Sufficiently High Doses of Buprenorphine as the Precondition for Successful Substitution Treatment: a Case Study
Abstract
Opioid users account for approximately one quarter of all the problem (high-risk) drug users in the Czech Republic. Only about 18% of the problem opioid users are registered as being in treatment, out of whom about 70% are maintained on buprenorphine (Mravčík, 2017).
The average daily doses are difficult to determine, partly because of the patients' connections with the secondary market, but tend to be generally low (Gluzová, 2014). Both clinical experience (Minařík, 2015) and literature (Fareed, 2012) suggest, however, that sufficient doses of substitution medication are needed to achieve the effective stabilisation of those receiving maintenance treatment.
This paper presents a case study of a patient maintained on 24 mg buprenorphine in the form of Suboxone(R), where the sufficiency of the dose is considered the key factor leading to the patient's long-term stabilisation. It should be noted that medication was not the only treatment factor; the patient was also provided with parallel counselling and psychotherapeutic and sociotherapeutic support.
While he also received this support repeatedly during his previous treatment episodes, involving both substitution and abstinence treatment, it was not until the administration of a sufficiently high dose of substitution agent that his condition stabilised and his long-term prognosis improved.