Buprenorphine Implants

Working in Wales as a Consultant Psychiatrist specialising in Addictions, it is exciting to know and share the developments happening in Addiction Psychiatry.

Opiate dependence is a serious cause for concern and the dependence has evolved from illicit Heroin to other sources of Opiates as well such as Prescription Opioid Dependence. Buprenorphine is a valid treatment option and as with any other Chronic Health condition like Diabetes, Hypertension, Enduring Mental Health Problems- concordance to medication is a real clinical issue. We use Depot medication in cases of mental health disorders to improve medication concordance. The trial of Buprenorphine Implants may hold a promising future for Opiate Dependence Management as well. Watch the space!!

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Legal Highs- Getting a grip fast!!

According to EMCDDA report of 2011, UK has become number one in terms of online shops for the ‘Legal Highs’. Working as a Consultant Addiction Psychiatrist in Wales (UK), it is not surprising to see this in the clinical settings as well. The number of young people referred to integrated drug and alcohol services has gone up over the last couple of years and the nature of drugs has constantly evolved as we persistently get bombarded with newer drugs almost every time. The speed of input of the drugs in the market is far higher than the time taken and the resources spent on trying to understand the effects and management of these drugs. Guardian reports on the current state of resource allocation in UK.

I am going to be delivering a talk on some of these drugs- Mephadrone, GHB in Dublin next week in the Royal College of Psychiatrists- Liaison Coneference. Though we remain limited in knowledge of the management principles of the newer drugs coming in, it becomes important to monitor the trends.  RedNet project and EMCDDA are doing a good job by keeping us informed of these trends.

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Naltrexone in Alcohol Dependence

Alcohol Dependence is still a major cause of concern throughout UK. The issue of ‘minimum pricing’ is up for debate (probably for my next blog) but this post is about the use of Naltrexone in Alcohol Use Disorders. One of the mechanisms that Alcohol gives a pleasurable effect is through our Brain’s Opioid System. Naltrexone is an Opiate Blocker which is used for maintaining abstinence from Opiate Dependence and is licensed in UK in its Oral form. Several studies across the world have been done to demonstrate efficiency of other forms- Depot Naltrexone and Implants as well (most suited for motivated individuals).

Naltrexone has also been used over many years for Alcohol Use disorders for people in recovery, as it blocks the Opioid System, thus causing less pleasurable effects with drinking. The British Association of Pharmacology- Substance Misuse Guidelines have endorsed its use as well. Since it is not licensed in UK for this indication, only specialists in Addiction Psychiatry would generally prescribe this. Naltrexone has beneficial effects- one mechanism of ‘pharmacological extinction’ with Naltrexone and drinking alcohol may be possible but in my experience as a Consultant Psychiatrist in Wales, it has not caused a total extinction of the effects but has certainly helped people with reducing the amounts of alcohol they consume, the number of heavy drinking days and have reported that Alcohol does not affect them the same way as without the Naltrexone. One other effect is that the cravings to drink (which is a significant factor for relapse to heavy drinking) have reduced with Naltrexone.

The Naltrexone depot is a useful formulation which has its effect up to a month and aids concordance along with sustaining its effects. Vivitrol (US Preparation) is already licensed as a treatment for Alcohol Use Disorder in the USA. A similar preparation is available in UK, albeit in the Private Sector only.

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