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GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE

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Gazzetta Medica Italiana Archivio per le Scienze Mediche 2002 December;161(6):231-5

Copyright © 2002 EDIZIONI MINERVA MEDICA

language: Italian

Buprenorphine in the treatment of heroin addiction. Therapeutical use and professional liability

Snenghi R. 1, Montisci M. 2

1 Unità Operativa di Tossicologia forense e Antidoping, Azienda Ospedaliera Università di Padova, Padova; 2 Sede di Medicina Legale, Dipartimento di Medicina Ambientale e Sanità Pubblica, Università di Padova, Padova


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In ­Italy, mar­keting has ­been author­ized for prep­ar­a­tions con­taining ­high-­dosage bupre­nor­phine, for sub­lin­gual appli­ca­tion, as replace­ment ­therapy for ­heroin addic­tion. ­These prep­ar­a­tions are sub­ject to the ­penal and admin­is­tra­tive meas­ures ­regarding stu­pe­fying and psy­cho­ac­tive sub­stances ­already ­adopted in the ­past for low-­dosage prep­ar­a­tions of bupre­nor­phine ­used as an anal­gesic. The ­authors ­examine the ther­a­peu­tional use of bupre­nor­phine, pro­viding a ­final assess­ment of phar­maco-tox­i­co­log­ical ­studies, clin­ical and ther­a­peu­tical ratio­nale, cur­rent leg­is­la­tion, and ­forensic prob­lems ­emerging ­from ­cases exam­ined ­within the Judi­cial frame­work. ­Among the ­main ­aspects ­noted ­were: the prev­a­lent involve­ment of pro­fes­sional doc­tors and ­general prac­ti­tioners; fre­quent omis­sion of objec­tive clin­ical and tox­i­co­logico-ana­lyt­ical ­checks ­during diag­nosis and mon­i­toring ­phases; con­stant appli­ca­tion of incor­rect dos­ages, ­methods of admin­is­tra­tion and dura­tion of ­therapy; mul­tiple pre­scrip­tions (bupre­nor­phine + bupre­nor­phine; bupre­nor­phine + meth­a­done; bupre­nor­phine + ben­zod­i­az­e­pines; bupre­nor­phine + phen­di­met­ra­zine); and the ­repeated occur­rence of ­cases of iat­ro­genic addic­tion (the so-­called “replace­ment ­abuse”) asso­ciated ­with bupre­nor­phine by injec­tion. Low-­dosage main­te­nance ther­a­pies ­using bupre­nor­phine ­have no ­true ther­a­peutic pur­pose, due to the ­very low ­anti-­craving ­effect ­which ­causes the ­self-main­te­nance of pri­mary addic­tion, or diver­sion ­towards ­other psy­cho­ac­tive sub­stances, of ­which ­some (ben­zod­i­az­e­pines) ­play a sig­nif­i­cant ­role in the occur­rence of ­fatal over­doses. ­Forensic impli­ca­tions ­must not ­hinder the devel­op­ment of ter­ri­to­rial net­works of facil­ities, ­based on the ­multi-dis­ci­pli­nary com­pe­tence of addic­tion ­units, and enhance­ment of the ­role of gen­eral prac­ti­tioners.

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