7.
Buprenorphine's Role in Opioid Dependence Treatment
Comparison with Methadone
Buprenorphine is widely used in the maintenance treatment of opioid dependence. Studies comparing buprenorphine to methadone have shown that while buprenorphine is effective, it is generally less effective than methadone in retaining patients in treatment. However, buprenorphine does suppress illicit opioid use significantly at higher doses3 4 10. This indicates that while buprenorphine is a valuable tool in opioid dependence treatment, its role in alcohol use disorder is less clear and potentially risky when combined with alcohol.
Conclusion
Buprenorphine has a complex relationship with alcohol consumption and presents significant risks when used concurrently with alcohol. While it shows promise in reducing alcohol intake at higher doses through NOP receptor activation, its efficacy in treating comorbid AUD and PTSD is not supported by current evidence. Additionally, the combination of buprenorphine with alcohol and other substances poses a high risk of fatal poisoning, underscoring the need for careful monitoring and regulation in its use.
Sources and full results
Most relevant research papers on this topic
Buprenorphine Reduces Alcohol Drinking Through Activation of the Nociceptin/Orphanin FQ-NOP Receptor System
Buprenorphine has dualistic effects on ethanol consumption, with low doses increasing it through classic opioid receptors and higher doses reducing it through activation of NOP receptors.
Non-RCT
Animal Study
Rigorous Journal
Highly CitedComorbid alcohol use disorder and post-traumatic stress disorder: A proof-of-concept randomized placebo-controlled trial with buprenorphine and naltrexone combination treatment.
Sublingual buprenorphine combined with extended-release naltrexone-XR showed no statistically significant improvement in comorbid alcohol use disorder and post-traumatic stress disorder treatment outcomes compared to placebo.
RCTBuprenorphine maintenance versus placebo or methadone maintenance for opioid dependence.
Buprenorphine maintenance is more effective than methadone maintenance in retaining patients in treatment and suppressing heroin use, but flexible doses are less effective than low dose methadone.
Meta-AnalysisHighly CitedBuprenorphine maintenance versus placebo or methadone maintenance for opioid dependence.
Buprenorphine maintenance is less effective than methadone in retaining patients in treatment and suppressing illicit drug use for opioid dependence.
Meta-AnalysisHighly CitedConcomitant drugs with buprenorphine user deaths.
High concomitant use of benzodiazepines in buprenorphine user deaths obscures other potential risk factors, and higher mortality in the younger age group suggests particularly unsafe drug use patterns.
Observational StudyBuprenorphine: a controlled clinical trial in the treatment of opioid dependence.
Buprenorphine is as effective as methadone for treating opioid dependence, with both showing similar urinalysis results and a non-significant trend in favor of methadone in retention.
RCTHighly CitedFatal poisoning due to snorting buprenorphine and alcohol consumption.
Snorting buprenorphine and alcohol consumption can cause fatal poisoning, highlighting the risk of fatal poisoning by this method.
Case ReportA placebo controlled clinical trial of buprenorphine as a treatment for opioid dependence.
Buprenorphine shows greater time on initial dose, fewer dose changes, less illicit opioid use, and higher dose adequacy compared to placebo in opioid dependent patients.
RCTHighly CitedBenzodiazepines and alcohol are associated with cases of fatal buprenorphine poisoning
Fatal buprenorphine poisoning is typically accidental, with benzodiazepines and alcohol being involved in 82% and 58% of cases, respectively.
Observational StudyRigorous JournalHighly CitedBuprenorphine maintenance versus placebo or methadone maintenance for opioid dependence.
Buprenorphine maintenance treatment effectively retains opioid-dependent individuals in treatment, but only high-dose doses effectively suppress illicit opioid use.
Meta-Analysis
Very Rigorous JournalHighly Cited