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Biol Psychiatry 1990; 28:1065-1080

Letter to the Editor

To the Editor:

Buprenorphine (BPN), an analgesic currently being evaluated in treating substance abuse (Reisinger 1985; Mello et al 1989), has potential utility in other psychiatric conditions (Schmauss et al 1987; Emrich et al 1982; Resnick and Falk 1988). We decided to familiarize ourselves with BPN’s effects in psychiatric patients with a variety of diagnoses who were not currently abusing drugs. Though there were inconsistencies in procedure and data collection, some of our observations may be of interest to others.

Subjects were 12 males aged 37 to 52. Eleven were psychiatric inpatients, veterans and most had served in Vietnam. DSM-III-R diagnoses included major depression, schizophrenia, borderline personality, PTSD and bipolar-affective disorder. Most had multiple diagnoses combining one or more of the above with adjustment, panic or impulse control disorder. The twelfth subject was a normal staff member.

All patients but one had abused drugs. Half had abused multiple drugs, including cocaine and/or heroin. None admitted recent use or were experiencing withdrawal. Six had some chronic pain, but five had no pain.

BPN comes with .3 mg dissolved in 1 cc 5% dextrose. Sublingually, BPN can not be distinguished from tap water. On each test, the examiner gave ½ cc of either BPN or water sublingually to the subject. If no response was noted by the subject within 45 minutes, another ½ cc was given. Four subjects had open tests. The other eight were tested double blind on two separate days.

A short mood scale, a pain scale and the Profile of Mood Scale (POMS) were used, but the most useful data came from notes which recorded the subjects’ reactions continuously over a 2 ½ hour period and were supplemented by reports of the ward staff and interviews with the subject on the following day.

Table 1 summarizes our observations. Nine subjects reported definite responses to BPN. These responses were confirmed either by the examiner (during the first 2 ½ hours), or by ward staff when response was delayed. Response duration was always six hours or longer. Responders with pain reported relief from BPN. However, one nonresponder with pain had no relief and three responders had no pain.

Responders reported increased ability and willingness to talk, (especially about painful topics), with relief of tension-anxiety, anger-hostility and depression. Some reported dizziness. Most commented on how much better they felt after BPN, using words like "relaxed," "peaceful," "more friendly." Many remarked on their unusual talkativeness. Some went into a discussion group after BPN and for the first time spoke about painful experiences. Staff often volunteered comments on these changes. Most responders spontaneously indicated they would like to take BPN. The only responder who did not like BPN was the normal subject.. He reported feeling "spacey" and nauseated.

The three non-responders had no response to either placebo or drug. Clinically, they did not differ from the responders. All had abused drugs. Substance abuse, PTSD, depression, schizophrenia and chronic pain were all represented among both responders and non-responders. Neither the degree of response nor the onset time of response seemed to be characteristic of any particular diagnostic subgroup. However, response times for Blacks and Caucasians differed. Black responders noted changes within 2 to 40 minutes. (There was one Black non-responder). All Caucasian responders required 2—3 hours before noticing a change.

Veterans Administration Medical Center
4150 Clement St.
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Emrich HM, Vogt P, Herz A, Kissling W (1982): Anti-depressant effects of buprenorphine. Lancet 2(8300):709
Jasinski DR, Pevnick JS, Griffith JD(1978): Human pharmacology and abuse potential of the analgesic buprenorphine. Arch Gen Psychiat 35:501-516.
Mello NK, Mendelson JH, Bree MP, Lukas SE (1989): Buprenorphine suppresses cocaine self- administration in monkeys. Science 245:859-852
Connor JJ, Moloney E, Travers R, Campbell A (1988): Buprenorphine abuse among opiate addicts. Br J Addict 83:1085-1087.
Reisinger M (1985): Buprenorphine as a new treatment for heroin dependence. Drug Alcohol Depend 16:257-262.
Resnick RB and Falk F (1987): Buprenorphine: pilot trials in borderline patients and opiate dependence. In Harris LS (ed), Problems of Drug Dependence, U.S. Government Printing Office, p 289.
Schmauss C, Yassouridis A, Emrich HM (1987): Antipsychotic effects of buprenorphine in schizophrenia. Am J Psychiat 144:1340-1342.

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