Low-dose buccal buprenorphine: Relative abuse potential and postoperative analgesic acceptability

摘要 2020年，美国69，710例阿片类药物过量死亡中约有25%直接涉及处方阿片类药物，许多 其余的过量受害者开始使用阿片类药物与处方药。术后阿片类药物 处方包括越来越多的阿片类药物处方，滥用风险相当大，新 持续性阿片类药物使用（NPOU）和阿片类药物使用障碍（OUD）。有必要减少这些医源性 不影响术后镇痛。口含丁丙诺啡是一种潜在的替代药物， 传统的术后阿片类药物处方与已知的下呼吸抑制风险。然而，最少的数据 存在关于其施用是否产生：（1）降低的滥用可能性或（2）可接受的镇痛， 剧烈疼痛。研究培训计划解决了对风险/获益理解方面的这些关键差距 术后颊含丁丙诺啡的比例。目的1涉及药效学和心理物理学 在对照组中评估含服丁丙诺啡后的滥用可能性和镇痛作用 实验设置。目标2需要进行初步研究，评估一项 开口腔丁丙诺啡用于术后疼痛管理的随机临床试验。在每个目标中， 口含丁丙诺啡将与羟考酮（一种常用的术后阿片类药物）进行比较。的 候选人之前有小型观察性研究和大型临床数据库研究的经验， 手术后阿片类药物和疼痛，在主要期刊上发表了几篇第一作者和共同第一作者的论文。职业 发展计划将使他在评估滥用潜力和痛苦方面获得新的专业知识， 以及临床试验设计和执行、生物统计学、粒度分析和专业发展。导师 博士Stephen Bruehl专门从事主观和镇痛反应的实验评估， 阿片类药物给药。共同导师Sharon沃尔什博士进行了丁丙诺啡的开创性研究 药效学，是OUD的专家。Chad Brummett博士和大卫爱德华兹博士是 术后阿片类药物处方的权威，共同导师本杰明·弗伦奇博士是一位临床专家， 试验设计和生物统计学。范德比尔特的环境非常有利于研究培训和实施。 该项目将设置候选人的职业生涯作为一个独立的翻译和临床 调查员拟议的研究承诺提供深入了解是否颊丁丙诺啡可以作为 一种具有较低滥用可能性的替代术后镇痛药。随后计划的最终试验可能会 重塑术后阿片类药物处方模式。

ABSTRACT About 25% of the 69,710 U.S. opioid overdose deaths in 2020 involved prescription opioids directly, and many of the remaining overdose victims started opioid use with prescribed medication. Post-surgical opioid prescribing comprises an increasing share of opioid prescribing, with considerable risks for misuse, new persistent opioid use (NPOU), and opioid use disorder (OUD). There is a need to decrease these iatrogenic risks without compromising postoperative analgesia. Buccal buprenorphine represents a potential alternative to traditional post-surgical opioid prescribing with known lower respiratory depression risk. However, minimal data exists regarding whether its administration yields: (1) decreased abuse potential or (2) acceptable analgesia for acute pain. The Research Training Plan addresses these key gaps in understanding regarding the risk/benefit ratio of postoperative buccal buprenorphine. Aim 1 involves pharmacodynamic and psychophysical assessment of abuse potential and analgesia following buccal buprenorphine administration in a controlled experimental setting. Aim 2 entails a preliminary study assessing the feasibility and acceptability of a randomized clinical trial of prescribing buccal buprenorphine for postoperative pain management. In each aim, buccal buprenorphine will be compared with oxycodone, a commonly prescribed postoperative opioid. The candidate has prior experience with small observational studies and large clinical database studies related to post-surgical opioids and pain, with several first- and co-first-author publications in major journals. The Career Development Plan will allow him to gain new proficiencies in the assessment of abuse potential and pain as well as clinical trial design and execution, biostatistics, grantsmanship, and professional development. Mentor Dr. Stephen Bruehl specializes in the experimental assessment of the subjective and analgesic response to opioid administration. Co-mentor Dr. Sharon Walsh performed the seminal studies on buprenorphine pharmacodynamics and is an expert on OUD. Co-mentors Dr. Chad Brummett and Dr. David Edwards are authorities on postoperative opioid prescribing, and co-mentor Dr. Benjamin French is a specialist in clinical trial design and biostatistics. Vanderbilt’s setting is highly conducive to research training and implementation. This project will set the candidate on course for a career as an independent translational and clinical investigator. The proposed studies promise to offer insights into whether buccal buprenorphine can serve as an alternative postoperative analgesic with lower abuse potential. The subsequent planned definitive trial could reshape post-surgical opioid prescribing patterns.