TREATMENT GUIDELINES
The guidelines are intended only as an outline of Addnok in Substitution therapy for treatment of opioid addiction. A definitive treatment plan should be considered according to individual needs of each patient. Addnok must be taken sublingually and supervised delivery is strongly recommended.
There are “three separate facets” to substitution therapy with Addnok :
1) INDUCTION onto ADDNOK :Rapid transition to ADDNOK over 2-3 days is associated with few side effects.
Time to first dose :
Heroin--------ADDNOK = 4hours
Doses given: Initial dose = 0.8mg to 4mg
Increase daily up to a maximum of 32mg/ day
2) MAINTENANCE on ADDNOK
This phase may take a considerable length of time since the patient must be allowed to settle at a maintenance dose of ADDNOK. The duration is variable, and must be decided by the progress of the Individual patient. During this stage, psychological and social help is essential to wean the patient away from the dependence of illicit drugs and the associated lifestyle.
Dosage: Clinical trials suggest an average maintenance dose of 8mg/day;(1) maintenance dose should be triturated to an appropriate level for each individual up to a maximum of 32 mg /day.
3. DETOXIFICATION by ADDNOK dose reduction
The decision to detoxify from opioids completely should be a joint decision by patient and clinical. Detoxification must be implemented slowly and carefully with gradual dose reduction over time until total cessation of addnok is possible, and will take up to a month in most cases. Once addnok has been completly withdrawn, naltrexone may be prescribed to aid continuing abstinence. Dose reduction in stages of 2 mg or 0.4 mg, with out precipitating withdrawal symptoms, until drug free. Naltrexone therapy may be used following complete detoxification.
References(1)-Strain EC, Stizler ML,Liebson IA & Bigelow GE.Comparision of buprenorphine & methadone in the treatment of opioid dependence Am J Psychiatry 14; 151
