Chronic High-Dose Buprenorphine Does Not Block Subjective High from Diacetylmorphine in a Patient in Heroin-Assisted Treatment

Vogel, Marc; Köck, Patrick; Strasser, Johannes; Wiesbeck, Gerhard; Walter, Marc; Dürsteler, Kenneth M

doi:10.1080/02791072.2019.1610200

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Vogel, M., Köck, P., Strasser, J., Wiesbeck, G., Walter, M., & Dürsteler, K. M. (2019). Chronic High-Dose Buprenorphine Does Not Block Subjective High from Diacetylmorphine in a Patient in Heroin-Assisted Treatment. Journal of Psychoactive Drugs, 51, 377–382. https://doi.org/10.1080/02791072.2019.1610200

Abstract

We present the case of a 35-year-old woman in heroin-assisted treatment (HAT) expressing the wish for the transition to oral opioid agonist treatment. After failed attempts to change to oral diacetylmorphine and slow-release oral morphine, respectively, she was induced on overlapping buprenorphine (BUP) treatment with the Bernese method. Gradual dose increases to BUP 48 mg per day did not result in attenuation of subjective effects of IV diacetylmorphine (DAM) 190 mg. Instead, the patient showed increased sedation. BUP was then reduce