Possible Interaction: Buprenorphine and Cocaine

“Interestingly, with a higher dose of buprenorphine (6 mg), cocaine may have increased opiate withdrawal symptoms, suggesting a possible mechanism for the reduction of illicit cocaine abuse also recently observed in another study in patients treated with high dose (120 mg) methadone maintenance.”

“This reduction from Day 3 to Day 5 suggests that cocaine may interact differently with buprenorphine as treatment is more prolonged.”

“In fact, the mOR agonists methadone and buprenorphine decrease cocaine self-administration in laboratory animals (10), and in clinical studies, buprenorphine has been shown to reduce cocaine use in dually dependent cocaine/heroin abusers (reviewed in McCann [11]).”

“Recent preclinical studies have shown that buprenorphine also significantly reduces cocaine self‐administration by rhesus monkeys for periods up to 120 days.”

“Veterans with cocaine and anxiolytic-sedative hypnotic use disorders had higher odds of being started on both buprenorphine and methadone compared with no OAT.”

“ Cocaine decreases methadone and buprenorphine plasma concentrations.”

“Of the concurrent use of marijuana and cocaine with buprenorphine , cocaine is most concerning since it decreases exposure to buprenorphine (lower area under the concentration-time curve and maximum concentration).”

“The use of cocaine by heroin-dependent individuals, or by patients in methadone or buprenorphine maintenance treatment, is substantial and has negative consequences on health, social adjustment and outcome of opioid-addiction treatment.”

“Although buprenorphine appears to reduce cocaine self-administration in studies of non-opiate dependent animals, clinical evidence for the same response in opiate addicts abusing cocaine has not been demonstrated.”

“Preclinical studies in both primates and rodents have also indicated that buprenorphine may reduce cocaine self-administration and attenuate place preference for cocaine.”