Buprenorphine for Treatment of Cocaine Dependence

This is not all that new, but it was just pointed out to me recently and I figure many of you will find it interesting.  As most readers know, the receptors that mediate the actions of cocaine are completely different than the receptors that are activated during use of opioids.  I will be posting related information in the next few days.
From DataMonitor:
Alkermes, Inc., an integrated biotechnology company, has announced positive topline results from a Phase I clinical study of an investigational combination of ALKS 33 and buprenorphine, an existing medication for the treatment of opioid addiction, for the treatment of cocaine addiction.
Data from the study showed that the combination therapy was generally well tolerated and sublingual administration of ALKS 33 effectively blocked the agonist effects of buprenorphine. Based on these positive results, Alkermes expects to initiate a phase IIa study of the combination therapy in the first half of calendar year 2011, the company said.
The phase I study was a randomized, double-blind, multi-dose,placebo-controlled clinical trial that assessed the safety, tolerability and pharmacodynamic effects of the combination of ALKS 33 and buprenorphine when administered alone and in combination to 12 opioid-experienced users.
Buprenorphine is used for the treatment of opioid addiction, despite its own potential for abuse. Combining ALKS 33, an opioid modulator, with buprenorphine, a partial opioid agonist, may block the agonist effects of buprenorphine thereby reducing the potential for the development of opioid dependence while still maintaining effective therapeutic action. Furthermore,
the pharmacologic properties and low dose of ALKS 33 required to effectively block mu opioid receptors may allow for a co-formulation with buprenorphine as a single sublingual tablet, the company added.
Elliot Ehrich, chief medical officer of Alkermes, said: “We look forward to continuing the recent momentum in our R&D efforts by initiating a phase IIa clinical trial to generate further data, as we advance the ALKS 33 and buprenorphine combination therapy as part of Alkermes’s growing pipeline of proprietary product candidates.”

Another one?

I have no idea what killed Brittany Murphy.  The press are reporting that she had a ‘heart attack’ at age 32, not fully understanding the difference between a ‘heart attack’– which typically refers to a heart that stops functioning because of an inadequate suppy of oxygen, usually from coronary artery blockage– vs. ‘cardiac arrest’, a garden-variety term used by coroners who must cite a cause of death without an autopsy, reliable history, or lab results.  We ALL die of cardiac arrest in the end.  Opiate addicts usually suffer respiratory failure, either because of a reduced drive to breathe secondary to the effects of opiates at the brainstem, or because of a ‘blocked airway’ caused by stomach contents gettting into the throat and/or trachea.  The respiratory failure ultimately leads to too little oxygen at the heart, causing the heart to either stop beating or to go into an erratic beating pattern called ‘V-Tach’ or ‘V-Fib’, eventually failing to keep blood flowing to the rest of the body– particularly the brain.

Britttany Murphy with USO, July 2009
Britttany Murphy with USO, July 2009

Reports of Brittany’s death have mentioned that ‘prescription medications’ were found at the scene.  The phrase ‘prescription medications’ is usually code for ‘pain pills.’  And since the death rate for opiate addicts is so high, I am going out on a limb in a BIG way.  I am not trying to make a prediction– only to eventually make a point about opiate addiction, admitting that I may be making the point prematurely.
Britttany Murphy was rumored to have an eating disorder and an addiction to cocaine.  I don’t mean to impugn her character, and hopefully anyone who reads my blog understands that addiction is a disease that NOBODY asks for or deserves.  My concept of addiction would include an eating disorder, by the way.  I am sure that readers have a hard time understanding where I draw lines of responsibility;  I often write from a stance requiring ‘personal responsibility,’ so where do I get off, you ask, painting Brittany Murphy as a victim?  My answer is that it is possible to be everything at once.  We are all responsible for maintaining the behavior necessary to keep ourselves alive.  But there are times when we fail– all of us.  And most people who ‘fail’ and as a result become addicted to drugs face penalties constantly from that point forward– very rapidy getting to a point where we have been punished enough.  IF Brittany Murphy died from complications related to addiction, her death would be on top of the many evenings of misery she already endured– waking up early shaking with chills, running to the bathroom with diarrhea, missing parties at the last minute because of being too sick to go, and the demoralization that comes from looking in the mirror each morning and seeing that pathetic, failure of a person looking back.  Sometimes we look at celebrities and picture the moments when flashes are going off and the person is mugging for the cameras.  But from the moment this morning when I heard that Britttany Murphy had died, I felt (again, perhaps incorrectly) as if I know her very well.  I know how she felt each morning.  I know the relief she felt when certain people ‘came through’ for her.  I know how she felt about having a double personality– that all of her fans thought she was this great person, and deep inside she felt like a liar for keeping her secret from them.  I know how she felt when things looked hopeless– when she thought there was no possible way to escape.  I know how she felt when she was alone with the bathroom door closed and locked, wishing that things would just end without ever taking another step outside that safe little space.

If I am wrong, I am sorry– and I am thinking about someone else who is one of thousands of people who think exactly alike about a few deeply-personal things.  If I am right, I’m sorry that the long list got a little longer with the name of someone so obviously special.
JJ